Annual Price Review

The NDIA sets price controls for certain NDIS supports to ensure a balance between NDIS participants obtaining reasonable value for money and enabling providers to operate within a market of adequate size, quality and return.

The Annual Price Review cycle to determine 2019‒20 prices is complete and the NDIA has released an updated NDIS Price Guide and Support Catalogue 2019–20, effective 1 July 2019. 

Key updates effective 1 July 2019 include:

  • general price increases and specific increases for therapists and attendant care and community participation
  • the introduction of a Temporary Transformation Payment (TTP)
  • increases to remote and very remote loadings
  • updates to travel, non face-to-face services and cancellation billing policies
  • updates to Assistive Technology and Home Modifications
  • outcomes from the WA Market and Therapy Reviews

Before claiming any new price limits, providers and participants must discuss and agree to any proposed changes. It is only from the time of agreement that providers can start to charge and claim new prices.

Therapy and therapy assistants

The price limit for most therapy supports, including Early Childhood Early Intervention (ECEI), will increase from 1 July 2019.

Psychologists and physiotherapists will also see additional increases to price limits based on the location in which these supports are delivered.

Two support levels of therapy assistants are included in the NDIS Price Guide 2019–20, effective 1 July 2019. 

Providers can also claim for travel, cancellations and non-face-to-face time for therapy assistant activities.

For further information, visit the Therapy Review page.

Attendant care

Increases to base attendant care and community participation supports across standard and levels one, two and three of high intensity price limits are effective from 1 July 2019.

Funding in participant plans will be automatically adjusted to reflect the changes in the price limits for attendant care and community participation, effective from 1 July 2019, as part of the annual indexation of plans.

Participants will not need to seek a plan review to access the additional funds.

For more information, refer to the NDIS Price Guide and Support Catalogue 2019–20, effective 1 July 2019.

Temporary Transformation Payment for Attendant Care and Community Participation supports

From 1 July 2019, providers of attendant care and community and centre based activities have access to a higher support price limit through a Temporary Transformation Payment (TTP). The TTP is a conditional loading to assist providers with any costs associated in transitioning to the NDIS.

In 2019–20, the TTP is set at 7.5 per cent on the relevant level 1 support item and will reduce by 1.5 per cent each year thereafter.

The TTP support item number is the support base number with the addition of the letter T. These support item numbers are outlined in the NDIS Support Catalogue 2019–20, effective 1 July 2019.

Providers will need to comply with the following requirements if they wish to claim the higher TTP price limits:

  • publish their service prices
  • list and keep up-to-date their business contact details in the Provider Finder
  • participate annually in an Agency-approved market benchmarking survey.

The TTP is similar to and replaces the Temporary Support of Overheads (TSO) but is of a higher value and is in place for a longer period. 

The TSO will be obsolete as of 1 July 2019 and providers are encouraged to adopt the higher valued TTP and conditions for claiming.

Before claiming the TTP price limit, providers and participants must discuss and agree to any proposed changes.

TTP is not applicable to Supported Independent Living (SIL).

Unregistered providers are unable to claim TTP as they are unable to meet the eligibility criteria.

Providers choosing to take up the TTP should familiarise themselves with the full requirements of the TTP as outlined in the NDIS Price Guide 2019–20, effective 1 July 2019.

Clarity around billing arrangements

Payment claims for non-face-to-face activities, cancellations, travel and support coordinators.

From 3 August 2019 the myplace provider portal will be updated to allow providers to claim, where applicable and agreed with the participant, for policy and price changes to: 

  • billable non-face-to-face activities, provider travel, cancellations and NDIA report writing
  • Support Coordinator non-face-to-face activities, travel, cancellations, NDIA report writing.

Payments requests for these items can be backdated to the point in time a participant gave their agreement to any price change – post 1 July 2019. 

Non-face-to-face

From 1 July 2019, providers can claim for non-face-to-face direct care-related activities as hours of support against the relevant support item. 

Non-face–to-face activities are billable if:

  • the activities are part of delivering a disability support item to a participant such as writing a report about the client’s progress (rather than a general activity such as staff rostering)
  • the provider explains the activities to be billed to the participant
  • the proposed charges for the activities comply with the conditions set out in the NDIS Price Guide.

Billable non-face-to-face activities must relate specifically to the non-face-to-face services delivered to a particular participant, and do not include general administrative tasks.

The amount charged is based on the time spent delivering the non-face-to-face support each time.

  • For example: providers cannot simply adopt and apply a standard non face-to-face fee to all support items and/or a participant’s ongoing appointments. The charge needs to be reflective of what is delivered each time a support is provided.

Providers must negotiate and seek agreement with their participants before charging for non-face-to-face activities. Once an agreement is reached, providers will need to update the appropriate service bookings to reflect the changes agreed. Refer to the NDIS Price Guide and Support Catalogue 2019–20, effective 1 July 2019, for more information.

Cancellations

There are updated cancellation rules, effective 1 July 2019.

A short notice cancellation (or no show) is now defined as when there is a failure to provide:

  • Two clear business days’ notice for a support or service which is eight hours or less in duration and less than $1,000
  • Five clear business days’ notice, in all other cases.

Providers are able to recover 90 per cent of the fee associated with the cancellation of a support activity, when these cancellation timelines are not met by the participant and subject to the terms of the service agreement with the participant.

When claiming a cancellation, providers should request a claim of 100 per cent of the negotiated price. The NDIS payment system will automatically calculate 90 per cent of the claimed amount.

There is no limit on the number of short notice cancellations (or no shows) that a provider can claim; however, providers do have a responsibility to the participant. If a participant has an unusual number of cancellations then the provider should seek to understand why these are occurring.

The NDIA will monitor claims for cancellations and may contact providers who have a participant with an unusual number of cancellations.

Provider travel

The length of time providers can claim for travel has changed, effective 1 July 2019.

If agreed by participants, providers can claim for the time spent travelling to each participant, for core supports—as indicated by the travel column in the Support Catalogue 2019–20. Only the actual travel time can be claimed, up to a maximum of:

  • 30 minutes within city areas (MMM 1–3)
  • 60 minutes in regional areas (MMM 4–5).

This is an increase from 20 and 45 minutes, respectively. Examples are provided to help give further clarification. Refer to the NDIS Price Guide 2019–20.

Providers delivering capacity-building supports are also able to claim time spent travelling from the last participant to their usual place of work. The maximum amount that can be claimed for return travel is 30 minutes within city areas and 60 minutes in regional areas.

Before providers can charge for travel, they must first discuss and get agreement on any changes with the participant. Once an agreement is reached, providers will need to update the relevant service bookings to reflect the changes agreed. 

The NDIA has made it easy to distinguish when and where travel is claimable by outlining this against each claimable support item number in the NDIS Support Catalogue 2019–20.

Refer to the NDIS Price Guide and Support Catalogue 2019–20, effective 1 July 2019 for details. 

Support Coordination: inclusion for travel, cancellations, NDIA report writing and non-face-to-face activities

Support Coordinators will be able to claim for travel, cancellations NDIA report writing and non-face-to-face activities—where agreed with the participant.

From mid-August 2019 the myplace provider portal is being updated to allow providers to claim for these policy and price changes where applicable. Payment requests for these items can be backdated to the date as agreed with the participant, from 1 July 2019.

The NDIA has made this change to ensure Support Coordinators are remunerated appropriately and to clear up any confusion. Until now, support coordinators were claiming these items incorrectly or absorbing the costs.

Before providers can charge a participant for these activities, they must first discuss and get agreement from the participant. Once an agreement is reached, providers will need to update the relevant service bookings to reflect the changes agreed.

Refer to the NDIS Price Guide and Support Catalogue 2019–20 for further details.

Community and centre based supports

In March 2019, base rate increases were announced for Community Participation supports.

The price limits for Community and centre based supports have been modified to reflect the Temporary Transformation Payment (TTP) from 1 July 2019. 

Community and centre based supports include a non-face-to-face component in the price. Providers can therefore not make any additional or separate claims for non-face-to-face activities linked to this support.

Centre based rates still include a capital component, community based rates do not.

Remote and very remote

A key finding of the WA Market Review was the determination that the cost to deliver services to lower density populated areas is discouraging providers from delivering services to participants in these areas, in effect, reducing choice for participants.

This issue affects remote and very remote areas across Australia.

In response, the NDIA has increased the remote and very remote loadings on price limits from 20 per cent to 40 per cent, and from 25 per cent to 50 per cent respectively.

This increase proposes to support the ongoing delivery of support services right across Australia.

Geographical reclassification

In addition, the NDIA is amending its geographic arrangements so that towns classified as ‘regional’ and completely surrounded by ‘remote’ or ‘very remote’ areas, will be classified as ‘remote’ for planning and pricing purposes 

From 3 August 2019, NDIA systems will be updated to accommodate this change.  At this time, providers will be able to backdate their claims for remote and very remote loadings to the point in time they received agreement from a participant to change their prices - post-1 July 2019.

There are 38 locations benefitting from the geographical reclassification. The reclassified locations are:

  • WA: Kalgoorlie. Broadwood, Hannans, Karlkurla, Lamington, Mullingar, Piccadilly, Somerville, South Kalgoorlie, West Kalgoorlie, West Lamington, Williamstown, Kambalda West and Kambalda East 
  • NSW: Broken Hill, Hay and Balranald 
  • QLD: Roma, Blythdale, Euthulla, Orange Hill, Emerald, Blackwater, Dysart, Moranbah, Coppabella, Queenton, Charters Towers, Alabama Hill, Breddan, Broughton, Grand Secret, Millchester, Mosman Park, Richmond Hill, Southern Cross, Toll and Towers Hill.

Reclassifying these areas as remote aims to encourage more providers to deliver supports in these locations.

The NDIA uses the Modified Monash Model (MMM) to determine regional, remote and very remote areas. To determine the MMM classification of a town where services are delivered, visit the Australian Government’s ‘Health Workforce Locator’. This replaces the website formerly known as Dr Connect.  

The above-mentioned towns listed as ‘regional’ on the Health Workforce Locator  are subject to an additional ‘remote’ loading under the NDIS reclassification.

Refer to the NDIS Price Guide and Support Catalogue 2019–20 for details on the remote and very remote loadings and geographic arrangements.

Assistive Technology and Home Modification

The NDIA has introduced a number of changes to support line item numbers for assistive technology (AT), home modifications (HM) and to related benchmark pricing, effective 1 July 2019.

Section two of the Assistive Technology and Consumables Code Guide has been updated to address confusion and how to apply units of measure to low cost AT and repairs and maintenance.

For more information, visit the Pricing and Payments for AT providers page.

School Leaver Employment Supports (SLES)

Providers of school leaver employment supports are now able to claim mandatory NDIA report writing. 

Refer to the NDIS Price Guide and Support Catalogue 2019–20 for more information.

Supported Independent Living

TTP is not applicable to Supported Independent Living (SIL) supports. 

SIL quotes will no longer be accepted in the old format. SIL providers must use the templates downloaded as part of the Provider SIL pack.

Quotes must be submitted within the specified timeframes to ensure timely processing and inclusion for approval in participant plans. 

Independent Living Options

Three new interim support line items have been added to the NDIS Support Catalogue for “Individual Living Options” (ILOs). 

These line items cover:

  • Individual Living Option—co-residency
  • Individual Living Option—host arrangement
  • Individual Living Option—rostered support

These items have been included in the NDIS Price Guide and Support Catalogue 2019-20, effective 1 July 2019 and are for planning purposes only.

Renamed claim types in portal

Options in the drop down menu in the payment request screen, in the myplace portal have been updated.

  • To better reflect what is being claimed, 
    • ‘standard’ has been updated to ‘direct service’,
    • ‘report writing’ has been updated to ‘NDIA required report’.
  • To ensure a clear distinction between provider travel and participant transport, ‘travel’ has been replaced with ‘provider travel’.
  • To reflect the new claimable item, non-face-to-face services’ has been added. 

Providers should select the item relevant to what they are claiming at this stage of the claiming process.

Refer to the myplace provider portal step-by-step guide on the Provider Toolkit  for an outline of the claiming process.   

Support line items removed from the NDIS Price Guide and Support Catalogue 2019-20

A small number of support line items are no longer listed in the NDIS Price Guide and Support Catalogue 2019–20.

Where relevant, these items have been replaced with new support line items.

Where the removed items are stated in existing plans, they are still available for claiming purposes and/or to create service bookings. 

These items are also available for claiming purposes where they are in current service bookings.

Participant plans and service bookings

Indexation

NDIS funding in existing participant plans has been adjusted to reflect indexation, the changes in the price limits for therapy, attendant care and community participation and the application of the Temporary Transformation Payment.

Indexation of participant plans is a complex calculation. It takes into consideration, price limit changes, what is in a participant’s plan, how the plan is set up and the amount of unspent funds within a plan.

The calculation is a multiplication of unspent funds by a percentage figure, based on a number of inflation indexes. The calculation can result in minor rounding errors of a few cents. If a participant and/or provider feels they are significantly impacted by this rounding error they can let us know by contacting: provider.support@ndis.gov.au 

Service Bookings

Before any changes can be made to existing service bookings, providers and participants need to discuss and agree on any proposed changes. Once agreed, providers are then required to update service bookings to reflect the agreed changes.

The NDIA will not be adjusting existing service bookings. Providers can only start claiming a new price level, agreed to by the participant, from the start date of the revised or newly created service agreement and service booking (unless the provider has pre-arranged agreements with the participant written into the service agreement as follows):

  • In some instances, providers may have service agreements that allow the provider to automatically claim annual indexed price limits without the need to update the existing service agreement. 

To update service bookings to reflect any agreed changes, providers will need to end date and create new service bookings or update the ‘Allocated Dollar’ amount in the service booking, via the myplace provider portal. 

For more information on how to amend service bookings, visit the Provider Toolkit

This page current as of
8 November 2019