Price guides and pricing

NDIS Price Guide 2020-21

The NDIS Price Guide and Support Catalogue 2020‒21 reflects the Annual Price Review and indexed prices as a result of the Fair Work Commission Annual Wage Review 2019‒20.

Update to the NDIS Price Guide and Support Catalogue – November 2020

The NDIS Price Guide was updated on 17 November with the following:

A final adjustment of the Equal Remuneration Order (ERO)

Effective 1 December 2020, price limits of 369 support items will increase due to the final ERO adjustment. Price limits for impacted support items will increase by between 1.5% and 2.7%.

For a list of impacted support items, please refer to ‘Price limits determined by the Cost Model’, located in the Disability Support Worker Cost Model 2020-21.

Clarifying programs of support for Early Childhood Intervention (ECI) supports.

Providers of capacity building ECI supports can enter into an agreement with a participant for programs of support. Programs of support for ECI can include group and one-to-one supports for participants.

Clarifying claiming for telehealth

Telehealth services can be offered to participants who are not, or cannot be, in the same physical location as the provider. Providers must ensure the standard of care delivered through telehealth is equal to face-to-face care.

A new ‘Telehealth’ claim field has been added to the myplace provider portal for supports delivered via telehealth.

Increased price limits and new columns in the Support Catalogue

The Support Catalogue has been updated to reflect increased price limits of 369 support items as a result of the final ERO adjustment. There are also 5 new columns in the Support Catalogue to help providers identify if a support item is eligible for:

non-face-to-face support provision
provider travel
short notice cancellation
NDIA requested reports
irregular Supported Independent Living (SIL) options.

Update to the NDIS Price Guide – October 2020

The NDIS Price Guide was updated on 22 October with the following:

Geographic classifications

A list of locations impacted by changes to geographic classifications is available on the Annual price review page.

Psychosocial recovery coaches – report writing

Psychosocial recovery coaches are able to claim for report writing under the applicable Psychosocial Recovery Coaching line items.

New ‘Irregular SIL Supports’ claim field for providers

A new claim field in the myplace provider portal for ‘Irregular SIL Supports.’ The new claim field should be used when a SIL support is provided in unexpected or unplanned circumstances.

Price Guide COVID-19 response summary

The following temporary measures apply by area and timeframe.

Please refer to the Coronavirus (COVID-19) Response section of the NDIS Price Guide 2020-21 and Price Guide Addendum for more information. An updated Addendum was published 19 November 2020.

Ongoing increased access to support coordination

Support items for support coordination have been temporarily duplicated in the Core Support Category – Assistance with Daily Life so participants can have greater access to support coordination services if needed.

The following measures are available nationally until 28 February 2021

Assistive technology (AT)

Two support items are available so participants discharged from hospital have immediate access to AT needed to be safe at home for 6 months until their longer term AT and home modification needs can be assessed and an amended plan is in place.

One support item is available so participants can use Capacity Building funds to access low cost AT items associated with the delivery of their supports and in consultation with their existing support providers.

Supported independent living (SIL) providers

Two support items - cleaning services and additional supports - are available for participants living in SIL arrangements who:

have been diagnosed with COVID-19
are required to self-isolate or quarantine
are in isolation or quarantine while waiting for the results of a COVID-19 test or because of measures taken by government or medical authorities in response to the COVID-19 pandemic.

Deep cleaning

Participants can access a one-time deep clean cost when a support worker who has visited their home has received a positive COVID-19 diagnosis.

The following measures apply to restricted areas only, inclusive dates below:

NSW and Victoria – 29 July 2020 to 28 February 2021
South Australia - 19 November to 30 November 2020
restricted areas in Queensland – from 22 August to 25 September 2020
a list of restrictions by local government area/state and the date they are applicable appears in the NDIS Price Guide Addendum.

Low cost disability-related health consumables – personal protective equipment (PPE)

Participants who receive an average of at least one hour a day of face-to-face daily living supports can access up to $50 per week from their budget for PPE for their use when their support worker is supporting them.

PPE for support workers

Providers can claim PPE for support workers of up to $50 per worker, per participant, per day, or directly invoice the NDIA up to $1.70 per hour of support delivered, per participant, up to 24 hours per day.

Providers must be delivering essential daily life services to participants in one of these three support categories:

0104 High Intensity Daily Personal Activities
0107 Daily Personal Activities
0115 Assistance with Daily Life Tasks in a Group or Shared Living Arrangement.

Temporary changes to 30 June 2020

From 25 March 2020 to 30 June 2020, a 10 per cent temporary increase was applied to the price limits of 402 price controlled items in selected support categories.

These items were identified in the NDIS Support Catalogue 2019-20 with “Includes COVID Loading” in the description of the item.

Cancellations

From 25 March 2020 to 30 June 2020, the notice period for a short notice cancellation was temporarily increased.

How pricing works

The NDIA sets price limits for some supports to ensure they provide value for money for participants.

Changes to prices are updated to respond to market trends and changes in costs and are generally identified through an Annual Price Review, with any new prices outlined in an updated price guide, effective 1 July each year.

The Pricing Reference Group helps guide NDIS price regulation activities and decisions.

Refer to the Annual price review page for the latest updates.

Providers can also read the NDIA's Market position statements and recently released quarterly data on the performance of the NDIS.

Understanding the Price Guide - for participants

Understanding the Price Guide explains the key changes in the Price Guide and Support Catalogue and how they might affect participants, their families and carers.

It’s important for participants to understand all of the prices they might be charged, so they can be confident of receiving value for money from their plan budget.

Other information

Please direct queries to your local NDIA Provider Engagement team or email the NDIA.

The Price Guide and Support Catalogue 2020‒21 published 29 June 2020 also reflect the end of some of the temporary arrangements introduced in response to the coronavirus (COVID-19) pandemic.

Other clarifications include:

Group-based supports

In response to feedback, providers have until 30 June 2021 to transition to the new pricing arrangements for group-based supports.

From 1 July 2020, providers will have the opportunity to use either the new streamlined pricing arrangements for group-based supports or continue to use the 2019‒20 arrangements.

The new arrangements introduced for 2020‒21 remove the worker to participant ratio and instead allow providers to claim against the appropriate 1:1 support line item. This means providers can accurately apportion time spent with a group and among members of that group. Providers can also claim for non-face-to-face supports rather than having an allowance for non-face-to-face supports built into the price limit.

The current 2019‒20 arrangements will be retained in the NDIS Price Guide 2020‒21 until 30 June 2021 and allow for the support items covering the range of ratios to allow for one support worker to different numbers of participants and have allowances built into the price limits for non-face-to-face supports.

Evening support times and shift boundaries

The Price Guide 2020‒21 clarifies evening support times as any support to an individual participant that starts after 8.00pm and finishes at or before midnight on a single weekday, unless that support is a public holiday support or a night-time sleepover support.

The Price Guide also clarifies arrangements when a support crosses a shift boundary and the same worker delivers the entire support. The higher of the relevant price limits applies to the entire support and providers can claim against the relevant support item.

Establishment fees

From 1 July 2020, the changes to establishment fee rules mean that a provider can only claim an establishment fee once per participant across all plans.

Line item updates

The Price Guide and Support Catalogue 2020‒21 have been amended to include the following support items:

Self-Management Capacity Building (01_134_0117_8_1)
Skills Development and Training (09_009_0117_6_3)
Innovative Community Participation (09_008_0116_6_3).

The new look Price Guide aims to be clear and transparent about pricing arrangements and make it easier to find information for specific supports by including applicable line items and claiming rules within the one document.

In addition to the Price Guide updates outlined as part of the Annual Price Review, the Price Guide 2020‒21 also incorporates pricing details to support other significant initiatives from 1 July including:

Psychosocial recovery coaches—to offer added support to participants with a psychosocial disability.
- Six new line items introduced to support participants to achieve outcomes.
- For more information visit the mental health page
Individualised Living Options—two new line items, to give people with disability access to alternative living arrangements within the Assistance with Daily Living Support Category:
- Individualised Living Option – Exploration and Design
- Individualised Living Option – Support Model
  - More information will be provided in July including the funding bands that will used when making this determination.
  - Providers interested in further information about ILO can email the NDIA ILO Project Team at ILO@ndis.gov.au.
Supported Independent Living (SIL)—set price limits for SIL supports will replace the current quoting and negotiation process.
- The NDIA is conducting a review of SIL price controls and endorsed recommendations will be included in a Price Guide released later in 2020. Until this review is complete the price limits for assistance with daily living will apply to SIL supports.
- Existing plans containing agreed SIL quotes will continue until the end of their 12 month term, at which point the new SIL price limit will apply.
- A new Provider SIL Pack was published 30 June 2020.
Supports in Employment—to support increased employment opportunities for participants:
- Five new line items introduced so eligible providers can claim for different times of day and days of week to deliver supports in employment.
- Two new line items introduced to allow eligible providers to transport one or more participants to / from a community-based support and claim non-labour costs associated with provider travel
- Amending the unit of measurement for ‘Employment related assessment and counselling’ support item from ‘each’ to ‘per hour’
- Introducing new establishment fee rules for Supports in Employment
- For more information visit the Supports in Employment page.