Features common to the existing catalogue and the revised NDIA price guide
Maximum prices remain for personal care, community access, domestic assistance and professional services. These have been indexed at the appropriate rates for the 2015/16 Financial Year to take effect from 1 August 2015.
There are several items that lend themselves to a small variation in pricing. This is particularly the case with Assistive Technology. These support items are indicated in the Price Guide as a range or “varies”. The planner uses the indicative price for approval of the plan.
A supplier/provider needs to notify NDIA of any necessary increase above the amount in the plan providing reasons for this increase above the Agency’s indicative rate.
Quotes are required from providers for a number of service offers. This most commonly occurs for the following supports:
- supported accommodation
- early childhood intervention services
- multidisciplinary programs
- customised assistive technology, and
- home modifications.
The NDIA Price Guide is not a comprehensive list of all available supports to assist participants to achieve their outcomes, nor does it prescribe the only supports funded by the NDIS. It includes an item descriptor (support item) against which the cost of the delivery of support can be claimed. This descriptor is expressed as the most commonly used support in a Support Category (see Table 1).
The NDIA Price Guide is intended to assist providers to claim using a “Best Fit” approach and to assist participants in engaging and negotiating with disability support workers and organisations.
Providers are to maintain accurate records of service provision, including the type, time of day and duration, in accordance with the Service Agreement developed with the participant. Provider claims are monitored by the Agency and provider records are subject to audits conducted or commissioned by the Agency.
Most items in the NDIA Price Guide are GST exempt as described in s38-38 of the GST Act. For the small number of items where GST is applicable, ( e.g., delivery fees and taxi fares) the price is inclusive of GST.
For the supply of the support to be GST-free, it must be made under a written agreement between the provider or supplier, and the participant. Further information can be obtained from the ATO website (new window):
Remote and very remote loading
For supports provided to participants in remote and very remote regions of Australia, the Independent Hospital Pricing Authority loading (which was increased in 2015-16 by 1% to16% in remote areas and 22% in very remote areas) is applied to the unit price of the support.
Provider travel for personal care and community access
Workers Travel for personal care and community access
A worker’s travel time from home to work (or first participant) and from work to home cannot be deducted from a participant’s budget.
For workers travelling between participants, a provider may deduct up to a maximum of 20 minutes from the hours of service for each participant.
If 4 or more hours is delivered to one client, no worker travel time is to be deducted.
Accompanying Participants for Community Access
When workers accompany participants on community outings no travel time is to be deducted from the participant’s budget.
If providers incur a cost for transporting participants in the community, they may negotiate a reasonable contribution from the participant. The participant may be allocated transport funds within their package to assist with such contributions.
The cost of public transport when training a participant in the use of public transport can be deducted from the budget of the participant when a cost is incurred (taking account of arrangements for companion cards).
Provision of Therapeutic Supports
The newly designed NDIA Price Guide and accompanying processes require practitioners to claim for all costs of delivering a service against the single support item: Individual assessment, therapy and/or training.
Travel costs are now incorporated in the funding for the provision of all therapy and are not payable as additional items.
There is no change to the requirements for providers charging for travel when delivering therapeutic supports:
- travel of less than 10 km cannot be claimed; and
- travel costs over $1000 cannot be claimed in any one year.
Services delivered by a provider located in a remote or very remote region attract the Independent Hospital Pricing Authority (IHPA) loading – 15% for remote and 21% for very remote in 2015/16.
If local providers are not available, the Agency will enter into agreements with specific providers for provision of services including more remote regions. The contract with a service provider will allocate the cost of travel and associated expenses among the participants that receive services under the contract/ arrangement in these areas.
Cancellations and “no shows” of scheduled supports
Providers need to have business arrangements in place to minimise the risk of cancellation, no show or late changes to the delivery of a scheduled support. Service agreements between participants and providers need to include details of these arrangements including: rescheduling the appointment; notice periods for cancellations; and changes to agreed appointments.
If there are unforeseen circumstances and the participant agrees that they did not comply with the agreed requirements, a fee may be charged against a participant’s plan up to 8 times per year for personal care and community access supports. However, the provider should notify the Agency that the participant is at risk of not receiving the budgeted supports as a plan review might be indicated.
Where a participant fails, without notice, to keep the scheduled arrangement for the support, the provider must make every effort to contact the participant to determine if there is an additional problem (e.g. the person has fallen out of bed and cannot raise an alarm, or there is a sudden break down in the informal supports and additional support is likely to be required).
Where there is a specific risk that a participant will frequently “not show” for a support due to the nature of a person’s disability or the nature of the support, for example behaviour intervention supports, the provider will put in place suitable individual arrangements to maximise the likelihood that the person will receive all their required supports.
No fee is payable by the NDIA or the participant, for cancellation by a provider or due to the provider’s failure to deliver the agreed supports.
No fee is payable by NDIA for a therapeutic support that is not delivered.
When an NDIS participant dies, they cease to be a participant of the Scheme and no further NDIA funded supports can be delivered. The NDIS legislation does not allow for post-bereavement supports intended for the participant’s family to be funded. However there may be some circumstances where support for a family is required that cannot be adequately delivered from mainstream services. The provider should contact the Agency to discuss their concerns.
NDIA does not permit collection of deposits, or money as a bond from participants that a provider would retain in the event of cancellation of a support.
Changes to supports from 1 August, 2015
As part of the catalogue redesign for 1 August, 2015, there are:
- a small number of new support items;
- name changes to some support items; and
- support items that will not be included in new plans from 1 August as they have been discontinued. Some examples include:
- supports with the same intention and price that have been wrapped up into a single support item; and
- supports delivered by a therapist that are now grouped under a single support item, not according to the specific discipline of the therapist. A new support item has been created to cover the range of services that therapists deliver.
Plans approved prior to 1 August 2015
Providers will still be able to claim against the discontinued support items for the duration of the participant’s plan (for plans finalised prior to 1 August).