There are a range of guidelines under the National Disability Insurance Scheme that help providers and participants navigate the scheme effectively. In particular, the NDIS Pricing Arrangement and Price Limits (also known as the Price Guide) sets out the maximum amount a provider should charge for certain services and the conditions for claiming some support. The Price Guide is updated annually, with the most recent round of amendments coming into effect from 1 July 2024. This article outlines the key changes from this update and guides NDIS providers on how to apply the Price Guide to their provision of services to participants.
What is the Price Guide?
The Price Guide is a document provided by the National Disability Insurance Agency (NDIA). It sets out conditions and pricing applicable to service providers and participants. Your business does not need to charge the exact amounts set out in the Price Guide. Instead, the Price Guide outlines the maximum amounts your business can charge.
The NDIS does not want providers to indicate that the NDIS sets the amount for a service to the maximum amount. NDIS participants should have choice, control, and the ability to negotiate lower prices.
The Price Guide also sets out the rules for claiming certain items, such as whether a provider can charge a short notice cancellation fee for certain services or travel costs.
Generally, the NDIA will update the Price Guide at the start of each financial year, though it can also release amendments throughout the year. The most recent 2024-25 Price Guide update, effective from 1 July 2024, includes the following key changes:
- increased price limits for certain supports, such as assistance with self-care activities, Supported Independent Living, Short-Term and Medium-Term Accommodation, nursing support, and supports provided by psychologists, to reflect the Fair Work Commission’s wage and superannuation increases and the rising cost of living;
- updates to ‘Employment Assistance’ support to specifically include assistance tailored for youth aged 15-25, such as obtaining part-time work whilst finishing secondary education;
- introduction of a new ‘Assistive Technology Mentors’ support item to provide participants with independent advice on selecting and using assistive technology; and
- previously, NDIS providers could only claim their fees for short notice cancellations if a participant cancelled within 7 days of their scheduled booking. This is known as the short notice cancellation period. Now, the Price Guide has introduced a separate 2 business day short notice cancellation period specifically for non-disability support worker-related supports. This means providers can now claim their service fee if a participant gives less than 2 business days’ notice for cancelling supports like assistance with household tasks, specialised home assistance for children, physical wellbeing activities, and other non-direct disability support worker services. The existing 7-day cancellation notice period still applies for disability support worker services. To provide clarity, the Price Guide now details the short-notice cancellation period applicable to each type of support.
Is My Business Bound?
Only providers registered with the NDIA need to follow the Price Guide. However, unregistered providers who provide services to a plan-managed client should also invoice in accordance with it.
If you are not a registered provider and provide service to self-managed clients only, you are not bound by the price limits set out in the Price Guide. Still, it is a helpful guide to follow. Unregistered providers still need to follow the NDIS Code of Conduct including the relevant clauses relating to payments.
Continue reading this article below the formAre There Other Relevant Pricing Documents?
The Price Guide is the primary document that relates to pricing, but there are other relevant guides, including:
- the NDIS Support Catalogue;
- the NDIS Disability Support Worker Cost Model;
- any addenda to the Price Guide;
- the NDIS Pricing Arrangements for Specialist Disability Accommodation; and
- the NDIS Assistive Technology, Home Modifications and Consumables Code Guide.
Other Pricing Considerations
Price Differentiation
Generally, a provider cannot charge clients more purely because they participate in the NDIS. This practice is known as ‘Price Differentiation’ and is considered unfair by the NDIS Commission and the Australian Competition and Consumer Commission.
Charging Different Prices Depending on Location
The limits set out in the Price Guide may vary depending on the location of the participant. For example, some providers can charge a higher price for participants located in very remote areas. Prices may also vary for some supports depending on the day and time of delivery.
Charging in Advance for Services
The NDIS states that prepayments for services are only acceptable in particular circumstances. These are limited to certain home modifications and assistive technology supports. If the support you are providing requires you to pay a substantial amount of money upfront, you can contact the NDIA to request approval to invoice the participant in advance.
Charging an Exit Fee
If your client wishes to cancel, you cannot charge them an exit fee. The NDIS emphasises that participants should have choice and control, including the freedom to change providers without receiving a financial penalty.
In some circumstances, you may be able to charge cancellation fees for pre-booked shifts, provided you meet the conditions in the Price Guide.
Consequences for Non-Compliance
If your services or the invoice setting out the services does not comply with the Price Guide, you may not get paid. If you are working with a plan-managed client, the plan manager has the right to reject an invoice for services that do not comply with the Price Guide. The plan manager can refuse to pay for a service that is not compliant or may ask you to reissue a compliant invoice. A participant or other provider may also report you to the NDIS Quality and Safeguards Commission.
Using a Service Agreement
We recommend that you document any relationship between a provider and a participant in a client service agreement. In addition to complying with the Price Guide, you must follow the general principles of Australian Consumer Law when providing goods and services.
This fact sheet will help you to identify the key terms you must include in your NDIS service agreement.
Key Takeaways
All providers should familiarise themselves with the pricing limits and conditions for claiming set out in the Price Guide. Registered providers must follow the Price Guide. Notably, providers should not tell clients that the NDIS sets the amount for a service to the maximum amount.
If you need assistance with the Price Guide, our experienced NDIS lawyers can assist as part of our LegalVision membership. For a low monthly fee, you will have unlimited access to lawyers to answer your questions and draft and review your documents. Call us today on 1300 544 755 or visit our membership page.
Frequently Asked Questions
Only providers registered with the NDIA need to follow the Price Guide. However, unregistered providers who provide services to a plan-managed client should also invoice in accordance with it.
You cannot charge prepayments for services except in very specific circumstances, such as certain home modifications and assistive technology supports. You may wish to contact the NDIA to request approval to invoice the participant in advance.
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