NDIS Pricing Guide Update

Published 26 June 2018

The National Disability Insurance Agency (NDIA) has just released its 2018/19 NDIS Price Guide for providers. The Agency has also shared an update on the Independent Pricing Review from NDIS CEO, Rob De Luca. To assist you in understanding the impact of both, we’ve provided a short summary of the key points in both. We gratefully acknowledge the work of Occupational Therapy Australia in developing this information.

We encourage you to review the Pricing Guide in its entirety as there is a considerable amount of useful and important detail contained within the Guide.

NDIS Price Guide for 2018/19

The new price guide has been released and the changes it includes will come into effect on 1 July 2018. In positive news for the sector, Therapy Support prices have been increased with indexation of 2.1% applied.

The table below includes new price limits for some of the supports that you may provide. This is not an exhaustive list.

Individual assessment, therapy and/or training (includes assistive technology) $179.26
Capacity building supports for early childhood $182.74
Specialist Support Coordination $182.74

As with previous NDIS price guides, providers who provide therapy supports in remote areas (MMM6) are paid an additional 20% on top of the standard hourly rate and in very remote areas (MMM7) they receive an additional 25%.

The NDIA have advised that the 1 July 2018 price limit changes will be automatically updated in participant budgets and service bookings. Any services that you provide after 1 July 2018 should be automatically adjusted to enable you to claim at the new increased hourly rate.

Remember, participants who use agency management (i.e., the provider is paid via the NDIS portal) or who use plan management must not be invoiced above the maximum rate that is published in the price guide. Participants who self-manage are not subject to the pricing arrangements in the NDIS price guide.

Changes based on Independent Pricing Review recommendations

The Independent Pricing Review proposed a number of changes to pricing related to therapy supports. Some changes will go ahead on July 1st while others have been delayed. The changes scheduled to proceed on July 1st are broadly positive and are outlined below. We encourage you to provide feedback around these changes to AHPA and your professional associations if there are any issues with how they are being implemented. Other proposed changes including tiered therapy pricing will not go ahead on July 1st. AHPA and its member associations are continuing to work with the NDIA to ensure that our concerns are head during the consultation and implementation phase.

Therapy Travel (phase one)

Therapy travel pricing is guided by the geographical location of where the participant receives the service. The new guide enables providers to claim up to 20 minutes travel at the hourly rate of the relevant support item between participants. This means that you can claim 20 minutes travel from your office to the first participant, from participant to participant and a final 20 minutes from your last participant of the day back to the office.

Providers who provide support to participants in regional, remote and very remote areas can claim up to 45 minutes travel to a participant. To enable you to calculate how much travel you can claim for an individual participant, the NDIA uses the Modified Monash Model (MMM) to assist in setting these price limits. The MMM classifies geographical areas of Australia on a scale of 1-7.

  • Regional Area pricing applies to participants who receive support in areas MMM4 and MMM5.
  • Remote Area pricing relates to people who receive support in area MMM6.
  • Very Remote Area pricing relates to people who receive support in area MMM6.

The below table provides you with a quick summary:

Travel Amount of time Claimable MMM Area
Local 20 minutes MMM 1 – 3
Regional 45 minutes MMM4 and MMM5
Remote 45 minutes MMM6
Very Remote Refer below MMM7
*Remote travel

The NDIA have advised that more specific travel claiming arrangements for remote areas will not be implemented on 1 July 2018. They have advised that they will be implementing a system whereby remote travel costs will be managed on a quoting basis. In the meantime, whilst we wait phase two, Providers are encouraged to ensure that they have an explicit agreement with the participant that covers how remote travel will be costed.

Providers should assist participants to minimise the travel costs that they need to pay (e.g. co-ordinating appointments with other participants in an area, so that travel costs can be shared between participants).

Cancellation policy for therapy

Providers will now be able to charge 90 per cent of the service booking price for short notice cancellations (after 3pm the day before) up to a maximum of 6 hours per service booking. Where the participant has provided notice of cancellation prior to 3pm the day before the scheduled service, providers cannot charge a cancellation fee.

Reports requested by the NDIA

NDIA provide the following explanation related to changes to report writing that will be introduced on 1 July 2018. Therapists will be expected to provide progress reports to the participant and NDIS at agreed times. A provider may charge for the time taken to write a therapy report that is requested by the NDIA, and claim this against the appointment at the hourly rate for the relevant support item. A report requested by the NDIA is considered a report that is required at the commencement of a plan which outlines plan objectives and goals, and at plan review which measures against the originally stipulated goals. Providers may also charge for any other NDIA-requested therapy report that is stipulated as being required in a participant’s plan.

Over  the years  there has been considerable discussion about whether providers can claim the time it takes to write session progress notes.  The latest price guide provides some clarity on this in that it states  “Therapists often spend time making notes at the end of appointments as part of the delivery of support to participants. This is standard practice and part of individual support for participants, even when this activity is not during face-to face time. Therapists may charge for a portion of this time, as long as this is agreed with the participant in advance.”

Final note

The NDIA advise that travel and cancellation changes will be monitored closely on an individual participant basis to ensure participants are not adversely affected. Areas with high risk of cancellations and heavy reliance on provider travel (e.g. participants living in regional areas) in particular will be monitored closely and the NDIA will consider targeted action if there is a risk to the delivery of reasonable and necessary supports.

AHPA and its members will continue to work collaboratively with the NDIA over the next few months as further therapy support changes are considered. We encourage you to keep in touch with us and to provide feedback about the changes.