Navigating the NDIS Price Guide: A Comprehensive Guide for Providers (Part 1)
The NDIS plays a pivotal role in providing support and care for individuals with disabilities. Central to this scheme is the NDIS Price Guide, which is a comprehensive document released annually to guide participants and service providers on funding utilisation and service charges.
Understanding the NDIS Price Guide
The NDIS Price Guide for the current year of 2023-2024 serves as the fundamental rule book for participants and service providers alike. This detailed guide, available here, outlines pricing arrangements, invoicing procedures, and applicable price caps for various supports. However, with its extensive content spanning over 50 pages and utilising complex language, navigating the Price Guide can be daunting for newcomers to the NDIS landscape.
Navigating the Price Guide
Recognising the importance of comprehending the Price Guide, Swift Aid has developed strategies to empower participants and service providers in confidently navigating its contents. By breaking down the complexities of the Price Guide, we aim to facilitate informed decision-making and efficient service provision within the NDIS framework.
Utilising the NDIS Price Guide Navigator
Recognising the importance of comprehending the Price Guide, Swift Aid has developed strategies to empower participants and service providers in confidently navigating its contents. Furthermore, by breaking down the complexities of the Price Guide, we aim to facilitate informed decision-making and efficient service provision within the NDIS framework. Consequently, this approach ensures that users can better understand and utilise the guide effectively.
Key Concepts in the NDIS Industry
Before we dig deep into the NDIS price guide, you, as a provider, need to be aware of a few things when it comes to charing participants.
Unregistered vs. Registered NDIS Providers
- Unregistered NDIS providers (or the ones who are waiting to be approved by the NDIA) cannot bill NDIA-managed participants.
- Unregistered NDIS providers (or the ones who are waiting to be approved by the NDIA) can only bill plan-managed or self-managed participants (each participant can have a plan manager to manage the participant’s funding). If you have a participant who’s NDIA-managed then you can ask them to switch to becoming plan-managed or self-managed by choosing one of the many NDIS plan-managers available.
- Registered NDIS providers can bill NDIA-managed, plan-managed or self-managed participants (Lucky for them..)
NDIA-Managed Participants:
- Providers must have an agreement with the participant about the price of each support item before carrying out the work (subject to the price limits and pricing arrangements that are imposed by the NDIA).
- Providers should not indicate in any way to participants that the prices that they charge are
set by the NDIA. In general, providers should not charge NDIS participants more for a support than they would charge anyone else for the same support. If the price a provider offers to a NDIS participant is different to that which they would offer to a person who was not an NDIS participant, then the provider should ensure that the participant is aware of this difference and the reasons for the
difference. - Providers must include their ABN in all the invoices issued and sent to the NDIA-managed participants for all the services completed.
Plan-Managed Participants:
- Providers (registered and unregistered) must adhere to the arrangements prescribed in the NDIS Pricing Arrangements and Price Limits
- Providers must include their ABN in all the invoices issued and sent to the NDIA-managed participants for all the services completed.
- Providers must only send out tax invoices to the plan manager with relevant information (this will be addressed in a later article) for items included in the participant’s plan only.
Self-Managed Participants:
Self-managing participants can use registered or unregistered providers and are not subject to the price limits or other pricing arrangements set out in the NDIS Pricing Arrangements and Price Limits and its associated documents.
How much can a provider charge?
Looking at the NDIS price guide, the listed figures are the maximum the provider can charge the participant. These figures are not expected to be utilised 100%. Be fair, be empathetic and be professional when you bill the participant.
What items can the provider use?
The provider can only use the items the participant is allowed to utilise. The items can only be claimed by a provider from a participant’s plan when they are reasonable and necessary to meet a participant’s needs.
Key Concepts in the NDIS Price Guide
Disability Support Categorisation
The NDIS categorises disability supports into the three items shown below. These categories are relevant for participants about how they can spend their support budgets, and for providers when seeking payment for delivered supports; these categories are support purpose, support categories (which aligns with NDIS outcome framework), and support items. These may sound like gibberish to you, but once you see how we’re going to carve them into small pieced then we put them together, you’d see how easy it is. So grab your coffee and let’s dive in..
Support Purpose
The Price Guide categorises NDIS supports into Core, Capital, and Capacity Building types, each serving distinct purposes within participants’ plans:
- (01) CORE – Supports that enable participants to complete activities of daily living. Participant budgets often have a lot of flexibility to choose specific supports with their core support budgets, but cannot reallocate this funding for other support purposes (i.e., capital or capacity building supports).
- (02) CAPITAL – Investments, such as assistive technologies – equipment, home or vehicle modifications, or for Specialist Disability Accommodation (SDA). Participant budgets for this support purpose are restricted to specific items identified in the participant’s plan.
- (03) CAPACITY BUILDING – Supports that enable a participant to build their independence and skills.
Support Categories
Support categories are aligned with the NDIS Outcomes Framework. How so?
There are 15 support categories delineating funding allocations, participants can flexibly allocate budgets to address their specific needs. These categories are:
- (01) Assistance with Daily Life
- (02) Transport
- (03) Consumables
- (04) Assistance with Social, Economic and Community Participation
- (05) Assistive Technology
- (06) Home Modifications and Specialised Disability Accommodation (SDA)
- (07) Support Coordination
- (08) Improved Living Arrangements
- (09) Increased Social and Community Participation
- (10) Finding and Keeping a Job
- (11) Improved Relationships
- (12) Improved Health and Wellbeing
- (13) Improved Learning
- (14) Improved Life Choices
- (15) Improved Daily Living Skills
There are 8 outcome domains in the NDIS Outcomes Framework, which help participants think about goals in different areas of their life:
- (1) Daily Living
- (2) Home
- (3) Health & Wellbeing
- (4) Lifelong Learning
- (5) Work
- (6) Social & Communication Participation
- (7) Relationship
- (8) Choice & Control
How do the support categories and outcome domains associated with each other? It’s a tree structure or a hierarhical structure. Each outcome domain (which is the outcome the participant is expecting to achieve) is linked to an associated support category.
- (1) Daily Living
- (01) Assistance with Daily Life
- (02) Transport
- (03) Consumables
- (05) Assistive Technology
- (15) Improved Daily Living Skills
- (2) Home
- (08) Improved Living Arrangements
- (06) Home Modifications and Specialised Disability Accommodation (SDA)
- (3) Health & Wellbeing
- (12) Improved Health and Wellbeing
- (4) Lifelong Learning
- (13) Improved Learning
- (5) Work
- (04) Assistance with Social, Economic and Community Participation
- (10) Finding and Keeping a Job
- (6) Social & Communication Participation
- (04) Assistance with Social, Economic and Community Participation
- (09) Increased Social and Community Participation
- (7) Relationship
- (11) Improved Relationships
- (8) Choice & Control
- (07) Support Coordination
- (14) Improved Life Choices
For example, if the participant’s plan has an outcome to support Daily Living, then the asscociated support category with this outcome can be one or more of the categories: (01) Assistance with Daily Life, (02) Transport, (03) Consumables, (05) Assistive Technology and/or (15) Improved Daily Living Skills.
To sum up the above, and before moving on to the next section, each NDIS Outcome Domain encapsulates one or more Support Category item in order to achieve the outcome of the participant.
But wait…
How do support categories and NDIS outcome domain relate to the support purposes mentioned in the first point?
Aha…
Do you remember how we said that the NDIS Outcome Domain encompass one or more Support Category? Well, the Support Purpose encompasses the entire Outcome Domain (which, as you know now, encompasses the Support Category).
Gee, this is now complicated! Not at all. Have a look at the following table (copied from the NDIS Price Guide which clearly shows how this relation works). Keep in mind that we’re not there yet (we still need to look into the support items).
Now, why am I insisting on showing the number of those items?
Well, this would let you understand the items listed in the price guide! This will save you the hassle of posting a question on a Facebook group and then being shot at by some of the angry members.
Anyway, you don’t need to remember those numbers. Just understand how those items are connected together and now let’s seriously move on into the next and last category which is the item itself.
Support Items
Each support that a provider supplies to a participant can be classified as one of the support items listed in the NDIS Pricing Arrangements and Price Limits and in the NDIS Support Catalogue. Providers should claim payments against the support item that aligns to the service they have delivered.
Each support item has a unique reference number, according to the following structure:
Support Category: 1-15 (we discussed it before – the green coloured items).
Sequence Number: This is just a sequence number of the item in the price guide (fixed value)
Registration Group: Which registration group this item falls under. Noting that, as a provider, you must only provide services from the registration groups you are enrolled in. We’ll talk about registration groups at a later article.
Outcome Domain: 1-8 (we discussed it before – the blue coloured items).
Support Purpose: 1-3 (we discussed it before – the orange coloured items).
Let’s have an example of how a support item looks like:
The above item has a code of 01_013_0107_1_1. This code is what you need to include when you send out an invoice. The description next to it can also be added on a seprate field in the invoice.
So what does the above item mean how can you interpret it?
Reading from left to right:
- 01 is the ‘Assistance with Daily Life‘ support category that we addressed before.
- 013 is just a sequence number added by the NDIA
- 0107 refers to the registration group this support item falls under (i.e. Daily Personal Activities)
- 1 is the outcome domain (i.e. Daily Living)
- 1 is the support purpose (i.e. Core)
Stay Tuned for the Next Article
In the upcoming articles, Swift Aid will delve into finishing off what we started. We will also address the process of invoicing the plan manager or the National Disability Insurance Agency (NDIA) for the support services provided, and possibly explaining the difference between registration groups, and many more. Therefore, stay tuned for practical insights and step-by-step guidance on navigating this crucial aspect of the NDIS framework. Furthermore, we will provide tips to streamline your invoicing process and ensure accuracy.
Conclusion
Navigating the NDIS Price Guide is essential for participants and service providers to effectively utilise funding and ensure quality service delivery. Consequently, understanding the guide’s detailed information can significantly impact the management of support services. With Swift Aid’s commitment to simplifying the complexities of the Price Guide, participants can navigate the NDIS landscape with confidence and clarity. Furthermore, our tools and resources are designed to make the process more accessible and user-friendly.
In conclusion, mastering the NDIS Price Guide is crucial for maximising the benefits of the NDIS. By leveraging Swift Aid’s expertise and resources, participants and providers alike can achieve a better understanding of the guide’s intricacies. Therefore, stay informed, utilise available tools, and continue to seek guidance to ensure effective and efficient use of NDIS funding.