NDIS Pricing Arrangements and Price Limits explainer

Whether you’re a participant or provider, the National Disability Insurance Scheme (NDIS) Pricing Arrangements and Price Limits will have an impact on your experience in the NDIS.

That’s why it’s important to know what it is, what it does, and how to read it – and why we’ve broken it down into this simple explainer.

What's the NDIS Pricing Arrangements and Price Limits?

Released annually on 1 July, and updated regularly throughout the year, the NDIS Pricing Arrangements and Price Limits (formerly known as the NDIS Price Guide) sets out how price controls for supports and services work in the NDIS.

You can keep track of updates to this highly detailed price regulation document here.

The NDIS Pricing Arrangements and Price Limits includes what’s known as a support catalogue, which outlines all the supports recognised in the Scheme and funded by the National Disability Insurance Agency (NDIA), and the maximum prices providers can charge for them.

The support catalogue includes helpful things like:

• a unique code that’s attached to every support – known as a line item
• the date a support was first introduced – and, if that support’s no longer funded, the date funding ceased
• if a support needs a quote to be provided to the NDIA before it’s approved, and claims can be processed
• the supports that can be accompanied by claims for provider travel costs
• when a provider can claim non-face-to-face costs for a support
• when a provider is allowed to charge more for delivering a support in a remote or very remote area

Its important participants know the maximum price NDIS providers can charge, so they can find competitive pricing and make sure they’re receiving value for money. It's equally important for providers to know, so they can set their fees in accordance with the price limits.

The NDIS Pricing Arrangements and Price Limits serves as a vital reference point when preparing invoices and submitting claims – and it assists staff at the NDIA to accurately determine if a claim is compliant and which budget category claims should be paid from.

Using the right line item not only speeds up invoice processing, but it also helps ensure compliance with NDIA requirements. The NDIS Pricing Arrangements and Price Limits includes more than 600 line items, and providers must adhere to the line item rules if they want their claims to be successful.

How the NDIS Pricing Arrangements and Price Limits is structured

The four NDIS support budgets (which include several support categories) include:

• Core Supports – which enable participants to complete basic activities of daily living. They include consumables (e.g. continence aids), daily activities (e.g. assistance with personal care), and social and community participation (e.g. supports to engage in activities outside of the home)
• Capital Supports – which are purchases participants make, like assistive technology or modifications to a home or a vehicle
• Capacity Building Supports – which help participants to build their skills and independence (e.g. employment-related supports)
• Recurring Supports – which is funding for regular, recurring transport that’s paid directly into a participant’s bank account

If you open the NDIS Pricing Arrangements and Price Limits, you’ll notice it sets out:

• how supports are categorised – each line item is made up of a support category number, a sequence number, a registration group, an outcome domain, and a support purpose
• the four NDIS support budgets and their support categories
• rules for claiming payments – for example, the conditions under which providers can claim for telehealth services
• the support catalogue – with line items broken down by Core Supports, Capital Supports and Capacity Building Supports budgets

To better meets the needs of participants, their families, carers and providers, and to keep the NDIS affordable and in place for future generations, the NDIA uses a mix of data, market research and consultation to develop its Annual Pricing Review and inform changes to the NDIS Pricing Arrangements and Price Limits.

That’s why – whether you’re a participant or a provider – it's vital to know what the document is, what it does, and how to read it.

We're here to help

If you need help to understand it, and its impact on your supports and funding, you can email us at enquiries@myplanmanager.com.au or call us on 1800 861 272 from 8am-5.30pm, Monday to Friday.