NDIS Pricing Arrangements and Price Limits

In this article, we introduce you to the NDIS Pricing Arrangements and Price Limits (formerly known as the NDIS Price Guide).

Whether you’re a National Disability Insurance Scheme (NDIS) participant, supporter or provider, the NDIS Pricing Arrangements and Price Limits will have an impact on your journey in the Scheme – so it’s important to know what it is, what it does, and how to read it.

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 is a highly detailed price regulation document.

It was created to regulate prices in the National Disability Insurance Scheme (NDIS) to ensure participants receive value for money, and to assist both participants and providers to understand how price controls work.

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

• the way the NDIS categorises supports – for example, with a support category number, sequence number, registration group, outcome domain and support purpose
• support budgets and their purposes – for example, a ‘Core Supports’ budget is for supports that enable participants to complete activities of daily living
• rules for claiming payments – for example, the conditions under which providers can claim for telehealth services

What’s the NDIS Support Catalogue?

The NDIS Pricing Arrangements and Price Limits goes hand in hand with the NDIS Support Catalogue, which is another price regulation document.

The Support Catalogue lists all the supports recognised in the Scheme, sometimes called ‘support items’, and the maximum price providers can charge participants for those supports.

It’s important for participants to know the maximum price providers can charge through the NDIS so they can find competitive pricing and it’s equally important for providers to know so they can set prices and fees fairly.

When looking for providers, we recommend participants source a minimum of two quotes that lay out the cost of services (including additional costs like travel or transport), to enable them to make an informed choice about the providers they use.

The Support Catalogue also lists helpful things like:

• support item numbers, sometimes called ‘codes’
• the date a support was introduced – and if it’s ended
• if a support needs a quote
• which supports allow providers to claim their travel costs from a participant’s plan
• 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

How to read the NDIS Pricing Arrangements and Price Limits

The NDIS Pricing Arrangements and Price Limits document is broken up into three parts:

• Support purposes
• Support categories
• Line items

Support purposes

All NDIS supports fall into one of four support purposes: Core, Capital, Capacity Building and Recurring. Check below for a little more detail:

• Core Supports 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 are purchases participants make, like assistive technology or modifications to a home or a vehicle.
• Capacity Building Supports can help participants to build their skills and independence. They may include employment-related supports, or training and assessments that help someone to find and keep a job.
• Recurring Supports is funding for regular, recurring transport and is paid directly into the participant’s bank account. This support purpose is new under PACE – the National Disability Insurance Agency’s (NDIA) new computer system.

Support categories

Each support purpose has support categories within it. In the new world of PACE, there are currently 21 support categories in total.

Line items

Every support in the NDIS has a line item – or code – attached to it. When providers deliver a support to participants they include the relevant line item on their invoice and the NDIA then uses the line item to identify which budget in the participant’s NDIS plan their supports should be paid from.

The NDIS Pricing Arrangements and Price Limits includes more than 800 line items. Importantly, providers need to adhere to the NDIA’s line item rules so the processing of invoices is not delayed or payments declined.

How often does the NDIS Pricing Arrangements and Price Limits change?

The National Disability Insurance Agency (NDIA) releases a new NDIS Pricing Arrangements and Price Limits document each year and makes regular updates as the need arises. It does this to better meets the needs of participants, their support networks, and providers, and to ensure the Scheme remains affordable and in place for future generations of Australians.

You can keep track of updates here.

Extra resources

• NDIS funding explained (plans on PACE) – this downloadable resource unpacks each NDIS support purpose and category. It’s for plans on the NDIA’s PACE computer system.
• NDIS funding explained (plans not on PACE) – this downloadable resource unpacks each NDIS support purpose and category. It’s for plans not yet on the NDIA’s PACE computer system.

We’re here to help

If you need help to understand the NDIS Pricing Arrangements and Price Limits and its impact on your supports and funding, you can email us at [email protected] or call us on 1800 861 272 from 8am-6pm (SA time), Monday to Friday.