How do I determine what to charge NDIS participants?

Acacia Plan Management what to charge NDIS participants
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Providers are fundamental to the lives of every NDIS participant as they provide the essential supports and services they require to live with a disability.  Providers are in control of what to charge NDIS participants to supply these supports however the NDIS sets out guidelines for providers when they determine their pricing.  The onus is on providers to fully understand the contents of the NDIS Pricing Arrangements and Price Limits document so they can make fully informed pricing decisions to provide the best value to their clients and themselves.

Understanding the Pricing Arrangements & Price Limits

NDIS Pricing Arrangements and Price Limits (previously the NDIS Price Guide) assist participants and disability support providers in understanding how price controls for supports and services work in the NDIS.  Price regulation is in place to ensure that participants receive value for money in the supports that they receive.

The Support Catalogue lists all available supports providers can use when lodging a payment request.

It also provides information on current (and previous) price limits for each support item and indicates which claim types (travel, non-face-to-face, etc.) apply for each price-limited support item.  Price limits are the maximum prices that registered providers can charge NDIS participants for specific supports.  Participants and providers can negotiate lower prices.

When is the Pricing Arrangements and Price Limits updated?

The Pricing Arrangements and Price Limits is updated throughout the year with minor updates. A full review is undertaken annually at the end of financial year. Normally, this review is issued by 30 June with updates implemented on 1 July each year.

The NDIA uses a combination of market data research, public consultation and industry engagement to determine the necessary updates made to the guide.  It is very important for providers to stay up to date with the latest changes throughout the year so changes can be applied to their invoices.

Setting your Pricing

The NDIS Pricing Arrangements and Price Limits lists the maximum price registered providers can charge a NDIS participant for each service.  This is not a set price meaning that services can be negotiated at a lower rate than what is stated, but not a higher rate.

While NDIS registered providers must follow the Pricing Arrangements and Price Limits, unregistered providers are not obliged to do so.  That being said, they are encouraged to follow the same pricing guidelines as registered providers to ensure that NDIS participants have access to the supports they need at a fair and reasonable price.

Whether you are registered with the NDIS or not, it is vital to discuss the price of your supports and services with any participant.  This is then used when establishing a service agreement and clear communication with your NDIS participants.

Some things you may wish to consider when setting the price for your supports and services:

  • What is the maximum amount listed in the Pricing Arrangements and Price Limits for each service you provide?
  • What price would be considered fair and provide value for money for each service provided?
  • Have you discussed pricing with your NDIS participant?
  • Does any adjustments need to be made to the pricing set?
  • Is there a pricing difference based on whether the support is in person or not in person?

Work with participants to understand your pricing decisions

As with any successful partnership, strong communication is vital from both parties.  Your pricing decisions should be openly discussed with your clients to ensure they fully understand what they may be charged if they engage with you.  This also allows them to ask you questions and negotiate if required.  This discussion should include:

  • An understanding of the prices in the Pricing Arrangements and Price Limits
  • What pricing has been set by you in line with the guide
  • If they can expect any additional costs on top of the provider service costs e.g. travel
  • What your protocol is if the NDIS makes an update to the Pricing Arrangements and Price Limits (i.e., how will you let the participant know if there are pricing adjustments)

It is important for participants to be fully informed and comfortable they are receiving value for money at a fair and reasonable cost when it comes to their plan budget.