Tuesday 18 July 2023

Pricing Arrangements Under the NDIS

Original article by Astrid Rivalland, Senior Lawyer, LegalVision.

There is a range of guidelines under the National Disability Insurance Scheme that help providers and participants to navigate the scheme effectively. In particular, the NDIS Pricing Arrangement and Price Limits (also known as the Price Guide) sets out the maximum amount a provider should charge for certain services and the conditions for claiming some support. This article provides guidance on applying the Price Guide to service providers delivering services to NDIS participants. 

What is the Price Guide?

The Price Guide is a document provided by the National Disability Insurance Agency (NDIA). It sets out conditions and pricing applicable to service providers and participants. Your business does not need to charge the exact amounts set out in the Price Guide. Rather, the Price Guide outlines the maximum amounts your business can charge. 

The NDIS does not want providers to indicate that the NDIS sets the amount for a service to the maximum amount. NDIS participants should have choice, control, and the ability to negotiate lower prices. 

The Price Guide also sets out the rules for claiming certain items. For example, whether a provider can charge a short notice cancellation fee for certain supports or travel costs. 

Generally, the NDIA will update the Price Guide at the start of each financial year, though can also release amendments throughout the year.

Is My Business Bound?

Only providers who are registered with the NDIA need to follow the Price Guide. However, unregistered providers who provide services to a plan-managed client should also invoice in line with the Price Guide. 

If you are not a registered provider and provide service to self-managed clients only, you are not bound by the price limits set out in the Price Guide. Still, it is a useful guide to follow. Unregistered providers still need to follow the NDIS Code of Conduct. 

Are There Other Relevant Pricing Documents?

The Price Guide is the primary document that relates to pricing, but there are other relevant guides, including:

  • the NDIS Support Catalogue; 
  • any addenda to the Price Guide; 
  • the NDIS Pricing Arrangements for Specialist Disability Accommodation; and 
  • the NDIS Assistive Technology, Home Modifications and Consumables Code Guide. 

Other Pricing Considerations

Charging Self-Funded vs NDIS Participants 

Generally, a provider cannot charge clients more purely because they participate in the NDIS. It may be possible to charge a higher price to NDIS participants versus a self-funded participant. However, there must be a valid reason for doing so, such as certain additional administration costs. 

Charging Different Prices Depending on Location

The limits set out in the Price Guide may vary depending on the location of the participant. For example, some providers can charge a higher price for participants located in very remote areas. Prices may also vary for some supports depending on the day and time of delivery. 

Charging in Advance for Services

The NDIS states that prepayments for services are only acceptable in very specific circumstances. These are limited to certain home modifications and assistive technology supports. If the support you are providing requires you to pay a substantial amount of money upfront, you can contact the NDIA to request approval to invoice the participant in advance. 

Charging an Exit Fee

If your client wishes to cancel, you cannot charge them an exit fee. The NDIS emphasises that participants should have choice and control, including the freedom to change providers without receiving a financial penalty.

In some circumstances, you may be able to charge cancellation fees for pre-booked shifts, provided you meet the conditions in the Price Guide.

Consequences for Non-Compliance

If your services or the invoice setting out the services does not comply with the Price Guide, you may not get paid. If you are working with a plan-managed client, the plan manager has the right to reject an invoice for services that do not comply with the Price Guide. The plan manager can refuse to pay for a service that is not compliant or may ask you to reissue an invoice that is compliant. A participant or other provider may also report you to the NDIS Quality and Safeguards Commission. 

Using a Service Agreement

We recommend that you document any relationship between a provider and a participant in a client service agreement. In addition to ensuring you comply with the Price Guide, you also need to make sure that you follow the general principles of Australian Consumer Law when providing goods and services. 

Key Takeaways

All providers should familiarise themselves with the pricing limits and conditions for claiming set out in the Price Guide. Registered providers must follow the Price Guide. Notably, providers should not tell clients that the NDIS sets the amount for a service to the maximum amount. 

If you have any questions about interpreting the Price Guide or how to set up a service agreement, our experienced commercial lawyers can assist as part of our LegalVision membership. For a low monthly fee, you will have unlimited access to lawyers to answer your questions and draft and review your documents. Call us today on 1800 534 315 or visit our membership page.

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