NDIS Price Summary Guide

The NDIS released its annual revision of the Price Guide on 21 June for the 2018/19 financial year. The new prices and other changes contained within the price guide will come into effect on 1 July 2018.

This pricing guide also includes the first round of changes being implemented as a result of the recommendations from McKinsey & Co’s Independent Pricing Review (IPR).

The Association, along with others including Allied Health Professions Australia (AHPA), advocated strongly around several of the IPR recommendations, including tiered pricing, travel, cancellations, and payment for progress reports and other participant related administration. The introduction of tiered pricing has been delayed, pending further consultation.

Pricing for travel has also been adjusted to allow for the trip to the first participant, and from the last participant, as well as travel between participants, to be claimed (which differs from the arrangements for provision of attendant care).

The NDIA have advised that they will consult with provider groups to finalise the recommendations around therapy price limits and complexity following the implementation of the current changes, with the expectation that that this work will be completed and ready to implement in late 2018. Speech Pathology Australia will continue to work with AHPA as part of the engagement and consultation with the NDIA on this matter.

Summary of changes impacting upon provision of allied health supports

NB: The Association encourages members to review the new price guide documents in their entirety when time allows.

The pricing guide applies to provision of supports for plan managed and agency managed participants. As previously, claims for supports provided to agency managed participants must be at or below the pricing cap. Plan managers will be unable to pay invoices greater than the pricing caps as set out in the price guide.

Therapy rates

There have been small increases in the pricing for provision of therapy interventions, both for Early Childhood (under 7) and others, and for individuals and groups.

The Pricing Guideline also provides for greater flexibility in pricing for groups delivered for non EI clients “For support ratios that are not stated in this Guide (such as one therapist to two participants, or one therapist to four participants), the NDIA encourages participants and providers to discuss arrangements both parties agree to, including price. Therapy delivered in a group may be claimed using the relevant therapy support line item but with lower prices than the price limit as agreed between provider and participant.” Please see the new NDIS Pricing table.

The NDIA have advised that participant budgets and service bookings will be automatically updated to reflect these changes, meaning that for services provided after 1 July 2018, existent service bookings will be automatically adjusted to enable providers to claim at the new increased hourly rate if they choose to do so.

Progress notes

“Therapists may charge for a portion of this time (for writing progress notes), as long as this is agreed with the participant in advance.”

Reports

Providers are able to claim for reports that are requested by the NDIA. These are defined as: “a report that is required at the commencement of a plan which outlines plan objectives and goals, and at plan review which measures against the originally stipulated goals.

Providers may also charge for any other NDIA-requested therapy report that is stipulated as being required in a participant’s plan.”

Service Agreements

When registered providers sign the Declaration of Suitability they agree to be bound by the current Pricing Guide as per the Terms of Business.

New service agreements will need to be developed if as a provider you wish to implement the increased pricing caps, or any of the changes and additions to the type/amount that can be claimed for supports (e.g. charging for a portion of progress noting times, or for reports for the NDIS). You may also be required to make a change to an existent service agreement if it includes arrangements which are now outside of the new Pricing Guideline (e.g. payment for travel to a participant who is the first in the day which is greater than the equivalent of 20 minutes). The changed prices can only be applied to services provided after 1 July 2018.

If a provider chooses to retain prior arrangements that do not result in higher fees being charged to participants, or additional charges for non face to face activities being added, then these arrangements could continue.

Monthly payment statements will now be available for participants to assist them in tracking their remaining budgets- this was recommended by the Association through a target NDIS consultation with AHPA. These statements will include details on what has been spent, in addition to remaining therapy budgets, and allow participants to better understand what funds have been allocated and spent.

Pre-payment

This is still not permitted- this is stated several times within the pricing guide:

“NDIA does not permit collection of deposits, or money as a bond from participants that a provider would retain in the event of cancellation of a support per the NDIS Terms of Business.”

“Providers should make claims only for supports that have been delivered.”

Travel

 The 10 km travel ‘included’ travel restriction, and caps on total travel claims have both been lifted. Travel can now be claimed based on time spent rather than kilometres travelled, and based upon the hourly rate for the support being delivered.

In metro areas, it is possible to claim for up to 20 minutes travel to the first participant, up to 20 minutes travel between participants, and for return travel from the final appointment in a day.

If providing supports to participants in rural and remote areas (MMM4 or 5 areas) providers can claim up to 45 minutes travel to a participant, and from one participant visit to the next, as per the hourly rate for the support item.

Additionally, the pricing guide states that: “In remote areas, therapy providers may enter specific arrangements with participants to cover travel costs, up to the relevant hourly rate for the support item. Providers should assist participants to minimise the travel costs that they need to pay (e.g. co-ordinating appointments with other participants in an area, so that travel costs can be shared between participants).”

Members wishing to know more about the MMM areas, can look up the map on the doctor connect website, or search the MMM locator.

Cancellations

Service agreements need to include details of cancellation arrangements including:

“rescheduling the appointment; notice periods for cancellations and the cancellation fee that can apply; and changes to agreed appointments”.

Providers are able to charge up to 90 per cent of the hourly fee for cancellations made after 3 pm the day before the appointment. There is a maximum of six hours of cancelled appointments that are allowed to be charged per service booking.

Please note that unlike the price guide updates that relate to indexation, the provider travel and appointment cancellation changes cannot be readily adjusted within plans.

It is advisable that members consider the number of hours that have been funded for therapy provision and how this may be affected as a result of a change (and potential increase) in the amount that will be claimed for travel. For instance, some clients may be within a 10km radius, but a provider may routinely be travelling for 20 minutes each way due to traffic. Under the new pricing guide the 20 minutes travel would now be claimable, however plans will not be increased to allow for this, leading to a potential impact on the funding available for the provision of therapy.

The NDIA have advised that the impacts of the changed rules regarding cancellation will be monitored closely on an individual participant basis to ensure participants are not adversely affected. Rob De Luca explained “The NDIA will monitor cancellation practices, particularly in areas with high risk of cancellations and heavy reliance on provider travel (e.g. participants living in regional areas). The NDIA will consider targeted action if there is a risk to the delivery of reasonable and necessary supports, without the need for a plan review.”

Specific questions regarding the NDIS can be emailed to the NDIS/Clinical Practice and Support Advisor or National Disability Advisor, or contact Speech Pathology Australia.