Update to NDIS Price Guide Effective 1 December 2020

Posted on 07 Dec 2020
By Tegan Carrison, Executive Director, AAPi

NDIS has updated its price guide effective 1 December, 2020. We outline changes relevant for Psychologists below. Please ensure that if you are changing your prices for services you need to have informed consent and a new service agreement with your participants.

You can find the price guide in full here Price guides and pricing | NDIS.

Claiming for Telehealth Services

NDIS confirms in this price guide that Telehealth can be used to deliver direct supports where appropriate and with the agreement of the participant. When claiming you will need to ensure that the support item is marked as telehealth.

From the price guide P 16. “Providers can only claim Telehealth Services where the following conditions are met:

  • the delivery of the support by telehealth is appropriate; and
  • the proposed charges for the activities comply with this Price Guide and with the Service Agreement with the participant; and
  • the activities are part of delivering a specific disability support item to that participant (rather than a general activity such as enrolment, administration or staff rostering); and
  • the provider explains the activities to the participant, including why they represent the best use of the participant’s funds (that is, the provider explains the value of these activities to the participant); and
  • the provider has the agreement of the participant in advance (that is, the service agreement between the participant and provider specifies that Telehealth services can be claimed).”

Claiming for non-direct services

These items cover such things as communicating with other members of the care team, writing reports and researching that informs part of the treatment plan and assists the participant to meet their goals.

The costs of training and upskilling staff, administration and of supervision, are included in the base price limits for supports and are not considered billable Non-Face-to-Face supports.

To claim these items providers need to have a service agreement outlining the fees associated that is agreed to by the participant, activities are part of delivering a specific disability support item and not administrative in nature and the provider has outlined why this is the best use of the participants funding.

Claims for Non-Face-to-Face supports are made using the relevant support item, using the “Non-Face-to-Face” option in the myplace portal.

Provider Travel

Providers can claim up to 30 minutes in MMM1-3 areas and 60 minutes in MMM4-5 areas. When a provider is travelling to provide services to more than one participant in a ‘region’ then the provider should apportion that travel time (including the return journey where applicable) between the participants, with the agreement of each participant in advance. In addition, capacity-building providers who are permitted to claim for provider travel in respect of a support item can also claim for the time spent travelling from the last participant to their usual place of work. As with all NDIS services, you need agreement from the participant prior to providing the service and have a service agreement that outlines the costs associated with the support items being claimed.

Claims for travel in respect of a support must be made separately to the claim for the primary support (the support for which the travel is necessary) using the same line item as the primary support and the “Provider Travel” option in the myplace portal. When claiming for travel in respect of a support, a provider should use the same hourly rate as they have agreed with the participant for the primary support (or a lower hourly rate for the travel if that is what they have agreed with the participant) in calculating the claimable travel cost.

Provider Travel - Non-Labour Costs

If a provider incurs costs, in addition to the cost of a worker’s time, when travelling to deliver Face-to-Face supports to a participant (such as road tolls, parking fees and the running costs of the vehicle), they may negotiate with the participant for them to make a reasonable contribution towards these costs. The NDIA considers that the following would be reasonable contributions:

  • up to $0.85 a kilometre for a vehicle that is not modified for accessibility; and
  • other forms of transport or associated costs up to the full amount, such as road tolls, parking, public transport fares.

Short Notice Cancellations

Where a provider has a Short Notice Cancellation (or no show) they are able to claim 100% of the agreed fee associated with the activity from the participant’s plan, subject to this Price Guide and the terms of the service agreement with the participant.

A cancellation is a short notice cancellation if the participant:

  • does not show up for a scheduled support within a reasonable time, or is not present at the agreed place and within a reasonable time when the provider is travelling to deliver the support; or
  • has given less than two (2) clear business days’ notice for a support that meets both of the following conditions:
    • the support is less than 8 hours continuous duration; AND
    • the agreed total price for the support is less than $1000; or
  • has given less than five (5) clear business days’ notice for any other support.

Providers can only claim from a participant’s plan for a Short Notice Cancellation of the delivery of a support item to the participant if there is an existing service agreement that outlines that Short Notice Cancellations can be claimed, the provider could not find alternative billable work for completion during the allocated session, and the price guide indicates that providers can claim for Short Notice Cancellations for that support item.

Claims for a short notice cancellation should be made using the same support item as would have been used if the support had been delivered, using the “Cancellation” option in the myplace portal.

There is no limit on the number of short notice cancellations (or no shows) a provider can claim. It is good practice and following your duty of care to work through any issues the participant may have with attending their appointments.

NDIA Requested Reports

Providers can only claim from a participant’s plan for a NDIA Requested Report if all of the following conditions are met:

  • this Price Guide indicates that providers can claim for NDIA Requested Reports in respect of that support item; and
  • the proposed charges for the activities comply with this Price Guide; and
  • the provider has the agreement of the participant in advance (i.e. the service agreement between the participant and provider should specify that NDIA Requested Reports can be claimed); and
  • the report is requested by the NDIA.

A report is considered to have been requested by the NDIA if it is a report that is required at the commencement of a plan that outlines plan objectives and goals, or at plan review that measures functional outcomes against the originally stipulated goals, or that makes recommendations for ongoing needs (informal, community, mainstream or funded supports). Providers may also claim for other NDIA-requested therapy report that is stipulated as being required in a participant’s plan.

Claims for NDIS requested reports should be made using the relevant support item, using the “NDIA Report” option in the myplace portal.

Claiming for Group-Based Supports

When a support item is delivered to more than one participant at the same time (a group of participants) then the price limit for each participant is the applicable price limit set out in the relevant support table divided by the number of participants in the group. Providers should make a claim for each participant using the relevant support item. Each claim should be for the total time of the support but is subject to the lower price limit as set out above.

Providers can only claim for supports that are related to the reasonable and necessary needs of a participant. Where a participant attends a group-based session then a provider should only claim for the time of more than one worker against that participant’s plan if all those workers were involved in the direct support of the participant for the time claimed.

Programs of Support Early Childhood Intervention Supports

Providers in Registration Group 0118 (Early Intervention Supports for Early Childhood) can include 1:1 supports in a program of support but only where these are provided in combination with group supports and as long as the duration of the program is no longer than 12 weeks. Participants need to be able to exit from the program of supports without incurring costs. A notice period of no more than 2 weeks applies. This needs to be clearly outlined in a schedule of supports that is pre-agreed with the participants representative. You cannot pre-claim for programs of support, billing needs to be done when supports are delivered.