NDIS Pricing Arrangements and Price Limits: how registered providers must charge

What the document is

The NDIS Pricing Arrangements and Price Limits, often referred to as the ‘price guide’, is a document published by the National Disability Insurance Agency (NDIA). It outlines the maximum prices registered NDIS providers are permitted to charge for supports funded under the National Disability Insurance Scheme.

This document is designed to ensure reasonable and transparent pricing for NDIS participants. It is subject to regular review and amendment, with updates occurring at least once per year. A major refresh usually takes effect from 1 July, and further in-year updates are released as required. Providers should use the compliance calendar tool to stay informed of these changes.

The price guide is a key reference for registered providers to understand their obligations regarding pricing. It is essential that providers familiarise themselves with the current version to ensure compliance.

How prices are structured

Registered NDIS providers must adhere to specific pricing arrangements when charging participants. These arrangements vary depending on the type of support being delivered. Many therapeutic and personal-support services are priced using hourly rates, while some equipment-related supports utilise item rates. Cancellation provisions also exist to address short-notice cancellations.

Pricing can be further adjusted through the application of loadings. These loadings recognise additional costs associated with specific circumstances, such as delivering supports in regional or remote areas, providing specialised supports, or undertaking short-notice work.

Travel-related costs are subject to specific rules that dictate when providers can claim these costs, the amount that can be claimed, and the applicable rate.

Who the price limits apply to

Price limits are a key component of the NDIS pricing arrangements and apply to supports funded under the National Disability Insurance Scheme. This includes supports delivered to participants whose plans are managed by an agency or a plan manager.

Self-managed participants have the option to pay above the established price limits for supports. They can utilise their own plan funds to do so, however, the total cost of supports remains constrained by the overall budget allocated within their NDIS plan.

The pricing rules outlined in the NDIS pricing arrangements do not directly apply to unregistered providers. While unregistered providers must adhere to the NDIS Code of Conduct when delivering supports to self-managed or plan-managed participants, they are not subject to the registered-provider pricing rules.

Compliance obligations for providers

Registered providers have a clear obligation to adhere to the NDIS pricing arrangements. This means providers must charge no more than the price limit established for each support item, considering the specific circumstances of the delivery. Failure to do so constitutes a breach of these arrangements.

Pricing errors, including over-claiming, double-claiming, and applying inappropriate cancellation charges, are not permitted. Such errors can result in action from the NDIS Quality and Safeguards Commission and the NDIA seeking recovery of any overpayments made.

To maintain compliance, providers are required to regularly update their practice-management and invoicing systems to reflect changes to the Pricing Arrangements. Service agreements with participants must also be kept current, accurately reflecting the applicable pricing and the support items being provided.