Every year on 1 July, the National Disability Insurance Scheme publishes a new price guide. Officially named the ‘NDIS Pricing Arrangements and Price Limits’, this document sets maximum amounts for the costs of specific NDIS supports and services. You can use these price limits to plan your NDIS budget and determine how much support funding you need for necessary services.
The purpose of the price guide is to ensure that NDIS participants receive value for money for the NDIS supports they purchase. The price limits ensure that providers can’t charge unreasonable fees for supports and services. In addition, the price guide ensures fair payment for providers. The price guide is not legislation, and it can be updated at any time at the discretion of the NDIA. The funding limits are reviewed at least annually and are adjusted based on minimum wage increases and changes in the consumer price index.
As an NDIS participant, it’s important for you to know that prices are negotiable, and your provider may agree to charge less than the prices listed in the guide. However, providers who are registered with NDIA are not allowed to charge more than the pricing arrangement limits. If you are self-managing your plan, you can choose to use an unregistered provider, and they are allowed to charge higher than the pricing limits. If you decide to work with a provider who does not follow the pricing limits, make sure you understand the reason for their prices and that you are satisfied with the value you receive.
What are NDIS price limits?
Price limits are the federally-determined maximum prices that you can be charged for specific NDIS services. Registered providers cannot charge more than the maximum price limit, although you can negotiate lower prices with your provider based on your specific needs.
Not all types of supports have a designated price limit. For example, consumables such as nappies and urinary catheters do not have a price limit, since they are usually bought retail and the prices are not negotiated. Some high-priced assistive technology such as wheelchairs and orthotics also do not have set pricing limits, but they require that you get a price quote from the provider which must be approved before you can purchase the item.
Services that you receive directly from a support worker usually have a price limit which is determined by the type of support worker and the time when the service is received. For example, there is a price limit for the hourly rate for a support worker to assist you with activities of daily living, and there is a different hourly rate price limit for a clinical nurse to provide health support services. Price limits also can vary depending on where you live; the NDIS sets higher limits for regions that are classified as ‘remote’ or ‘very remote’. Reference the full NDIS Pricing Arrangements and Price Limits document to determine which type of price limit applies where you live.
Finally, price limits may vary by provider, depending on whether a specific provider qualifies for the higher Temporary Transformation Payment, or TTP. This additional funding helps providers with the administrative costs of transitioning to NDIS. It was created in 2019 as 7.5% additional funding to each support item, and it is reduced by 1.5% each year. To qualify for TTP funding, a provider must be registered with NDIS, publicly publish their service prices, be listed on the NDIS provider finder, and complete an NDIA benchmarking survey each year. In 2021, the TTP price limit is 4.15845% higher than the standard price limit for each type of service.
What do NDIS price limits mean for participants?
The main purpose of the NDIS price limits is to ensure that participants receive value for money and prevent overcharging by providers. Although the pricing guide and detailed support catalogue can seem overwhelming, they are designed to allow significant flexibility for participants.
One of the primary goals of NDIA is to offer each participant choice and flexibility in accessing individualised supports that best meet their needs. To accomplish this, the pricing arrangements document includes many support items that can be used for a variety of services and activities. This is why it’s important for you as a participant to start by setting the goals you want to accomplish with your NDIS funding. After you’ve determined the types of supports that will help you meet those goals, you can then use the pricing arrangement document to design your support budget.
Why does NDIS change its price limits?
NDIS reviews its price guide annually to ensure that the price limits are fair and reasonable. The price limit is adjusted to account for changes in the Consumer Price Index, or cost of living. This is to ensure that providers receive a fair price for their services relative to economic changes. Changes to the price limits also take into account significant changes to participant needs, such as changes caused by the global COVID-19 pandemic.
How do the 2021 price guide changes affect NDIS participants?
Changes to the 2021 guides could affect you as a participant.
First, price limits for hourly services from disability support workers have been raised to account for the national minimum wage change which went into effect on 1 July 2021. The minimum wage for support workers is now $20.33 per hour, an increase of 2.5% from 2020. The cost of this increase is built into the increased price limits for all services. Talk with your provider to find out whether they are increasing the cost of your services in response to this change.
The limits for specialist disability accommodation, or SDA, have also increased in response to a 1.1% increase in the Consumer Price Index. SDA is support you can receive to help pay for the cost of your housing if you need special housing features to accommodate your disability. If you receive SDA support, your provider may raise the cost of your dwelling unit in response to the higher SDA 2021 price limit.
In addition to pricing limit changes, there are several changes in 2021 that affect the way your support funds are managed. For example, your provider is now able to claim prepayment for some high-cost supports, which means that they might ask you to make advance payments for a support before you receive it. In addition, your provider can now charge two support workers for the same support if it’s warranted (for example, if two workers are discussing your support services with each other). In both of these cases, your provider should discuss any charges with you ahead of time.
Finally, the 2021 price guide includes some provisions specifically related to COVID-19. NDIS participants who want to receive the COVID-19 vaccine can receive additional funding for this, separate from their plan. In addition, the 2021 price guide includes a support category for PPE. If you receive face-to-face daily living support for at least one hour per day, then you can claim up to $50 per week for personal protection equipment such as masks and gloves to wear while you are receiving face-to-face support.
What are the NDIS 2021-2022 Price Limits?
The NDIS Pricing Arrangements and Price Limits are organised into three support purpose budgets: Core Support, Capacity Building, and Capital Support. Within each type of budget are various categories, and within each category are specific support items. Pricing limits are set by support item. There are no limits on the total amount of funding that can be budgeted for each category; this is determined by your needs and your NDIS plan.
To learn about the 2021-2022 pricing limits in each category, use the links below (Our guide is currently under construction- the blue links are active, the rest are coming soon!):
- Assistance with Daily Life
- Assistance with Social, Economic, and Community Participation
- Support Coordination
- Improved Living Arrangements
- Increased Social & Community Participation
- Finding & Keeping a Job
- Improved Relationships
- Improved Health & Wellbeing
- Improved Learning
- Improved Life Choices
- Improved Daily Living
- Assistive Technology
- Home Modifications