2018/19 National Disability Insurance Scheme (NDIS) Price Guide This Price Guide (Guide) is a summary of NDIS price limits and associated arrangements (price controls) that will apply from 1 July 2018 as set by the National Disability Insurance Agency (NDIA). It is designed to assist participants and disability support providers, both current and prospective, to understand the way that price controls for supports and services work in the NDIS. The NDIA sets price controls for certain NDIS supports to ensure NDIS participants obtain reasonable value from their support packages. The price limits in this Guide are the maximum prices that Registered Providers can charge NDIS participants for specific supports. There is no requirement for providers to charge at the maximum price for a given support or service. Participants and providers are free to negotiate lower prices. Price controls must be sustainable, which means that efficient providers must be able to recover the cost of delivering high quality disability supports. The NDIA takes into account market risks, when setting price controls to protect against supply gaps and ensure participants receive critical supports. This is important especially in markets that are immature or where there is limited choice for participants. Over time, the need for price controls will reduce, as disability support markets develop and competitive tension increasingly keeps support prices at reasonable levels. Not all NDIS support items have price limits, and this NDIS Price Guide is not a comprehensive list of all supports that are available to NDIS participants. Instead, this Guide lists the specific supports that have maximum prices, and also sets out other rules and support definitions that are part of NDIA’ market intervention approach. A complete list of disability supports recognised by the NDIS (Support Catalogue) is maintained on the NDIS website (). Application of Price Controls
CAPACITY BUILDING Choice & Control Home Social and Community Participation Work Relationships Health & Wellbeing Lifelong Learning Choice and Control Daily Living Support Coordination (3.07) Improved Living Arrangements (3.08) Increased Social and Community Participation (3.09) Finding and Keeping a Job (3.10) Improved Relationships (3.11) Improved Health and Wellbeing (3.12) Improved Learning (3.13) Improved Life Choices (3.14) Improved Daily Living Skills (3.15) Support Line Items Although most are not all listed in this document, each support category has many specific supports and services that are recognised in the NDIS payment system. These are referred to as ‘line items’ and are in most cases are not prescribed in participant plans. A comprehensive listing of support line items is kept up to date as a separate file (csv format) on the NDIS website. This file includes item descriptors to assist providers to claim payments using a “best-fit” approach, and to assist participants in engaging and negotiating with service providers.
To for these additional costs, this Price Guide defines both ‘standard needs’ and ‘high intensity’ line items for some supports, such as assistance with self-care activities and group-based community participation supports. High intensity line items will have price limits that are set at higher price levels than the equivalent ‘standard needs’ support. Regional, Remote and Very Remote Areas Supports delivered in remote and very remote areas may have higher additional service delivery costs, and may require higher price limits in place to accommodate for this. The Modified Monash Model (MMM) is used to determine regional, remote and very remote areas using a scale from 1-7 based on population size and locality. Participants located in MMM4 and MMM5 areas are classified as ‘Regional’, MMM6 as ‘Remote’, and MMM7 as ‘Very Remote’. Further details on the MMM can be found on the Department of Health’s DoctorConnect website. This website also contains a resource to look up the MMM area for particular locations. There are separate Price Guides for Remote and Very Remote areas. Prices are 20% higher in remote areas and 25% higher in very remote areas for some supports. There is no additional loading applied for delivery of supports in regional areas. Providers should refer to support price limits based on where the support is delivered, which is not necessarily where the participant lives. For example, if a participant living in a Remote location visits a therapist in their capital city, the therapist should not attempt to claim a price that is higher than the price limit for the support in that city. On the other hand, if the therapist was to visit the participant in their local area to deliver the support, then the therapist could claim a price that is within the limit set by the ‘Remote’ Price Guide (i.e. 20% higher).
Assistance With Self-Care Activities - Complex – Public Holiday 01_005_0104_1_1 Assisting with, and/or supervising, personal tasks of daily life to develop skills of the participant to live as autonomously as possible. Hour $128.79 Assistance with self-care activities: Overnight Support Item Support Item Ref No. Description UOM Price Limit Assistance With Self-Care - Night-Time Sleepover 01_010_0107_1_1 Assistance with, or supervision of, personal of daily living where overnight support is needed, but the care giver can sleep when not required to provide support. Each $245.77 Assistance With Self-Care - Active Overnight - Standard 01_002_0107_1_1 Assistance with, or supervision of, personal tasks of daily living where overnight support is needed and the care giver will not have the option to sleep. Hour $65.20 Assistance With Self-Care - Active Overnight - Complex 01_018_0104_1_1 Assistance with, or supervision of, personal tasks of daily living where intensive overnight support is needed and the care giver will not have the option to sleep. Hour $67.96 Assistance with daily life Support Item Support Item Ref No. Description UOM Limit Assistance With Personal Domestic Activities 01_004_0107_1_1 Assist participant to undertake and/or develop skills to maintain their home environment where the participant owns their own home and/or has sole or substantial responsibility for its maintenance. Includes assisting participant to do basic house and yard work. Hour $57.46 Specialised Home Based Assistance For A Child 01_016_0104_1_1 Specialist assistance in the home required due to additional requirements of a child’s disability; may be provided to strengthen the sustainability of informal supports. Hour $57.46 House And/Or Yard Maintenance 01_019_0120_1_1 Performing essential house and/or yard activities that the participant is not able to undertake. Hour $55.44
House Cleaning And Other Household Activities 01_020_0120_1_1 Performing essential house cleaning activities that the participant is not able to undertake. Hour $56.45 Term Accommodation The cells in the table contain the price limits for each support and the support item reference number in the following format: Price Limit Support Item Reference Number $627.36 01_045_0115_1_1 Support ratio Weekday (per 24 hour day) Saturday (per 24 hour day) Sunday (per 24 hour day) Public Holiday (per 24 hour day) 1:1 $1,775.76 01_058_0115_1_1 $2,226.96 01_059_0115_1_1 $2,781.36 01_060_0115_1_1 $3,335.76 01_061_0115_1_1 1:2 $1,010.16 01_054_0115_1_1 $1,235.76 01_055_0115_1_1 $1,512.96 01_056_0115_1_1 $1,790.16 01_057_0115_1_1 1:3 $754.56 01_062_0115_1_1 $905.76 01_063_0115_1_1 $1,090.56 01_064_0115_1_1 $1,275.36 01_065_0115_1_1 1:4 $627.36 01_045_0115_1_1 $740.16 01_051_0115_1_1 $879.36 01_052_0115_1_1 $1,017.36 01_053_0115_1_1
Assistance to access social and recreational activities – Complex needs Support ratio Weekday (max per hour) Weekday evening (max per hour) Saturday (max per hour) Sunday (max per hour) Public Holiday (max per hour) 1:1 $63.14 04_185_0104_6_1 $68.85 04_186_0104_6_1 $85.90 04_187_0104_6_1 $108.63 04_188_0104_6_1 $131.32 04_189_0104_6_1 1:2 $38.22 04_190_0104_6_1 $41.70 04_191_0104_6_1 $54.00 04_192_0104_6_1 $71.14 04_193_0104_6_1 $78.41 04_194_0104_6_1 1:3 $28.87 04_195_0104_6_1 $31.44 04_196_0104_6_1 $40.52 04_197_0104_6_1 $53.17 04_198_0104_6_1 $58.53 04_199_0104_6_1 1:4 $24.20 04_200_0104_6_1 $26.31 04_201_0104_6_1 $33.78 04_202_0104_6_1 $44.18 04_203_0104_6_1 $48.59 04_204_0104_6_1 1:5 $21.39 04_205_0104_6_1 $23.23 04_206_0104_6_1 $29.73 04_207_0104_6_1 $38.79 04_208_0104_6_1 $42.63 04_209_0104_6_1
CAPITAL SUPPORTS This section describes the rules and arrangements that apply to capital supports. Assistive Technology (Support Category 2.05) This category includes all aids or equipment supports that assist participants to live independently or assist a to support the participant. It also includes related delivery, set-up and some training support items. Usually providing independent advice, guidance, trials, set-up and training (not bundled with sale of an item) is funded through Capacity Building (Support Category 2.15). More detailed information on assistive technologies and consumables codes can be found in the Assistive Technologies and Consumables Guide. Vehicle Modifications Vehicle modifications include the installation of, or changes to, equipment in a vehicle to enable a participant to travel safely as a passenger or to drive. A participant is free to choose a more expensive option at their own expense, where the more expensive option is not considered to be reasonable and necessary. An example of this situation would be where a vehicle modification has been approved for a participant, but the participant would like cosmetic or personalised fittings that are not related to their disability or are more expensive than others that have an equivalent function. In this situation, the NDIA will cover the reasonable and necessary component of the modification, and the participant will pay the additional cost.
Support Item Support Item Ref No. Description UOM Limit Assistance With Accommodation And Tenancy Obligations 08_005_0106_2_3 Support is provided to guide, prompt or undertake activities to ensure the participant obtains and/or retains appropriate accommodation. May include assisting to apply for a rental tenancy or to undertake tenancy obligations. Hour $70.71 Increased Social and Community Participation Support Item Support Item Ref No. Description UOM Price Limit Life Transition Planning Including Mentoring, And Individual Skill Development 09_006_0106_6_3 Establishing volunteer assistance within the participant’s home or community to develop skills. For instance, assistance in attending appointments, shopping, bill paying, taking part in social activities and maintaining contact with others. Hour $70.71 Skills Development In A Group 09_007_0117_6_3 Training for the participant in a group of 2 or more to increase their independence in daily personal activities. Hour $34.39 Individual Skills Development And Training 09_009_0117_6_3 Individual life skills development and training including public transport training and support, developing skills for community, social and recreational participation. Hour $68.78 Finding and Keeping a Job Support Item Support Item Ref No. Description UOM Price Limit Employment Related Assessment And Counselling 10_011_0128_5_3 Workplace assessment conducted by a workplace rehabilitation provider to determine adjustments or modifications to the workplace or work processes to ensure employment is maintained and matches the employee’s capabilities. Hour $219.29 Individual Employment Support 10_016_0102_5_3 Time limited, on-the-job training including post placement support related to the participant’s disability that enables them to adjust and manage demands of the job in the workplace environment, and to assist employers to successfully manage the participant's placement. Hour $69.38 Employment Preparation And Support In A Group - Group Of 3 10_017_0102_5_3 In a setting, building capacity by providing skills training such as transport, time/financial management and self-care to Hour $23.13
Group Therapy – Group Of 3 15_044_0128_1_3 Provision of interventions by more than one professional in a group session towards the participants agreed goals. Group of 3. Hour $71.71 Community Engagement Assistance 15_045_0128_1_3 Program to empower participants and improve interactions between participants and their social networks. Assistance to engage effectively in the community through a group approach to help achieve goals, gain insight into their lives and make informed decisions. Hour $51.10 Therapy Assistants (Level 1) 15_052_0128_1_3 Support role for an allied health assistant working under the supervision of a therapist. Hour $55.80 Selection And/Or Manufacture Of Customised Or Wearable Technology 15_047_0135_1_3 Selection and/or manufacturing of customised or wearable technology. Hour $197.89 Individual Assessment, Therapy And/Or Training (Includes Assistive Technology) 15_048_0128_1_3 Assessment, therapy, training, fitting and any approved travel to deliver support. Hour $215.11 Community Nursing Care For Continence Aid 15_051_0114_1_3 Continence aids: assessment, recommendation, and training delivered by a Hour $117.34