- 2.0. Section 2 Introduction
- 2.1 Provider Readiness Checklist
- 2.2 Understand what participants want from the NDIS
- 2.3 What services or supports can be delivered under the NDIS?
- 2.4 When is the NDIS coming to my area?
- 2.5 Building my organisation's capacity
- 2.6 Key registration requirements
- 2.7 Meeting the Quality & Safeguard requirements
- 2.8 NDIS pricing and payment
- 2.9 Becoming a registered provider
2.8 NDIS pricing and payment
The NDIS provides funding to participants to purchase a range of supports aimed at increasing their independence, inclusion, and social and economic participation. This funding model is designed to be flexible and to allow service innovation. Importantly, the supports delivered will be chosen, and paid for, by individual participants. The range of supports funded by the NDIS will expand over time.
In the NDIS payment system, supports for participants fall into three categories:
1. Core supports
A support that enables a participant to complete activities of daily living and enables them to work towards their goals and meet their objectives.
2. Capital supports
An investment, such as assistive technologies, equipment and home or vehicle modifications, or funding for capital costs (e.g. to pay for Specialist Disability Accommodation).
3. Capacity building supports
A support that enables a participant to build their independence and skills.
Supports in participant plans are categorised according to these three categories. Within a plan, participant budgets are subject to NDIS rules in relation to these three categories.
Prices for supports are negotiated and agreed between a participant and a provider up to any maximum price limit published in the NDIS Price Guide and Support Catalogue. In some cases, a participant may choose a more expensive option at their own expense. Self-managing participants are not subject to the pricing arrangements in the NDIS Price Guide and Support Catalogue but still need to agree a price with their provider/s. No other charges are to be added to the cost of the support, including credit card surcharges, or any additional fees including any ‘gap’ fees and late payment fees.
The NDIS Price Guide and Support Catalogue are available on the NDIS website and include price limits for certain supports and services. The NDIA updates the Price Guide and Support Catalogue annually for 1 July implementation. On limited occasions, there are exceptional circumstances that warrant separate price reviews and updates.
All registered NDIS providers should refer to the NDIA Terms of Business (PDF) (DOC), which includes details about the application of price limits and other requirements that providers must comply with when offering and delivering services to Scheme participants. As a Provider, your responsibilities under the Terms of Business include:
- not charging more than the price caps set in the NDIA Price Guide
- not charging cancellation fees, except when specifically provided for in the NDIA Price Guide
- declaring relevant prices to participants before delivering a service (including declaring any notice periods or cancellation terms)
- making a payment request only after that support has been delivered or provided
- submitting claim for payment within a reasonable time (and no later than 60 days from the end of the Service Booking).
In the future the NDIA expects prices will be increasingly deregulated. Pressure from active, informed participants exercising choice, and from competition between service providers, should reduce or remove the need for price controls.
Participants who are self-managing their plan will pay the provider directly and obtain a receipt from the provider in order to acquit their expenditure against their plan.
Payment Requests for participants who are not self-managing will be lodged online and will be paid within 2 business days of successful lodgment.
Registered providers can make a Payment Request once a support has been delivered or provided. Pre-payment is generally not permitted for supports or services.
To receive payment for services or supports for NDIA managed participants you submit a Payment Request electronically through the myplace provider portal. Further details about how to use the myplace provider portal to make online payment requests are available in Section 6 of the Provider Toolkit.
To receive payment for services or supports for plan managed participants, providers will send invoices to the participants Plan Manager, and once verified by the participant, the Plan Manager will submit a payment request to arrange payment to the provider.
Some providers do not get paid by the NDIS for supports they provide because the support is “in kind” and they are instead paid by the state or territory government. However, in-kind supports are progressively transitioning to the NDIS.
For further information and resources on in-kind funding go to the In-kind supports provider information page on the NDIS website.