NDISPriceGuide
Victoria,NewSouthWales,Queensland, Tasmania
Validfrom:1 July2017
Version release date:1July2017
Table ofContents
2017/18NDIS PriceGuide...... 4
Audience...... 5
Typesofpricecontrols...... 6
There aremanysupport‘lineitems’within eachsupportcategory...... 7
NDISOutcomesFramework: Supportsshouldhelpparticipantsachieve theirgoals...... 8
Participantbudgets...... 9
Claiming for2017-18NDIS supports and services using thisGuide...... 11
SupportItemReferenceNumbers...... 12
Units of Measure...... 12
ServiceBookings...... 13
Specialpricing andextracharges...... 13
RemoteandVery Remote...... 14
Provider TravelParticipantTransport...... 14
Cancellationsand“noshows”for scheduledsupports...... 16
Other considerations...... 18
CORE SUPPORTS...... 20
AssistancewithDailyLiving(Support Category1.01)...... 20
TransportAllowance (replacesMobilityAllowance) (SupportCategory1.02)...... 27
Consumables(SupportCategory1.03)...... 27
Assistancewith Socialand CommunityParticipation(SupportCategory1.04)...... 28
Price controlsfor coresupports...... 29
CAPITAL SUPPORTS...... 41
Assistive Technology(SupportCategory2.05)...... 41
Home (SupportCategory2.06)...... 42
CAPACITYBUILDING SUPPORTS...... 45
SupportCoordination(SupportCategory3.07)...... 45
ImprovedLiving Arrangements(SupportCategory3.08)...... 46
IncreasedSocialandCommunityParticipation(SupportCategory3.09)...... 46
Finding andKeeping aJob (SupportCategory3.10)...... 48
ImprovedRelationships(SupportCategory3.11)...... 48
ImprovedHealthWell-being(Support Category3.12)...... 49
ImprovedLearning (SupportCategory3.13)...... 49
ImprovedLifeChoices(SupportCategory3.14)...... 49
ImprovedDailyLiving (SupportCategory3.15)...... 51
2017/18NDISPriceGuide
This guideis a summaryofNDISpricelimitsandassociatedarrangements(pricecontrols)thatwill applyfrom1 July2017.It isdesignedto assist disabilitysupport providers,bothcurrentandprospective, to understandthe waythatpricecontrols for NDISsupportsandservicesworkin the NDIS.
Intransition,theNDISmarketwillgrowsignificantlyandcompetitivetensionwillensurethepriceofsupportsarekeptatareasonablelevel.Duringthistime,Pricecontrolswill be used toprotect“value formoney”forparticipantsbyensuringthatthe costsofthesupport are reasonable,relative to boththebenefitsachievedandthecostofalternativesupport.
The NDISprovidesfundingto participants topurchase arangeofreasonableandnecessary supports aimedat increasing theirindependence,inclusion,andsocialandeconomicparticipation.This funding is providedthroughparticipantbudgets,which aredesignedtobeflexibleandto allowserviceinnovation.Importantly, the supportsdelivered are chosen,andpaidfor, byindividualparticipants,whohave choiceand controlover howtheirbudgetis spent.
This Guide shouldbe readinconjunction with the NDISTerms of Business for RegisteredSupportProviders(the‘TermsofBusiness’)1.
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Serviceprovidersshould alsomakeuseoftheinformationavailablein the NDIS providerportal2. All Registered Providers shouldrefer totheNDIATermsofBusiness,which includedetailsabouttheapplicationofthe pricecontrolsin thisguide, andotherrequirementsthatprovidersmustcomply withwhen offeringanddeliveringservices toSchemeparticipants.
Unless statedotherwise,theseprice limitsare themaximum thatRegisteredProviderscancharge NDISparticipantsfor theirservices.Price limits are in placetoensurethatparticipantsreceivevaluefor moneyin thesupportsandservices thattheyreceive.This isan importantmeasureformanyparticipants, especiallyin marketsthat areimmature or wherethere arefewoptionsforparticipants to choosefrom.
There is norequirementforproviders to charge themaximumpricefor a given support. Participantsandprovidersshouldnegotiateprices,likeothersuppliers andconsumers,basedontheneedsandpreferencesoftheparticipantsandthespecificsupportsrequired. This allowstheparticipantflexibility andcontrolover theirbudgetfor supports.
Audience
Thepriceguide is a usefulreferenceforall participants,providersandplanmanagersunder the NDIS.This Guideappliestoeachoftheseasfollows:
- Providers foragency-managedplans mustberegisteredproviders andare subjecttothepricing arrangementsinthepriceguide(pricecaps,quotes etc.).
- Plan managerscanpurchasesupports onbehalfofparticipantsfromeitherregistered orunregisteredserviceproviders, buttheysubmit claimsaccordingto lineitems in thesupportcatalogue,andtheyare responsible for ensuring that theseclaimsadhere to thearrangements in theNDISPriceGuide,including pricelimits forsomesupports.
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- Self-Managing participantscanuse registered or unregisteredserviceprovidersand arenot subject tothepricingarrangements intheNDISPriceGuide.
Theserules are describedinthe NDISTermsofBusiness.Specifically, planmanagers areregisteredproviders,andthereforesubjecttothefollowingclause in TermsofBusiness-“RegisteredProvidersmustadheretothe NDIAPriceGuide or anyotherAgencypricing arrangements andguidelinesas in force fromtime to time.”
Types ofpricecontrols
This guideincludes a rangeofpricecontrolsthatapplyregardlessofwhetherfundingfor thesupport ismanagedbyNationalDisabilityInsuranceAgency(NDIA).Conversely, participants whoare self-managing theirsupports,(with or withouttheassistanceofanintermediary) are not subject to pricecontrols;pricecontrolsare applicablein allothercases.
Thetypesofpricecontrols thatmaybe appliedunderthe NDISareasfollows:
1.Price limits–Maximum pricesthatproviders are permittedto chargefor NDISservices andsupportsunderthisline item.
2.Benchmarks–Wheretheprovidermustprovidesufficientevidencetojustifywhere the supportbeing providedshouldbeclaimedata ratehigher thatthebenchmark.
For somesupports ‘benchmarkprices’arelisted, whichmayrequire aquote tobe submitted.Thesebenchmarkprices indicatetheNDIAhasnot specificallyset a price limit.Insteadthebenchmarkisan indication of theNDIA’sviewof efficientservicedeliveryandshouldbethehighestpricechargedbymostproviders.Throughthequote process,anappropriate fundingamount is agreedandincludedin theparticipant’sbudget.For exampleSupportedIndependentLiving(SIL) usesbenchmarkprices.
The NDISfundingis sufficientto cover thefull cost ofprovisionofthesupportconsideredbythe NDIA tobereasonableandnecessary. Insomecases, aparticipant isfree to choosea more expensiveoptionat theirownexpense,wherethemoreexpensiveoption is notconsidered tobe reasonableandnecessary. An exampleof this situationwould bewhere ahomemodificationhasbeenapprovedfor a participant,buttheparticipant would likecosmetic or personalisedfittings thatare notdeemedreasonableandnecessary. Inthis situation,the NDIAwill cover the reasonableandnecessarycomponentofthemodification,andtheparticipantwill paythe extracosts.Pleaserefer to resourcesavailable in relation to HomeModifications.
Therearemanysupport‘lineitems’withineach supportcategory
The NDIA PriceGuideis nota comprehensive list of all availablesupports,nordoesit prescribe theonlysupportsfundedbytheNDIS.
Althoughtheyarenot listed inthis document,each supportcategoryhasmanyspecific supportsandservices thatare recognisedin theNDIS paymentsystem.These arereferred toas ‘lineitems’and arenotdetailedinparticipant plans.A comprehensivelistingofsupportline items iskeptup todateasa separatefile (csvformat) on the NDIS website3.Thisfileincludesitem descriptorstoassist providers to claimpaymentsusinga“best-fit” approach,andto assistparticipants inengaging and negotiatingwithserviceproviders.
Providersshould claimpaymentsagainsta support lineitem that most closelyaligns tothe service theyhave delivered.
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NDISOutcomes Framework: Supports should helpparticipants achievetheirgoals
The NDIS OutcomesFramework hasbeendeveloped tomeasuregoalattainmentfor individualparticipantsandoverallperformanceoftheScheme.Thereare 8OutcomeDomains(‘Domains’)in theframework. These Domainshelpparticipantsthinkaboutgoals indifferentareasoftheirlifeandassist plannerstoexplorewheresupports intheseareasalreadyexistandwherefurther supports are required.
1.DailyLiving
2.Home
3.HealthandWell-being
4.LifelongLearning
5.Work
6.Social andCommunityParticipation
7.Relationships
8.Choice andControl
Theoutcomesframeworkdirectlyrelates tothe15supportcategories outlinedbelow.NDISserviceproviders shouldbe awarethatall supportsandservicesfor Schemeparticipantsmust contribute totheachievementoftheirindividualgoalsasoutlined in theparticipant’s NDIS plan.
Participantbudgets
Eachparticipantwithfunding undertheNDISis given abudgetthataligns with theirindividualplanandsupportsthem in achievingtheirgoals.Thesebudgets are brokenintothreeSupportPurposecategories:core,capitalandcapacitybuilding:
1.CORE –A supportthatenables aparticipanttocompleteactivities of dailyliving and enablesthemtoworktowards theirgoalsandmeettheirobjectives.Participantbudgetsareflexible acrossthefour sub-categories:Assistancewith dailyliving, exceptwhere abudget is allocatedtoSupported IndependentLiving (SIL), whichis alwaysAgency managed;Transport;Consumables;andAssistancewithSocialandCommunityParticipation. Aparticipantmaychoosehowto spendtheircoresupportfunding,butcannotreallocate coresupportfundingtoother supportpurposes(i.e.capital or capacitybuildingsupports).
2.CAPITAL–Aninvestment,suchas assistivetechnologies- equipment,home or vehiclemodifications,orfor Specialist DisabilityAccommodation.Participantbudgetsfor thissupportpurposeare restricted tospecific itemsidentified intheparticipant’splan.Mostitemsrequirequotes,whichmeansthatproviders mustnegotiatea pricewith aparticipantin accordancewiththespecificationsusuallydevelopedbyan assessing therapist.Thefundingfor supportswill, as needed,includeassessment,delivery, set-up,adjustmentandmaintenancecosts.
3.CAPACITYBUILDING-A supportthatenables a participanttobuildtheirindependenceandskills.Participantbudgets areallocated atasupportcategorylevel and must beused toachievethegoalssetoutintheparticipant’splan.ThesesupportsincludeSupportCoordination,ImprovedLiving Arrangements,IncreasedSocial &CommunityParticipation,FindingandKeepingaJob,ImprovedRelationships,Improved HealthWellbeing, ImprovedLearning,ImprovedLifeChoices andImproved DailyLivingSkills.
Thesupportcategoriesdescribedabove aredesigned toalignwiththeoutcomesframework. This helpsparticipants chosesupportsthathelptheminachieving theirgoals,andproviders tounderstandhowthe supportstheyprovidecontributetotheparticipant’sgoals.
These linksare providedbelow:SUPPORTPURPOSE / OUTCOMES FRAMEWORK DOMAIN / SUPPORTCATEGORY(Plan Budgets)CORE / DailyLivingDailyLivingDailyLiving
Social & CommunityParticipation / AssistancewithDailyLifeTransport
Consumables
Assistancewith SocialCommunityParticipation
CAPITAL / DailyLivingHome / AssistiveTechnology
Home ModificationsandSpecialisedDisabilityAccommodation (SDA)
CAPACITYBUILDING / Choice & ControlHome
Social andCommunityParticipationWork
RelationshipsHealth &WellbeingLifelongLearningChoice andControlDailyLiving / SupportCoordinationImprovedLiving Arrangements
IncreasedSocialand CommunityParticipationFinding andKeeping aJob
ImprovedRelationshipsImprovedHealthandWellbeingImprovedLearning
ImprovedLifeChoicesImprovedDailyLivingSkills
Claimingfor2017-18NDISsupportsandservicesusingthisGuide
ThisPrice Guideappliesfor servicesdeliveredfrom1 July2017 onwards.Providers and participantscanmakeserviceagreementsusingthe2017/18pricelimitsaslongastheservice is delivered onor after1 July2017. Pricesthathavealreadybeenexplicitlysetinserviceagreements betweenproviders andparticipantsarenotaffectedbychangestomaximum prices, evenifthe serviceagreement isfor thedeliveryofsupportsafter 1July2017.
Registered Providers canmakeaclaim for paymentoncethatsupport has been deliveredorprovided.Prepayment is notpermittedunless,the NDIAhasgivenpriorapprovalinwriting tothe RegisteredProvider.This will onlyoccur inexceptionalcircumstancessuch ashomemodificationsandremote area servicing.
Whereprice limitsapply,pricescharged toparticipantsmustnotexceedthepricelevelprescribedforthatsupportin thePriceGuide.No other charges are tobeaddedtothecostofthesupport,includingcredit cardsurcharges, or anyadditionalfeesincludingany‘gap’fees, latepaymentfeesor cancellationfees.Providers should refer to the NDIATermsofBusinessforfurtherdetailsor OtherConsiderationssectionof thisguide.
Whenclaiming, it is theresponsibilityof theprovider to ensurethattheclaimaccuratelyreflects thesupportsdelivered,includingthe frequencyand volumeofsupports.Falsifyingclaimsfor any aspectofsupportsdelivered, is a seriouscompliance issue andmayresult inactionagainsttheprovider, includingde-registration.Providers are also required tokeepaccuraterecords of claims,whichare subjecttoauditatanytime.
A claimfor paymentis to besubmittedwithina reasonabletime(andno laterthan 90 days fromtheendof theService Booking–see below).
SupportItem ReferenceNumbers
NDISpaymentssystemappliesuniquenumbersforeachsupportline item,accordingtothefollowing structure:
For example:
Assistancewith self-care- overnight -higher intensityline item number is: 01_018_0104_1_1
SupportCategory / LineItem / Reg’n Grp / Domain / FundingType1 / 018 / 0104 / 1 / 1
Support Connection line itemnumber is:- 07_001_0106_8_3
SupportCategory / LineItem / Reg’n Grp / Domain / FundingType7 / 001 / 0106 / 8 / 3
Units of Measure
The NDISpaymentsystem for 2017/18includesunitsofmeasureto suiteachsupportline item:
- Each
- Hour
- Daily
- Week
- Month
- Annual
Service Bookings
2017/18NDIS operatingsystemprovidesforServiceBookings tobecreatedbetweentheparticipantandtheirprovider. Thisensuresthatboth parties areawareoftherequirementsfor service, the length oftimetheservice is required for,andthattheparticipantwill be abletopayforthe service. For moreinformation please seeSection5.2oftheProviderToolkit4.
Tohelpparticipantskeep trackoftheirservicebookingsandbudget, aMonthlyPaymentStatementwill be availableonline.ThePaymentStatement iscreatedfromthesystemandavailable to theparticipant(and/ ortheirnominee)on thefirstbusinessdayofeachmonth.This statementwill contain asummaryof thepreviousmonth’s payments,availablebudgetremaining,committedbudgetandspentbudget. Itwilllistwhich participantandproviderclaimshavebeenreceived,whichServiceBookingstheyrelateto, whichSupportCategories themoneywasdeductedfromandonwhich dates thedeductionswere made.ThePaymentSummarywill be availablein theirpreferreddocumentformat,eitherpdf or word. Theparticipant(and/ortheirnominee)will be sentan emailor SMS notificationwhentheirstatements areavailableonline.
Specialpricingandextracharges
Incertaincircumstances,providersmaybe entitledtocharge athigher ratesorforexpensesincurredintheprovisionsupports.Thesemayincludecertaintransportandtravel, or providingin remoteor veryremoteareas,which are outlinedbelow.
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RemoteandVeryRemote
Servicesdelivered inremote andveryremoteareasmayhavehigherprice limits,to accommodate additionalservicedeliverycosts.TheModifiedMonashModel(MMM)is used todetermineremote orveryremoteareas. There are separate PriceGuidesforRemoteandVeryRemoteareas.
Providers shouldclaim thepriceapplicabletowherethe service is delivered.Prices are 20%higherinremoteareasand25%higherinveryremoteareas.
ProviderTravelParticipantTransport
Providertravel and participanttransport aredifferentthings.This sectionexplainsthedifferencesandnotes specific rules andarrangementsfor both travel and transportinNDISpricing andpaymentssystem.
ProviderTravel
Travel to providepersonal careandcommunityaccess
Thetimethataworkerspends travellingfrom hometotheworkplace(or firstparticipant)and fromtheworkplace(orlastparticipant) to homecannotbeclaimedat thehourlyratefor therelevantsupportitem.
Whereaworkertravelsfrom oneparticipantappointment toanother, up to 20minutes oftimecanbe claimedagainstthenextappointmentatthehourlyratefor therelevantsupportitem.
Travel to providetherapeuticsupports
Providerswhotravel toprovidetherapeuticsupportstoparticipantscannotclaimanytraveltimeat thehourlyratefor the relevantsupportitemwherethedistancetravelled is lessthan10kmas thiscost is includedinthehourlyrate.
Providers can claimtravel time atthehourlyratefor therelevantsupportitem for travel in excess of 10km,up to amaximum annuallimit of$1000per participant(perannum). Travel time shouldbecalculated usingthisformula5
Claimabletravel time(inminutes) =(total kmtravelled–10/60)
Providerswho intendto claim travel costsfroma participant’splanusingthis provisionmust seektheagreementofthe participantprior to anyclaim beingmade(e.g.theserviceagreementbetweentheparticipantandprovidershouldspecifyiftravelcosts are tobe claimed).
Participant Transport
Accompanying participantsfor communityaccess
Providingcommunityaccess supportsmayalsoinvolve aworkeraccompanying aparticipantona communityoutingand/ortransportingaparticipantfromtheirhome tothecommunity.Inthesesituations,the worker’s time canbeclaimedat thehourlyratefor therelevantsupport itemfor thetotaltimethe workerprovidessupportto a participant(s), including timespentaccompanyingand/ortransportingtheparticipant.Where a provideristransporting two or more participants on thesametrip,theworker’s timeshouldbe claimedattheappropriategroupratefor therelevantsupport.
5ThisformulapublishedontheNDISwebsiteimplicitlyassumesthat,onaverage,travelspeedis60km/hour–seeNDIS/provider/pricingandpayments
Contribution towardscosts of transport
If a providerincurscosts, in additionto the costof a worker’s time, whenaccompanying and/or transportingparticipantsin thecommunity, theymaynegotiatewith theparticipantfor themto make areasonablecontributiontowardsthesecosts. Aplanmayincludefundingfor transportsupportsthat arepaiddirectlyto the participant.Thisfunding canbeusedtomeet thesetypesofcontributions,whichshouldbe clearlyspecified in theserviceagreement.
Remote travel
If localproviders are notavailable,theNDIA mayenterinto agreements(andat timescontracts)with specificproviders forprovisionofservicestomoreremote regions.Thecontractwith aserviceproviderspecifyhow the costoftravelandanyotherassociatedexpensesintheseareas.
Cancellations and“no shows”for scheduledsupports
Providers needtohavebusinessarrangements inplaceto minimisetheriskofcancellation,noshowor latechanges to thedeliveryofascheduled support.Serviceagreementsbetweenparticipantsandprovidersneedto includedetailsofthesearrangementsincluding:reschedulingtheappointment;noticeperiodsfor cancellationsandthecancellationfee thatcanapply; andchangestoagreedappointments.
If there areunforeseencircumstancesandtheparticipantagreesthattheydid notcomplywith the agreedrequirements, afeemaybe chargedagainstaparticipant’splanupto8 timesperyear forpersonal careandcommunityaccess supports.However, theprovider shouldnotifytheNDIAthattheparticipant isat riskofnotreceiving the supports, incase theparticipantneedsspecialassistance.
Whereparticipantsfailtopresentfor therapyservices, the therapistcan charge acancellationfeefor amaximum of2 hoursofservicewithin theperiodof anyServiceAgreement.
Wherea participantfails, withoutnotice,tokeepthescheduled arrangementfor thesupport, theprovidermustmakeeveryefforttocontacttheparticipanttodetermineifthere isan additionalproblem(e.g. thepersonhasfallen outofbedandcannotraiseanalarm,or there is asuddenbreakdown in theinformalsupportsandadditionalsupport is likelyto be required).
Wherethere is aspecificrisk that aparticipantwillfrequently“not show”fora supportdue tothenatureof aperson’sdisabilityorthenature ofthesupport,forexamplebehaviourinterventionsupports,theserviceprovidershouldput inplacesuitableindividualarrangementstomaximisethelikelihoodthatthepersonwillreceive alltheirrequiredsupports.
Nofeeis payablebythe NDIA ortheparticipant,for cancellationbyaprovider or duetotheprovider’sfailuretodeliver the agreedsupportsunlesspreviouslyagreed to anddocumented intheServiceAgreementwiththe Participant.
NDIA doesnotpermitcollectionofdeposits,or moneyas a bondfrom participantsthataproviderwould retain intheeventofcancellationof a supportper theNDIA TermsofBusiness.
Otherconsiderations
This sectionoutlines variousotherconsiderationsthatmaybe relevanttoparticipantsandproviders. Theseshould bereviewedwhenengaging in anewserviceagreementorifsomething significantchanges intheparticipantscircumstances.
Medicareand insurance
Someelementsof a participant’s caremaybecovered byfundsoutsidethe NDIS.Theseexpensesaregenerallymedical,including thosecovered byprivatehealthinsuranceor Medicare.Thesemedicalexpensesare notfundedundertheNDIS,eveniftheyare relatedto,ora symptom ofdisability.Theseexpensesshouldbeclaimedunderthe relevanthealthcareschemeorinsurancepolicy.
Prepayments
Prepayments aregenerallynot requiredunder the NDIS,unlesstheNDIA has givenpriorapproval totheRegistered Provider.Providers shouldmakeclaims onlyforsupportsthathavebeendelivered.Approvalforprepaymentmaybegiven for certainassistivetechnologieswhere this hasbeenagreed bytheparticipant.
Co-Paymentsfor Capital itemsincludingAT
Co-Paymentsbytheparticipantare notrequired;however,wheretheparticipantwouldlikea customisationto a support orassistivetechnologythat is notconsideredreasonableor necessary,theyarerequiredtopayforthisthemselves.Thesemayincludeanaestheticcustomisationtoanassistivetechnologyormodificationsto a vehiclethatare additional totheassistivecomponents.
GST
Mostitems areGSTexempt, asperAustralianTaxOffice informationaboutGST andNDIS andtheapplicationofsection38-38ofthe GSTAct. For asmall numberofitems,where GST is applicable(for exampledeliveryfeesandbuilding materials) the price isinclusive of GST.
Other fees (Commissions and exitfees)
Participants aregenerallynotrequired to payexit fees,evenwhenchanging providers partwaythrough aplan.Acoreprinciple ofthe NDIS is choiceand controlfor participants,allowing themtochangeproviderswithoutexpense.Furtherinformationonestablishmentfees claimable bytheincoming provider can befoundbelowunderEstablishmentfeefor personalcare/communityaccess.
While commissionbasedfeemodelsmaybeappropriate for someproviders, participantsshouldnever becharged afeeabove theagreedrate,being theServiceProvideradvertisedrate,theagreedrateintheServiceAgreementor NDIApricelimit(whereoneexists).
CORESUPPORTS
This sectiondescribesthe rulesandarrangementsthatapplyto coresupports.It alsonotesprice limits thatapply to specificlineitems.
AssistancewithDailyLiving(Support Category1.01)
Assistancewith dailypersonalactivities
Assisting with and/or supervisingpersonal tasksofdailylife toenable theparticipanttolive as autonomouslyas possible.Thesesupports areprovidedindividuallyto participantsandcanbe provided in a rangeofenvironments,including butnotlimitedto,theparticipant’sownhome.
A hierarchyofpricecontrolsapplytothecategoryofsupport,basedon:
A.Thelevel ofsupport required:
A higherintensitysupport maybe paidwherea participantrequiresassistancefrom asupportworkerwithadditionalqualificationsandexperiencerelevanttotheparticipant’scomplexneeds.Thehigherintensityratemaybe consideredwhen:
- Frequent (at least1 instanceper shift)assistance is requiredtomanagechallenging behavioursthatrequireintensivepositivebehavioursupportand/or
- Continualactivesupport is requireddue tohigh medical supportneeds (suchas unstableseizure activityor respiratorysupport)
B.Thetimeofdaythatthesupport isprovided:
- Daytime startsat 6amandfinishesat8pm
- Evening is where the supportfinishes after8pmandbefore12midnightandtheevening rateapplies totheentireshift
- Overnight iswhere thesupportfinishes after12midnightandbefore6am.
C.Thedayof theweekthatthesupport is provided:
- A weekdayisMondayto Friday
- Theextra ratespaidfor Saturday,Sundayandpublicholidays are insubstitutionfor,andnotcumulativeupon,the shiftpremiumspayableforevening andovernightsupports
- Theextra ratesforSaturday/Sunday/Publicholidaysdo notincreasefurtherwherethesupportfinishes after8pm.
Provisions for ‘shadowshifts’
Shadowshiftsmaybeconsideredwheretheparticipanthascomplexindividualsupportneedsthatare bestmetbyintroducinganewworker tothe participantbeforeit is reasonablethattheycommenceprovidingthe supportindependently.These areconsideredwherethespecific individual supportneedsinclude:
- verylimited communication;
- behaviour supportneeds; and/or
- medicalneeds/procedures suchas ventilation orhome enteralnutrition.
Wheretheindividualwouldrequireshadowshifts toassist withtheintroductionof newworkers,and this isthedesiredmethod bytheparticipant or theirfamily, theprovidermayclaim for upto6 hoursofweek-daysupportper year.
Introducing newworkersis not designedtoreplace formal,recognised trainingthatwill be provided byanemployer to theirworkforcee.g.Shadowing (or “Buddying”)less experiencedstaff(newstaff) withexperiencedworkers or informalcarers tohelpbuildknowledge and social capital(workerretention),which is notclaimableunder theNDIS.
Establishment fee forpersonalcare/communityaccess
Thisfeeapplies toallplansfornewNDIS participants intheirfirstplanwhoreceive at least20 hoursofpersonal care/communityaccess supportpermonth.This payment isto covernon-ongoing costsforprovidersestablishingarrangementsandassistingparticipants in implementingtheirplan.Theestablishmentfee is claimablebythe providerwho assists theparticipantwith theimplementationoftheirNDIS Plan,delivers a minimum of 20hourspermonth ofpersonalcare/communityaccesssupportandhasmade an agreementwiththeparticipant to supplythese services.
Theestablishmentfeewill operateasfollows:
- providers can charge$500against a planifassisting anewparticipant,who isnewto NDIS andnewto theprovider,
- aprovider can charge$250when theyare maintaininganexisting client oftheirswho is commencingasa participantofthe NDIS,
- shouldaparticipantwish to changeproviders on commencing theirfirst NDIS plan,$250 isavailable tothenewprovider.This is to assisttheparticipantinchanging providers.
- A budgetof$750 is includedin thefirst Planfor NDISparticipants.Providersmusttocharge in accordancewiththedefinitionsabove. A changeofprovidersafter thefirstNDIS planrequirespaymentfrom theCore Budgetfor establishinga Care Plan.
Assistancewith household tasks
This includestheprovisionofsupportstoenabletheparticipant tomaintaintheirhomeenvironment.Thismayinvolveundertakingessentialhouseholdtasks thattheparticipantis notabletoundertake.
MealsonWheels / preparation and deliveryof meals
Providerswill be invited toprovidequotesforpreparing anddelivering thefoodfor theparticipantona weeklybasis, taking theirspecificneedsinto account.Thecostoftheactualfoodis not covered bythis SupportItem.
This supportusesbenchmarkprices which are basedon preparationanddeliveryof meals for a singleday.Costs to participantswillvarydepending onhowmanymeals arepreparedandhowoftentheyare delivered.
Assistance inSharedLivingArrangements–SupportedIndependentLiving
This supportcategoryincorporates assistancewithand/orsupervisingtasks ofdailylife in a sharedliving environment,with afocuson developing theskillsofeachindividual tolive as autonomouslyas possible. Thesupport is providedtoeachpersonliving in theshared arrangementinaccordancewiththeirneed.
Thebenchmarkpricesdo notincludethecostofrent,boardandlodging or other daytodayusual livingexpenses suchasfoodandactivities. Further, anycapital contribution(i.e.paymentstocovercostsassociatedwith thehouse/accommodationfacility) forparticipants residinginSpecialist DisabilityAccommodation (SDA) isassessedandfundedseparatelyunderSDA(refer totheCapital Supportsectionof this document).ParticipantswhoreceiveSupportedIndependentLiving supports intheirplanmayalsobe eligible toreceiveSDA.
SupportedIndependentLiving is not pricecapped;however,benchmarkpricing applies.Benchmarks are setat alevel thatmostproviders shouldbeable to providethesupport.However, a quoteis requiredfor allparticipantsresidingin Supported IndependentLiving.Sufficient evidencewill be requiredforanyabovebenchmarkquotes.
Toassist providerswithquotingfor supportedindependentliving, the NDIAhasdeveloped aProvider SIL Pack.TheProviderSILPack containstemplatesthat assistprovidersindevelopinganindividualisedquotefor theparticipantbasedonsupportrequirements(link).
A hierarchyoffunding levelsappliesto this supportandis basedon:
- ·the numberofpeoplein theliving arrangements
- ·the levelofneedoftheparticipantfunded byNDIS, as setoutbelow
Lowerneeds:
This supportprovidessupervisionofliving arrangementsas awhole including occasionaltointermittentpromptingto undertakehouseholdtasksand/orself- careactivities:
- Supervision is notusuallyprovided 24/7,supervision maybe providedviaoff-sitemonitoringif appropriate
- If theparticipanthashad incidentsofchallenging behaviour, a behaviour support plan is inplaceandit is demonstratedthattheparticipantcanbe supportedeffectively within the availablesupport
- Wherea participanthasadditionalsupportneeds,theymaybesupported inthis living arrangement through amixofadditionalpaidandinformalsupports
Standardneeds:
This supportprovides24/7 supportwhichincludes:
- Active assistanceor supervisionofmostdailytasks
- Regularinactiveovernight(sleepover)
- Participantsmaybe able tospend sometimewith theirfamilyor afriendwithoutpaidsupportandmaycallon them forincidentalassistanceorcompanionship
- If theparticipanthasepisodic oroccasionalchallenging behaviours there isa behavioursupportplaninplacewhich hasbeendemonstratedto effectivelysupport theperson withintheavailablesupport
Higher needs:
This supportprovideshighlyfrequent (atleast 1 instancepershift)assistancetotheindividualwherefeatures suchas:
- Managing challenging behaviours that requireintensivepositivebehaviour support;
- Continual,activeassistancewith all dailytasks;
- Activemanagementofcomplexmedicalneeds suchas ventilation;
- Active supportis provided24/7usuallywith anactiveovernightshift;
- Inactiveovernightsleepover maybe includedas anexception,for examplewhenfamilyor friendssleepover;
- Mayinclude higherstaffingratios atpeakperiods,for episodic or incidentalbehavioursupports, or emergencymedicalneeds(e.g.seizuremanagementor dischargefrom hospital)
Whenit is reasonableandnecessaryfora participanttobesupported in a sharedliving arrangement,aquoteis requiredfromaregisteredproviderfordeliveryof thesupport.
Thepurposeof this quoteis toidentify:
- Theindividualsupports thatwill be available for theperson,focusedonmaximisingtheperson’scapacityto be asindependentaspossiblewithhouseholddecisionmaking,personalcareanddomestictasks
- Thetypical rosterofsupportsthatis sharedbetweenparticipantstomaximisetheefficientuse ofresources
- Whatsupportsare available toall residentstoensurethesmoothoperationandrunning of thehouseholdThequotationprocessaims toidentifyapricefor theNDIAfundedsupportsassociatedwithsupportsthehousehold.
Theserviceagreementalso confirmsthecostswhich are theresponsibilityoftheparticipant, anyadditionalarrangementsbetweentheprovider andparticipantfor homerepairandmaintenanceandhow vacanciesandselectionofnewtenantswill be managed.
Quotingfor Supported Independent Living
Whenit is reasonableandnecessaryfora participanttobesupported in a sharedliving arrangement,aquoteis requestedfromaregisteredproviderfordeliveryof thesupport.6
Thepurposeof this quoteis toidentify:
- Theindividualsupports thatwill be available for theperson,focusedonmaximisingtheperson’scapacityto be asindependentaspossiblewithhouseholddecisionmaking,personalcareanddomestictasks
- Thetypical rosterofsupportsthatissharedbetweenparticipantstomaximisetheefficientuse ofresources
- Whatsupportsare available toall residentstoensurethesmoothoperationandrunning of thehouseholdThequotationprocessaims toidentifyapricefor theNDIS fundedsupportsassociated withthehousehold.
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TheServiceAgreementconfirmsthecostswhich are theresponsibilityoftheparticipant,anyadditionalarrangementsbetweentheprovider andparticipantfor homerepairandmaintenanceandhowvacanciesandselectionof newtenantswill be managed.
ShorttermAccommodation andAssistance
Participantsmayrequireperiodswheretheirsupportarrangementsaredifferent from thesupportusuallyavailablein thefamilyhome.Thesearenon-typicaldays andmayincludefundingto providesubstitutesupport“respite”, inagroupbasedfacilityor inhomesupport.
TransportAllowance(replaces MobilityAllowance)(SupportCategory1.02)
Travelenables participantstoaccessthecommunityforeducational,recreationalandvocational purposes.Transportsupportsgenerallydonot haveprice controls;however,participantsshouldusetheleastexpensivetransportthatmeetstheirneeds.
Transportfunding is paid fortnightlyin advance totheparticipant.Fundingfor transportassistanceislimited tothosewhocannotuse publictransportdue totheirdisability. If theparticipanthas questionsaboutthemobilityallowance,providersmaydirectthemtotheMobilityAllowanceandthe NDISfactsheetavailableontheNDISWebsite.
Consumables(Support Category1.03)
Consumablesarea supportcategoryavailable toassist participantswith purchasing everydayuse items. Supportssuchascontinenceandhomeenteralnutrition(HEN)productsare includedin this category.Moreinformation onthesesupportscanbefound intheAssistiveTechnologyand ConsumablesCodeGuide7.
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AssistancewithSocial andCommunityParticipation(SupportCategory 1.04)
Provision of supportstoenablea participanttoengage in community/social or recreationalactivitieswithin thecommunity.Thesesupports maybe providedin aCentreor inopencommunitiesat standard or complex/higherintensitylevels.Ifarranged in advancewith participants,providersmaycharge upto4 hoursforeachplan period todocumentthe process andexpectedoutcomes.
Providers shouldnotclaim paymentfor:
- Expensesrelatedtorecreationalpursuits,such as tickets or sportingclubfeesfor theparticipantbecausetheyarenot covered bythe NDIS.
- The costoftravel or entryfor apaid support worker to attenda socialor recreationalevent.
Communityand social activitycosts
This support is included in a participant’splanto enablethemto pursuerecreationalactivities andengageinthe community.As acore support itmaybeusedfor activities suchas camps,vacationandoutsideschoolhours’care, courseor membershipfees.Theintentof this SupportItemis toprovide fundingto enablea participant to participateincommunityactivities, particularly when theparticipant is atriskof beingsociallyisolated. Fundedhours inaCommunityAccessbudgetmaybe convertedtoafee andclaimedbyaprovider for thesepurposes.
Whenclaimingfor groupactivitiesproviders are to claim as perthenumbersofgroupmembersper individualstaffassistingwiththe group.
Price controlsforcoresupports
This sectionlists supportitemprice limitsandbenchmarksfor Coresupports.
Assistancewithself-careactivities:day
Standard needs:assistancewith self-care activities
SupportItem / SupportItemRefNo. / Description / UOM / QuoteRequired / PriceAssistancewithself-careactivitiesduringdaytimeweekdays / 01_011_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $44.72
Assistancewithself-careactivitiesperweekdayevening / 01_015_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $49.04
Assistancewithself-careactivities onSaturdays / 01_013_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $62.03
Assistancewithself-careactivitiesonSundays / 01_014_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $79.38
Assistancewithself-careactivities onPublicHolidays / 01_012_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $96.69
High Intensityneeds: assistancewithself-care activities
SupportItem / SupportItemRefNo. / Description / UOM / QuoteRequired / PriceAssistancewithself-careactivitiesduringdaytimeweekdays- higher intensity / 01_008_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $47.20
Assistancewithself-careactivitiesperweekdayevening-higher intensity / 01_009_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $51.76
Assistancewithself-careactivities onSaturdays- higherintensity / 01_006_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $65.48
Assistancewithself-careactivities onSundays- higherintensity / 01_007_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $83.78
Assistancewithself-careactivities onPublicHolidays-higher intensity / 01_005_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdailylifetodevelopskillsoftheparticipantto liveasautonomouslyaspossible. / Hour / N / $102.08
Assistance with self-care activities:overnight
SupportItem / SupportItemRefNo. / Description / UOM / QuoteRequired / PriceAssistancewithself-care -night-timesleepover / 01_010_0107_1_1 / Assistancewith,or supervision of, personaltasksofdailylivingwhereovernightsupportisneeded,butthe caregivercansleepwhennot required toprovidesupport. / Each / N / $194.79
Assistancewithself-care -activeovernight / 01_002_0107_1_1 / Assistancewith,or supervision of, personaltasksofdailylivingwhereovernightsupportisneededandthe caregiverwill nothavetheoption tosleep / Hour / N / $49.90
Assistancewithself-care -overnight- higher intensity / 01_018_0104_1_1 / Assistancewith,or supervision of, personaltasksofdailylivingwhereintensiveovernightsupportisneededandthecaregiverwillnot havetheoptiontosleep / Hour / N / $52.69