NDISPriceGuide

VIC/NSW/QLD/TAS

Validfrom:1 July2016

Versionrelease date:11July2016

TableofContents

PRICE GUIDEINTRODUCTION…………………………………………...... 3

SUPPORTPURPOSE………………………………...... 3

OUTCOMESFRAMEWORK…………………………………………………………………………………………………………………...4SUPPORTCATEGORIES……………………………………………………………………………………………………………………..5SUPPORTLINEITEMSPARTICIPANTBUDGETS…………………………………………………………………………………………..6PRICELIMITS………………………………………………………………………………………………………………………………..7PAYMENTSANDINVOICING2016/17……………………………………………………………………………………………………….8SERVICEBOOKINGS……………………………………………………………………………………………………………………..8-11SUPPORTITEMREFERENCENUMBERS………………………………. 11

UNITOFMEASURE…………………………………………………………………………………………………………………………12REMOTEANDVERYREMOTE……………………………………………………………………………………………………………...12QUOTES………………………………………………………………………………………………………………………………… 13

PROVIDERTRAVELPARTICIPANTTRANSPORT………………………………………………………………………………… 13-14

CANCELLATIONS AND“NOSHOWS”OFSCHEDULED SUPPORTS………...... 15

GST……………………………………………………………………...... 15

CO-PAYMENTS………………………………………………………………………………………………………………………… 16

CORESUPPORTS–DESCRIPTIONSLINEITEMS....…………………………………………………………………………………17-33CAPITALSUPPORTS………………………………………………………………………………...... ………………….34-36

CAPACITYBUILDINGSUPPORTSLINEITEMS………………………………………………………………………………………..37-50

2016/17NDISPriceGuide

ThisdocumentisasummaryofNDISpricesand associated arrangementsthat willapplyfrom1 July2016. Itisdesignedto assistdisabilitysupportproviders, both currentand prospective, to understandthewaythatpricing andpaymentsworkintheNDIS.

TheNationalDisabilityInsuranceSchemeAct2013statesthata fundedsupportmustrepresent“value formoney” inthatthecostsofthesupportarereasonable,relativeto boththe benefitsachieved andthecostofalternativesupport.Thisdocumentdescribesthe pricing andpaymentarrangementsthat willbein place for 2016/17 tosupportthisobjective.

This Guide should bereadinconjunctionwiththeNDISTerms of Business for Registered SupportProviders(the ‘Termsof Business’)1.Serviceprovidersshouldalso makeuseoftheinformationavailable intheNDISprovider portal2.

Thereare threecategoriesof SupportPurposein theNDIS

TheNDISprovidesfunding toparticipants topurchasearangeofsupportsaimedatincreasing their independence,inclusion,andsocialandeconomicparticipation.Thisfunding model isdesignedtobe flexible andto allowserviceinnovation.Importantly, thesupportsdelivered will bechosen,and paid for,byindividualparticipants.Therangeofsupportsfundedbythe Schemewillexpandover time.

IntheNDISpaymentsystem,supportsfor participantsfallinto three SupportPurpose categories:core,capitaland capacitybuilding.

1

1.CORE–Asupportthatenables a participanttocompleteactivities of dailyliving andenablesthemtoworktowardstheir goalsandmeettheirobjectives.

2.CAPITAL –Aninvestment,such as assistivetechnologies,equipmentand home or vehiclemodifications,funding for capital costs (e.g.topayfor SpecialistDisabilityAccommodation).

3.CAPACITYBUILDING-Asupportthatenables a participanttobuildtheir independenceandskills.

NDIS Outcomes Framework: Supportsshould help participants achievetheirgoals

TheNDISOutcomesFramework hasbeendevelopedto measuregoalattainmentfor individualparticipantsand overallperformanceoftheScheme.There are 8 OutcomeDomains(‘Domains’) inthe framework.TheseDomainshelpparticipantsthinkaboutgoalsindifferentlife areasandassistplannerstoexplorewheresupportsin these areasalreadyexistandwhere further supportsarerequired.

1.DailyLiving

2.Home

3.Health andWell-being

4.Lifelong Learning

5.Work

6.SocialandCommunityParticipation

7.Relationships

8.ChoiceandControl

NDISserviceprovidersshouldbe awarethatallsupportsandservicesfor Scheme participantsshould contribute totheachievementoftheirindividualgoals.

SupportCategories

This NDIAPriceGuide isarrangedinto15categories thatalignto thepurpose ofthe fundedsupportsand theNDIAOutcomesFramework(seeabove).

SUPPORTPURPOSE / OUTCOMESFRAMEWORKDOMAIN / SUPPORTCATEGORY(PlanBudgets)
CORE / DailyLivingDailyLivingDailyLiving
SocialCommunityParticipation / 1.AssistancewithDailyLife
2.Transport
3.Consumables
4.AssistancewithSocialCommunityParticipation
CAPITAL / DailyLivingHome / 5.AssistiveTechnology
6.Home
CAPACITYBUILDING / ChoiceControlHome
SocialandCommunityParticipationWork
RelationshipsHealthWellbeingLifelong LearningChoiceandControlDailyLiving / 7.Coordination ofSupports
8.ImprovedLiving Arrangements
9.Increased SocialandCommunityParticipation
10.Finding and Keeping aJob
11.ImprovedRelationships
12.ImprovedHealth and Wellbeing
13.Improved Learning
14.Improved LifeChoices
15.ImprovedDailyLivingSkills

Therearemanysupport‘lineitems’withineach supportcategory

TheNDIAPrice Guide is notacomprehensivelistofallavailablesupports,nordoesitprescribethe onlysupportsfunded bytheNDIS.

Although theyare not listedin thisdocument,eachsupportcategoryhasmanyspecificsupportsandservices thatarerecognisedinthe NDISpaymentsystem.Thesearereferred toas‘lineitems’. Acomprehensivelisting ofsupportlineitemsiskeptuptodateasaseparate file (csvformat)ontheNDISwebsite.Thisfile includesitem descriptorstoassistproviders toclaim paymentsusing a “best-fit” approach,andtoassistparticipantsinengaging and negotiating withdisabilitysupportworkers andserviceproviders.

Providersshouldclaim paymentsagainstasupportlineitem thatmostcloselyaligns totheservicetheyhavedelivered.

Participantbudgets are allocatedaccordingtosupportpurpose

Supportsin participantplansarecategorised according tothe three supportpurposesnotedearlier.Withinaplan participantbudgetsare subjecttothe following rulesinrelationtosupportpurposes:

CORESUPPORTS:Participantbudgetsare flexibleacross thefour sub-categories:Assistancewithdailyliving,Transport,Consumables,andAssistance withSocialandCommunityParticipation. Aparticipantmaychoosehowtospendtheir coresupportfunding,butcannotreallocate coresupportfunding to other supportpurposes(i.e.capital or capacitybuilding supports).

CAPITAL SUPPORTS:Participantbudgetsfor thissupportpurpose areusuallyrestrictedtospecificitemsidentifiedin the participant’splan.Theseinclude AssistiveTechnologyandHomeModifications,as well as SpecialistDisabilityAccommodation.Mostitemsare ‘quotable’,whichmeansthatproviders mustnegotiatea pricein aServiceAgreementwithaparticipant.Supportscaninclude assessment,delivery,set-up,adjustmentandmaintenance costs.

CAPACITYBUILDING:Participantbudgetsareallocated at a supportcategorylevel, andmustbe usedtoachievegoalsinthe participant’splan.ThesesupportsincludeCoordinationofSupports,ImprovedLiving Arrangements,IncreasedSocialCommunityParticipation,Finding KeepingaJob, ImprovedRelationships,ImprovedHealthWellbeing,ImprovedLearning,ImprovedLifeChoicesand ImprovedDailyLiving Skills.

Price limits applyforsomesupports and services

ThisPriceGuideincludes a pricelimitfor somesupportsandservices.

Unlessstated otherwise,these pricelevelsarethemaximum thatproviders canchargeNDISparticipantsfor their services.Pricelimitsareinplacetoensurethatparticipantsreceivevalue formoneyinthesupportsandservicesthattheyreceive.Thisis an importantmeasure for manyparticipants,especiallyindisabilitysupportmarketsthatareimmatureor wherethere are fewoptionsfor participantstochoose from.

Theexceptionstothisruleare‘benchmarkprices’for some of the supportsand servicesthatarelisted as ‘quotableitems’.Thesebenchmarkpricesindicate the NDIA’sviewofefficientservicedeliveryandshouldbethehighestpricechargedbymostproviders.Supported IndependentLiving usesbenchmarkprices.

AllregisteredNDISprovidersshouldrefer to theNDIATermsofBusiness,whichincludedetailsaboutthe applicationofpricelimitsandotherrequirementsthatprovidersmustcomplywithwhenoffering and delivering services toScheme participants.

PAYMENTSANDINVOICINGIN2016/17

ThisPriceGuideappliesfor servicesdelivered1July2016 onwards.Claimsagainstexisting plans canbe madeusing the2016/17 prices as longas theserviceisdeliveredonor after 1 July2016.

RegisteredProviders canmakeaclaim for paymentoncethatsupport has beendeliveredor provided. Arequirementfor prepaymentisnotpermitted unless,inrelation to particular supports or services, the Agencyhas givenprior approval totheRegisteredProvider.

Where pricelimitsapply,priceschargedto participantsmustnotexceed the pricelevelprescribed forthatsupportinthePriceGuide,thoughlessmaybecharged.No other chargesaretobeaddedtothecostofthesupport,including creditcard surcharges,or anyadditionalfees including any‘gap’ fees, late paymentfees or cancellation fees.

Aclaim for paymentis tobesubmittedwithin areasonabletime(and nolater than 60 daysfromthe end of theServiceBooking –seebelow).

ProvidersshouldrefertotheNDISTermsofBusinessforfurther details. In particular,theTermsofBusinessspecifythatproviderswillcharge forsupportsdeliveredin accordancewiththeNDIApricing arrangements and guidelines,afterthesupporthasbeen provided. Noadditionalco-paymentis tobeleviedtothe participantwherean NDIAregistered provider issubmitting aclaimaspartoftheir negotiated serviceagreementwiththatparticipant.

ServiceBookings

2016/17NDISoperating systemprovidesforServiceBookings to becreated between theparticipantandtheir provider.Thisensuresthatbothpartiesareawareoftherequirementsfor service, thelength of timetheserviceisrequiredfor,and thattheparticipant will beabletopayfor theservice. The systemallows for ONEprovider,ONEServiceBooking–thatis:

  • AparticipantwillcreateoneServiceBooking for eachprovider theyhavechosentodelivertheir supports.Theallocated funds willbe‘locked’ tothe chosenproviderforthe life oftheServiceBooking.
  • ThisServiceBookingmayinclude severalsupportsacrosstheparticipantsplan from anyoftheDomainsincludedinthatplan.
  • TheServiceBooking mustbe acceptedbyboth parties.
  • TheAgency will not be partytoanyServiceBooking created betweentheparticipantandtheir provider(s).
  • TheServiceBooking maybecancelledwith28days’notice.Underexceptionalcircumstancesthe participant orprovider mayelecttoshorten thistime.
  • At theend ofthe ServiceBooking,theprovider hasupto60days to processaclaim. Iftheclaimisnotlodged withinthistime,anoff-lineclaim mustbelodged.The Agencyhas upto30 days to processtheclaim.
  • Noclaimcan belodgedbyaprovider withoutaServiceBooking being created andclaimslodged mustbewithinthedatesof theServiceBooking.
  • TheServiceBooking cannotbeend dated prior tothe dateofthelastclaimlodged.
  • Where theparticipanthas a Plan Manager,onlyoneServiceBookingwill becreated.The ServiceBooking iscreatedfor allservicesfor whichthe PlanManager has beenrequestedtoarrangesupportsfor.Wherea PlanManagerhasalreadybeenappointed foraParticipant, a Participantwill not berequired toapprovePlan-ManagementAgreementssubmitted bytheProvider Supportswhicharein-kindwill not beincludedinthe ServiceBooking.
  • AServiceBookingmaycontainthe allofthe allocated fundsattributedtothesupportcategoryorsome ofthe budget.
  • Morethantwoproviders mayhavea ServiceBookingforthe samesupportcategory–ie:where30hoursofindividualsupportisallocatedinthe participantsplan,theparticipantmaychooseto splittheallocation oftheseresourcesacrossproviders,allowing forone provider todeliver supports sayonaweekend,assisting withsocial and recreationalevents and another during theweektosupportin-home andemploymentoutcomes.
  • When thePlan ends,sodo allServiceBookings, these arealsocreatedwithinthedatesof thePlan.
  • ServiceBookingsaretypicallycreatedatthe SupportCategorylevel,ratherthantheline item– thisallowsforflexibilityacross thesupportcategories.Theexception iswithinCoreSupports,wherea ServiceBooking maybecreated acrosstheentirebudgetinclusiveofDailySupports,Transport,ConsumablesandCommunityandSocialActivities. CapitalandCapacityBuilding supportsdeliveredareclaimedat theidentifiedsupportcategorylevel.
  • AServiceBooking cannotbe made for morethan the valueof the budgetallocated tothe plan.
  • Allclaimslodgedbytheprovider mustbeattheline itemlevel and inaccordancewiththe TermsofBusinessand ServiceAgreement.
  • At thetimethe ServiceBooking iscancelled,anassessmentmustbemade regarding theamountoflockedfunds thatshould bereturnedbacktothe availableSupportCategorybalance.Thisensuresthatproviderscancontinuetoclaim for servicesrendered,but the participantcan utilisetheunspentfundsinanewServiceBooking.
  • AServiceBooking can becreatedbythe participant(their nominee,oraplan managementprovider acting ontheparticipant’sbehalf), a provider or anauthorisedagentoftheAgency.
  • Aparticipantcannotcreate/changeServiceBookingseffectiveretrospectively(inthepast),from the currentdate ora future date.
  • Wherea ServiceBooking ischanged bythe participantor provider,theotherparty(participant/provider) mustapprovethenewversionof theServiceBooking beforeittakeseffect.
  • AServiceBooking can bechanged onlyasfollows:
  • If theend dateoftheServiceBooking is notalreadyinthe past,extendthe end dateintothe future,butnotbeyondtheend oftheParticipantPlanenddate;
  • Increase thebudgetavailableagainst acategory/item(assuming budgetremainsavailable todoso),thiscanoccur whethertheServiceBooking isalreadyended or not;
  • Theprovider mustberegisteredto providetheitemor itemsintheSupportCategory.
  • TheServiceBooking mustbe approvedbyboththe participant(their nominee ora plan managementprovider acting ontheparticipant’sbehalf),andthe provider.
  • Whena ServiceBooking has notbeenapprovedafter 21days,then thesystemwillautomaticallyreject the ServiceBookingwiththereason“NoActionafter 21days(Auto)”
  • Online notificationsare createdwhenthe participantinitiatesaServiceBooking withtheselected provider. Likewise,whenaprovider createsaServiceBooking withtheparticipant,thesystem willautomaticallysendanOnlineNotificationAdvicetotheparticipant(or their nominee/representative). Ifthe eitherpartyhasnotapproved aServiceBooking assigned to them,anOnline
  • Whena participant(ortheir nominee/representative) changesaServiceBooking, the systemshould automaticallysendan OnlineNotification Adviceto theapplicableprovider.

AMonthlyPaymentStatementwill beavailableonline to participants.The PaymentStatementiscreated fromthe systemandavailable totheparticipant(and/ ortheir nominee)onthe firstbusinessdayof eachmonth.This statementwillcontain asummaryofthe previousmonth’spayments,providethe participantwiththe availablebudgetremaining,committedbudgetandspentbudget.Itwilllistwhichparticipantandproviderclaimshavebeenreceived,whichServiceAgreementstheyrelatedto,whichSupportCategories the moneywasdeductedfromand on whichdatesthe deductionsweremade.The PaymentSummarywill beavailableintheir preferreddocumentformat,eitherpdfor word.Theparticipant(and/ ortheir nominee) will besentanEmail or SMSnotificationwhentheir statementsare available Online.

Introduction ofnewSupportItemReference Numbers

From1July2016,the NDISpaymentssystemisadopting anewreference system for supportsandservices.

Uniquenumbershave beenallocatedforeachsupportlineitem,witheachnumber isallocated according tothe following structure:

For example:

Assistance with self-care- overnight - higherintensitylineitemnumberis: 01_018_0104_1_1

SupportCategoryLineItemReg’nGrpDomainFundingType1018010411

Support Connectionlineitemnumberis: - 07_001_0106_8_3

SupportCategoryLineItemReg’nGrpDomainFundingType7001010683

UnitsofMeasure

TheNDISpaymentsystem for 20161/7includesunitsofmeasuretosuiteach supportlineitem:

  • Each
  • Hour
  • Daily
  • Fortnightly
  • Week
  • Month
  • Annual

RemoteandVeryRemote

Servicesdeliveredinremote and veryremoteareasmayhavehigher pricelimits,to accommodate additionalservicedeliverycosts.TheModifiedMonashModel(MMM) is usedto determineremote or veryremote areas.There areseparatePrice Guidesfor Remote and VeryRemoteareas.

Providersshouldclaim the priceapplicable to wheretheserviceisdelivered.Iftheserviceisdeliveredinthe participants’community,thentheremoteor veryremote pricemaybeclaimed.Pricesare18%higherinremote areasand23%higher inveryremote areas.

If localprovidersarenotavailable,the Agencymayenter intoagreementswithspecificproviders for provisionofservicesincludingtomoreremoteregions.Thecontractwithaserviceproviderwillallocatethecostoftravel and associated expensesamong theparticipantsandother clientsoftheprovider whoreceiveservices under thecontract/arrangementin theseareas.

Serviceprovidersmustofferquotes forsome supports

Quotesarerequired from providers fora numberofspecificserviceoffers.Thismostcommonlyoccursforthe following supports:

  • Earlychildhoodinterventionservices
  • Multidisciplinaryprograms
  • Customised assistivetechnology,
  • Home modifications,and
  • SpecialistDisabilityAccommodation.

If thequotereceivedishigher thanthe benchmarkrate forthatsupportitem,specificapprovalwill berequired fromtheNDIA.Identification ofsupportsandapprovalofquotescouldrequirean assessmentbyaspecialist.

ProviderTravelParticipantTransport

Provider travel andparticipanttransportare differentthings.Thissectionexplainsthe differencesand notesspecificrulesandarrangementsforboth travel and transportinNDISpricing and paymentssystem.

ProviderTravel

Travel to providepersonal care andcommunityaccess

Thetimethataworker spendstravelling from hometotheworkplace (or firstparticipant) and fromtheworkplace(or lastparticipant)to home cannotbeclaimed atthe hourlyratefor therelevantsupportitem.

Whereaworker travelsfrom oneparticipantappointment to another, upto20 minutesoftimecan beclaimedagainstthesecondappointmentatthehourlyrate for therelevantsupportitem.

Travel to providetherapeuticsupports

Providerswhotravel toprovidetherapeuticsupportstoparticipantscannotclaimanytraveltimeat the hourlyrate fortherelevantsupportitem

Providers canclaim travel timeatthe hourlyratefor therelevantsupportitem for travelinexcess of 10km,uptoa maximumannuallimitof$1000per participant(per annum).Travel timeshouldbecalculated using thisformula:claimabletravel time(inminutes)= (total km travelled–10)3.

Providerswhointend toclaim travel costsfroma participant’splan using thisprovisionmust seekthe agreementoftheparticipantprior toanyclaimbeing made (e.g.theserviceagreementbetween the participantand provider should specifyiftravel costs are tobeclaimed).

Participant Transport

Accompanyingparticipantsforcommunityaccess

Providing communityaccess supportsmayalsoinvolveaworker accompanying aparticipantonacommunityouting and/or transporting aparticipantfromtheir home tothe community. Inthese situations,theworkers timecanbe claimed atthe hourlyratefor therelevantsupportitem forthetotaltime theworker providessupportto aparticipant(s),including timespentaccompanying and/or transporting the participant.Whereaprovider istransportingtwoormore participants onthe sametrip,the workers timeshould beclaimed at the appropriategrouprate for therelevantsupport.

Contributiontowards costsof transport

If a provider incurscosts,inadditiontothecostof aworker’s time, when accompanying and/or transporting participantsinthecommunity, theymaynegotiate withaparticipantfor the participanttomakeareasonable contributiontowardsthesecosts. Aparticipant’splan mayinclude fundingfortransportsupportsand thisfunding canbeusedtomeetthesetypesofcontributions.

Remotetravel

If localprovidersarenotavailable,the Agencymayenter intoagreementswithspecificproviders for provisionofservicesincluding tomoreremoteregions.Thecontractwithaserviceproviderwillallocatethecostoftravel and associated expensesamong theparticipantsthatreceiveservicesunder the contract/arrangementinthese areas.

3Thisformulaimplicitlyassumesthat,onaverage,travelspeedis60km/hour

Cancellations and “noshows” for scheduledsupports

Providers needto havebusinessarrangementsin place to minimisetheriskofcancellation,noshowor latechanges tothe deliveryofascheduledsupport.Serviceagreementsbetweenparticipantsandprovidersneedtoincludedetailsof these arrangementsincluding:rescheduling theappointment;notice periodsfor cancellations;andchangesto agreed appointments.

If thereare unforeseen circumstancesand theparticipantagreesthattheydidnotcomplywiththeagreedrequirements, afeemaybechargedagainst a participant’splan upto8 timesper year forpersonalcare andcommunityaccesssupports.However, theprovider shouldnotifytheAgencythat the participantis at riskofnotreceiving thebudgetedsupports asaplanreviewmight beindicated.

Wherea participantfails,withoutnotice,tokeepthescheduled arrangementfor thesupport, the provider mustmakeeveryefforttocontact theparticipant to determineifthereisanadditionalproblem(e.g. the personhasfallenoutofbedandcannotraisean alarm,or thereisasuddenbreakdowninthe informalsupportsandadditionalsupportislikelytoberequired).

Where thereis a specificrisk that a participantwillfrequently“notshow” forasupportduetothe natureof a person’sdisabilityorthe natureof thesupport,forexample behaviour interventionsupports,theserviceprovider should putinplacesuitableindividualarrangementsto maximisethelikelihoodthatthepersonwillreceivealltheir requiredsupports.

No fee ispayable bytheNDIAor the participant,for cancellation byaprovider or duetotheprovider’sfailuretodeliver theagreedsupportsunlesspreviouslyagreedto anddocumentedinthe ServiceAgreement.

No fee ispayable byNDIAfora therapeuticsupportthatisnotdelivered.

NDIAdoesnotpermitcollection ofdeposits,or moneyas a bond from participantsthata provider wouldretainintheeventofcancellationof asupport perthe NDIATermsofBusiness.

GST

Mostitemsare GSTexempt, asperAustralian TaxOfficeinformationaboutGST and NDISandtheapplicationofsection38-38 ofthe GST Act.Forasmallnumber ofitems,whereGSTisapplicable(forexample deliveryfeesandtaxifares)the priceisinclusiveof GST.

Co-Payments

Generally, aparticipantis notrequiredto contributetothepaymentofdeliveryofa productor servicethathas beenincluded ontheir plan.TheNDISwillcover thefullcost ofprovisionofthesupportconsideredreasonable andnecessary. Inmostcases, a participantisfree tochoosea moreexpensiveoption attheir ownexpense,wherethemore expensiveoptionisnotconsideredtobereasonableand necessary. Anexampleofthissituationwouldbe whereahome modification hasbeenapproved for aparticipant,butthe participantwouldlikecosmetic or personalised fittingsthatarenotreasonableandnecessary. In thissituation,theNDIAwillcover thereasonableandnecessarycomponentofthe modification,and theparticipantwill paytheextracosts. Also refer toresourcesavailable onconsiderationsin relationtoHomeModifications.

CORESUPPORTS

This section describestherulesandarrangementsthatapplytocoresupports.It alsonotespricelimitsthatapply tospecificlineitems.

AssistancewithDailyLiving (SupportCategory1.01)

Assistance with dailypersonalactivities

Assisting withand/or supervising personaltasksofdailylifetoenablethe participanttoliveas autonomouslyas possible.Thesesupportsareprovidedindividuallytoparticipantsandcan beprovidedin arangeofenvironments,including butnot limited to,theparticipant’sownhome.

Ahierarchyofpricesappliestothissupport,basedon:

A.Thelevelofsupportprovided:

Ahigher intensitysupportmaybepaidwhere aparticipantrequiresassistance from asupportworkerwithadditionalqualificationsandexperiencerelevanttothe participant’scomplexneeds. Thehigherintensityrate maybeconsideredwhen:

  • Frequent(atleast1instance per shift) assistanceisrequiredto managechallenging behavioursthatrequireintensivepositivebehavioursupportand/or
  • Continualactivesupportisrequireddueto highmedicalsupportneeds(such as unstableseizureactivityor respiratorysupport)

B.Thetime ofdaythatthesupportisprovided:

  • Daytimestartsat 6amand finishesat8pm
  • Evening iswherethesupportfinishesafter 8pmand before12 midnight
  • Overnightiswherethe supportfinishesafter12 midnightand before 6am.

C.Thedayof theweekthatthesupportisprovided:

  • AweekdayisMondaytoFriday
  • Theextraratespaid for Saturday,Sundayandpublicholidaysarein substitutionfor,and notcumulativeupon,theshiftpremiumspayablefor evening andovernightsupports
  • Noadditionalratesare payable for Saturday/Sunday/Publicholidayswherethesupportfinishesafter 8pm.

Provisionsfor‘shadowshifts’

A.Shadowshiftsmaybe consideredwherethe participanthascomplexindividualsupportneedsthatarebestmetbyintroducing anewworkertotheparticipantbeforeitisreasonablethattheycommenceproviding thesupportindependently.Theseareconsideredwherethespecificindividualsupportneedsinclude:

  • verylimitedcommunication;
  • behaviour supportneeds;and/or
  • medicalneeds/procedures suchas ventilationor homeenteralnutrition.

Where theindividualwouldrequireshadowshifts to assistwiththeintroduction of newworkers,andthisisthe desiredmethodbytheparticipant or theirfamily, theprovider mayclaim forupto6hoursofweek-daysupportperyear.

B.Introducing newworkersis not designed toreplace formal,recognizedtrainingthat will beprovidedbyan employer totheir workforce e.g.Shadowing (or “Buddying”) lessexperienced staff(newstaff)withexperiencedworkers or informalcarerstohelp buildknowledgeandsocialcapital(worker retention).

C.Preparation of meals

Establishment feeforpersonalcare/communityaccess

Thisfee applies to allplansfornewNDISparticipantsin theirfirstplanwhoreceiveat least20hoursofpersonalcare/communityaccesssupportper month.Thispaymentis to cover non-ongoing costsfor providersestablishing arrangementsand assisting participantsinimplementing theirplan.The establishmentfeeisclaimablebytheprovider whoassists the participantwiththeimplementation oftheir NDISPlan,delivers a minimumof20hoursper month ofpersonalcare/communityaccess supportandhasmadeanagreementwiththe participant to supplytheseservices.

Theestablishmentfee willoperate asfollows:

  • providers cancharge$500 against a planifassisting anewparticipant,whoisnewtoNDISandnewtothe provider,
  • aprovider cancharge $250whentheyaremaintaining anexisting clientoftheirswhoiscommencing asaparticipantofthe NDIS,
  • should aparticipantwishtochangeproviders oncommencing theirfirstNDISplan,$250isavailabletothe newprovider. This isto assistthe participantinchanging providers.

Assistance with householdtasks

This includestheprovisionofsupportstoenabletheparticipant to maintain theirhome environment.Thismayinvolveundertaking essentialhousehold tasksthattheparticipantisnotableto undertake.

MealsonWheels / preparationanddeliveryofmeals

Providerswill beinvitedto providequotesforpreparing anddelivering thefoodfor theparticipantonaweeklybasis,taking their specificneedsintoaccount.Thecostoftheactualfood is notcoveredbythisSupportItem.

This supportusesbenchmarkpriceswhicharebased on preparationanddeliveryof meals forasingle day.Costs toparticipantswillvarydepending onhowmanymeals are prepared andhowoftentheyaredelivered.

Assistancein SharedLivingArrangements–SupportedIndependent Living

This supportcategoryincorporatesassistancewithand/or supervising tasks ofdailylifeinasharedliving environment,whichiseither temporaryorongoing,withafocusondeveloping theskillsofeachindividual toliveasautonomouslyas possible.

Thesupportisprovidedto eachpersonlivingintheshared arrangementin accordancewiththeir need.

Theitem prices do notinclude thecostofrent,boardandlodging orotherdaytodayusualliving expenses such asfoodand activities.Further,anycapitalcontribution(i.e.paymentstocover costsassociated withthe house/accommodation facility) forparticipantsresiding inSpecialistDisabilityAccommodation(SDA)isassessedand fundedunder separatelybytheNDIS(refer tothe CapitalSupportsection ofthisdocument).ParticipantswhoreceiveSupported IndependentLiving supportsin their plan mayalsobeeligibletoreceiveSDA.

Ahierarchyofpricesappliestothissupportandisbased on:

  • the numberofpeopleintheliving arrangements
  • thelevelofneed ofthe participantfunded byNDIS, as setoutbelow

Lowerneeds:

This supportprovidessupervisionofliving arrangementsas a wholeincluding occasionaltointermittentprompting toundertakehouseholdtasksand/or self- care activities:

  • Supervisionisnotusuallyprovided24/7,supervisionmaybeprovidedviaoff-site monitoring ifappropriate
  • If theparticipanthashadincidentsofchallenging behaviour, abehaviour supportplanisin place and itisdemonstrated thattheparticipantcanbesupported effectivelywithintheavailablesupport
  • Wherea participanthasadditionalsupportneeds,theymaybe supportedin thisliving arrangementthroughamixofadditionalpaid andinformalsupports

Standard needs:

This supportprovides24/7 supportwhichincludes:

  • Activeassistance or supervisionofmostdailytasks
  • Regular inactiveovernight(sleepover)
  • Participantsmaybeabletospendsome time withtheir familyora friendwithoutpaidsupportand maycall onthem for incidentalassistanceor companionship
  • If theparticipanthasepisodic oroccasionalchallenging behavioursthereisabehaviour supportplaninplacewhichhasbeendemonstrated to effectivelysupportthe personwithinthe availablesupport

Higherneeds:

This supportprovideshighlyfrequent(atleast 1instanceper shift) assistance totheindividualwhere featuressuchas:

  • Managing challenging behaviours that require intensivepositivebehaviour support;
  • Continual,activeassistancewithalldailytasks;
  • Activemanagementofcomplexmedicalneeds suchas ventilation;
  • Activesupportisprovided 24/7usuallywithanactiveovernightshift;
  • Inactiveovernightsleepover maybeincluded as anexception,for examplewhen familyor friendssleepover;
  • Mayincludehigher staffing ratios atpeakperiods,for episodic or incidentalbehaviour supports, or emergencymedicalneeds(e.g.seizuremanagementor discharge from hospital)

When itisreasonableand necessaryforaparticipanttobesupportedina sharedliving arrangement,aquoteisrequestedfroma registeredprovider for deliveryofthesupport.*

If theprovider chargesareator belowbenchmarkpricingfor SupportedIndependentLiving (SIL) supportitems,thereisnotarequirementtoprovideaquote.This isonlyapplicableto sharedliving arrangements.Where there is no prescribedbenchmarkpriceand/or provider pricing isabovebenchmarkpricing,thenaquote mustbeprovided tothe participant.

Thepurpose ofthisquoteistoidentify:

  • Theindividualsupports that will beavailableforthe person,focused on maximising the person’scapacitytobeasindependent aspossiblewithhouseholddecision making,personalcareand domestic tasks
  • Thetypicalrosterofsupportsthatissharedbetweenparticipantsto maximisetheefficientuseofresources
  • Whatsupportsareavailableto allresidentsto ensure thesmoothoperation andrunning of the household

Thequotation processaims toidentifyaprice forthe NDIAfundedsupportsassociatedwith the householdandrelatedcommunityactivities.

Thequotealso confirms thecostswhichare theresponsibilityofthe participant,anyadditionalarrangementsbetween the provider andparticipantfor home repair and maintenanceand howvacanciesandselection ofnewtenantswill bemanaged.

Short termAccommodationandAssistance(e.g.Respite care)

Participantsarelikelytohavea number ofdayswheretheir supportarrangementswill bedifferent.Theseare non-typicaldays andmayincludefunding toprovidereplacementsupport,or respite,in groupbased facilityor inhomesupport.

Evidence fromconsultationsto dateindicatesthatsupportcangenerallyfall into one ofthreelevels:

  • Betweenthe equivalentof 7and 14 days peryear:wherethe familyprovidessupportmostdays. Thissupportisprovidedtotheparticipant so thattheinformalcarerscanattendkeyactivitiesrelevant to othermembersof the family.
  • Betweenthe equivalentof 14and28 days peryear:whererespiteisastrategytobuildcapabilitiesfor independence.
  • Nomorethan the equivalentof 28 days per year:wherethe familyprovidessupportmostdays andinformalcareis at riskof notbeingabletobesustainedduetoseverebehavioural issuesor wherethe personrequiresintensiveinformalsupport.

Thesesupportswill befunded over astandard24 hour periodand participantsor nomineeswill beable tochoosehowand whentheyusethisfunding inrelation to weekdays,weekends orpublicholidays.

Ahigher levelofsupport mayalso be appropriate fora defined periodof timeto ensurethata familyor carer isabletosustainemployment,complete their educationorputmoresustainablesupportarrangementsin place.

Insomelimited circumstancesNDISwillcontributetothecostofaccommodation,food andactivities.For example,wherean integrated packageisrequiredtosupportthe participantin emergencyor "respite" circumstancesforashortperiod(lessthan 2weeks)

TravelandTransport-Mobility Allowance (SupportCategory1.02)

Travelenablesparticipantstoaccessthecommunityforeducational,recreationalandvocationalpurposes. Participantsreceive fundsfortnightlyinadvancetopayfor services oftheir choice.Fundingfortransportassistanceisgenerallylimitedto thosewhocannotuse publictransportduetotheir disabilityandconsiders anyrelevanttaxisubsidyschemes.Iftheparticipanthasquestionsaboutthe mobilityallowance,providersmaydirectthemto theMobilityAllowanceandtheNDISfactsheetavailableontheNDISWebsite.

Consumables(SupportCategory1.03)

Consumablesare asupportcategoryavailableto assistparticipantswithpurchasing everydayuseitems.Supportssuchas interpreting,translating,continence andhome enteralnutrition(HEN) productsareincludedinthiscategory.

AssistancewithSocialand CommunityParticipation (SupportCategory1.04)

Provisionof supportstoenable aparticipanttoengageincommunity/social or recreationalactivitieswithinthecommunity. Supportsmaybeprovidedina Centre orinopencommunitieswithinthiscategory,andsupportmayberequiredat standard or complex/higher intensitylevels.

Participantsmaybe funded for4hoursforeachplanperiod forthe provider todocumentprocessand expected outcomes.Inthismodel, theprovider cannegotiatetospend some fundstobuild the capabilityofmainstreamservicestobetter supporttheparticipantwherethereisadefinedtransition plan aboutbuilding capacityandidentifying mainstream activities.

Providersshould notclaimpaymentfor:

  • Expensesrelated torecreationalpursuits,suchas tickets or sporting club feesfor theparticipantbecause theyare not coveredbythe NDIS.
  • Thecostofentryfora paidsupportworker to attend asocialor recreationaleventattended bytheparticipantbecauseagencypricesforgroupbased activitiesareinclusiveoftransportfor socialoutings.

Communityandsocialactivitycosts

This supportisincludedina participant’splan toenablea participanttopursuerecreationalactivities andengageinbroader communityparticipation.As acoresupportitmaybeused for activities such ascamps,vacationand outsideschoolhours’care,courseormembership fees.TheintentofthisSupportItemistoprovide funding to enable aparticipantto participatein communityactivities,particularlywhenthe participantisat riskofbeing sociallyisolated.

Pricecontrolsforcoresupports

This section listssupportitempricelimitsandbenchmarksfor Core supports.

Assistancewithself-care activities: day

Standardneeds: assistancewith self-care activities

SupportItem / SupportItemRefNo. / Description / UOM / QuoteRequired / Price
Assistancewithself-careactivitiesduringdaytimeweekdays / 01_011_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $42.79
Assistancewithself-careactivitiesperweekdayevening / 01_015_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $46.93
Assistancewithself-careactivitiesonSaturdays / 01_013_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $59.36
Assistancewithself-careactivitiesonSundays / 01_014_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $75.96
Assistancewithself-careactivitiesonPublicHolidays / 01_012_0107_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $92.53

HighIntensityneeds: assistance withself-care activities

SupportItem / SupportItemRefNo. / Description / UOM / QuoteRequired / Price
Assistancewithself-careactivitiesduringdaytimeweekdays- higherintensity / 01_008_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $45.17
Assistancewithself-careactivitiesperweekdayevening - higher intensity / 01_009_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $49.53
Assistancewithself-careactivitiesonSaturdays-higher intensity / 01_006_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $62.66
Assistancewithself-careactivitiesonSundays-higher intensity / 01_007_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $80.17
Assistancewithself-careactivitiesonPublicHolidays- higherintensity / 01_005_0104_1_1 / Assistingwith,and/orsupervising,personaltasksofdaily lifetodevelopskillsoftheparticipanttoliveasautonomously aspossible. / Hour / N / $97.68

Assistance with self-care activities:overnight

SupportItem / SupportItemRefNo. / Description / UOM / QuoteRequired / Price
Overnightmonitoringofself-care- off siteoronsite,on call(incl 1hrassist) / 01_017_0107_1_1 / Overnighton-callassistancewith, orsupervisionof,personaltasks of daily living. / Each / Y / Quote
Assistancewithself-care-night-timesleepover / 01_010_0107_1_1 / Assistancewith,or supervisionof, personaltasksofdaily livingwhereovernightsupportisneeded,but thecaregivercansleepwhennotrequiredtoprovidesupport. / Each / N / $186.40
Assistancewithself-care-activeovernight / 01_002_0107_1_1 / Assistancewith,or supervisionof, personaltasksofdaily livingwhereovernightsupportisneededandthecaregiverwillnothavetheoptiontosleep / Hour / N / $47.75
Assistancewithself-care-overnight - higherintensity / 01_018_0104_1_1 / Assistancewith,or supervisionof, personaltasksofdaily livingwhereintensiveovernightsupportisneededandthecaregiverwillnothavetheoptiontosleep / Hour / N / $50.42