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Who Sets Provider Service Rates?

Despite changing the name from ‘Price Guide’ to ‘Pricing Arrangements and Price Limits’ in 2022, there is still some contention as to who sets the rate a provider will charge a participant for a support or service. So, who really makes the prices and do participants have a say in what they are charged?


Two people in conversation
Two people in conversation

Who decides the price for supports and services?


Although the NDIA set a price limit (essentially the maximum price a provider can charge for a service), they don’t set the actual price a participant will pay. This is up to the provider and the participant.


Typically providers will decide their own prices based on the cost of delivering supports and services. They cannot charge you more than the limit set by the NDIA but often providers will charge whatever the limit is.


For example: The maximum rate for 01_011_0107_1_1 Assistance with self-care activity is $62.17 per hour. Which means, a provider could charge anything up to $62.17.


Top tip: larger provider businesses typically charge the maximum rate because they have additional costs that need to be covered (i.e., admin costs). For some participants, it might be beneficial to consider a smaller provider.


What are the Pricing Arrangements & Price Limits?


The Pricing Arrangements and Price Limits are designed to let providers know the maximum price they can charge for their services. They can also help participants better understand and manage their budgets.


The NDIS Pricing Arrangements and Price Limits document is broken up into three parts:

  • Support purpose

  • Support categories

  • Line items

Support Purpose & Support Categories


There are three support categories (or purposes) that make up and NDIS plan – Core Capital, and Capacity Building.


Core Supports: help with everyday activities and community access.


Capital Supports: fund Assistive Technology (AT) and/or Home Modifications.


Capacity Building Supports: help to build skills and independence in daily life, and help you pursue your goals. Plan Management support is allocated under this support category under Improved Life Choices.


There are a total of 15 support categories.


Support Items (also known as line items)


Line items are codes that help to identify which funding category supports will be paid from.


Each support item has a unique reference number based on the below structure:


Support Category > Sequence number > Registration Group > Outcome Domain > Support Purpose


For example:

Support Category

Sequence Number

Registration Group

Outcome Domain

Support Purpose

01

013

0107

1

1

Top tip: A provider should never indicate to a participant that the price they set is decided by the NDIA. The Pricing Arrangements and Price Limits only shows the maximum rate.


Why it’s important to understand the Pricing Arrangements & Price Limits


As a participant, you can negotiate the rate with your service provider. This is best done when you are initially engaging their services and creating a service agreement with your provider.


When you know what the maximum price a provider can charge is, you will be better equipped to gauge what that support or service is actually worth. You can do this by shopping around. Find out what other providers are charging for the same supports and services and use this as evidence to negotiate a better rate.


If you feel like a provider, registered or unregistered is charging an unreasonable amount for their services, a disability advocate, or your support coordinator (if you have one) can help on your behalf. Having a NDIS plan doesn’t mean you should be charged more. You have a right to a fair rate.


Top tip: when searching for a provider, consider what their qualifications are and the price they are charging for their services and compare them to ensure you are getting the support you need for a good price.


How we can help


When our accounts team receive an invoice, we check the price against the NDIS Pricing Arrangements and Price Limits to ensure that providers are claiming within the limits.


If you need help to better understand the Pricing Limits and Price Arrangements, you can contact our team or speak with your support coordinator or LAC.


Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

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