FOI 24/25-1685 DOCUMENT 9

Knowledge Article - Understand therapy supports

Description

This article provides guidance for all NDIA staff and partners to:

understand therapy supports
add funding for a new therapy support
add funding when the participant has accessed therapy supports before
ask for more or the right type of information
understand when and how to request TAPIB advice
understand any additional considerations
support self-managed participants to make a claim for art or music therapy.

Note: this guidance is for participants aged 9 and older. To learn more about capacity building supports for children younger than 9, go to article EC Early childhood intervention supports overview.

Recent updates

7 April 2026 Linked article name update

24 November 2025 Guidance updated to:

change article name from Guide – Therapy supports
link to Our Guideline – Therapy supports
include content from, and retire, Guide – Therapy supports Appendix B
remove link to, and retire, Guide – Therapy supports Appendix A
let planner delegates know how to apply art and music therapy.

Before you start

You have read and understood:

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Our Guideline – Therapy supports (external)
Our Guideline – Mainstream and community supports (external)
Our Guideline – Reasonable and necessary supports (external)
Our Guideline – Principles we follow to create your plan (external).

Understand therapy supports

Therapy supports are sometimes known as therapeutic supports. They are:

to build or maintain the participant’s skills and independence in their home or community, at school or their place of work
evidence-based supports
delivered by qualified allied health professionals.

You can review the list of evidence-based therapy supports we can and can’t fund and who can deliver them in Our Guideline – Therapy supports.

Add funding for a new therapy support

This section is for planner delegates only

Review the information on the participant’s record to decide whether to add funding for a new therapy support. This information could be an assessment or a letter from an allied health professional. It should give you details of:

the requested therapy support. This includes the reason the participant needs it, the amount and how often they need
how the therapy support will build or maintain the participant’s skills and independence. This includes what the outcomes will be, how they’ll be measured and how long it will take to achieve them
how the therapy support will be best delivered, such as at home, in their community or a clinical setting. This includes how often and for how long they need it. This also includes how the therapist works with the participant’s informal supports to build their skills and capability to implement these supports in different settings over the long term.

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Note: if the information you have doesn’t show how the therapy support will be delivered, you can talk to the participant about this. For example, is the therapy support best delivered individually or in group sessions, as intensive blocks of therapy at regular intervals or a particular therapy or combination of therapies over a certain time. It could also be delivered as part of a multidisciplinary team approach. Think about the participant’s situation, their preferences and what is a reasonable and necessary support for them.

Add funding when the participant has accessed therapy supports before

This section is for planner delegates only

Review the information on the participant’s record, which might have been collected and recorded at the reassessment check-in. The information could be:

a summary of the supports provided
a progress report
a record of the conversation you, or their my NDIS contact, have had with the participant, like at a reassessment check-in.

Review the information to understand what therapy supports the participant has accessed and:

how they’ve helped to improve their skills and independence
how they’ve helped the participant pursue their goals
any measurable gains they’ve achieved or barriers they’ve faced
if they’ve linked in with any informal, community or mainstream supports to help them continue to build these skills at home or in their community.

This will help you decide whether or not you add funding for this type of therapy support in the participant’s next plan. It will also help you decide whether you fund it at the same level or an increased level.

Learn more about plan reassessment reports.

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Ask for more or the right type of information

This section is for planner delegates only

There may be times when the information you have on the participant’s record is incomplete or inconsistent. This means you can’t make a decision to approve the requested support.

If there isn’t enough, or the right type of information to make a decision, you can:
- review other types of evidence provided by the participant
- consider if you need to add funding to pay for more or different types of assessments or reports. Before you do this:
- think about the costs and benefits of the request and how it will help you decide whether or not to include funding for the therapy support
- think about the type of assessment that will likely produce the information you need
- make sure the request aligns with the general principles in the NDIS Act 2013 (external).
If you need to ask the participant to provide more information from their allied health professional, be clear about what you need. The information should include:
- how the therapy support will build or maintain the participant’s skills and independence
- the functional area to be assessed for example, mobility and movement or language and communication
- how the participant’s informal, mainstream and community supports will help them achieve their therapy goals
- how the outcomes will be measured and how long it will take to achieve these outcomes.

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If you’re still unsure whether you have enough or the right information to make a decision, talk to your line manager or ask a practice lead.
If you still can’t resolve the query, follow the process to request Technical Advice and Practice Improvement Branch (TAPIB) advice. Go to mandatory and non-mandatory advice requests.

Understand when and how to request TAPIB advice

This section is for planner delegates only

For some therapy supports, you must request mandatory TAPIB advice before you decide to include this in the participant’s plan as a funded support. This includes all requests for art and music therapy. Learn more about supports that need mandatory TAPIB advice on the Technical Advice and Practice Improvement Branch confluence page.

You can also choose to request non-mandatory TAPIB advice. This could be for a query about funding for a specific therapy support.

For all TAPIB advice requests, you’ll need to:

Create a Technical Advice case, using article Create a technical advice case.
When advice is back from the TAPIB advisor in the Technical Advice case, review and action using article Review and action returned technical advice case.

Understand any additional considerations

This section is for planner delegates only

As part of the usual planning process, you may need to think about the following general considerations. These include:

Does the therapy support meet all the NDIS funding criteria, including that it’s a support we can fund?
Is the therapy support they’ve requested for capacity building or maintenance and how it will be delivered?
Is there a specific reason why you’d need to add or edit plan comments? Before you do this, you must check guidance in article Understand and check plan comments.

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How to apply funding to the first funding period. Learn more in articles Apply custom distribution of funds in a budget update or Apply custom distribution of funds in a plan approval case.
How to record justifications for approved or declined therapy supports using articles Understand support justifications and Record a declined support. This will help you explain your decision.

Learn more about therapy supports in the NDIS Pricing Arrangements and Price Limits (external).

Case study – Arnold’s story

Arnold is 10 years old and has Down Syndrome. He lives at home with his parents and wants to build his verbal communication and mobility skills.

Arnold’s allied health providers recommend a multidisciplinary approach of capacity building therapy support funding as follows:

16 hours in total of occupational therapy to develop strategies to help him build his motor skills. This also includes building his parents’ skills to practice these exercises and games at home.
12 hours in total of speech therapy to build his verbal communication using 1-2 word phrases. This includes support to build his parents’ skills to implement these strategies at home.
7 hours in total of music therapy to build his verbal communication skills and use rhythm of the music to build his motor skills.
Additional recommendations include $300 of low cost assistive technology (AT) to develop communication supports, travel associated with delivery of supports in Arnold’s natural environments and 10 hours of report writing.

As music therapy is a mandatory TAPIB referral, the planner delegate completes a request for mandatory advice and submits it to TAPIB. After a few days, the planner delegate receives the TAPIB advice. TAPIB advises that music therapy is a duplicate of other supports. The therapy goals identified by the music therapist are already included in his other allied health supports.

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Based on this advice, Arnold’s planner delegate approves funding for 36 hours of therapy supports, including 16 hours of occupational therapy, 12 hours for speech therapy, 8 hours of report writing and all the additional recommendations. Funding for music therapy is not included as it would duplicate other supports in his plan.

Support self-managed participants to make a claim for art or music therapy

This section is for all NDIA staff

When the participant submits a claim for art or music therapy under the Capacity Building - Improved Daily Living Skills support category, they’ll need to know that:

they can claim art or music therapy against their own separate line item numbers, at a national price limit outlined in the NDIA Pricing Arrangements and Price Limits. Any equipment or supplies used to deliver the therapy should be included in the cost of the therapy session
they can’t claim art or music therapy against line item ‘Other Professional’
when submitting a claim, they’ll need to write a clear description that this support is art or music therapy. They’ll also need to give us evidence, such as an invoice from their provider. To learn more go to article Support the participant to submit a self-managed claim.

Remember that art or music therapy is different to the participant taking part in art or music classes. If the participant needs support to get ready for, or take part in social and community activities, this can be claimed from their core budget. We can’t fund the cost of the activity or the class.

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Introduction ………………………………………………………………………………………………………………….. 7 Price regulation documents ………………………………………………………………………………………… 7

NDIS Pricing Arrangements and Price Limits ………………………………………………………….. 7
NDIS Support Catalogue ……………………………………………………………………………………… 7
Addenda to the NDIS Pricing Arrangements and Price Limits ……………………………………. 7
NDIS Pricing Arrangements for Specialist Disability Accommodation ………………………….. 8
NDIS Assistive Technology, Home Modifications and Consumables Code Guide …………. 8
NDIS Disability Support Worker Cost Model ……………………………………………………………. 8
Priority of Interpretation ……………………………………………………………………………………….. 8
Applicability of Price Limits …………………………………………………………………………………………. 9
Agency Managed Participants ………………………………………………………………………………. 9
Plan Managed Participants …………………………………………………………………………………. 10
Self-managing Participants …………………………………………………………………………………. 10 Support Purposes, Support Categories and Support Items ……………………………………………. 11
Support Items …………………………………………………………………………………………………………. 11
Support Purposes …………………………………………………………………………………………………… 11
Support Categories aligned to the NDIS Outcomes Framework ……………………………………… 11
Registration Groups ………………………………………………………………………………………………… 12
Units of Measure …………………………………………………………………………………………………….. 13 General Claiming Rules ……………………………………………………………………………………………….. 14
Supports funded by the NDIS ……………………………………………………………………………………. 14
Conflicts of Interest in the NDIS Provider Market………………………………………………………….. 14
Service Agreements ………………………………………………………………………………………………… 14
Service Bookings ……………………………………………………………………………………………………. 15
My providers ………………………………………………………………………………………………………….. 15
Claiming for support items that are subject to quotation ………………………………………………… 16
Claiming for support items that have a price limit …………………………………………………………. 16
Claiming for support items that do not have a price limit ………………………………………………… 17
Time of Day and Day of Week …………………………………………………………………………………… 17
Night-Time Sleepover supports …………………………………………………………………………… 18
Claiming for Telehealth Services ……………………………………………………………………………….. 20
Claiming for Non-direct Services ……………………………………………………………………………….. 20
Non-Face-to-Face Support Provision …………………………………………………………………… 20
Provider Travel …………………………………………………………………………………………………. 21
Short Notice Cancellations …………………………………………………………………………………. 26

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NDIA Requested Reports …………………………………………………………………………………… 27
Claiming for Activity Based Transport …………………………………………………………………………. 28
Activity Based Transport – Social, Economic and Community Participation Supports ….. 28
Activity Based Transport – Capacity Building Supports …………………………………………… 29
Regional, Remote and Very Remote Areas …………………………………………………………………. 30
Modified Monash Model ………………………………………………………………………—————– 30
Pricing Arrangements in Regional, Remote and Very Remote Areas ………………………… 31
Claiming for Group-Based Supports …………………………………………………………………………… 32
Programs of Support ……………………………………………………………………………………………….. 32
Claiming for Centre Capital Costs ……………………………………………………………………………… 34
Claiming for Establishment Fees for Personal Care/Participation Supports ………………………. 34
Claiming for Irregular SIL Supports ……………………………………………………………………………. 36
Claiming for more than one worker or therapist ……………………………………………………………. 36
Shadow Shifts ………………………………………………………………………………………………….. 36
Supervision / Specific Training for Therapy Assistants ……………………………………………. 37
Case Conferences for Therapists ………………………………………………………………………… 37
Other Considerations ………………………………………………………………………………………………. 37
Supports must be Reasonable and Necessary ………………………………………………………. 37
Medicare and Insurance ……………………………………………………………………………………………. 37
Expenses Related to Recreational Pursuits …………………………………………………………… 38
Prepayments ……………………………………………………………………………………………………. 38
Subscription services ……………………………………………………………………………………. 39
Co-payments for Capital items, including Assistive Technology …………………………… 39
Other Fees and Charges ……………………………………………………………………………………. 40
Goods and Services Tax (GST)…………………………………………………………………………… 40 Special NDIS Pricing Arrangements ……………………………………………………………………………… 41
High Intensity Supports ……………………………………………………………………………………………. 41
Implementing Intensive and Complex Behaviour Supports …………………………………………….. 41
Disability-Related Health Supports …………………………………………………………………………….. 41 Core – Assistance with Daily Life …………………………………………………………………………………. 43
Daily Personal Activities …………………………………………………………………………………………… 43
Assistance with Self Care Activities ……………………………………………………………………… 43
Assistance with Self Care Activities – Night-Time Sleepover Support………………………… 44
Assistance from Live-in Carer ……………………………………………………………………… 44
Assistance with Personal Domestic Activities ………………………………………………………… 44
On-Call Overnight Monitoring ……………………………………………………………………………… 45
High Intensity Daily Personal Activities ……………………………………………………………………….. 45
Assistance with Self Care Activities ……………………………………………………………………… 45

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Specialised Home-Based Assistance for a Child ……………………………………………………. 46
Assistance with household tasks ……………………………………………………………………………….. 47
Assistance with Household Tasks ……………………………………………………………………….. 47
Linen Service …………………………………………………………………………………………………… 47
Preparation and Delivery of Meals ……………………………………………………………………….. 47
Assistance with Daily Life Tasks in a Group or Shared Living Arrangement …………….. 49
Assistance in Shared Living Arrangements – Supported Independent Living ……… 49
Short Term Accommodation and Assistance (including the provision of respite care) 52
Medium Term Accommodation (MTA) ………………………………………………………………….. 54
Onsite Shared Supports in SDA ………………………………………………………………………….. 55
Other living arrangements ………………………………………………………………………………….. 55
Individualised Living Options …………………………………………………………………………….. 56
Exploration and Design ……………………………………………………………………………………… 56
Support Model ………………………………………………………………………………………………….. 57
Capacity Building and Training in Self-Management and Plan Management ……………….. 58
Disability Related Health Supports …………………………………………………………………………….. 59
Nursing Supports ……………………………………………………………………………………………… 59
Therapy Supports and Early Childhood Supports …………………………………………………… 61 Core – Transport ………………………………………………………………………………………………….. 63
General Transport …………………………………………………………………………………………………… 63
Specialised Transport ……………………………………………………………………………………………… 63 Core – Consumables ……………………………………………………………………………………………….. 64 Core – Assistance with Social, Economic and Community Participation …………………………. 65
Assistance to Access Community, Social and Recreational Activities ……………………………… 65
Participation in Community, Social and Civic Activities ……………………………………………. 65
Participation in Community, Social and Civic Activities – High Intensity Supports ……….. 66
Community, Social and Recreational Activities ………………………………………………………. 66
Group and Centre Based Activities ……………………………………………………………………………. 67
Group and Centre Based Activities – Standard ……………………………………………………… 67
Group and Centre Based Activities – High Intensity ……………………………………………….. 68
Supports in Employment ………………………………………………………………………………………….. 69
Specialised Supported Employment …………………………………………………………………….. 69 Capital – Assistive Technology ……………………………………………………………………………………. 71 Capital – Home Modifications and Specialist Disability Accommodation ………………………… 72
Home Modifications …………………………………………………………………………………………………. 72
Specialist Disability Accommodation (SDA)…………………………………………………………………. 72

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Capacity Building – Support Coordination ……………………………………………………………………. 73

Level 1: Support Connection …………………………………………………………………………….. 73
Level 2: Coordination of Supports ……………………………………………………………………………… 74
Level 3: Specialist Support Coordination …………………………………………………………………….. 75
Psychosocial Recovery Coaches ………………………………………………………………………………. 76 Capacity Building – Improved Living Arrangements ………………………………………………………. 77
Assistance with Accommodation and Tenancy Obligations ……………………………………………. 77 Capacity Building – Increased Social and Community Participation ……………………………….. 78
Assistance in Coordinating or Managing Life Stages, Transitions and Supports ……………….. 78
Development of Daily Living and Life Skills …………………………………………………………………. 79
Innovative Community Participation …………………………………………………………………………… 79
Community Participation Activities …………………………………………………………………………….. 80 Capacity Building – Finding and Keeping a Job …………………………………………………………….. 81
Employment Related Assessment, Counselling and Advice …………………………………………… 81
Employment Assistance including youth aged 15 to 25 …………………………………………………. 82 Capacity Building – Improved Relationships ………………………………………………………………….. 86
Specialist Behavioural Intervention Support ………………………………………………………………… 86
Individual Social Skills Development ………………………………………………………………………….. 87 Capacity Building – Improved Health and Wellbeing ……………………………………………………… 88
Physical Wellbeing Activities …………………………………………………………………………….. 88
Dietetics ………………………………………………………………………………………………………………… 89 Capacity Building – Improved Learning ……………………………………………………………………… 90
Transition through School and to Further Education ……………………………………………………… 90 Capacity Building – Improved Life Choices …………………………………………………………………… 91
Plan Management – Financial Administration Supports………………………………………… 91 Capacity Building – Improved Daily Living …………………………………………………………………… 92
Early Intervention Supports for Early Childhood Supports – younger than 9 ………………….. 92
Therapy Supports (9 or older) …………………………………………………………………………………… 94
Community Engagement Assistance ……………………………………………………………………. 97
Hearing Supports ……………………………………………………………………………………………………. 98
Multidisciplinary Team Supports ………………………………………………………………………………… 98
Delivery of Disability Related Health Supports by a Nurse …………………………………………….. 99
Specialised Driver Training Support ……………………………………………………………………… 101
Other Supports ……………………………………………………………………………………………………… 102
Assistive Technology Mentors (AT Mentors) ……………………………………………………………… 103
Appendix A: History of Changes ………………………………………………………………………………. 104

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Introduction

The provision of supports for participants in the National Disability Insurance Scheme (NDIS) is subject to regulation by the National Disability Insurance Agency (NDIA) and the NDIS Quality and Safeguards Commission through the provisions of the National Disability Insurance Scheme Act 2013 and its subordinate legislation.

This document, which is called the NDIS Pricing Arrangements and Price Limits, and its associated documents (see below), set out the pricing arrangements and price limits that the NDIA has determined will apply to the provision of supports for participants in the NDIS. The intent of these documents is to assist participants and providers, both current and prospective, to understand the ways in which price controls work in the NDIS. Price regulation is in place to help ensure that participants receive value for money when they purchase the supports that they need.

Price regulation documents

NDIS Pricing Arrangements and Price Limits

This document sets out the general pricing arrangements that apply to all supports in the NDIS and the specific arrangements that apply to individual supports.

NDIS Support Catalogue

This document provides information on the current price limits for each support item and indicates for each price-limited support item the claim types (Travel, non-face-to-face, etc.) that can be used. Requirements specified in the Support Catalogue are part of the pricing arrangements and price limits that the NDIA has determined should apply to NDIS.

The NDIA sometimes deactivates support items. Deactivated support items cannot be used. Before a support is deactivated it is converted into a Legacy Support. These legacy supports are listed in a separate tab of the Support Catalogue for the information of providers and participants. Providers and participants should not create new service bookings for legacy supports. In general, claims for legacy supports should only continue to be made against a service booking if that service booking was in existence at the time the support was turned into a legacy support.

Addenda to the NDIS Pricing Arrangements and Price Limits

These documents allow the NDIA to respond to changing market conditions in an efficient manner. They are used to make temporary changes to some of the support items and arrangements listed in the NDIS Pricing Arrangements and Price Limits. Addenda are not stand-alone documents and must be read in conjunction with the NDIS Pricing Arrangements and Price Limits. Requirements specified in Addenda are part of the pricing arrangements and price limits that the NDIA has determined will apply to NDIS.

NDIS Bereavement Addendum: lists support items that providers can claim after a NDIS participant has died. There are three items in the current Addendum, one for plan managers, one for support coordinators and the other for supported independent living (SIL) providers to use in the event of a participant’s death.

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NDIS Pricing Arrangements for Specialist Disability Accommodation

This document sets out the specific pricing arrangements that apply for Specialist Disability Accommodation (SDA). Providers of SDA supports are also subject to the general arrangements set out in the NDIS Pricing Arrangements and Price Limits.

NDIS Assistive Technology, Home Modifications and Consumables Code Guide

This document gives further information on the specific pricing arrangements that apply for these types of support. Providers of these supports are also subject to the general arrangements set out in the NDIS Pricing Arrangements and Price Limits.

NDIS Disability Support Worker Cost Model

The NDIA uses the Disability Support Worker Cost Model that is described within this document to determine the price limits for supports that are delivered by Disability Support Workers (DSWs). The DSW Cost Model estimates the fully loaded cost of a billable hour of support considering: base pay; shift loadings; leave entitlements; salary on costs; employee allowances; operational overheads (including supervision costs, utilisation costs and workers’ compensation costs); corporate overheads and margin.

The NDIA expects that providers pay their disability support workers in accordance with relevant awards and agreements. Participants should expect that the price for services is in line with the quality and cost of service provision. For example, where providers employ DSWs in line with Social and Community Services Employees section for the SCHADS Industry Award, a price for services at the limit would be justified.

Note: The NDIA is not involved in individual employment disputes or wage negotiations. These matters are governed by industrial law and are a matter for relevant bodies to resolve such as the Fair Work Ombudsman.

Priority of Interpretation

To the extent of any inconsistency between provisions of the various documents that set out the pricing arrangements for the NDIS, priority will be accorded in descending order to:

(a) The NDIS Pricing Arrangements and Price Limits; (b) The NDIS Support Catalogue; (c) Any Addenda to the NDIS Pricing Arrangements and Price Limits; (d) The NDIS Pricing Arrangements for Specialist Disability Accommodation; and (e) The NDIS Assistive Technology, Home Modifications and Consumables Code Guide.

These documents are updated from time to time and are published on the NDIS website: https://www.ndis.gov.au/providers/pricing-arrangements. Participants and providers should always refer to the website version of a document when they are seeking to understand pricing arrangements that apply in the NDIS.

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Applicability of Price Limits

Supports can be subject to price regulation in different ways:

Price controlled supports should only be claimed by a provider from a participant’s plan when they are reasonable and necessary to meet a participant’s needs and are subject to the conditions set out in the NDIS Pricing Arrangements and Price Limits.
Quotable supports should only be claimed by a provider from a participant’s plan if the support is specifically included in the participant’s plan. They are subject to the conditions set out in the NDIS Pricing Arrangements and Price Limits.
Some supports are not subject to price control. These supports should only be claimed by a provider from a participant’s plan when they are reasonable and necessary to meet the participant’s needs. They are subject to the other conditions set out in the NDIS Pricing Arrangements and Price Limits.

In most cases, support items subject to price limits have a single national price limit. In some cases, there are different price limits for different jurisdictions. Higher price limits can apply in remote and very remote areas.

The pricing arrangements do not only set the price limits for supports. They also specify when and how supports can be claimed, including what must have happened for a support to be claimable.

Agency Managed Participants

A provider of a support that is agency managed in a participant’s plan:

Must be a Registered Provider with the NDIS;
Must declare relevant prices and conditions to participants before delivering a service, including any notice periods or cancellation terms; and
Must adhere to the arrangements prescribed in the NDIS Pricing Arrangements and Price Limits, including ensuring that their prices do not exceed the price limits.

The NDIA does not set the prices that providers charge participants. Each provider must agree the price for each support with each participant, subject to the price limits and pricing arrangements that are imposed by the NDIA.

Providers should not indicate in any way to participants that the prices that they charge are set by the NDIA.

In general, providers should not charge NDIS participants more for a support than they would charge anyone else for the same support. If the price a provider offers to a NDIS participant is different to that which they would offer to a person who was not an NDIS participant, then the provider should ensure that the participant is aware of this difference and the reasons for the difference.

Providers are required to acknowledge compliance with the NDIS Pricing Arrangements and Price Limits and its associated documents when submitting a payment request through the myplace Provider Portal.

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Plan Managed Participants

Plan managers must adhere to the arrangements prescribed in the NDIS Pricing Arrangements and Price Limits, including ensuring that the prices charged by providers do not exceed the price limits. This rule applies regardless of whether the participant purchases the support from a registered or an unregistered provider.

Plan managers must provide the Australian Business Number (ABN) of the service provider who delivers the support for all payment requests. The NDIA will only accept payment requests without an ABN if the service provider is exempt from quoting an ABN under Australian Taxation Office (ATO) rules. Exempt providers must complete the ATO’s Statement by a Supplier form which can be found on the ATO’s website: https://www.ato.gov.au/uploadedFiles/Content/MEI/downloads/Statement by a supplier.pdf. Plan managers are expected to keep a copy of the completed form.

Plan managers must always ensure that a valid tax invoice is included with relevant information about the goods/services purchased for all payment requests. A plan manager may be liable to pay back any amount not spent in accordance with a participant’s plan.

Plan managers are required to acknowledge compliance with the NDIS Pricing Arrangements and Price Limits and its associated documents when submitting payment requests through the myplace Provider Portal.

Self-managing Participants

Self-managing participants can use registered or unregistered providers and are not subject to the price limits or other pricing arrangements set out in the NDIS Pricing Arrangements and Price Limits and its associated documents.

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General Claiming Rules

Registered Providers can only make a claim for payment for a support once they have delivered or provided that support. Where price limits apply to a support, prices charged to participants must not exceed the price limit prescribed for that support in the NDIS Pricing Arrangements and Price Limits. Providers are responsible for ensuring that the claims for payment that they make accurately reflect the supports delivered, including the frequency, volume and type of support. Claims need to be made against the specific support item that aligns to the service delivered. Falsifying claims for payment is a serious compliance issue and may result in action against the provider. Providers are also required to keep accurate records of claims, which are subject to audit.

Supports funded by the NDIS

Participants can only use their NDIS funds for items listed as NDIS supports. There is also a list of things NDIS funding that are not NDIS supports. In some circumstances participants may be able to request a substitution from the replacement support list. Refer to the NDIS website for further information about NDIS supports: https://www.ndis.gov.au/understanding/supports-funded-ndis.

Conflicts of Interest in the NDIS Provider Market

In line with the NDIA Position Statement on Conflicts of Interest in the NDIS Provider Market, providers are expected to make all efforts to avoid conflicts of interest. They should declare all conflicts of interest when they occur and be open with participants, their supports, or representatives with any conflicts of interest and associated risks and discuss options to manage these risks. Providers should document strategies for monitoring conflicts of interest.

The Position Statement states the limited circumstances where a conflict of interest may be unavoidable. In such cases, providers should complete a Conflict of Interest Declaration Form. The Position Statement, Conflict of Interest Declaration Form and supporting resources are on Conflicts of Interest in the NDIS Provider Market page of the NDIS website: www.ndis.gov.au/providers/provider-compliance/conflicts-interest-ndis-provider-market.

For more information, providers can refer to the NDIA Position Statement on Conflicts of interest in the NDIS provider market: https://www.ndis.gov.au/media/7385/download?attachment.

Service Agreements

A Service Agreement is a formal agreement between a participant and provider. They help to ensure there is a shared understanding of:

Expectations of what supports will be delivered and how they will be delivered; and
The respective responsibilities and obligations of the provider and the participant and how to resolve any problems that may arise.

Service Agreements should be simple and set out how and when supports will be delivered. They can include information such as:

What supports and services the provider has agreed to provide;
The prices of those supports and services;
How, when and where the supports and services are provided;

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General Claiming Rules

The duration of the Service Agreement and when and how the Agreement will be reviewed;
How the participant or the provider may change or end the Service Agreement;
How any problems or issues that may arise will be handled;
Participant responsibilities under the Service Agreement; and
Provider responsibilities under the Service Agreement.

Providers should not seek to impose conditions on participants through Service Agreements that are not in line with those set out in the NDIS Pricing Arrangements and Price Limits and its associated documents.

Service Bookings

Service bookings are used to set aside funding in a participant’s plan for a registered provider for a support they will deliver. Service bookings can be made by the participant or provider in the myplace portal. Providers claim payments against the service booking in the myplace portal. Each service booking sets out the specific support items or support category delivered and period of service delivery within the plan dates. Service bookings are not the same as service agreements.

The Agency recommends that service bookings should be created at the category level, where possible. This allows providers and participants to negotiate or access supports on a more flexible basis, especially for on-the-spot assessments or less predictable support needs. A provider must have a service booking in place to make a payment claim in the Portal. Further information can be found on the NDIS website: https://www.ndis.gov.au/providers/working-provider/myplace-provider-portal-and-resources.

My providers

NDIS Plans in our PACE system don’t have service bookings.

“My providers” are the providers a participant regularly works with and records as part of their NDIS plan.

By recording a provider, participants are letting us know that a provider can receive payments for claims on their NDIS plan.

Being recorded as my providers means less administration and time spent chasing details and following up claims. This is because my providers claims are generally paid within 2 to 3 days.

Participants can still choose to use any provider, however if a claim is made by a provider who is not recorded as my providers, we’ll check with the participant or their nominee by SMS to confirm the claim is for a NDIS support they agreed to.

Only participants who have a plan developed in the PACE system need to record my providers.

Participants or their nominees with a plan in the PACE system need to tell us who their my providers are when they have:

NDIA-managed supports funded within their NDIS plan.
Specialist disability accommodation, home and living supports and/or behaviour supports.
A plan manager. Only the plan manager needs to be recorded as a my provider.

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A Public Holiday Support is any support to a participant that starts at or after midnight on the night prior to a Public Holiday and ends before or at midnight of that Public Holiday (unless it is a Night-time Sleepover Support).
A Saturday Support is any support to a participant that starts at or after midnight on the night prior to a Saturday and ends before or at midnight of that Saturday (unless it is a Public Holiday or Night-time Sleepover Support).
A Sunday Support is any support to a participant that starts at or after midnight on the night prior to a Sunday and ends before or at midnight of that Sunday (unless it is a Public Holiday or Night-time Sleepover Support).
A Weekday Support is any other support:
- For Disability Support Workers:
  - A Weekday Daytime Support is any support to a participant that starts at or after 6:00 am and ends before or at 8:00 pm on a single weekday (unless it is a Public Holiday or Night-time Sleepover Support).
  - A Weekday Evening Support is any support to a participant that starts at or after 8:00 pm and finishes at or before midnight on a single weekday (unless it is a Public Holiday or Night-time Sleepover Support).
  - A Weekday Night Support is any support to a participant that commences at or before midnight on a weekday and finishes after midnight on that weekday, or commences before 6:00 am on a weekday and finishes on that weekday (unless it is a Public Holiday, Saturday, Sunday or Night-time Sleepover Support).
- For Nurses delivering Nursing Supports:
  - A Weekday Daytime Support is any support to a participant that commences before 12.00 noon on a Weekday and finishes on the same day (unless it is a Public Holiday, Weekday Evening, or Weekday Night Support).
  - A Weekday Evening Support is any support to a participant that commences not earlier than 12.00 noon on a Weekday and finishes after 6.00 pm on the same day (unless it is a Public Holiday Support).
  - A Weekday Night Support is any support to a participant that commences on or after 6.00 pm on a Weekday and finishes before 7.30 am on the following day (unless it is a Public Holiday Support).

If a support to a participant does not meet one of the above criteria, then it needs to be billed as two or more separate supports. An exception to this general rule occurs when a particular support crosses a shift boundary and the same worker delivers the entire support. In this case, the higher of the relevant price limits applies to the entire support and the provider should make the claim against the relevant support item. Providers are required to discuss this billing arrangement with the participant.

Night-Time Sleepover supports

This support provides a participant with assistance with, or supervision of, personal tasks of daily life where overnight support is needed, but the caregiver can sleep when not required to provide support. This support applies to any day of the week and on public holidays. This support item includes up to two hours of active supports provided to the participant for the duration of the period.

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Providers may claim for the third or additional hour at Saturday rates on weekdays, or at applicable rates on other days (Saturday, Sunday or Public Holidays).

Note: there is no night-time sleepover support item for nurses.

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Claiming for Telehealth Services

Telehealth can be used to deliver direct supports where appropriate and with the agreement of the participant.

Providers can only claim Telehealth Services where the following conditions are met:

The delivery of the support by telehealth is appropriate; and
The proposed charges for the activities comply with the NDIS Pricing Arrangements and Price Limits and with the Service Agreement with the participant; and
The activities are part of delivering a specific disability support item to that participant (rather than a general activity such as enrolment, administration or staff rostering); and
The provider explains the activities to the participant, including why they represent the best use of the participant’s funds (that is, the provider explains the value of these activities to the participant); and
The provider has the agreement of the participant in advance (that is, the service agreement between the participant and provider specifies that Telehealth services can be claimed).

Providers have a duty of care to their participants to ensure they are providing the same standard of care through video technology as in a clinical setting.

Claims for Telehealth Services should be made using the relevant support item as indicated in NDIS Pricing Arrangements and Price Limits by using the “Telehealth Services” option in the myplace Provider Portal.

Claiming for Non-direct Services

Non-Face-to-Face Support Provision

Providers can only claim from a participant’s plan for the Non-Face-to-Face delivery of a support item if all of the following conditions are met:

The NDIS Pricing Arrangements and Price Limits indicates that providers can claim for Non-Face-to-Face Support Provision in respect of that support item; and
The proposed charges for the activities comply with the NDIS Pricing Arrangements and Price Limits and with the Service Agreement with the participant; and
The activities are part of delivering a specific disability support item to that participant or in the case of group-based supports, are required to enable the group support to be delivered (rather than a general activity such as enrolment, administration or staff rostering); and
The provider explains the activities to the participant, including why they represent the best use of the participant’s funds (that is, the provider explains the value of these activities to the participant); and
The provider has the agreement of the participant in advance (that is, the service agreement between the participant and provider specifies that Non-Face-to-Face supports can be claimed).

For example, the Assistance with Self Care support items are described as covering activities “Assisting with, and/or supervising, personal tasks of daily life to develop skills of the participant to

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live as autonomously as possible”. Therefore, time spent on Non-Face-to-Face activities that assist the participant – for example, writing reports for co-workers and other providers about the client’s progress with skill development – could be claimed against this support item.

The costs of training and up-skilling staff, and of supervision, are included in the base price limits for supports and are not considered billable Non-Face-to-Face supports. However, research undertaken by a capacity-building provider specifically linked to the needs of a participant and to the achievement of the participant’s goals may be billable as a Non-Face-to-Face support with the participant’s prior agreement.

Service agreements with each client can ‘pre-authorise’ these activities, but providers should only claim a support item from a participant’s plan if they have completed activities that are part of the support for that participant. Charging a fee that is not linked to completed activities is not permitted.

Time spent on administration, such as the processing of NDIS payment claims for all clients, should not be claimed from a participant’s budget as a Non-Face-to-Face support. The NDIS price limits include an allowance for overheads, including the costs of administration tasks. Examples of administrative activities that are covered by the overhead component of the support price limits and that should not be billed as Non-Face-to-Face supports include, but are not limited to:

Pre-engagement visits;
Developing and agreeing Service Agreements;
Entering or amending participant details into system;
Making participant service time changes;
Staff / participant travel monitoring and adjustment;
Ongoing NDIS plan monitoring;
Completing a quoting tool;
Making service bookings; and
Making payment claims.

The fee charged for Non-Face-To-Face supports must be reflective of the needs of the participant in the context of the relevant support, and in agreement with the participant.

Claims for Non-Face-to-Face supports are made using the relevant support item, using the “Non-Face-to-Face” option in the myplace portal.

Provider Travel

Providers can only claim travel costs from a participant’s plan when delivering a support item if all the following conditions are met:

The NDIS Pricing Arrangements and Price Limits indicates that providers can claim for Provider Travel for that support item; and
The proposed charges for the activities comply with the NDIS Pricing Arrangements and Price Limits; and
The activities are part of delivering a specific disability support item to that participant; and
The primary support is delivered directly (face-to-face) to the participant; and

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The provider explains the activities to the participant, this includes why the activities represent the best use of the participant’s funds (that is, the provider explains the value of these activities to the participant); and
The participant has agreed to the travel costs in advance (that is, the Agreement between the participant and provider should specify the travel costs that can be claimed); and
The provider is required to pay the worker delivering the support for the time spent travelling because of the agreement under which the worker is employed; or the provider is a sole trader and is travelling from their usual place of work to or from the participant, or between participants.

Provider Travel – Labour Costs (Time)

The NDIA uses the Modified Monash Model (MMM) to classify locations based on remoteness and population size, categorising them into MMM1 (major cities) to MMM7 (very remote areas). The NDIA modifies the classification of some locations to enable service delivery in isolated areas to support service delivery.

When a provider claims for labour costs (travel time) related to a support, they can claim for up to 30 minutes of travel to and from each participant in MMM1-3 areas and up to 60 minutes in MMM4-5 areas for each eligible worker. This is known as a travel time limit. The MMM classification is based on where the participant is when the support is delivered. More information can be found on page 30.

In addition to the above travel, providers delivering core and capacity-building supports can also claim for travel time from the last participant to their usual place of work but only if they must pay their worker for the return travel time and this is subject to the relevant travel time limit.

If a worker travels to provide services to multiple participants during the same trip, the travel time (including return travel where applicable) can be divided among the participants. This division should be agreed upon with each participant in advance as part of their Service Agreement. Travel time claims must be made separately from the primary support claim using the same line item and the “Provider Travel” option in the myplace Provider Portal. The hourly rate for travel claims should be the same as the rate agreed for the primary support, or lower if agreed with the participant.

For therapy supports providers, including early childhood therapy, the price limit for provider travel time is 50% of the regular price limit for these items. For example, if a speech pathologist travelled for 1 hour in an MMM5 area to deliver support to a participant, the maximum claimable for this travel time component would be $97.00 (which represents 50% of the direct hourly price limit of $193.99). This does not impact the amount that can be claimed for non-labour costs.

The price limit for travel for providers delivering therapeutic supports in Remote (MMM6) and Very Remote (MMM7) areas are subject to existing loadings for 40% and 50% respectively.

Providers cannot claim for travel if they have already claimed for a support that has travel costs built in.

Provider Travel (in Remote and Very Remote Areas)

In Remote (MMM6) and Very Remote (MMM7) areas, providers delivering core and capacity building supports may enter specific arrangements with participants to cover travel costs, up to the relevant hourly rate for the support item. For providers delivering therapeutic supports, the price limit for provider travel time is 50% of the respective loaded price limit (40% loading for Remote,

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Short Notice Cancellations

Where a provider has a Short Notice Cancellation (or no show), they can claim up to 100% of the agreed fee associated with the activity from the participant’s plan, subject to the NDIS Pricing Arrangements and Price Limits and the terms of the service agreement with the participant.

Providers can only claim from a participant’s plan for a Short Notice Cancellation of the delivery of a support item to the participant if all of the following conditions are met:

Short Notice Cancellation – 2 clear business days

This policy typically applies to non-DSW supports where a participant has provided less than two (2) clear business days’ notice of cancellation for a support, or if a participant does not show up for a scheduled support within a reasonable time or is not present at the agreed place within a reasonable time when the provider is travelling to deliver the support.
The NDIS Pricing Arrangements and Price Limits document indicates that providers can claim for a Short Notice Cancellation – 2 clear business days, in respect of that support item.
Providers may choose to waive the short notice cancellation fee at their discretion (this may relate to the individual circumstances of the participant) or offer better terms of a notice period from their own policies.
The provider was not able to find alternative billable work for the relevant worker and, if not a sole trader/partnership, are required to pay the worker for the time that would have been spent providing the support
Providers should document the terms of short notice cancellations polices in participant service agreements.

Short Notice Cancellation – 7 days

This policy typically applies to DSW supports where a participant has provided less than seven (7) days’ notice of cancellation for a support for a support, or if a participant does not show up for a scheduled support within a reasonable time or is not present at the agreed place within a reasonable time when the provider is travelling to deliver the support.
The NDIS Pricing Arrangements and Price Limits document indicates that providers can claim for a Short Notice Cancellation - 7 days, in respect of that support item.
The provider was not able to find alternative billable work for the relevant worker and, if not a sole trader/partnership, are required to pay the worker for the time that would have been spent providing the support
Providers may choose to waive the short notice cancellation fee at their discretion (this may relate to the individual circumstances of the participant) or offer better terms of a notice period from their own policies.
Providers should document the terms of short notice cancellations polices in participant service agreements.

For supports delivered to a group of participants, if a participant cancels their attendance and if the provider is unable find another participant to attend the group session in their place then, if the other requirements for a Short Notice Cancellation are met, the provider is permitted to bill the participant who has made the short notice cancellation at the previously agreed rate that they would have billed if the participant had attended the group session. All other participants in the group should also be billed as though all participants had attended the group.

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When a support is provided directly to a participant, and the worker delivering the support is at the same location as the participant, the price limit that applies to the support is determined by the location of the participant at the time of service. For example, if a participant living in a Remote location visits a provider to receive a service, the support is subject to the price limit that applies to that location – not the Remote price limit.

When a support is provided directly to a participant via telehealth, the price limit that applies to the support should, in general, be the price limit that would apply if the participant was receiving the support at the place that the person who is delivering the support is located at the time of service. However, participants in Remote or Very Remote areas can agree that those price limits should apply to the support if they are satisfied that the support provides value for money.

When a support is not provided directly (for example, Non-Face-to-Face Support Provision or NDIA Requested Reports) then the price limit that applies to the support is the price limit that would apply if the participant was receiving the support at the place that the person who is delivering the support is located at the time of service delivery.

Claiming for Group-Based Supports

When a support item is delivered to more than one person at the same time (a group of people) then, unless the NDIS Pricing Arrangements and Price Limits states otherwise, the price limit for each participant is the applicable price limit set out in the relevant support table divided by the number of people in the group. Providers should make a claim for each participant using the relevant support item. Each claim should be for the total time of the support but is subject to the lower price limit as set out above.

Providers can only claim for supports that are related to the reasonable and necessary needs of a participant. Where a participant attends a group-based session then a provider should only claim for the time of more than one worker against that participant’s plan if all those workers were involved in the direct support of the participant for the time claimed.

Programs of Support

A provider of group-based supports in any of the following categories can enter into an agreement with a participant for a “program of support”, especially where the program is towards the achievement of a specified outcome:

Any support in the Assistance in Shared Living Arrangements – Supported Independent Living section of the Assistance with Daily Life Support Category;
Any support in the Assistance with Social, Economic and Community Participation Support Category, including Supports in Employment; and
Any support in any Capacity Building Support Category.

Under this approach, providers claim against the plans of all the participants who had agreed to attend an instance of support in the program of support as though they had attended (whether or not they did) – as long as the provider had the capacity to deliver the support. Supports delivered as part of a program of supports are not subject to the short notice cancellation rules.

Note: Providers in Registration Group 0118 (Early Intervention Supports for Early Childhood) can include 1:1 supports in a program of support but only where these are provided in combination with group supports.

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Programs of support must be no longer than six months (unless specifically allowed for in the NDIS Pricing Arrangements and Price Limits; where a Program of Support is longer than 12 weeks, providers must ensure that participants have an opportunity to regularly review their program of support. Participants must be able to exit from a program of supports without cost, subject to a notice period of no more than two (2) weeks. Providers and participants can agree to a new Program of Support at any time.

Where a participant stops attending an agreed program of support but does not provide a notice, a provider may only continue claiming for a total of four (4) consecutive weeks from when the participant stopped attending. This is considered an unplanned exit. A provider is not able to continue to claim past four (4) consecutive weeks of non-attendance, unless the participant notifies the provider during that period that they wish to continue in the Program of Support.

Providers who offer programs of support must enter into an agreement with each participant specifying the program of support, including its length, exit rules and intended outcomes. These agreements must be consistent with the NDIS Pricing Arrangements and Price Limits. In particular, providers cannot pre-claim for programs of support. Each instance of support in the program of support has to be delivered before the provider can claim for that instance of support.

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Claiming for Irregular SIL Supports

Irregular SIL Supports are intermittent or unplanned events that disrupt supports initially planned for in the SIL plan budget. Examples of situations where Irregular SIL Supports would be required include a participant falling ill or the cancellation of a day program, so that participants are in their home and require SIL supports for a period that was not initially planned and rostered for.

Claims for Irregular SIL supports are made using the relevant support item, using the “Irregular SIL Support” option in the myplace portal.

SIL Providers are only permitted to claim from a participant’s plan for Irregular SIL Supports if all of the following conditions are met:

The NDIS Pricing Arrangements and Price Limits indicates that providers can claim for Irregular SIL Supports in respect of that support item;
The proposed charges for the activities comply with the NDIS Pricing Arrangements and Price Limits;
Where the SIL activity does not sit within the definition of a Regular SIL Supports;
The provider works with the participant and/or their nominee to explain why Irregular SIL Supports are required, and the other options available; and
The provider has agreement from the participant and/or their nominee to claim for the support before a payment request is made (i.e., the service agreement between the participant and the provider should specify that Irregular SIL Supports can be claimed when required).

In contrast, Regular SIL supports (claimed as Direct Services) are considered as those planned for as part of a usual week in the SIL plan budget, via an agreement with the participant and provider based on the levels of care that can be provided within the approved SIL budget.

The SIL Operational Guideline provides more detail about the types of services that are included and excluded from the provision of SIL supports.

Claiming for more than one worker or therapist

Sometimes a participant requires assistance from more than one worker or therapist at the same time. In these cases, the provider is entitled to bill for the time spent providing the support by all workers and therapists involved in delivering the support. Examples of cases where this may occur include:

Shadow shifts that allow new workers to be introduced to a participant who has complex individual support needs so that they can understand their support needs and patterns;
Supervision of, or specific training for, therapy assistants by the supervising therapist as part of the handover of the support delivery to the participant by the therapist to the therapy assistant;
Case conferences between therapists about the specific support needs of a participant.

Shadow Shifts

Shadow shifts may be claimed where the participant has complex individual support needs that are best met by introducing a new worker to the participant before it is reasonable that they commence providing the support independently – for example, where the specific individual support needs

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include very limited communication; behaviour support needs; and/or medical needs/procedures such as ventilation or Home Enteral Nutrition (HEN).

Where the individual would require shadow shifts to assist with the introduction of new workers, and this is the desired method by the participant or their family, the provider may claim for up to 6 hours of weekday support per year.

Supervision / Specific Training for Therapy Assistants

Level 1 Therapy Assistants can only deliver support under the direct supervision of a therapist. Level 2 Therapy Assistants can deliver supports under indirect supervision but may require specific training in the needs of the participant from the therapist before they take responsibility for the delivery of the therapy.

In these cases, it is appropriate for the provider to bill for the time spent by both the therapist and the therapy assistant. This arrangement can represent value for money for the participant compared to the alternative of all supports being delivered by the supervising therapists.

Case Conferences for Therapists

Therapists, especially in rural and remote areas, may benefit from a case conference with other therapists about the specific care needs of a participant. In these cases, it is appropriate for the provider to bill for the time spent by all therapists on the case conference.

Other Considerations

Supports must be Reasonable and Necessary

The NDIS provides funding to participants for supports and services aimed at increasing their independence, inclusion, and social and economic participation.

Supports funded by the NDIS need to:

Be related to the participant’s disability;
Not include day-to-day living costs that are not related to a participant’s disability support needs;
Represent value for money; and
Be likely to be effective and beneficial to the participant.

Providers should not claim for supports from a participant’s plan where the support is not in line with the participant’s goals, objectives and aspirations as set out in their plan or where the support is not reasonable and necessary. Providers should also not claim for supports from a participant’s plan where the support is more appropriately funded or provided through other service systems. Further information on when a support is considered reasonable and necessary can be found on the NDIS website: https://www.ndis.gov.au/providers/becoming-ndis-provider/am-i-ready/supports-and-services-funded-ndis.

Medicare and Insurance

Some elements of a participant’s care may be covered by funds outside the NDIS. These expenses are commonly medical, including those covered by private health insurance or Medicare. These medical expenses are not funded under the NDIS, even if they are related to, or a symptom

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of, the disability. These expenses should be claimed under the relevant health care scheme or insurance policy. Some providers (e.g., therapists) may need to distinguish between the health services and disability supports that they provide to a single client, and make separate payment claims to, for example, Medicare and the NDIS.

Providers should not claim payment from participant’s plans for:

Expenses related to recreational pursuits, such as event tickets for the participant, as they are not covered by the NDIS; or
The cost of entry for a paid support worker to attend a social or recreational event.

Prepayments

In general, Registered Providers can only make a claim for payment once a service booking has been created and the support has been delivered or provided.

For higher cost supports, the cost of the support may be claimed in stages in some circumstances, and before the support is finally delivered to the participant.

Prepayments represent funds paid in advance of the provider delivering the agreed support to the participant. Sometimes providers require prepayment(s) as collateral and/or to cover their expenses to source, build or tailor the support to meet the participant’s unique needs.

In general, prepayments should only be sought where a business will incur unrecoverable costs should delivery of the support to the requesting participant not proceed (e.g., a custom-made support).

Prepayments are subject to all the following conditions:

The support item is an assistive technology (including vehicle modification), or a home modification;
The support item value exceeds $1,500 or is custom made to address the participant’s disability related requirements, and a valid quote has been provided and accepted by the participant (or their nominee);
a service agreement between the provider and participant (or nominee) outlines the requirement of a prepayment (e.g., deposit) or milestone payments, in line with normal business practice; and
The final payment of not less than 10% of the total cost, may not be claimed until the participant has received the support ready for use.

A participant is entitled to a refund of any balance of prepayment(s) less the actual unrecoverable expense incurred by the business to that point when supply is terminated. The participant remains fully entitled to their rights under Australian Consumer Law in all circumstances.

Prepayments can be claimed by providers for a support where that support is specifically identified as eligible for prepayments in the NDIS Pricing Arrangements and Price Limits. Other supports may be eligible for prepayment where the NDIA has given prior written approval (including conditions) to the registered provider to claim for prepayments.

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Subscription services

In some cases, a provider may claim for a service agreed with a participant using a subscription model of payment. In these cases, the participant is paying to be able to use that service (on the terms/hours agreed) for the period of the subscription. Subscriptions may only be used for the supply of the following supports: Consumables (Support Category 03) and Assistive Technology (Support Category 05).

Providers wanting to claim for a subscription-based service must make sure that:

A plain English service agreement has been accepted by the participant, that makes clear to the participant the service and its costs (including any extra fees), as well as reasonable exit conditions.
The maximum price limit for a subscription is $5,000 per annum.
Subscriptions are to be charged monthly (paid at or before the start of the service period). Small subscriptions, where the annual cost is not more than $1,500, may be charged less frequently (quarterly or annually). For example, if a subscription service cost $199 per year, it could be charged for just once per year.
There are no penalties (for example exit fees) should a participant wish to cancel a subscription (with reasonable one month’s notice) on or prior to the end of the paid subscription period.
Invoices for the subscription to be paid, clearly describe the supports for the participant to be delivered/available during the subscription period. For monthly subscriptions, participants may agree in writing to be billed quarterly (in advance of the quarter) but must be refunded any unused months if they cancel the subscription with due notice (as stated above).

High value subscription claiming applies where the bundle of available Assistive Technology Products that a participant can access at any time is more than $15,000.

Under high value AT, all the conditions of the subscription services apply, with exception to the maximum price limit, which is set to $10,000 per annum.

Additional payments are permitted for high value AT subscriptions as follows:

a) freight and in-home technical setup costs may be claimed at the commencement of the subscription;

b) removal, and return to provider’s agent nearest to the participant’s residence, of the supplied AT at the end of the subscription (which may coincide with the death of the participant); and

c) each such claim under a) or b) shall not exceed one (1) month’s subscription fee or $600, whichever is less.

Co-payments for Capital items, including Assistive Technology

In general, providers are not permitted to request a co-payment by the participant for a support. However, where a participant would like a customisation to a support or assistive technology that is not considered reasonable or necessary, they are required to pay for these themselves. These may include an aesthetic customisation to an assistive technology or modifications to a vehicle that are additional to the assistive components.

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Other Fees and Charges

All registered providers must not add any other charge to the cost of the supports they provide to any participant, such as credit card surcharges, or any additional fees including any ‘gap’ fees, late payment fees or cancellation fees, unless otherwise permitted by the NDIS Pricing Arrangements and Price Limits. Participants are generally not required to pay exit fees, even when changing provider’s part way through a plan. A core principle of the NDIS is choice and control for participants, allowing them to change providers without expense.

Goods and Services Tax (GST)

Many, but not all, NDIA supports provided to NDIS participants are GST-free. Further information about the NDIS and GST can be accessed on the Australian Taxation Office website: www.ato.gov.au/businesses-and-organisations/gst-excise-and-indirect-taxes/gst/in-detail/your-industry/gst-and-health/national-disability-insurance-scheme. Providers should seek independent legal or financial advice if they require assistance with tax law compliance. If GST is applicable to a support, the price limit is inclusive of GST.

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High Intensity Supports

A support is considered High Intensity if it is provided to a participant that is one or more of the supports set out in Schedule 2 - Module 1: High intensity daily personal activities of the National Disability Insurance Scheme (Provider Registration and Practice Standards) Rules 2018: https://www.legislation.gov.au/F2018L00631/latest/text.

Implementing Intensive and Complex Behaviour Supports

A support is considered Intensive and Complex Behaviour Support if it is implemented with a participant who, during the course of service provision:

displays frequent behaviours of concern that have a significant effect on their or others’ wellbeing and safety; and
requires intensive support and the implementation of intensive proactive strategies (frequent/daily), skill development, and response strategies, which may include the use of restrictive practices to minimise the risk of harm to themselves or others; and
may, or is likely to, be experiencing other issues that exacerbate or increase the complexity of their behaviour support needs.

To deliver this support to a participant the provider must:

be implementing behaviour support (as described above) with the participant and in accordance with their interim or comprehensive behaviour support plan; and
be registered and assessed for Module 2A (Implementing Behaviour Support Plans); or
have submitted a registration amendment application or new registration application to the NDIS Quality and Safeguards Commission including a completed audit assessment against Module 2A by 30 June 2025.

Note: plan managed participants must use a provider who has completed Module 2A during the provision of intensive and complex behaviour supports or when delivering restrictive practices.

The NDIS will fund disability-related health supports where these supports directly relate to a participant’s significant and permanent functional impairment and assist them to undertake activities of daily living. These supports are provided individually to participants and can be provided in a range of environments, including, but not limited to, the participant’s own home.

Participants are not permitted to claim for health supports from their plans when those health supports do not relate to their disability and when they do not require health supports on a regular basis. Those health supports will continue to be provided by the health system. Additionally, if a participant’s support needs become acute, that support should be provided in a hospital or another health setting by the relevant state/territory health care system or private health system and not be claimed from the participant’s plan.

The list below provides an indication of the majority of disability-related health supports that may be required by NDIS participants; however, it is not an exhaustive list. Disability-related health supports are expected to assist in areas such as:

Dysphagia: for participants who have trouble eating, drinking or swallowing on a daily basis.

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Special NDIS Pricing Arrangements

Respiratory: for participants requiring help with their breathing and maintenance of their respiratory health, including any associated care, comfort, planning or supports
Nutrition: for participants requiring help with the way they eat or understanding the food they need.
Diabetes: for participants who have daily problems with how much sugar is in their blood.
Continence: for participants who need daily assistance with toileting (bladder and bowel).
Wound & Pressure Care: for participants who need daily wound and pressure care (resulting from pressure wounds or swollen limbs).
Podiatry: for participants who require help looking after their feet, ankles and lower limbs.
Epilepsy: for participants who need daily help managing the way epilepsy affects the way their brain and nerves work.
Botox and Splinting: It is unlikely Botox and splinting supports will be reasonable and necessary to include in a plan, as these are generally provided in a clinical setting.

Five types of disability-related health supports have been identified in the NDIS Support Catalogue:

Provision of Disability-Related Health Supports by Disability Support Workers – these supports should be claimed using the standard Daily Personal Activities and High Intensity Daily Personal Activities support items;
Assessment, planning and the provision of Disability-Related Health Supports by therapists these supports should be claimed using the standard early childhood and Therapy support items;
Assessment, planning and the provision of Disability-Related Health Supports by nurses – these supports should be claimed using the new nursing support items;
Consumables related to Disability Related Health Supports – these supports should be claimed using the new Low-Cost or High-Cost Disability Related Health Consumables support line items; and
Assistive Technology related to Disability Related Health Supports – these supports should be claimed using the new Disability Related Health Assistive Technology support line items.

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Core – Assistance with Daily Life

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Nursing Supports

These Disability-Related Health Supports provide nursing care to respond to the disability-related health needs of a participant where that care is not the usual responsibility of the health system. They have been duplicated into the Assistance with Daily Life Support Category so that participants can have greater access to these supports if they need them. See page 99 for further information on these support items.

These support items can be delivered to individual participants or to groups (see Claiming for Group-Based Supports) subject to the rules set out in the NDIS Pricing Arrangements and Price Limits. In particular:

The enrolled nurse support items should be used when the nurse who delivered the support would be classified as an Enrolled nurse under the Nurses Award 2020 (A.4) if they were classified under that Award. An enrolled nurse is a person who provides nursing care under the direct or indirect supervision of a registered nurse. They have completed the prescribed education preparation, and demonstrated competence to practice under the Health Practitioner Regulation National Law as an enrolled nurse in Australia. Enrolled nurses are accountable for their own practice and remain responsible to a registered nurse for the delegated care.
The registered nurse support items should be used when the nurse who delivered the support would be classified as a Registered nurse – level 1 (RN1) under the Nurses Award 2020 (A.5.1) if they were classified under that Award. Under the Award, a registered nurse is a person who has completed the prescribed education preparation, demonstrates competence to practice, and is registered under the Health Practitioner Regulation National Law as a registered nurse in Australia.
The clinical nurse support items should be used when the nurse who delivered the support would be classified as a Registered nurse – level 2 (RN2) under the Nurses Award 2020 (A.5.2) if they were classified under that Award. Under the Award, a clinical nurse is a more experienced and skilled registered nurse. Duties of a clinical nurse will substantially include, but are not confined to, delivering direct and comprehensive nursing care and individual case management to a specific group of patients or clients in a particular area of nursing practice.
The clinical nurse consultant support items should be used when the nurse who delivered the support would be classified as a Registered nurse – level 3 (RN3) or higher under the Nurses Award 2020 (A.5.3) if they were classified under that Award. Under the Award, a clinical nurse consultant is a nurse practicing in the advanced practice role. Advanced practice nursing is a qualitatively different level of advanced nursing practice to that of the registered nurse due to the additional legislative functions and the regulatory requirements. The requirements include a prescribed educational level, a specified advanced nursing practice experience, and continuing professional development.
The nurse practitioner support items should be used when the nurse who delivered the support would be classified as a Nurse Practitioner under the Nurses Award 2020 (A.7) if they were classified under that Award. Under the Award, a nurse practitioner is an advanced practice nurse endorsed by the Nursing and Midwifery Board of Australia who has direct clinical contact and practices within their scope under the legislatively protected title ‘nurse practitioner’ under the Health Practitioner Regulation National Law.

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Core – Consumables

Consumables are a support category available to assist participants with purchasing everyday use items. Supports such as Continence and Home Enteral Nutrition (HEN) products are included in this category.

Information on the pricing arrangements for Consumables can be found in the Assistive Technology and Consumables Code Guide on the NDIS website: www.ndis.gov.au/providers/pricing-arrangements.

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Core – Assistance with Social, Economic and Community Participation

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Supports in Employment

While some participants, with supports offered through DES or employer reasonable adjustment, will successfully maintain work, others will need higher intensity support delivered in the workplace to maintain employment. These supports can be used in a range of employment settings including: private, government or not for profit organisations; a social enterprise or similar environment; self-employment or a micro-business; or a family run business.

Specialised Supported Employment

These support items are for participants who are employed and who are less independent in performing their work tasks or need frequent prompting and coaching to stay on track, communicate with others, or manage their behaviours.

Supports may be provided one to one or within a group-based setting, complimenting existing or expected employer supports, and claimed according to the intensity and frequency of supports delivered to achieve employment goals. Supports can include:

on the job assessments related to the impact of a person’s disability on their ability to work;
job customisation;
on-the-job training and intermittent support with daily work tasks;
direct supervision and/or group-based support to enable meaningful participation at work;
physical assistance and personal care delivered in the workplace;
supports to manage disability-related behaviour or complex needs at work; and
non face-to-face activities that are directly related to supporting a participant’s employment.

These support items can be delivered to individual participants or to groups subject to the rules set out in the NDIS Pricing Arrangements and Price Limits. If a support item is delivered to a group then the price limit for each participant is the hourly rate divided by the number of people in the group. Providers should make a claim for each participant using the relevant support item. Each claim should be for the total time of the support but is subject to the price limit as set out below.

As well as direct service provision, these support items can be used to claim for:

Non-Face-to-Face Support Provision
Provider Travel
Short Notice Cancellation – 7 days

Providers of these supports can also claim for the costs of:

Provider Travel – Non-Labour Costs using the support item 04_799_0133_5_1
Activity Based Transport – Social, Economic and Community Participation Supports using support item 04_821_0133_6_1
Centre Capital Costs using support item 04_599_0133_5_1, when the support is provided in a centre rather than in the community.

These support items are subject to price limits as set out in the following table. Different price limits apply depending on the Time of Day and Day of Week when the support is delivered.

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Capital – Assistive Technology

This support category includes all aids or equipment supports that assist participants to live independently or assist a carer 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 the sale of an item) is funded through a capacity building support.

Information on the pricing arrangements for Assistive Technology can be found in the Assistive Technology, Home Modifications and Consumables Code Guide on the NDIS website: www.ndis.gov.au/providers/pricing-arrangements.

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Capital – Home Modifications and Specialist Disability Accommodation

This support category includes Home Modifications and Specialist Disability Accommodation (SDA) supports.

Home Modifications

Home modifications include design, construction, installation of, or changes to, equipment or non-structural components of the building, and installation of fixtures or fittings, to enable participants to live as independently as possible or to live safely at home.

Information on the pricing arrangements for Home Modifications can be found in the Assistive Technology and Consumables Code Guide on the NDIS website: www.ndis.gov.au/providers/pricing-arrangements.

Specialist Disability Accommodation (SDA)

Specialist Disability Accommodation (SDA) refers to accommodation for participants who require specialist housing solutions to assist with the delivery of supports that cater for their extreme functional impairment and/or very high support needs.

Information on the pricing arrangements for Specialist Disability Accommodation can be found in the NDIS Pricing Arrangements for Specialist Disability Accommodation on the NDIS website: www.ndis.gov.au/providers/housing-and-living-supports-and-services/specialist-disability-accommodation/sda-pricing-and-payments.

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Capacity Building – Support Coordination

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Level 3: Specialist Support Coordination

This support is delivered utilising an expert or specialist approach, necessitated by specific high complex needs or high level risks in a participant’s situation. Specialist Support Coordination is delivered by an appropriately qualified and experienced practitioner to meet the individual needs of the participant’s circumstances such as a Psychologist, Occupational Therapist, Social Worker, or Mental Health Nurse. Specialist Support Coordination is expected to address complex barriers impacting a participant’s ability to implement their plan and access appropriate supports. Specialist Support Coordinators assist participants to reduce complexity in their support environment, and overcome barriers to connecting with broader systems of supports as well as funded supports.

Specialist Support Coordinators are expected to negotiate appropriate support solutions with multiple stakeholders and seek to achieve well-coordinated plan implementation. Specialist Support Coordinators will assist stakeholders with resolving points of crisis for participants, assist to ensure a consistent delivery of service and access to relevant supports during crisis situations.

Specialist Support Coordination is generally delivered through an intensive and time limited period necessitated by the participant’s immediate and significant barriers to plan implementation. Depending on individual circumstances, a Specialist Support Coordinator may also design a complex service plan that focusses on how all the stakeholders in a participant’s life will interact to resolve barriers and promote appropriate plan implementation. Once developed, a Specialist Support Coordinator will continue to monitor the plan, but it may be maintained by one of the participant’s support workers or other care supports.

Specialist Support Coordination includes, but is not limited to

Understand the Plan;
Connect with Supports and Services;
Design Support Approaches;
Establish Supports;
Coach, Refine, Reflect;
Targeted Support Coordination;
Crisis: Planning, Prevention, Mitigation and Action;
Address Complex Barriers;
Design Complex Service Plan;
Build Capacity and Resilience; and
Report to the NDIA.

This support item can be delivered to individual participants subject to the rules set out in the NDIS Pricing Arrangements and Price Limits.

As well as direct service provision, these support items can be used to claim for:

Non-Face-to-Face Support Provision
Provider Travel
Short Notice Cancellation – 2 clear business days
NDIA Requested Reports

Providers of this support can also claim for the costs of:

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Capacity Building – Finding and Keeping a Job

The supports in this support category help participants to find and keep employment.

This support is designed to provide employment related assessment, counselling and advice to assist participants successfully engage in work. Functional and/or workplace assessments and employment related counselling may benefit participants who have, for example, experienced traumatic injury or exacerbation of an existing disability and need significant support to develop a new or modified work pathway.

These assessments can be useful for participants who have limited work experience to assist in identifying their unique barriers to employment and to inform a work goal and development plan. The support may also be used to assist with adjustments to work processes or workplaces that enable a participant to be productive and work safely.

Note: if a participant is employed and on award wages, a workplace assessment is available through the Employment Assistance Fund administered by JobAccess and is a free service to employers. These assessments inform employers about modifications to work processes or workplaces and/or equipment to enable an employee to perform their work safely.

This support item can be delivered to individual participants subject to the rules set out in the NDIS Pricing Arrangements and Price Limits. In particular: these support items can only be delivered by one of the following allied health professionals:

Occupational Therapist – A person who has a current Australian Health Practitioner Regulation Agency (AHPRA) Registration as an Occupational Therapist.
Psychologist – A person who has a current AHPRA Registration as a Psychologist. This includes paid provisionally registered Psychologists operating under supervision.
Physiotherapist – A person who has a current AHPRA Registration as a Physiotherapist.
Vocational Rehabilitation Counsellor with the relevant qualifications recognised by their professional association.
Speech Pathologist - A person who is a Certified Practising Speech Pathologist as approved by Speech Pathology Australia.
Developmental Educator - A person has a bachelor’s degree or higher and has current full membership with Developmental Educators Australia Inc.
Other Professionals – A person who is not one of the types of professionals listed above but who the provider considers to be an appropriate professional to deliver Employment related assessment, counselling and advice in line with the NDIS Quality and Safeguarding Commission’s requirements for the Therapeutic Supports Registration Group.

In line with the General Claiming Rules, providers need to make claims against the support item that most accurately reflect the support provided.

This means that where a line item exists for a specific type of professional, supports of that type need to be made against that item.

For example, Speech Pathology Therapy must be claimed using the Speech Pathologist Therapist line item, not under ‘Other Professional’ or any other listed professional.

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Capacity Building – Improved Daily Living

This support category includes assessment supports, training supports, strategy development supports, and therapeutic supports (including Early Intervention Supports for Early Childhood) to assist the development of, or to increase, a participant’s skills and their capacity for independence and community participation.

Early Intervention Supports for Early Childhood Supports – younger than 9

These support items provide capacity building supports in early childhood, including key worker, to assist a child (younger than 9) with developmental delay or disability and their family or carers in home, community, and early childhood education settings, to work towards increased functional independence and social participation. It is expected that the supports are delivered in line with the NDIS Commission’s NDIS Practice Standards and Quality Indicators for Early Childhood Supports.

These support items can also be used for the assessment, planning, and delivery of Disability-Related Health Supports where these supports directly relate to a participant’s significant and permanent functional impairment and assist them to undertake activities of daily living.

These support items can delivered to individual participants or to groups (see Claiming for Group-Based Supports) subject to the rules set out in the NDIS Pricing Arrangements and Price Limits. These support items can only be delivered by the following types of professionals (therapy assistants must operate under delegation and supervision)

Art Therapist – A person who is a Professional Member with the Australian, New Zealand and Asian Creative Arts Therapy Association (ANZACATA).
Dietitian – A person who is an Accredited Practising Dietitian with the Dietitians Australia
Other Early Childhood Intervention Professional – A person who does not meet the definitions of the other professions listed but has a bachelor’s degree or higher in their relevant area and holds current registration or membership with their relevant registration and or professional body. It is expected that the person delivers supports in line with the NDIS Commission’s NDIS Practice Standards and Quality Indicators for Early Childhood Supports.
Developmental Educator – A person who has a bachelor’s degree or higher and has current full membership with Developmental Educators Australia Inc.
Early Childhood Teacher or Educator – A person who has a bachelor’s degree or higher in Early Childhood Education or Special Education, who where applicable has a current registration or accreditation with their state or territory’s relevant professional body.
Occupational Therapist – A person who has a current Australian Health Practitioner Regulation Agency (AHPRA) Registration as an Occupational Therapist.
Social Worker – A person who is a member of the Australian Association of Social Workers.
Speech Pathologist – A person who is a Certified Practising Speech Pathologist as approved by Speech Pathology Australia.
Exercise Physiologist – A person who is an Accredited Exercise Physiologist with Exercise and Sports Science Australia.

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Capacity Building – Improved Daily Living

These support items can be delivered to individual participants or to groups (see Claiming for Group-Based Supports) subject to the rules set out in the NDIS Pricing Arrangements and Price Limits. In particular, these support items can only be delivered by the following types of professionals, and by therapy assistants operating under the delegation and supervision of one of the following types of professionals:

Art Therapist – A person who is a Professional Member with the Australian, New Zealand and Asian Creative Arts Therapy Association (ANZACATA).
Audiologist – A person who is either currently certified as an Audiology Australia Accredited Audiologist by Audiology Australia or as a Full Member as an audiologist with the Australian College of Audiology.
Counsellor – A person who is either a member of the Australian Counselling Association or an accredited Registrant with the Psychotherapy and Counselling Federation of Australia, or a person who is an AHPRA provisionally registered psychologist operating as a paid unsupervised practitioner can claim using this line item.
Developmental Educator – A person who is a Full Member of Developmental Educators Australia Inc.
Dietitian – A person who is an Accredited Practising Dietitian with the Dietitians Australia.
Exercise Physiologist – A person who is an Accredited exercise physiologist with Exercise and Sports Science Australia.
Music Therapist – A person who is an Active “Registered Music Therapist” with the Australian Music Therapy Association.
Occupational Therapist – A person who has a current Australian Health Practitioner Regulation Agency (AHPRA) Registration as an Occupational Therapist.
Orthoptist – A person who has current registration with the Australian Orthoptic Board.
Physiotherapist – A person who has a current AHPRA Registration as a Physiotherapist.
Podiatrist – A person who has a current AHPRA Registration as a Podiatrist.
Psychologist – A person who has a current AHPRA Registration as a Psychologist. This includes paid provisionally registered Psychologists operating under supervision.
Rehabilitation Counsellor – A person who is member of the Australian Society of Rehabilitation Counsellors Inc. or equivalent.
Social Worker – A person who is a member of the Australian Association of Social Workers.
Speech Pathologist – A person who is a Certified Practising Speech Pathologist (CPSP) as approved by Speech Pathology Australia.
Other Professional – A person who is not one of the types of professionals listed above but who the provider considers to be an appropriate professional to deliver therapeutic supports in line with the NDIS Quality and Safeguarding Commission’s requirements for the Therapeutic Supports Registration Group.

Note: Therapists who do not meet the above definitions but who have been accepted by an approved quality auditor of the NDIS Commission as having the relevant qualifications, expertise and experience should use the “Other Professional” support item.

In line with the General Claiming Rules, providers need to make claims against the support item that most accurately reflect the support provided.

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Capacity Building – Improved Daily Living

These Disability-Related Health Supports provide nursing care to respond to the disability-related health needs of a participant where that care is not the usual responsibility of the health system.

The enrolled nurse support items should be used when the nurse who delivered the support would be classified as an Enrolled nurse under the Nurses Award 2020 (A.4) if they were classified under that Award. An enrolled nurse is a person who provides nursing care under the direct or indirect supervision of a registered nurse. They have completed the prescribed education preparation and demonstrated competence to practice under the Health Practitioner Regulation National Law as an enrolled nurse in Australia. Enrolled nurses are accountable for their own practice and remain responsible to a registered nurse for the delegated care.
The registered nurse support items should be used when the nurse who delivered the support would be classified as a Registered nurse – level 1 (RN1) under the Nurses Award 2020 (A.5.1) if they were classified under that Award. Under the Award, a registered nurse is a person who has completed the prescribed education preparation, demonstrates competence to practice, and is registered under the Health Practitioner Regulation National Law as a registered nurse in Australia.
The clinical nurse support items should be used when the nurse who delivered the support would be classified as a Registered nurse – level 2 (RN2) under the Nurses Award 2020 (A.5.2) if they were classified under that Award. Under the Award, a clinical nurse is a more experienced and skilled registered nurse. Duties of a clinical nurse will substantially include, but are not confined to, delivering direct and comprehensive nursing care and individual case management to a specific group of patients or clients in a particular area of nursing practice.
The clinical nurse consultant support items should be used when the nurse who delivered the support would be classified as a Registered nurse – level 3 (RN3) or higher under the Nurses Award 2020 (A.5.3) if they were classified under that Award. Under the Award, a clinical nurse consultant is a nurse practicing in the advanced practice role. Advanced practice nursing is a qualitatively different level of advanced nursing practice to that of the registered nurse due to the additional legislative functions and the regulatory requirements. The requirements include a prescribed educational level, a specified advanced nursing practice experience, and continuing professional development.
The nurse practitioner support items should be used when the nurse who delivered the support would be classified as a Nurse Practitioner under the Nurses Award 2020 (A.7) if they were classified under that Award. Under the Award, a nurse practitioner is an advanced practice nurse endorsed by the Nursing and Midwifery Board of Australia who has direct clinical contact and practices within their scope under the legislatively protected title ‘nurse practitioner’ under the Health Practitioner Regulation National Law.

As well as direct service provision, these support items can be used to claim for:

Non-Face-to-Face Support Provision
Provider Travel

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Knowledge Article - Understand therapy supports

Description

Recent updates

Before you start

Understand therapy supports

Add funding for a new therapy support

Add funding when the participant has accessed therapy supports before

Ask for more or the right type of information

Understand when and how to request TAPIB advice

Understand any additional considerations

Case study – Arnold’s story

Support self-managed participants to make a claim for art or music therapy

Contents

Introduction

Price regulation documents

NDIS Pricing Arrangements and Price Limits

NDIS Support Catalogue

Addenda to the NDIS Pricing Arrangements and Price Limits

NDIS Pricing Arrangements for Specialist Disability Accommodation

NDIS Assistive Technology, Home Modifications and Consumables Code Guide

NDIS Disability Support Worker Cost Model

Priority of Interpretation

Applicability of Price Limits

Agency Managed Participants

Plan Managed Participants

Self-managing Participants

General Claiming Rules

Supports funded by the NDIS

Conflicts of Interest in the NDIS Provider Market

Service Agreements

General Claiming Rules

Service Bookings

My providers

General Claiming Rules

Night-Time Sleepover supports

General Claiming Rules

General Claiming Rules

Claiming for Telehealth Services

Claiming for Non-direct Services

Non-Face-to-Face Support Provision

General Claiming Rules

Provider Travel

General Claiming Rules

Provider Travel – Labour Costs (Time)

Provider Travel (in Remote and Very Remote Areas)

General Claiming Rules

Short Notice Cancellations

Short Notice Cancellation – 2 clear business days

Short Notice Cancellation – 7 days

General Claiming Rules

Claiming for Group-Based Supports

Programs of Support

General Claiming Rules

General Claiming Rules

Claiming for Irregular SIL Supports

Claiming for more than one worker or therapist

Shadow Shifts

General Claiming Rules

Supervision / Specific Training for Therapy Assistants

Case Conferences for Therapists

Other Considerations

Supports must be Reasonable and Necessary

Medicare and Insurance

General Claiming Rules

Expenses Related to Recreational Pursuits

Prepayments

General Claiming Rules

Subscription services

Co-payments for Capital items, including Assistive Technology

General Claiming Rules

Other Fees and Charges

Goods and Services Tax (GST)

Special NDIS Pricing Arrangements

High Intensity Supports

Implementing Intensive and Complex Behaviour Supports

Disability-Related Health Supports

Special NDIS Pricing Arrangements

Disability Related Health Supports

Nursing Supports

Core – Consumables