Price control arrangements for participants with complex needs

New price control arrangements for providers delivering assistance with self-care activities (one-to-one) and assistance to access community, social and recreational activities (one-to-one) are effective 1 February 2019.

There are now three levels of price controls (as opposed to two) as follows:

  • Level 1 – for standard supports
  • Level 2 – for high intensity supports
  • Level 3 – for very high intensity supports

Price controls are linked to the skill level of the worker who delivers the support, in line with the Social, Community, Home Care and Disability Industry Award 2010 (SCHADS Award).

The additional Temporary Support of Overheads (TSO) of 2.5 per cent that was applied to Level 1 (standard) price controls on 1 July 2018 will be extended to Level 2 (high intensity) and Level 3 (very high intensity) price controls from 1 February 2019.

The new price controls are not directly linked to a participant's level of complexity but instead to the skill level of the staff member who delivers each required support.

Providers must be registered under registration group 0104 to be able to charge all levels of high intensity pricing.

  • Providers registered in registration group 0104 are eligible to deliver Level 1 (equivalent to standard), Level 2 (high intensity) and Level 3 (very high intensity). These providers should refer to the tables labelled level 1, 2 and 3 in the Pricing arrangements and price limits.
  • Providers registered under registration group 0107 are registered to deliver standard supports only. These providers should refer to the table in the Pricing arrangements and price limits labelled 'standard'.
  • Price limits outlined in the 'standard' and 'level 1' tables for each of assistance with one-to-one self-care, and access community, social and recreational activities arethe same.

The new pricing arrangements are designed to:

  • enable participants with complex needs to better utilise the funding in their plans to purchase a more appropriate mix of supports, including the ability to mix and match higher and/or lower skilled workers across their support requirements; and
  • better align the price controls that apply to supports with the skill level of the worker who delivers the support.

The price controls indicate the maximum price that can be charged for each level of support. This price is not necessarily the price that is charged – it is the most that can be charged. In many cases, the price charged will be less than this maximum allowable price.

Funding in plans

The level of funding in each participant's plan will continue to be determined by the reasonable and necessary needs of the participant.

Participants are encouraged to discuss with their provider/s how the delivery of their supports can be configured to create the most efficient and effective plan tailored to their needs.

Providers are encouraged to assist participants to configure their supports within plan funding to support the attainment of their plan goals and drive overall efficiency, including the use of higher skilled and/or lower skilled workers according to the level of assistance the participant requires.

It is anticipated that in most cases the total cost of the mix of supports that participants can purchase will not increase as a result of the changes. The number of plan reassessments is therefore expected to be limited.

However where necessary, participants may seek a plan reassessment to ensure their reasonable and necessary needs are met.

In doing so, evidence may be required.

In cases where a plan reassessment is required, the timing of each reassessment will be assessed in line with the NDIA's standard prioritisation process.

Service bookings

Providers and participants are able, by agreement, to create new service bookings under the new price control arrangements from Friday 1 February 2019.

Providers should be aware that claims could be subject to audit. They may be required to provide proof that the staff member who delivered a support that was subject to the "high intensity" or "very high intensity" price control had the appropriate skills or experience.

Group supports

The price controls for group-based supports will not change on 1 February 2019. These price controls will be considered as part of the annual price review.

Frequently asked questions

This page current as of
7 September 2022
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