What is NDIS PAPL?

Written By Christian Halliley

For new participants and providers entering into the NDIS, understanding the Pricing Arrangements and Price Limits or PAPL can often cause great confusion - we have tried to simply it for you:

What is NDIS PAPL:

The NDIA (The Agency that implements NDIS) is responsible for setting the price limits for the supports and services that providers deliver to participants within the NDIS.

PAPL is a pricing guide that also includes a support catalogue that lists all available supports and services that providers can charge participants for the specific supports they deliver. Under this guide, the price limit for each stated service is the maximum amount that can be charged, and for Plan Managed participants, the amount that is charged cannot exceed this limit whether the support is delivered from a registered or unregistered provider.

Let’s dive a bit deeper into PAPL:

1. Provider supports can be subject to price regulation in a number of ways

  • Price controlled supports - Most supports delivered to NDIS participants fall under this category and should only be claimed by a provider from a participants plan when they are reasonable and necessary to meet the participants needs and are subject to the price limits set out in PAPL.

  • Quotable supports - Can only be claimed by a provider if the support is specifically included in the participants plan and approved by the NDIA. Quotable supports are subject the conditions set out in PAPL.

  • Supports that aren’t subject to Price Control - These supports can only be claimed when they are deemed Reasonable and necessary (R&N) to meet the participants needs. There are additional conditions that needs to be met as described in PAPL.

2. Support Purposes

NDIS participant plans are allocated to 3 separate support purposes as identified in PAPL:

  • CORE - Activities of Daily Living and includes a very wide range of supports and services.

  • CAPITAL - This includes items such as Assistive technology, equipment, home/vehicle mods or Specialist Disability Accommodation (SDA)

  • CAPACITY BUILDING - Supports that enable a participant to build their independence and skills.

Further to the support purposes, participants budgets are further broken down into a support category level (we will explore these support categories in a future blog).

3. Units of measurement

Every support or service delivered to an NDIS participant can be measured by the one of the following units:

  • Each

  • Hour

  • Daily

  • Week

  • Month

  • Annual

PAPL outlines with unit of measure is appropriate against each line item as stated.

4. General Claiming Rules

  • Providers can only claim for a payment for a support or service once it has been provided. Once the support is delivered, providers are responsible for ensuring that the claims for payments are appropriately made against the particular support item that has been delivered.

  • Teleheath Services - Providers can only claim Telehealth services when the following conditions are met:

    • The delivery of telehealth is appropriate

    • The proposed charges for the activities comply with PAPL

    • The activities are part of delivering a specific disability support item to the participant (rather than a broad and generic service)

    • The provider informs the participant as to the value of the activities

    • The provider and the participant have agreed on the Telehealth service (per the Service Agreement)

5. Specific Claiming Rules

  • Prepayments - Typically, higher cost supports may be claimed in stages and before the support is finally delivered or provided. There are number of conditions that are required to be met before claiming prepayments:

    • The items must be Assistive Technology or a Home Modification

    • The support items value exceeds $1,500 or is bespoke to meet the participants disability requirements

    • A service agreement has been completed between the provider and the participant and a valid quote has been provided and accepted

    • Where a final payment is more than 10% of the total cost, the participant must have received the support ready to use before the amount can be claimed

    In the unforeseen circumstances that a supply is terminated, the participant may be entitled to a refund of any prepayment balances.

  • Subscriptions - Subscriptions may only be used under the following supports:

    a) Consumables (support category 03)

    b) Assistive Technology (support category 05)

    To claim a subscription service, the following conditions should be in place:

    • A Service Agreement has been accepted by the participant which outlines the costs of the subscription, what the subscription entails and any reasonable exit conditions

    • The maximum price is $5,000 per annum

    • Larger subscriptions are to be charged monthly. For all annual subscriptions under $1,500, they may charged less frequently (quarterly or annually)

    • Should a participant wish to cancel the subscription the provider can include reasonable exit period, however, may not charge any penalty fees

    • The invoices for the subscription must clearly outline the services to be delivered to the participant during the subscription period

      In limited circumstances, high value subscription claiming may apply (maximum price limit of $10,000 per annum) if the participant has been approved for Assistive Technology above $15,000

6. Non-Direct Services:

  • Non-Face-to-Face Supports (NFTFS)- Some common NFTFS may include:

    • Writing reports for participants indicating skills and daily life progress as required

    • Specific research by Capacity Building providers linked to the participant and their goals

  • Providers can only claim Non-Face-to-Face Supports when the following conditions are met:

    • PAPL indicates that providers can claim for that particular support

    • The provider and the participant have agreed on the service (per the Service Agreement)

    • The activities are part of delivering a specific disability support item to the participant (rather than a broad and generic service)

    • The provider informs the participant as to the value of the activities

  • Travel

    Providers can only claim Non-Face-to-Face Supports when the following conditions are met:

    • PAPL indicates that providers can claim for that particular support

    • The activities are part of delivering a specific disability support item to the participant (rather than a broad and generic service) and the support is delivered directly (face-to-face)

    • The provider informs the participant as to the value of the activities

    • The provider and the participant have agreed on the Travel costs (per the Service Agreement)

    • The provider is required to pay the worker delivering the support for the time they were travelling per their employment agreement (also applies to sole-traders)

Labour Costs - The maximum amount of travel time that a provider can claim travelling to each participant is 30 minutes (60 minutes in remote areas). Providers delivering Core and Capacity Building are also entitled to claim and additional 30 minutes (60 minutes in remote areas) when they travel from their last participant back to their usual place of work. When delivering services to multiple participants in a region, then the provider should reasonable apportion that travel time (including return travel) against all participants who received support.

Non-Labour Costs - If a provider incurs additional expenses when travelling (road tolls, parking, running costs of the vehicle) then they can negotiate with the participant for a contribution towards these expenses. PAPL indicates that a vehicle owned by a provider can claim up to $0.99 per kilometre travelled and for all other associated costs the provider can claim up the full amount.

7. Cancellation Charges

Should a participant cancel their appointment/meeting at short notice, a provider may be able to claim the full agreed fee of the activity from the participants plan.

Providers can only claim Short Notice Cancellation charges when the following conditions are met:

a. Non-DSW Support (2 clear business days)

  • Where a participant has cancelled or failed to show up to an appointment with less than 2 business days notice

  • PAPL indicates that the provider can claim for short notice cancellation

  • The provider was not able to find alternative billable work due to the cancellation and are required to pay the worker for the time

  • The provider and the participant have agreed on the Short Notice Cancellation terms (per the Service Agreement)

b. DSW Support (7 clear business days)

  • Where a participant has cancelled or failed to show up to an appointment with less than 7 business days notice

  • PAPL indicates that the provider can claim for short notice cancellation

  • The provider was not able to find alternative billable work due to the cancellation and are required to pay the worker for the time

  • The provider and the participant have agreed on the Short Notice Cancellation terms (per the Service Agreement)

Claims for Short Notice Cancellation are made using the same support item under PAPL should the support have been delivered, however, the support type will be marked as ‘Cancellation’.

8. Price Changes Based on Location

The location of participant can change the prices that a provider charges for their services. To determine whether a support is being delivered to a regional, remote or very remote area, the NDIA use the what is called a Modified Monash Model (MMM). The MMM determines areas based on size, population and locality.

In general, the more remote the location the higher then price limit to deliver supports and can include Telehealth and NF2FS.

PAPL provides a link to Department of Health’s website that can help determine the MMM rating of a particpants location.

Key Takeaways of PAPL:

  • PAPL sets prices that providers can charge for supports and services

  • PAPL includes the descriptive support line items that providers can charge against

  • Prices are updated annually (NDIA regularly makes adjustments to supports throughout the year so it is worth regularly checking the NDIS website)

  • Providers cannot exceed the stated amount for services when Plan Managed

  • PAPL breaks the support purposes down into 3 categories (all supports and services will be included in one of the below):

    • CORE

    • CAPITAL

    • CAPACITY BUILDING

  • A providers claim is required to be entered against one of the support outlined in PAPL

  • Providers can generally only claim once the service or support is delivered, however, there are specific scenarios where a provider can claim prepayments or subscriptions before the service has been delivered

  • Late cancellation of a providers service may result in a full agreed fee if the provider is unable to find alternative work

  • Providers can claim travel expenses in accordance with the prices and rates set out in PAPL

  • Prices may vary depending on location of participant

  • PAPL is updated annually, however, there are often amendments to supports, so it is worth regularly checking the NDIS website for updates: https://www.ndis.gov.au/providers/pricing-arrangements

Please note, this information is general in nature and should not be solely relied upon before making a decision regarding supports delivered under PAPL.

For further information regarding NDIS PAPL please don’t hesitate to contact Managing Director, Christian Halliley:

E: Christian@adaptplanmanagement.com.au

P: 0416 112 369

Christian Halliley