In 2021, participants and their families, community members and providers were among others who provided over 250 submissions to the NDIA’s APR – 41 of these submissions included feedback regarding group-based supports and their pricing arrangements. Ongoing consultation ensued, followed by several years of transitional pricing arrangements. Effective Friday May 5th, 2023, the NDIS announced a number of changes to the transition plans, including: a six-month extension to the previously established transition date, meaning providers now have until 31st December 2023, to adopt the new pricing model.
We are mindful that different stakeholders use slightly different language to refer to the two pricing models. For ease of understanding, the mention of ‘Transitional’ pricing refers to the ratio-based pricing which currently exists and ‘Apportioned’ pricing refers to the new pricing model with a deadline of 31st December, 2023.
In anticipation of these changes coming into effect, we would like to make you aware of the below workflow in MYP that will allow you to prepare your organisation for the new pricing model.
The information in this article is current as of the 18th October, 2023.
Transitional Pricing vs Apportioned Pricing
Transitional pricing is based on ratios which are reflected within the line item – e.g. one worker : number of participants. In this pricing model, ‘Non face-to-face’ (NF2F) time and ‘Centre Capital Costs’ (CCC) are built in to the price of products, so do not have to be billed in addition. The delivery of supports under this pricing model is valid until 31st December, 2023.
Apportioned pricing will see the removal of ratio-based line items. This pricing model requires each participant involved in the delivery of a group-based service to be charged a portion of the total product value per hour; this portion is to be related to the amount of support actually received from the worker/s. E.g. one worker : number of participants.
‘Non face-to-face’ (NF2F) time and ‘Centre Capital Costs’ (CCC) are not included in the rate as part of the Apportioned pricing model, so are able to be billed in addition to the ‘Face-to-face’ (F2F) supports delivered (if relevant).
NF2F can be billed to each participant in addition to the F2F supports, provided it meets the requirements outlined by the NDIA and has been agreed to by the participant.
CCC can be billed to each participant (it is not apportioned – it is charged per person, per hour) provided that it meets the requirements outlined by the NDIA and has been agreed to by the participant.
Transitional Pricing in Practice
Scenario – Joe, Mary and Tom attend a 4 hour group activity held at the local bowling centre on a Saturday. The support is delivered by 1 support worker to Joe, Mary and Tom together as a group.
In this scenario, each participant would be billed in the following way –
04_170_0136_6_1 Group Activities In A Centre – 1:3 – Standard – Saturday ($40.52 per hour per person)
$40.52 x 4 (hours) = $162.08
No NF2F or CCC are to be billed in addition under the Transitional pricing model.
Apportioned Pricing in Practice
Scenario – Joe, Mary and Tom attend a 4 hour group activity held at the local bowling centre on a Saturday. The support is delivered by 1 support worker to Joe, Mary and Tom together as a group. Each participant has agreed for the support worker to conduct a maximum 30 minutes of Non-Face-To-Face time per group activity, at a 1:1 rate for this support. CCC is not able to be charged for this support as it is conducted in a public space.
In this scenario, each participant would be billed for this group activity using the following line item –
04_104_0136_6_1 Group Activities – Standard – Saturday ($92.12 per hour)
The ratio for this product in Joe, Mary and Tom’s schedules of support in GENIUS would be 1:3, making the price $30.71 per person per hour.
$30.71 x 4 (hours) = $122.84 for the delivery of direct ‘Face-to-face’ (F2F) supports
$92.12 x 0.5 (hours) = $46.06 for the delivery of ‘Non-face-to-face’ (NF2F) supports
Administering Schedule of Support
For all new Schedules of Support, the ratio box within a Schedule of Support will now be activated, which will ensure that the rate of a product is adjusted dependent on the ratio selected. This update means that products in a Price Book will no longer need to be edited to a ‘Fraction Price’ to achieve this same result. Please note that this update is only relevant for all new Schedules of Support. It will not take effect for existing Schedules of Support; existing Schedules of Support can be ‘copied’ to create a new version, or, ‘create new schedule of support’ can be selected.
As demonstrated by the example above, changes to a participants Schedule of Support are likely to be required when converting from the Transitional pricing model to the Apportioned model. Where this is the case, a new Schedule of Support will need to be created, the relevant line item from the Apportioned pricing model entered, and the associated ‘ratio’ selected against each entry.
- ‘Copy’ existing Schedule of Support/Create ‘New’ Schedule of Support
- Select ‘Add Item’
- Select Price Book
- Search for and select ‘Product’
- Select ‘Ratio’
- The ‘Rate $’ of the product will be automatically apportioned based upon the ratio selected
- The ratio selected will be added to the ‘Description’ field to allow simple identification at the Roster level
- Enter ‘Units’
- Enter ‘Frequency’
- Repeat for all required products
- Select ‘Finalise’
Please note: it is recommended to include an additional product entry within the Schedule of Support to account for the delivery of NF2F services at 1:1 ratio (where relevant).
Managing Non-Face-To-Face Delivery
Where NF2F supports are charged at the same rate as the Direct Support, the delivery of NF2F supports can now be accounted for within the ‘Edit Client NDIS Items In Shift’ window in the relevant PocketWatch shift. The two examples below detail how this can be accounted for in a shift that is using either ‘Timesheet Hrs’ or ‘Units’.
- Select ‘Timesheet Hrs’ or Enter required ‘Units’
- Select ‘Apply Non-F2F’ against the relevant line item
- Select ‘Save’
Following the approval of the relevant timesheet, the delivery of NF2F supports will be listed as an additional line item (under ‘Non face-to-face’ claim type) within the invoice/claim.
If you have any queries regarding the information provided above, you can lodge a ticket via the Support Centre, or contact the NDIS directly using the dedicated contact address – GROUP.SUPPORTS.TRANSITION@ndis.gov.au