What to Do When Your NDIS Provider Increases Their Rates

Key information:

• Provider rate increases are common and often linked to NDIS pricing updates, wage changes and rising business costs.
• Your provider should be able to explain any increase clearly, including how it affects your service agreement and funding.
• If your plan is agency-managed or plan-managed, your provider generally can’t charge above NDIS pricing limits.
• If a new rate feels too high, check your agreement, compare providers and ask questions before agreeing to the change.

It’s common for NDIS providers to increase their rates over time. However, if you’re unsure about whether the new price is justified, you can:

1. Check the new rate against the latest NDIS pricing guide
2. Review your service agreement 
3. Ask your provider why things are changing

In any case, there should be a clear explanation for why rates have increased and what that means for you.

Why do NDIS providers increase their rates?

It’s almost always linked to the following:

1. Annual updates to NDIS Pricing Arrangements and Limits

Every year on 1 July, the NDIS publishes an update to the Pricing Arrangements and Price Limits (PAPL – previously known as the Price Guide) after their annual review. They may also update this throughout the year if needed, to reflect latest policy and market conditions.

This impacts the maximum rate providers can charge you under the NDIS.

2. Wage increases (such as SCHADS Award changes)

The Fair Work Commission (FWC) also regularly reviews wage rates for various sectors, including recently for disability support workers under the Social, Community, Home Care and Disability Services Industry (SCHADS) Award.

This impacts the minimum rates at which many support workers are paid and is different from the provider rates in the PAPL.

3. Rising business costs

Providers must account for the costs of running their business. That includes things like superannuation, insurances, administrative, compliance and operational costs. This means certain things that aren’t technically part of the NDIS system, but are part of the wider market, can impact what different providers must charge.

Do all provider rates need to follow the PAPL?

If your plan is NDIA managed (agency managed, as opposed to self-managed or plan managed), you can only engage registered NDIS providers charging rates in line with the PAPL. However, not all plan management styles are the same.

• For agency-managed or plan-managed participants, rates must not be over the NDIS pricing limits.
• Self-managed participants can have more flexibility to negotiate rates with providers.

Related: NDIS Self Managed vs Plan Managed vs Agency Managed Explained

Reviewing your service agreement

Rate increases should not be a surprise at billing time. Your service agreements should outline how these changes happen, including:

• Pricing clauses
• Notice periods for changes
• Potential additional costs such as cancellation fees

Checking for changes beyond the price

NDIS updates often include more than just pricing. When the PAPL is updated, it can also impact what is and isn’t funded – as well as rules around service delivery like activity-based transport and minimum shift lengths. Some updates will impact what is and isn’t considered a NDIS support, or the funding mechanism for various supports.

It’s important to note that while the NDIA sets these price limits, they don’t decide on actual prices for providers – other factors may be involved. Getting the full picture can help to understand why changes are happening, and how they’ll impact your NDIS supports going forward. 

Speaking to your provider about the increase

Proactive communication can go a long way! If you’re concerned about rate increases, you can ask your provider questions like:

• Why has the rate increased?
• Is this the same price everyone is paying – and if not, what is the reason?
• Have any service terms changed?
• Does the service agreement need updating?

A good provider will be happy to explain the changes to you, so you can make informed decisions about what you want to do next with your available funding.

What if the new rates seem too high?

Talking to your provider is a good first step. This can help you understand the new rates and how they apply to the support you’re purchasing.

If you’re not happy with the outcome after speaking to your provider, you can:

1. Double check the right support item is being used, and that everything is being billed correctly.
2. Check the price against other providers – you might be able to get a better rate with a different support worker or organisation.
3. If you still believe your provider is overcharging after checking price guides, other provider pricing and asking your provider to explain the difference, you can contact the NDIS to report this.

What counts as overcharging?

Overcharging isn’t common as the NDIS takes it very seriously. It’s still important to know what to spot, so you can let your provider know right away if they’ve made a mistake with your invoice. Overcharging can look like:

• Charging at rates above the NDIS Pricing Arrangements and Price Limits: For many supports, registered providers can only charge up to the maximum rates in the current PAPL. They cannot charge you more than this.
• Billing for more time than delivered, such as if you receive an invoice where the time charged doesn’t match the length of your actual session.
• Charging full cancellation or no-show fees when you gave the appropriate notice beforehand, per your service agreement.
• Vague charges or added fees: The NDIS is very clear about what providers can charge for. If you see things like excessive travel time, unexplained non-face-to-face service costs, or fees that aren’t in your service agreement, you should bring this up right away.
• Double billing: If you’re charged twice for the same session or service.

Talk to your provider first if you see something amiss. This allows a quick fix for any mistakes – or if there’s a valid reason for the change, it gives them the opportunity to explain any new rates.

Your plan manager can also check for mistakes or rates discrepancies. For example, NDSP runs our own internal checks to make sure your provider’s invoice is compliant with your NDIS plan – before it goes to the NDIS portal for processing.

Related: How We Pay Your Providers: Invoices, Timelines and More

Will increasing provider rates impact your plan?

Rate increases are normal, but you’re always in control. Check your agreement, ask questions, and make sure the changes work for your plan.

If rates for your support services increase but your funding stays the same, you may need to stretch it further until your plan can be reviewed or reassessed. This might include:

• Adjusting your hours of support where possible.
• Shopping around for providers with lower rates or better value services.
• Checking if any of your informal supports (your friends, family and community) can bridge any gaps while you work on other solutions.

If your current NDIS plan budget isn’t providing the support you need, you can request a review with your NDIS planner at any time. You don’t have to wait for the end of your current plan to request a review.

Related: 

• 10 Tips to Prepare for Your NDIS Plan Reassessment
• Can a Family Member or Friend Provide Paid NDIS Support?

How NDSP Plan Managers can help you stay on top of funding

As your plan management provider, we can help with service agreements and make sure any invoices are compliant with the latest NDIS Pricing Arrangements and Price Limits. We help with financial admin like record-keeping and budget-tracking, with our easy-to-use Nappa portal allowing you to see your live budget at any time and on any device. That’s our job, and our passion - we take care of the financial management of your NDIS plan, so you can spend your time and energy on better things.

Need more info about the NDIS? We provide easy-to-understand guidance about your NDIS plan and how to use it through our free online participant toolbox. You can also find helpful resources about eligibility, funding, recent changes to the NDIS, and other key information on our blog.

If you’re new to the NDIS or looking to switch plan managers, why not contact our friendly team today for more information about whether NDSP is the right fit. We’d love to hear from you!