Pricing Guide July 2019: An Allied Health Perspective

With a new Price Guide now out, a price rise for allied health services will be in effect from 1st July 2019. So now is the time to familiarise yourself with your new pricing structure. From an allied health perspective, here are 7 things to take note of.  

1.    Therapeutic supports price has increased

The price limit for therapy supports has increased across the board (Yippee!). See the table below for a quick summary and then check out the Price Guide for more details.

Table. Capacity Building- Daily Living.   Psychology 234.83 ( Early Child Intervention, NT/ SA/ Tas/ WA), 214.41 (Early Child Intervention, ACT/ NSW/ QLD/ Vic), 234.83 (7 +, NT/ SA/ Tas/ WA), 214.41 (7+, ACT/ NSW/ QLD/ Vic)  Physiotherapy 224.62 (Early Child Intervention, NT/ SA/ Tas/ WA), 193.99 (Early Child Intervention, ACT/ NSW/ QLD/ Vic), 224.62 (7 +, NT/ SA/ Tas/ WA), 193.99 (7+, ACT/ NSW/ QLD/ Vic).  Occupational Therapy 193.99 (Early Child Intervention, NT/ SA/ Tas/ WA), 193.99 (Early Child Intervention, ACT/ NSW/ QLD/ Vic), Not listed (refer to Other Therapies) (7 +, NT/ SA/ Tas/ WA), Not listed (refer to Other Therapies) (7+, ACT/ NSW/ QLD/ Vic).  Other Therapies 193.99 (All ages, all states and territories).  Exercise Physiology Not listed (Early Child Intervention, NT/ SA/ Tas/ WA), Not listed (Early Child Intervention, ACT/ NSW/ QLD/ Vic), $166.99 (7 +, NT/ SA/ Tas/ WA), $166.99 (7+, ACT/ NSW/ QLD/ Vic).

2.  Exercise Physiology can now bill for Daily Living Capacity Building

That is not a typo in the table above, Exercise Physiologists (EPs) can now bill under Capacity Building- Improved Daily Living. Previously they could only claim under Improved Health and Wellbeing. This might create a bit more competition for funds allocated to Daily Living. But it gives Participants more choice about the therapists they use when working towards their goals.

3.    Does your service agreement allow to you start billing the higher rate?

How you can implement these new prices depends on your service agreements. If you have a service agreement that is set up to charge the price indicated in the most current NDIS Price Guide, then you can commence charging the new prices from the 1st July. But if your service agreements have a dollar figure in it, then you will need to update your service agreements to include the latest hourly rate.

If you have a service booking, then you will need to discuss any proposed changes with Participants. Once everyone is in agreement, providers are then required to update services bookings to reflect the agreed changes. The NDIS will not be automatically adjusting existing services bookings.

Funding in Participant Plans will be automatically adjusted to reflect the changes in the price limits for therapy. This will be in effect from 1 July 2019 as part of the annual indexation of Plans. So Participants do not need to seek a Plan Review to access these additional funds.

It is important to remember that the NDIS Price Guide is the document that defines the maximum prices that providers can charge Participants with Agency or Plan Managed Plans. Self Managed Participants can choose to pay at a higher rate.

4. Therapy Assistant Price Rise and New Classifications

The NDIA has introduced a higher price limit for therapy assistants to increase their usage and to enable providers to work with an optimal mix of therapists and therapy assistants. There are now also two levels of Allied Health Assistants (AHAs). The main difference between Level 1 and 2 is the assistant’s level of independence. Level 1 must have constant supervision by a therapist, whereas Level 2 may work independently without direct supervision at all times.

The AHAs (both levels) must be covered by the professional indemnity insurance of the supervising therapist.

Capacity Building – Daily Living   AHA – Level 1: $56.16 (Early Child Intervention, NT/ SA/ Tas/ WA), $78.62 (Early Child Intervention, ACT/ NSW/ QLD/ Vic), $56.16 (7+, NT/ SA/ Tas/ WA), $78.62 (7+, ACT/ NSW/ QLD/ Vic)  ANA – Level 2: $86.79 (Early Child Intervention, NT/ SA/ Tas/ WA), $121.51 (Early Child Intervention, ACT/ NSW/ QLD/ Vic), $86.79 (7+, NT/ SA/ Tas/ WA), $121.51 (7+, ACT/ NSW/ QLD/ Vic)

5. Pricing for Group Therapy

This part of the Price Guide continues to cause significant confusion because it does not contain an exhaustive list of potential group combinations. It specifies the costs for “Group of 3 Therapy” (age 7+) or “Group of 4” (Early Childhood) and describes this as the “provision of interventions by more than one professional in a group session towards the Participants agreed goals”. But what about when there is a group of three Participants with one professional? Or five Participants in a group with two professionals? Or a group of four Participants with one professional and one assistant? The combinations for group therapy are endless.

The NDIA prefers to allow Participants and providers flexibility in negotiating arrangements in these circumstance. So we should not expect there to be price controls or support items for specific group ratios beyond what is currently in place. For support ratios that are not stated in the Price Guide, the NDIA encourages Participants and providers to come to an agreement about the price. Therapy delivered in a group may be claimed using the relevant therapy support line item, but at a lower rate than the price limit for this item.

6. Rural and remote

The biggest prices changes are arguably where they’re most needed, with the loadings in remote areas doubling. Supports delivered in remote areas will now have a 40% loading applied (up from 20%) and in very remote areas, the loading is 50% (up from 25%).

7. The final columns in the Price Guide: Travel, Cancellations, Non-Face to Face and Reports

The Price Guide now has columns with a tick or a cross to indicate which supports can claim for travel, cancellation, non face-to-face and reports. Most of Allied Health supports can claim for all of these. Check out Evie’s article for details on changes here.

It is fantastic to see price rises for allied health supports and to see more done to build the AHA work force. But change can be difficult for everyone involved, so make sure you are carefully communicating with Participants how these changes will impact them. By bringing everyone along for the journey, we can ensure that these changes create better outcomes for both Participants and providers.