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NDIS REFORM | THE MASTER TIMELINEOver the past 15 posts, we've worked through the National Disability Insurance Scheme A...
05/09/2026

NDIS REFORM | THE MASTER TIMELINE

Over the past 15 posts, we've worked through the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) legislation.

Not the headlines.

Not Facebook rumours.

The legislation.

Now that Royal Assent occurred on 20 August 2026, we can put the major changes together and show when they actually commence.

20 AUGUST 2026

ROYAL ASSENT

The legislation became law.

This date also starts the clock for several provisions that commence after specified periods.

27 AUGUST 2026

THE FIRST MAJOR COMMENCEMENT DATE

Seven days after Royal Assent, a substantial group of reforms commence, including:

• the new definition of functional capacity
• restrictions around unscheduled plan reassessments
• expanded fraud and compliance measures
• stronger information-gathering and regulatory powers
• additional fraud penalties
• the new NDIS pricing determination framework
• automated administrative decision-making provisions; and
• amendments supporting new framework planning.

Importantly, commencement does not necessarily mean every power will immediately be exercised.

Some reforms create powers that require future determinations, Rules, instruments or implementation before their practical effect is known.

1 OCTOBER 2026

FUNDING & PLAN SUSPENSION

Two significant participant-facing reforms commence.

Support Determinations

The Minister gains the power to make legislative instruments reducing funding by specified percentages for specified groups of supports and classes of plans.

This does NOT mean everyone's funding automatically drops on 1 October.

A determination must actually be made.

Plan Suspension

New provisions also allow plans to be suspended where the Agency has made the required attempts to contact a participant and cannot reach them.

Again — there are statutory requirements around those contact attempts.

NOVEMBER 2026

INDUCEMENTS & KICKBACKS

This is one we need to distinguish from the fraud provisions commencing in August.

The prohibition on certain provider inducements commences after the three-month period following Royal Assent.

This includes the new framework preventing providers from offering certain gifts, benefits or things designed to induce people to use, continue using or increase particular NDIS services.

This is also where cash, gift cards, vouchers and similar incentives become particularly important.

1 DECEMBER 2026

90-DAY CLAIMING PERIOD

The statutory claim period changes from:

2 YEARS

to

90 DAYS.

This is a significant operational change for providers, participants and Plan Managers.

Old invoices sitting in drawers are going to become a considerably bigger problem.

1 FEBRUARY 2027

PLAN RENEWALS & REASONABLE AND NECESSARY

The legislation introduces significant changes around old framework plan renewal.

Plans may automatically renew at their end date rather than automatically undergoing a full reassessment.

The reasonable and necessary framework also changes, with greater emphasis on sustainability, efficient use of resources, equitable distribution and supports connected to qualifying impairments.

FEBRUARY 2027

DEBT RECOVERY REFORMS

A new formal debt notification process commences following the six-month period after Royal Assent.

Where the provisions apply, the Agency must generally issue an initial notice and provide an opportunity to respond before issuing a debt determination notice.

Minimum response periods include:

NDIS providers — at least 14 days.

Other people — at least 28 days.

And if you respond, the eventual debt determination notice must explain how your response was considered.

1 JULY 2027

WHISTLEBLOWER PROTECTIONS

Expanded whistleblower protections commence.

These strengthen the pathways available for protected disclosures and the remedies available where someone suffers detriment because they spoke up.

PLAN MANAGEMENT REFORMS

DATE TO BE PROCLAIMED

This one deserves the asterisk.

The final legislation does NOT simply say:

“Plan Management changes on 1 October 2027.”

Schedule 2 Part 6 commences on a single day fixed by Proclamation, with a legislative backstop if it hasn't commenced within 24 months after Royal Assent.

The reforms establish Plan Management as its own registration category and introduce the new registration/deed framework.

So we'll continue watching this one.

1 JANUARY 2028

ACCESS & PERMANENCY

Major changes to NDIS access provisions commence.

These include changes to how permanent or likely permanent impairment is considered and the role of “appropriate treatment”.

Alternative support and compensation arrangements also become increasingly important when determining whether the NDIS is the appropriate system responsible for particular disability-related needs.

And again:

1 January 2028 does not mean every existing participant automatically loses access or undergoes reassessment that morning.

AND THEN THERE ARE THE RULES...

This may actually be the most important part of our entire series.

Parliament passing legislation doesn't answer every question.

Throughout these 151 pages, Parliament has authorised future:

NDIS Rules.

Ministerial determinations.

Legislative instruments.

Assessment methodologies.

Pricing determinations.

Funding methodologies.

Provider requirements.

And other implementation mechanisms.

Those documents will determine how many of these reforms actually operate in practice.

So our job isn't finished because the legislation passed.

We'll keep reading those instruments as they're released and explain what they actually mean.

Because there is going to be a lot of noise around these reforms over the next 18 months.

Our promise remains the same:

No fearmongering.

No clickbait.

No presenting possibilities as decisions already made.

If we know it, we'll tell you.

If the legislation allows something but it hasn't happened yet, we'll tell you that too.

And if we don't know yet because the Rules haven't been made?

We'll tell you that.

Thank you to everyone who has followed our 15-part NDIS Reform series.

Save this one.

I suspect we're going to be referring back to it quite a bit.

— Virtually Accountable
Plan Management & Support Coordination

NDIS REFORM #15 | New Framework Plans — How Future NDIS Budgets May Be BuiltThis is probably the right place to finish ...
04/09/2026

NDIS REFORM #15 | New Framework Plans — How Future NDIS Budgets May Be Built

This is probably the right place to finish the individual reform posts before we do one final master timeline.

Schedule 4 of the new legislation deals with “New Framework Planning”.

And unlike some of the reforms we've covered, this isn't simply changing one rule.

It further develops the machinery that will eventually determine how new framework plans are assessed and funded.

The amendments commence on 27 August 2026 — but that does not mean every participant suddenly moves onto a new framework plan on that date.

What is a “new framework plan”?

The NDIS already has legislation establishing the transition from existing “old framework plans” to “new framework plans”.

This Act changes and expands parts of that future planning system.

One of the biggest changes is how the reasonable and necessary budget can be calculated.

For new framework plans, funding amounts for:

• flexible funding; and
• stated supports or classes of stated supports

can be worked out by applying information about the participant's disability support needs from their needs assessment report to a method prescribed in the NDIS Rules.

That is quite different from thinking about planning simply as:

“What does this individual support cost?”

Funding can be linked to “levels of need”

The Rules may establish methods that:

• identify supports or groups of supports participants need
• establish different levels of need
• determine which level applies to a participant; and
• attach funding amounts to those levels.

And this next sentence matters.

The legislation expressly says that a funding amount attached to a level of need may be:

MORE THAN
EQUAL TO
OR LESS THAN

the actual cost of providing or acquiring that support.

That is something participants and providers need to understand.

There can also be funding caps

The methodology contained in future NDIS Rules may specify a maximum amount of funding for a support, group or class of supports.

Where such a maximum applies, the funding calculation method must ensure that maximum isn't exceeded.

Again, though:

The Act creates the legal framework.

We will still need to see the Rules and methodologies made under it before anyone can accurately say what particular participant budgets will look like.

Needs assessments become incredibly important

The needs assessment report feeds information about the participant's disability support needs into the budget methodology.

The legislation also says assessments must consider certain requested information and reports, as well as information prescribed by the NDIS Rules.

Interestingly, the Rules can also prescribe information that the assessment must not take into account.

Assessments may be undertaken by Agency staff, Agency consultants or another person prescribed by the Rules.

And there is one Plan Management detail worth noticing

For the purposes of the needs assessment, the legislation expressly says:

A participant's disability support needs do not include managing the funding of supports under their plan.

That doesn't mean Plan Management disappears.

It separates the need for funding management from the participant's disability support needs for the purposes of this assessment framework.

Does everyone move to this system on 27 August?

No.

And this is where social media posts about NDIS reform can very quickly become misleading.

27 August 2026 is the commencement of these legislative amendments.

It is not a declaration that every existing participant receives a new framework plan that day.

The legislation actually allows the CEO to revoke a notice transitioning a participant to new framework plans where it isn't reasonably practicable to facilitate preparation of those plans. The participant must be told in writing, and another notice can be issued later.

So this remains a transition.

What does #15 really tell us?

The future NDIS planning model is becoming much more structured.

Needs assessment → level of need → funding methodology → budget.

But many of the details that will determine how that works in practice will sit in future NDIS Rules, assessment tools, methodologies and Agency documents.

So when someone tells you today:

“This is exactly how much your new framework plan will receive”...

They are getting ahead of the legislation.

We know what Parliament has authorised.

We do not yet have every piece of the machinery that will operate underneath it.

And that distinction has been the entire point of this series.

Not rumours.

Not panic.

Not predictions dressed up as facts.

Just what the legislation actually says — and what we still don't know.

— Virtually Accountable
Plan Management & Support Coordination

NDIS REFORM #14 | Debt Recovery — A New Formal Notice ProcessThis one is important for both participants and providers....
03/09/2026

NDIS REFORM #14 | Debt Recovery — A New Formal Notice Process

This one is important for both participants and providers.

The new legislation introduces a more structured process for the NDIA when it intends to recover a debt owed to the Agency.

These provisions commence after the six-month commencement period following Royal Assent — with Royal Assent occurring on 20 August 2026, that places this reform in February 2027.

First — what is actually changing?

Where a debt is due to the Agency under section 182, and certain conditions are met, the CEO will be required to issue an initial written notice before progressing through the new debt determination process.

That initial notice must tell the person:

• what circumstances gave rise to the alleged debt
• how much the Agency intends to recover
• that they are invited to provide a written response
• how long they have to respond; and
• who they can contact with questions.

In other words:

There is a formal opportunity to respond before the Agency moves to the next stage.

How long do you have to respond?

The legislation establishes different minimum response periods.

For an NDIS provider:

AT LEAST 14 DAYS

For another person:

AT LEAST 28 DAYS

There can be exceptions where circumstances prescribed by future NDIS Rules apply.

That distinction is worth providers knowing.

If you receive one of these notices, it isn't something to leave sitting in the inbox for three weeks.

Then comes the Debt Determination Notice

After the response period ends, the CEO must issue a further written notice.

The Agency can determine that it does not intend to recover the debt — including because the debt does not exist, or because it intends to write off the debt or waive its right to recover it.

Or it can determine that recovery will proceed.

If recovery is proceeding, the notice must include information such as:

• why the debt arose
• when it arose
• the outstanding amount
• when it is due
• repayment options
• information about write-off or waiver; and
• contact information.

And importantly, if you responded to the original notice, the final notice must explain how your response was considered in the decision to recover the debt.

That is an important procedural safeguard.

This connects with the other reforms we've already discussed

Remember #11 on NDIS pricing?

Under the new pricing provisions, where a maximum price applies and the Agency pays more than that maximum, the legislation expressly provides that the excess can become a debt due to the Agency.

And across this reform package we've seen:

Stronger record keeping.

Stronger information-gathering powers.

More compliance mechanisms.

Greater scrutiny of claims.

And now a more formalised debt recovery pathway.

They're not really separate reforms when you look at the legislation as a whole.

They're pieces of the same integrity framework.

What should providers take from this?

Documentation matters.

If the Agency says money wasn't payable, you want to be able to establish why you believed it was.

Service agreements.

Invoices.

Support records.

Evidence the support was actually delivered.

Evidence the claim complied with the applicable rules.

Approvals and communications where relevant.

The legislation provides an opportunity to respond — but that opportunity isn't much use if there is nothing sitting behind the claim.

And for participants, receiving an initial notice does not itself mean you should assume the Agency's position cannot be challenged.

Read the notice.

Understand why the debt is being asserted.

Check the amount.

And use the opportunity provided to respond where you disagree or have information the Agency needs to consider.

The message from #14 is pretty simple:

A DEBT NOTICE IS NOT SOMETHING TO IGNORE.

The new framework creates a formal process.

And if the NDIA says money is owed, the paperwork sitting behind that money may become very important indeed.

— Virtually Accountable
Plan Management & Support Coordination

NDIS REFORM | MYTH vs FACT #02MYTH:“Plan Management is ending in October 2027.”FACT:No. The legislation does not abolis...
03/09/2026

NDIS REFORM | MYTH vs FACT #02

MYTH:

“Plan Management is ending in October 2027.”

FACT:

No. The legislation does not abolish Plan Management.

In fact, the new laws specifically create a new framework for registered Plan Management Providers.

SO WHAT IS ACTUALLY CHANGING?

Under the new framework, Plan Management becomes its own registration category.

Registered Plan Management Providers will also be required to enter into a deed with the NDIA, with requirements potentially covering areas such as:

• governance and integrity
• reporting
• staff and key personnel
• claims and payment processes
• participant identity verification
• verification that supports were actually provided
• ICT systems
• related parties and conflicts of interest

There is another significant change:

A provider registered for Plan Management will not also be able to be registered — or applying for registration — to provide other NDIS supports and services.

That could significantly reshape the Plan Management market.

BUT WHAT ABOUT OCTOBER 2027?

This is where we need to separate previous government implementation timelines from what Parliament actually passed.

The legislation itself does not say:

“Plan Management changes on 1 October 2027.”

The new Plan Management provisions commence on a day fixed by Proclamation.

The legislation also contains a backstop if commencement has not occurred within 24 months after Royal Assent.

So until a commencement date is formally set, we won't present October 2027 as a legislated deadline.

WHAT DOES THIS MEAN FOR PARTICIPANTS?

Right now?

Very little.

You don't need to suddenly leave your Plan Manager.

Plan Management hasn't disappeared.

And there is no reason to panic because you've seen a post saying Plan Management is “ending”.

The future model is changing.

The details of how that model will operate still need to be implemented.

And when those details arrive, we'll read those too.

Because there is a rather enormous difference between:

PLAN MANAGEMENT IS CHANGING.

and

PLAN MANAGEMENT IS ENDING.

The first is supported by the legislation.

The second isn't.

— Virtually Accountable
Plan Management & Support Coordination

NDIS REFORM #13 | Stronger Whistleblower ProtectionsFrom 1 July 2027, protections for people who speak up about potenti...
02/09/2026

NDIS REFORM #13 | Stronger Whistleblower Protections

From 1 July 2027, protections for people who speak up about potential wrongdoing within the NDIS will be strengthened.

This part of the legislation expands where protected disclosures can be made and strengthens the remedies available where someone suffers retaliation or harm because they spoke up.

Who can a protected disclosure be made to?

The legislation expands the pathways available to someone seeking whistleblower protection.

Depending on the circumstances, protected disclosures can be made to people and organisations including:

• the NDIS Quality and Safeguards Commissioner
• the NDIA
• appropriate people connected with an NDIS provider
• a medical practitioner or psychologist when seeking treatment or counselling
• an Australian legal practitioner when seeking legal advice or representation
• certain registered organisations or professional associations
• police, where there are reasonable grounds to suspect an NDIS provider has or may have contravened the NDIS Act
• a Commonwealth-funded disability advocate when seeking advice or assistance.

That last point is particularly important.

Whistleblower protection isn't being framed solely around employees reporting their employer internally.

The legislation recognises that people may need somewhere independent to go for advice, assistance, legal representation, counselling or reporting.

What counts as retaliation or “detriment”?

The definition is broad.

Detriment can include:

• dismissal from employment
• injury in employment
• changing someone's position or duties to their disadvantage
• workplace discrimination
• harassment or intimidation
• physical or psychological harm
• damage to property
• reputational damage
• damage to someone's business or financial position; or
• other forms of damage.

In other words:

Punishing someone because they spoke up can have serious consequences.

What remedies are available?

Where a court is satisfied that someone has contravened — or proposes to contravene — the whistleblower victimisation provisions, it can make orders including:

• an injunction to prevent or stop the conduct
• compensation for loss, damage or injury
• reinstatement of a person; and
• exemplary damages.

The legislation also introduces changes around the burden of proof in whistleblower protection proceedings. Once the required evidentiary threshold is met, the burden can shift to the other party to prove the relevant claim is not made out.

Why does this matter?

Because integrity doesn't work if people are too frightened to speak.

Participants, workers and others within the disability sector can sometimes be the first people to see concerning conduct.

Fraud.

False claims.

Poor practices.

Potential abuse or exploitation.

Improper provider behaviour.

And people need to be able to raise legitimate concerns without fearing that doing so will cost them their job, reputation, financial security or access to support.

These reforms don't mean every complaint automatically becomes a protected whistleblower disclosure.

The legal requirements still matter.

But they strengthen the framework protecting people who make qualifying disclosures through appropriate channels.

The new whistleblower provisions commence:

1 JULY 2027

And there is a pretty simple principle behind this one:

People who raise legitimate concerns about wrongdoing shouldn't become the target because they were brave enough to speak.

— Virtually Accountable
Plan Management & Support Coordination

NDIS REFORM #12 | Automated Decision-MakingFrom 27 August 2026, the NDIS legislation will expressly allow computer prog...
01/09/2026

NDIS REFORM #12 | Automated Decision-Making

From 27 August 2026, the NDIS legislation will expressly allow computer programs to take certain administrative actions under the NDIS Act.

Yes — that can include decisions.

But there are safeguards built into the legislation, so this one needs considerably more explanation than:

“AI is deciding your NDIS plan.”

That isn't what the Bill says.

What can be automated?

The CEO may arrange for computer programs, under the CEO's oversight, to take administrative action under specified provisions of the NDIS legislation.

“Administrative action” is defined broadly and can include:

• making or refusing to make a decision
• exercising or refusing to exercise a power
• performing a function or duty
• giving notices; and
• parts of larger decisions.

The Act initially identifies four provisions that can be used for automated administrative action:

• section 33 — participant plans
• section 45 — payment of NDIS amounts
• section 45A — claims
• section 45C — maximum amounts payable for supports.

The Minister can also specify additional provisions by legislative instrument.

Can a computer make a judgement call?

Potentially — but additional safeguards apply.

The legislation specifically recognises “evaluative determinations”, including:

• exercising discretion
• making an evaluative judgement; or
• forming a state of mind.

Where automated action involves this type of determination, the CEO must create a standard operating procedure instrument setting out the circumstances in which the determination should be made in a particular way.

Those circumstances must be sufficiently objective that a computer program can determine whether they exist.

And the proposed instrument must be published on the Agency's website at least 7 days before it is made.

Will participants know?

Where the law requires a person to receive notice of an administrative action and that action was taken by a computer program, the notice must tell them that the action was taken by a computer program.

That is an important transparency requirement.

What if the automated decision is wrong?

The legislation allows the CEO to substitute another action where the CEO is satisfied that the computer-generated action was not “correct or preferable”.

Importantly, the new automation provisions do not remove existing rights to review or reconsideration.

The Agency will also have to report annually on the kinds of automated actions that the CEO later determined were not correct or preferable.

So what does this actually mean?

Automation is becoming formally embedded within NDIS administration.

For participants, that makes something we've been saying throughout this series even more important:

Evidence matters.

Information matters.

Accurate records matter.

Because where a system is applying defined criteria to information in front of it, the quality and accuracy of that information becomes incredibly important.

But we also need to be careful about how this reform is described.

The legislation does not say:

“AI will now decide whether disabled people deserve support.”

It creates statutory authority for computer programs to undertake specified administrative actions, including some decision-making, subject to oversight, procedural rules, transparency requirements and existing review rights.

There is a considerable difference between those two statements.

And as always, we'll stick with what the legislation actually says.

— Virtually Accountable
Plan Management & Support Coordination

PROVIDER REMINDER | PLEASE CHECK WHERE YOU’RE SENDING YOUR ENQUIRIESWith the new NDIS 90-day claiming timeframe commenci...
01/09/2026

PROVIDER REMINDER | PLEASE CHECK WHERE YOU’RE SENDING YOUR ENQUIRIES

With the new NDIS 90-day claiming timeframe commencing 1 December 2026, timely invoice submission and follow-up is going to become increasingly important.

From 1 December, NDIS claims must be submitted within 90 days of the support being delivered.

For providers, this makes it particularly important to:

• submit invoices promptly after supports are delivered
• check that invoices contain all required information
• follow up outstanding invoices in a timely manner; and
• make sure your enquiry is being sent to an inbox that is actually monitored.

PLEASE NOTE — OUR ACCOUNTS INBOX IS FOR INVOICE SUBMISSION ONLY

📧 [email protected]

This inbox is not monitored for correspondence.

Please do not reply to the automated email generated from this inbox.

If you send an invoice enquiry or follow-up to the accounts inbox, there is a risk that your correspondence will not be seen.

Instead, please use:

📩 Invoice enquiries & follow-ups
[email protected]

📩 General enquiries, updates & feedback
[email protected]

📩 Escalations
[email protected]

PLEASE ALSO ALLOW TIME FOR PROCESSING

Timely follow-up does not mean an invoice needs to be chased immediately after submission.

Please allow reasonable processing time for your invoice to be received, checked, claimed and paid before following up.

As we move towards the 1 December changes, leaving invoices sitting for weeks — or months — before submitting or following them up will become increasingly risky.

The new 90-day timeframe is measured from when the support was delivered, not from when somebody eventually notices the invoice hasn't been paid.

The easiest rule:

INVOICE SUBMISSION → [email protected]
INVOICE FOLLOW-UP → [email protected]
EVERYTHING ELSE → [email protected]
ESCALATION → [email protected]

A little housekeeping now will help avoid much bigger headaches once the 90-day claiming timeframe commences.

— Virtually Accountable
Registered NDIS Plan Management

NDIS REFORM | MYTH vs FACT #01MYTH:“Everyone’s NDIS funding is being cut on 1 October 2026.”FACT:No.1 October 2026 is t...
01/09/2026

NDIS REFORM | MYTH vs FACT #01

MYTH:

“Everyone’s NDIS funding is being cut on 1 October 2026.”

FACT:

No.

1 October 2026 is the date the new support determination provisions commence.

That is not the same thing as every participant automatically receiving a funding cut.

So what actually changes?

From 1 October, the legislation gives the Minister the power to make a legislative instrument that can reduce funding by a specified percentage for particular groups of supports.

The legislation identifies:

• assistance with social, economic and community participation; and
• improved daily living skills.

But a reduction does not simply happen because the calendar reaches 1 October.

A determination needs to actually be made.

That determination would need to specify things including the percentage reduction, the relevant group or groups of supports and the class of plans to which it applies.

THE IMPORTANT DIFFERENCE

“The Minister CAN make a determination”

does not mean:

“The Minister HAS made a determination.”

And it definitely doesn't mean:

“Everyone's plan is being cut on 1 October.”

This distinction is going to matter enormously as the reforms roll out.

Throughout the new legislation there are powers that require future Rules, determinations or legislative instruments before we know exactly how they will operate.

So whenever you see an NDIS headline saying:

“THIS IS HAPPENING FROM [DATE]”

ask one more question:

Does the change itself happen on that date — or does the power to make a future change commence on that date?

Those are two very different things.

WHAT SHOULD PARTICIPANTS DO?

Nothing drastic.

Don't panic-spend your funding.

Don't cancel supports because you've been told your funding is definitely disappearing.

And don't make significant decisions about your supports based solely on something you've seen shared on social media.

If a support determination is made that changes the position, we'll read it.

We'll explain who it applies to.

We'll explain when it applies.

And we'll tell you what it actually says.

Until then:

POWER ≠ ACTION.

That little distinction might save everyone quite a lot of unnecessary panic over the next 18 months.

— Virtually Accountable
Plan Management & Support Coordination

For the graphic, I'd make these Myth vs Fact posts much simpler than the reform series:

NDIS REFORM
MYTH vs FACT #01

MYTH
“Everyone's NDIS funding is being cut on 1 October.”

Big gold divider:

FACT
NO. 1 OCTOBER IS WHEN THE NEW POWER COMMENCES.

Then the centrepiece:

POWER ≠ ACTION

“The Minister CAN make a support determination”
is not the same as
“The Minister HAS made a support determination.”

Bottom:

If a determination is made, we'll read it.
We'll explain it.
And we'll tell you who it actually affects.

Virtually Accountable
We read the fine print.

NDIS REFORM #11 | How NDIS Prices Will Be SetFrom 27 August 2026, new legislation governing NDIS pricing will commence....
31/08/2026

NDIS REFORM #11 | How NDIS Prices Will Be Set

From 27 August 2026, new legislation governing NDIS pricing will commence.

And this is bigger than simply publishing another annual Pricing Arrangement.

The legislation creates a new power allowing the Minister, by legislative instrument, to determine:

• the maximum amount payable for an NDIS support; or
• the method used to calculate that maximum amount.

This can apply to an individual support or an entire class of NDIS supports.

Who does the maximum price apply to?

This distinction is important.

Under the legislation, a maximum price determination applies where funding for the relevant support is managed by:

• a registered Plan Management provider; or
• the NDIA.

The provision does not say that these maximum price determinations apply to participant-managed funding.

What happens if a provider charges above the maximum?

Where the pricing determination applies, the legislation says an NDIS provider must not charge more than the determined maximum amount.

If a claim is submitted above the maximum, the NDIA may:

• refuse the claim; or
• pay only the maximum amount permitted.

And if an amount above the maximum has been paid, the excess can become a debt due to the Agency.

That is a significant compliance change.

Pricing rules may include more than just a dollar figure

This is another part worth watching.

A pricing determination may also require certain processes to occur before a support is purchased or provided.

The Bill actually gives an example:

requiring a participant to obtain a particular number of quotes.

So future pricing arrangements could potentially regulate both:

HOW MUCH CAN BE PAID

and

WHAT MUST HAPPEN BEFORE IT IS PAID.

But the Minister doesn't simply pick a number

The legislation also introduces greater structure around pricing decisions.

The NDIA can provide advice to the Minister about NDIS pricing, and where that advice relates to a pricing determination, either the advice or a summary must be tabled in each House of Parliament within 5 sitting days after the Minister makes the determination.

When making the determination, the Minister must have regard to:

• relevant advice from the Agency
• the financial sustainability of the NDIS; and
• the objects and principles of the NDIS Act.

What does this mean for providers?

Price limits are becoming more firmly embedded in legislation.

Providers will need to ensure they understand which pricing determination applies to the support being delivered and that claims do not exceed the applicable maximum.

It also makes keeping pricing systems current increasingly important.

An old price list sitting in someone's desktop folder is not going to be a particularly impressive defence. 😬

What does this mean for participants?

For Agency-managed and relevant Plan Managed supports, the maximum amount the NDIS will pay may be determined through these legislative pricing powers.

But this reform isn't simply:

“NDIS prices are being cut.”

The Bill creates the mechanism for setting maximum prices.

The actual financial impact will depend on the determinations made under that mechanism.

And that distinction matters.

So, as always:

No panic.

No guessing what the future price limits will be.

We will follow the actual pricing determinations when they are made and explain what they mean for participants and providers.

— Virtually Accountable
Plan Management & Support Coordination

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