New April 2022 Pricing Arrangements: What’s Changed?

With the recent NDIA updates, we take you through some of the key changes to look out for. If you’re using Lumary for your care management, the changes have been updated in the platform for you and your team by our team of specialists.

As part of the NDIA’s updates to NDIS Pricing Arrangements and Price Limits and Support Catalogue, new changes were announced on 19 April 2022, which came into immediate effect.

Notably, the NDIA has added two new items, including additional items to support weekly claiming for supported independent living (SIL), which will undoubtedly bring many providers a sigh of relief.

For those using Lumary, our team of in-house specialists have navigated the changes and updated our Lumary care management software with the latest updates to eliminate the burden on our customers of updating the changes manually and ensure they maintain compliance when claiming.

You can find all the details on the changes on the NDIA’s website, but read on for a quick summary.

SIL Weekly Claiming

From the 19th April 2022, providers can now claim for SIL regular supports by either using the current hourly claiming process or the new weekly claiming process.

The new weekly claim accounts for the package of assistance with daily life supports provided within the funded weekly amount for both shared and individual supports. This bundled support includes all planned supports within a typical week in the shared living environment that is agreed to via a typical schedule of supports.

There is no adjustment for weekdays, weekends or public holidays as the weekly amount claimed includes an annualised uplift for public holidays.

The price limit for this item is the total regular SIL funding specified in the participant’s plan, divided by the number of weeks in the plan period. The new support item is subject to a service agreement between the provider and participant (or nominee) specifying:

• an agreement to claim weekly amounts; and
• the agreed typical schedule of supports to be provided for the weekly amount claimed.

Providers should not use a combination of Weekly and Hourly SIL supports.

Claiming for SIL Unplanned Exits

A new payment for SIL may be made from a participant’s plan where the participant no longer occupies the SIL residence, and:

• the SIL supports were shared by 2 or more residents; and
• the participant either dies, or exits the accommodation permanently due to an irretrievable breakdown of supports/relationships resulting in the participant’s health and safety, or that of others, being critically compromised, requiring an immediate exit.

A provider can claim this support weekly at the specified weekly rate in the participant’s plan and is subject to the following conditions:

• A service agreement between the provider and participant (or nominee) that details notice periods for any intention to claim for unplanned exit in accordance with the Pricing Arrangements in the specified circumstances; and
• if a participant provides notice to exit and exits the SIL arrangement early, then only the remaining period of the notice period can be claimed during the planned notice period.

This item may not be claimed when a participant chooses to change SIL providers or when a participant is within a notice period.

The price limit for this item is the total regular SIL funding specified in the participant’s plan, divided by the number of weeks in the plan period. Only one claim for 28 days or four weekly claims is permissible per provider during a plan period.

What does this mean for providers?

If you’re using Lumary, you can rest easy knowing that these changes have already been updated in your system to save your staff valuable time, reduce downtime and ensure compliance. You can keep up to date with Lumary’s progress on the NDIS Pricing Arrangements and Price Limits updates on our NDIS pricing status page.

It’s not long until the Pricing Arrangements and Price Limits 2022-23 and Support Catalogue are due to be released (June 2022), so keep an eye on the NDIA’s website as we come closer to the end of the financial year.

With more regular updates expected from the NDIA, reviewing these changes is becoming an increasingly time-consuming task. If you don’t have care management software that manages the NDIA price updates for your organisation, it may be time to check out Lumary—an easy-to-use solution that streamlines admin so your staff have more time to focus on the things that matter most.

For further information about how Lumary’s care management software can support your organisation, speak with our healthcare consultants today.