The Dust Hasn’t Settled—But We’re Moving Forward Anyway

It’s been a demanding few weeks across the sector. Many of you have been balancing advocacy efforts with internal planning, trying to understand and respond to the latest NDIS changes—particularly the implementation of the PAPL and its wider effects. While we don’t have confirmation that the pricing changes will be paused or reversed, providers are moving forward, preparing for what’s next. 

Here’s a summary of key issues that have surfaced, along with current information and practical considerations.

1. Gap Fees: What We Know So Far

The issue of gap fees has caused considerable confusion. 

Current evidence indicates: 

• Registered providers must charge in line with the PAPL, regardless of how a participant’s plan is managed. 

• Agency-managed participants can only be charged according to the PAPL rates. 

• For plan-managed participants working with unregistered providers, the situation is less clear. The PAPL states that plan managers cannot process claims over the price cap, but it does not explicitly prohibit a separate invoice from being issued by the provider. 

• On the NDIS website (participant-facing), it states that providers cannot charge above the price cap for plan-managed clients. 

• The NDIA’s Provider Support team has informed some providers by email that gap fees may be allowed and even outlined how they could be implemented. 

• Speech Pathology Australia, during a recent Town Hall meeting, advised that gap fees should not be charged. 

Summary: There are conflicting messages from the NDIA and its stakeholders. Until clearer guidance is provided, providers should assess risk carefully before charging a gap fee.

2. Non-Registered Providers and Self-Managed Participants

Under current arrangements, it is permissible for non-registered providers to negotiate rates with self-managed participants. However, it is worth considering the ethical implications of charging a higher rate to these clients than to plan-managed ones. If you choose to do so, be prepared to justify this difference clearly. 

3. Funding Periods (Section 33)

The introduction of shorter funding periods (e.g., quarterly or monthly) under Section 33 has the potential to disrupt service delivery for both providers and participants. 

Considerations: 

• More detailed budget support will be required to manage shorter periods. 

• AT prescriptions are most likely to be impacted if not budgeted for within a single period. 

• Carrying unpaid invoices across funding periods increases risk to cash flow. 

• While the rationale for these changes is tied to better budget tracking, the administrative burden will likely increase. 

Suggested approach: 

• Ensure reports include clear forecasts for higher-intensity periods across the year. 

• Encourage participants to discuss funding period structure during plan review calls to ensure alignment with service needs. 

• Challenging funding periods can occur via an S100 Change of Circumstances application. 

Some providers have reported that even with thorough preparation and reporting, plan structures remain inconsistent. This remains an area of concern and will require ongoing monitoring.

4. Stated vs Flexible Supports in Plans

Providers have noted increased issues with the structuring of Daily Living supports in PACE-managed plans—particularly confusion between “stated” and “flexible” funding within the Improved Daily Living (IDL) category. 

Key observations: 

• Typically, IDL is supposed to be a flexible support category, with discretion over how the funds are used across disciplines. 

• However, some plans are now listing specific disciplines (e.g., speech pathology, OT) and marking them as “stated supports,” which appears to restrict how the funds can be used. 

• Participants and providers have reported difficulties when these supposed ‘stated’ supports do not reflect actual service needs. 

This appears to be due to: 

• Automated features during plan generation within PACE. 

• Plan Managers and Support Coordinators becoming more cautious due to the risk of repayment for ineligible invoices. 

Interpretation guidance: 

• If a plan lists disciplines and includes the note “This is a stated support” without further clarification, flexibility is limited to those disciplines. 

• If the plan includes a statement allowing flexibility within the IDL category, funds may be used across other services, even if some disciplines are listed with allocated hours. 

• If the plan refers broadly to “multidisciplinary team” or “therapy,” and states “This is a stated support,” full flexibility is likely within the category. 

• In the instance where a plan lists specific disciplines alongside a dollar amount, it is likely that this Plan must be used exactly as written. 

For clarity, providers can refer to Disability Intermediaries Australia, the peak body for Plan Management and Support Coordination.

5. Service Agreements: Time to Review

Given the changes to pricing, travel, and funding periods, it’s timely to review your current Service Agreements. 

Key areas to address: 

• Funding periods and how services will be scheduled and billed, especially important are the roll over dates. 

• Travel charges and any associated expectations. 

• The importance of identifying the ‘impairment’ that the NDIA have listed. 

• The need for participants to share sufficient plan detail to allow for the delivery of compliant support. 

You can maintain annual service agreement periods, but your Schedule of Supports may need to be updated more frequently to reflect funding windows or participant changes.

6. Impairment Notices and Support Alignment

Under legislative changes passed in 2024, the NDIA is placing greater emphasis on ensuring that funded supports directly relate to the participant’s listed impairment.  

What this means: 

• Participants will soon begin receiving formal impairment notices. Where possible, knowing what these notices say will help you to ensure that you are aligning your support. 

• Supports that do not align with the listed impairment may be declined, even if clinically appropriate. 

The NDIA’s operational guideline on access includes a diagnosis-to-impairment mapping. However, there is an internal list that does not match exactly. 

What to do: 

• Use both lists (if available) to anticipate how the NDIA has classified the impairment. 

• Align support recommendations and report language accordingly. 

• If the impairment on file is not accurate or is too narrow, a Change of Circumstances Review may be required with updated evidence. 

This area is evolving. More information will be shared as it becomes available.

7. 10-Minute Increments

The use of 10-minute increments was recommended within the Annual Pricing Review, but this was not reflected within the PAPL. Despite this, some Plan Managers distributed information indicating that invoicing was now expected to reflect these smaller increments of time.

Clarification: 

• There is no current requirement to invoice in 10-minute increments. 

• Providers can continue to use decimal points (e.g. 0.25 for 15 minutes) when invoicing for partial hours. 

Final Thoughts 

While there’s still much uncertainty, what’s clear is that the sector is entering a period of operational change that requires structure, vigilance, and ongoing review. We will continue to monitor developments and share updates and tools that help you adapt your systems accordingly. 

If you’re navigating these changes and could use a sounding board, we’re here to help. 
Book a complimentary Power Call with one of our Business Coaches to discuss what this means for your practice, your team, and your next steps. 

What to Action Now – A Guided Checklist 

Use this checklist to support your navigation through the current reform agenda