Who Sets the Price of NDIS Behaviour Support, and Where the Hours Go

This article provides general information only about how specialist behaviour support is funded under the National Disability Insurance Scheme (NDIS). It does not constitute advice, it does not take account of the circumstances of any individual participant, and the arrangements described are subject to change. Readers should confirm current requirements with the National Disability Insurance Agency (NDIA) or the NDIS Quality and Safeguards Commission.

The principal finding is simple. The amount a provider may charge for behaviour support is not set by the provider. It is governed by the maximum prices in the current NDIS pricing schedule and by what is written into the participant’s plan. Those dollar rates are revised from time to time, so this article does not state them, and a rate quoted in a blog post of any age should be checked against the current edition of the published limits.

How behaviour support is funded

1. Behaviour support is funded from the budget the NDIA sets for it in the plan, and the plan states which support category applies.
2. The Minister’s pricing determination sets the maximum prices for NDIS supports. They are published as the NDIS pricing schedule, and the NDIA’s support catalogue lists each support item, including items for specialist behaviour support. The version in force on the date of the service applies.
3. A plan contains a funded amount, not a promise of unlimited hours. Each hour billed draws that amount down, so the number of hours a service needs matters as much as the hourly rate.
4. A support is funded only where the NDIA considers it reasonable and necessary for the participant. Inclusion of behaviour support in a plan is therefore a decision made on the evidence presented, and a participant who believes funding is insufficient may ask for the plan to be reviewed.

Behaviour support draws on the same plan as other therapy supports. A participant weighing several of them may find it useful to read about NDIS speech therapy and NDIS exercise physiology alongside this article, since hours committed to one are not available to another.

Who may provide it

Specialist behaviour support is a regulated service. The NDIS Quality and Safeguards Commission requires providers of specialist behaviour support to be registered, and the practitioners who write behaviour support plans must be assessed by the Commission as suitable to do so.

Where a plan proposes a regulated restrictive practice, additional requirements apply. These include authorisation under the law of the relevant State or Territory and lodgement of the plan with the Commission, under the National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018. A participant or family member who is told that a restrictive practice is part of a proposed plan is entitled to ask which authorisation applies and who holds it.

Where the hours go

The stages below are the ordinary sequence of positive behaviour support work. Each draws on the funded amount, and a provider can be asked to estimate the hours for each.

1. Functional assessment. The practitioner seeks to understand the purpose a behaviour serves for the person, in the settings where it occurs.
2. Plan development. A written behaviour support plan sets out the strategies to be used, the skills to be taught and the responses to be applied when behaviour escalates.
3. Implementation support. Family members, carers, support workers and educators are shown how to apply the plan consistently. Consistency across settings is the usual purpose of this stage.
4. Review. The plan is reviewed and revised against what has been observed.

The first two stages are often completed before ongoing implementation begins, which means the early months of a plan may draw on funding differently from later months. A participant is entitled to ask for that expectation to be set out before work starts.

Questions to ask before engaging a provider

1. Is the provider registered with the NDIS Quality and Safeguards Commission for specialist behaviour support, and is the practitioner assessed as suitable?
2. Which version of the NDIS pricing schedule applies, and at what rate will each type of work be billed?
3. How many hours are estimated for assessment, for plan development, for training of family and carers, and for review?
4. Which line of the plan will be drawn on, and how will the remaining balance be reported?
5. Does the proposed plan involve any restrictive practice, and if so, what authorisation applies?
6. When will the plan first be reviewed, and what would prompt an earlier review?

On timing

Many readers search for this subject because of concern about a person’s behaviour at home, at school or in the community. This article does not state that earlier support always produces better results, because no source reviewed for it supports a precise claim of that kind. A narrower statement can be made safely. Raising a concern early with a general practitioner, a school or a current provider gives more time to arrange an assessment and, where needed, a plan review, because both take time to organise.

Matters to confirm with the issuing authorities

1. The current NDIS pricing schedule and support catalogue, from the NDIA.
2. Provider registration status and practitioner suitability, from the NDIS Quality and Safeguards Commission.
3. Any State or Territory requirement relating to restrictive practices, from the relevant authorising body.

A reader who requires an assessment of a specific plan is advised to speak with the NDIA, a local area coordinator or an independent disability advocate rather than to rely on general information.

Sources: National Disability Insurance Agency, Pricing arrangements: NDIS pricing schedule and support catalogue (https://www.ndis.gov.au/providers/pricing-and-payments/pricing/pricing-arrangements); NDIS Quality and Safeguards Commission, Behaviour support (https://www.ndiscommission.gov.au/rules-and-standards/behaviour-support-and-restrictive-practices); National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018 (https://www.legislation.gov.au/F2018L00632/latest/text)