Mastering NDIS Pricing and Planning

Will, EnableUs Community

Alright, folks, welcome back to another episode of The EnableUs Community Podcast. Today we're diving into the nitty gritty of NDIS pricing and planning—something that gets more complicated every July. Winter, have you noticed how the price guide always manages to trip people up right when they think they've finally got it sorted?

Winter, EnableUs Community

Oh absolutely, Will. And this year’s guide for 2025-26 didn’t hold back, did it? Not just your standard annual update but some mid-year changes, too. For anyone keeping score, everything kicked in on July 1, with a pretty hefty 3.95 percent jump across most core supports, and then bang—another update in November for art and music therapists. The real challenge is just staying on top of those shifting rates, especially if you’re a smaller provider without a big back-office team.

Will, EnableUs Community

Exactly. Those price caps aren’t just suggestions; for registered providers they’re compliance, pure and simple. So you get these crazy ranges—like, for support workers, hourly rates now go from about $31 for entry-level to around $43 for team leaders after the recent rise. But then you throw in adjustments for therapy, travel, early childhood supports—the works—and it’s like, how do you fit actual quality service into a set box, right?

Winter, EnableUs Community

That’s the question I get over and over, especially from coordinators new to the whole scheduling game. I remember my first time cracking open the price guide as a support coordinator. I thought, “Great, here’s a master list—this’ll be straightforward.” Spoiler alert: it wasn’t. I had a provider ask if they could just bill a bit extra on a public holiday shift to cover extra staffing. But, of course, price caps mean no wriggle room. You can’t just round things up—there’s always an audit trail.

Will, EnableUs Community

Yeah, and honestly, it’s easy to slip up. Even with the best systems, people end up billing at last year’s rates for a week or two. Or, worse, they miss a mid-year update like that November therapy adjustment. Suddenly, line items don’t match the new limits and those claims get spat right back. It’s kind of relentless—providers need systems that move as fast as the price guide changes, otherwise you’re basically leaving money on the table or risking compliance issues.

Winter, EnableUs Community

And it’s not just internal—participants need to get those updates, too. They want to know, “Why am I being charged more?” or “Is my plan still enough for the things I need?” That’s always an awkward conversation if you’re not ready for it. Honestly, the sooner you get your agreements and software sorted, and make sure everyone’s across travel rules or therapy caps, the smoother it goes for providers and participants alike.

Will, EnableUs Community

So, let’s shift gears a bit—once you’ve wrapped your head around the latest price limits, the next headache is making participant budgets actually work. Those NDIS plans all split funding into Core, Capacity Building, and Capital supports, but in reality, most people find the bulk of their flexibility in Core funding. Capacity Building is more locked down; Capital is even stricter. Winter, do you still see people getting surprised by how tight those categories are in practice?

Winter, EnableUs Community

Definitely, especially the first time around. It’s one thing to see, “Here’s my total budget,” but breaking it into silos is a rude shock. For example, you might have heaps in Core but hit a ceiling in Capacity Building the second you need more therapy or assessment time. Smart budgeting really isn’t optional. I always remind people: a plan is only as flexible as its structure—and often that means getting creative with how services are delivered within those boundaries.

Will, EnableUs Community

Yeah, and there are genuinely clever ways to do this if you don’t just default to “one support, one hour, one price.” Like, I remember helping a participant—let’s call him Sam—who was burning through his Core budget just on cleaning and weekly shopping supports. Together, we looked at what Sam’s informal supports—basically family—could take over. By shifting some routine stuff to family, he freed up funding for more specialist therapies that actually created long-term progress. That’s the kind of stretch you want!

Winter, EnableUs Community

That’s a great example. And it’s not just about shifting tasks, but combining supports strategically. Some budgets look tight on paper, but if you adjust rostering—maybe group allied health sessions or schedule certain tasks together—you squeeze out more value. I keep seeing teams that eyeball the hourly rate, but don’t think about efficiency gains. Like, if you can combine travel with other sessions, or schedule reviews together, you actually use the budget smarter and give participants more meaningful outcomes. It does take some active management, though.

Will, EnableUs Community

Right, and I reckon that real-time tracking is critical—building regular check-ins and soft monthly budgets, like we talked about back in Episode 5, is honestly a lifesaver for keeping things on course. A budget’s only useful if you know where you’re bleeding or saving, week to week. Otherwise, you hit month 10 and realize you’ve either overspent or left thousands unused, which is just heartbreaking for everyone involved.

Winter, EnableUs Community

Yep, and looping participants in is key. The best plans I’ve seen are the ones built together, not dictated out. When clients know how each dollar is being spent and which parts are rigid versus flexible, it’s way easier to set realistic expectations about the year ahead—and make changes early rather than trying to fix things retroactively.

Will, EnableUs Community

Alright, let’s get into the last bit—the nuts and bolts of claiming and keeping your audit trail tight. Even the most well-planned budgets are useless if your claims get knocked back for silly errors or—worse—trigger an audit. A lot of the big issues come down to basics like exceeding price caps, using the wrong line item codes, or not clearly documenting which supports are tangible versus intangible. Like, transport and therapy: one’s a real, measurable journey, the other’s a service. Stuff like that can easily get mixed up if you’re not careful.

Winter, EnableUs Community

Absolutely. I don’t think people realize how relentless audits can be—there is just no forgiveness for grey areas, especially when you're above a price cap. Recently, we had an audit where travel claims were scrutinized. Luckily, we’d clearly capped travel at half the therapy rate, as per the new guidelines. But that only happened because we double-checked the rules and documented everything. What saved us was a well-organized digital folder system for every client—notes, signed agreements, session logs, travel calculations, the lot.

Will, EnableUs Community

That resonates with what we talked about in Episode 1—if you can’t prove every line, it doesn’t count. And honestly, mistakes will happen, especially right after a pricing update. Maybe you bill at an old rate, or put in a claim with an out-of-date code. The trick is catching these quickly. If you undercharge—or, worse, overcharge—fix it straight away. Credit the participant, apologize, be transparent; people are forgiving when you’re honest and proactive. Not so much if you dodge the issue.

Winter, EnableUs Community

Right—good recordkeeping isn’t just a compliance box-tick, it’s peace of mind. You’ve got to keep your operations manual up to date, and train your team before each July so they actually understand the changes—not just what’s different, but why. When staff can explain price jumps to participants, everyone feels like they’re on the same page. And if you stay in the habit of running dummy invoices before submitting new claims, you catch so many bugs before they hit a participant’s plan.

Will, EnableUs Community

Honestly, being set for audits now is so much smoother than trying to rebuild a paper trail months down the line. All those systems for tracking, reviewing, and clear comms—boring as they sound—are the difference between sleeping easy or sweating through audit season. Anyway, that’s probably enough compliance talk for one episode. Winter, any final thoughts?

Winter, EnableUs Community

Just that staying curious and connected with peers makes a world of difference. Join a provider group, check those NDIA updates, and keep the conversations going. Pricing and planning will keep shifting, but if you get your systems right, you don’t have to panic every time the Price Guide drops.

Will, EnableUs Community

Couldn’t have said it better, Winter. Thanks everyone for tuning in—we’ll catch you next time as we tackle the art of negotiating unique supports and emerging therapies. See you soon, Winter.

Winter, EnableUs Community

Thanks Will! See you and thanks to everyone for listening. Take care!