This study guide provides a comprehensive review of the National Disability Insurance Scheme (NDIS) Pricing Arrangements and Price Limits for the 2025-26 period, specifically based on Version 1.1 released in October 2025. It is designed to assist in understanding the regulatory framework, claiming rules, and support structures governing the NDIS.

Part 1: Short-Answer Quiz

Instructions: Answer the following questions in 2–3 sentences based on the provided source context.

1. What is the primary purpose of NDIS price regulation and the "NDIS Pricing Arrangements and Price Limits" document?
2. How do the requirements for claiming supports differ between Agency-managed, Plan-managed, and Self-managing participants?
3. What does the NDIS Disability Support Worker (DSW) Cost Model estimate when determining price limits?
4. Under what specific conditions can a provider claim for a "Short Notice Cancellation"?
5. How is the Modified Monash Model (MMM) used to determine travel time limits and price loadings for providers?
6. What are "Programs of Support," and what are the rules regarding their duration and exit conditions?
7. What distinguishes "Level 1 Therapy Assistants" from "Level 2 Therapy Assistants" in terms of supervision?
8. What are the specific rules for providers wishing to claim "Non-Face-to-Face" support provision?
9. How does the NDIS define and categorize "Individualised Living Options" (ILO)?
10. What is the "Isolated Towns Modification," and how does it affect the MMM rating of certain locations?

Part 2: Quiz Answer Key

1. Purpose of Price Regulation: Price regulation is implemented to ensure that NDIS participants receive value for money when purchasing necessary supports. The document sets out general and specific pricing arrangements to assist both participants and providers in understanding how price controls and limits work within the scheme.
2. Management Types and Price Limits: Agency-managed and Plan-managed participants must adhere to NDIS price limits, and Agency-managed supports must be delivered by registered providers. Conversely, self-managing participants can use both registered and unregistered providers and are not subject to the price limits or arrangements set out in the document.
3. DSW Cost Model Components: The model estimates the fully loaded cost of a billable hour of support by accounting for base pay, shift loadings, leave entitlements, and salary on-costs. It also includes operational overheads (supervision, workers' compensation), corporate overheads, and a profit margin.
4. Short Notice Cancellation Rules: Providers can claim up to 100% of the agreed fee if the participant provides less than two clear business days' notice for non-DSW supports, or seven days' notice for DSW supports. Additionally, the provider must be able to demonstrate they were unable to find alternative billable work and are required to pay the worker for the scheduled time.
5. MMM and Travel Limits: The MMM classifies locations from MMM1 (major cities) to MMM7 (very remote); providers in MMM1-3 can claim up to 30 minutes of travel time, while those in MMM4-5 can claim up to 60 minutes. In Remote (MMM6) and Very Remote (MMM7) areas, there is no travel time limit, and price limits are increased by 40% and 50% respectively.
6. Programs of Support: These are agreements for group-based or certain capacity-building supports where providers claim for agreed attendance regardless of actual presence, provided they had the capacity to deliver. These programs must not exceed six months, and participants must be allowed to exit with a maximum of two weeks' notice without further cost.
7. Therapy Assistant Supervision: Level 1 Therapy Assistants must deliver support under the direct supervision of a qualified therapist at all times. Level 2 Therapy Assistants may deliver supports under indirect supervision, provided the therapist is satisfied the assistant can work independently after receiving specific training.
8. Non-Face-to-Face Claiming: Providers can only claim for non-face-to-face activities if the support item allows it, the activity is specific to the participant (not general administration), and the participant has agreed to the charges in advance. Examples include writing reports about a participant’s progress, whereas making payment claims or staff rostering are considered non-billable overheads.
9. Individualised Living Options (ILO): ILOs are support packages built holistically around a participant's preferences and strengths, separate from home ownership or SDA eligibility. They consist of two stages: "Exploration and Design," to create a suitable support model, and the "Support Model" itself, which combines formal and informal supports.
10. Isolated Towns Modification: This modification reclassifies certain locations as "Remote" (MMM6) or "Very Remote" (MMM7) if they are enclaves surrounded by those areas, even if their standard classification is lower. For instance, towns like Broken Hill and Kalgoorlie are reclassified as MMM6 despite having lower standard MMM ratings.

Part 3: Suggested Essay Questions

Instructions: These questions are designed for in-depth analysis. Answers are not provided.

1. Analyze the Conflict of Interest Framework: Discuss the responsibilities of NDIS providers in identifying, declaring, and monitoring conflicts of interest within the provider market as outlined in the NDIA Position Statement.
2. The Impact of Remoteness on Service Delivery: Evaluate how the NDIS uses the Modified Monash Model and various price loadings to incentivize service provision in remote and very remote Australia.
3. Core vs. Capacity Building Support Purposes: Compare and contrast the flexibility and intent of "Core" supports versus "Capacity Building" supports, focusing on how they align with the NDIS Outcomes Framework.
4. Regulation of Specialist Disability Accommodation (SDA) and Supported Independent Living (SIL): Explain the distinct pricing structures for SDA and SIL, and how they interact to provide comprehensive housing solutions for participants with extreme functional impairments.
5. Evolution of Employment Supports: Examine the transition from "School Leaver Employment Supports" to the current "Specialised Supported Employment" model, detailing the types of activities now claimable to help participants find and keep work.

Part 4: Glossary of Key Terms