05/01/2026
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2025–26 National Disability Insurance Scheme Annual Pricing Review provider consultation paper
Version: 1
Date: November 2025
Author: National Disability Insurance Agency
Contents
1. Overview 3
1.1 Introduction 3
1.2 Consultation purpose and scope 4
1.3 Consultation process and timeline 4
1.4 Market stewardship and pricing reform context 5
1.5 Quality Support Program 7
1.6 Broader NDIS reforms 8
2. Current economic conditions 8
3. 2025–26 Annual Pricing Review scope 10
3.1 The NDIA’s approach to differentiated pricing 10
3.2 Disability support worker related supports 11
3.3 Therapy supports 12
3.4 Support coordination 13
3.5 Plan management 13
3.6 Social, community and civic participation 14
4. Engagement Questions 15
1. Overview
1.1 Introduction
The National Disability Insurance Agency (NDIA) is reviewing current National Disability Insurance Scheme (NDIS) pricing in the 2025–26 Annual Pricing Review (APR).
We’re checking if it:
• Best supports the diverse disability support market
• Delivers value for participants
• Maintains provider sustainability.
This APR applies consistent, evidence-based methods to assess if pricing still supports participant outcomes and market sustainability, and if it needs any changes.
It also uses prior reviews and emerging data from the Quality Supports Program pilots to see if different pricing can do the following:
• Better recognise diverse value propositions and cost structures across the disability support market
• Still maintain participant choice and control.
About the 2025–26 APR
The 2025–26 APR will focus on 5 support categories:
• Disability Support Worker-related supports
• Therapy supports
• Support coordination
• Plan management
• Social, Community and Civic Participation (SCCP)
We’ll review others in later years under the 3-Year Pricing Workplan.
For stakeholder participation in the APR, this paper summarises current conditions including:
• Workforce
• Pricing
• Broader economic trends with an overview of related NDIA initiatives.
This consultation seeks stakeholder input about the following:
• If current pricing in these 5 key support areas still services participants effectively.
• If we need changes.
We need your feedback on how pricing could better reflect diverse provider models, while ensuring participant outcomes and market sustainability.
1.2 Consultation purpose and scope
This consultation seeks stakeholder input on if we need pricing changes and how to design and implement them across 5 key support areas.
• Disability Support Worker (DSW) Related Supports: Indexation and alignment with Industrial Award changes.
• Therapy Supports: Benchmark against health markets.
• Support Coordination: Consider registration-based price differentiation.
• Plan Management: Assess pricing and payment approach and market concentration.
• Social, Community and Civic Participation (SCCP): Comprehensive market analysis as the primary focus area, including potential differentiated pricing.
1.3 Consultation process and timeline
Consultation Period: November 2025 to February 2026
Key Dates:
• Consultation opens: November 2025
• Submissions close: 11:59pm AEDT 8 February 2026
• Start implementation: 1 July 2026
The NDIA is committed to meaningful consultation. We’ll gather and publish feedback in a consultation report with the following:
• Clear detail about how stakeholder input has informed the Agency’s conclusions.
• Any recommended changes.
Questions we will be focusing on are in this document. Please visit NDIS Engage to respond to these questions:
Submission guidelines:
• There are questions for the 5 key support categories in the 2025–26 APR.
• We encourage you to focus on questions relevant to your expertise and operations.
• Your submissions should include specific examples and evidence where possible.
• You don’t have to answer every question. Just those relevant to your expertise and experience.
• Focus on practical insights into market dynamics and potential implementation considerations, rather than general policy commentary.
• If you feel we haven’t captured something important, there’s a chance for more input at the end of the survey.
1.4 Market stewardship and pricing reform context
The NDIA has shared responsibility for market stewardship across disability support markets with the:
• Department of Health, Disability and Ageing (DHDA)
• National Disability Insurance Scheme Quality and Safeguards Commission (NDIS QSC).
Market stewardship ensures participants can access quality supports that enable them to pursue their goals and participate fully in community life.
This responsibility involves the following:
• Shaping market conditions where providers can sustainably deliver diverse, high-quality services.
• Making sure participants have choice and control.
In this shared framework, participants rely on functioning markets to exercise choice and control. When markets develop gaps, participants’ opportunities become limited. These gaps include:
• Service type
• Geographic coverage
• Quality standards
Good market stewardship involves the following:
• Finding gaps.
• Using coordinated policy, pricing and regulatory tools for appropriate provider responses.
• Protecting participants from poor quality or exploitative services.
Pricing frameworks are central to market stewardship. Effective pricing balances the diversity of service options while ensuring providers can deliver quality support over time.
The NDIA’s pricing policy supports disability system improvements, including quality enhancement initiatives and regulatory modernisation. It does this with coordinated, evidence-based approaches that complement regulatory and policy frameworks across the system.
Building on the 2024–25 Annual Pricing Review
The Independent Pricing Committee (IPC) review in 2024–25 analysed NDIS pricing arrangements. It found potential market effects associated with uniform price limits. These uniform price limits, while supporting market stability, may not fully reflect the diversity of service models or the cost of supporting participants with complex needs.
These insights inform the NDIA’s ongoing analysis of market dynamics as part of its broader evidence program.
The 2024–25 APR found that price limits likely influence market structure in Disability Support Worker (DSW) and other supports. Growth is strongest in:
• Small and unregistered providers
• Margin pressures for larger organisations investing in complex supports.
About two thirds of claims in support categories were at the price limit. This suggests uniform pricing may not reflect the diversity of delivery contexts.
For therapy supports, the 2024–25 review found:
• Most providers operate at small scale
• A few larger providers deliver most services.
Claiming patterns converged at the price limit. This suggests it may operate as a default rate rather than a ceiling.
Continued market evolution analysis shows these patterns persist and, in some cases, intensify. Multiple support markets show the following:
• Rapid growth in sole traders and small unregistered providers.
• Declining market share for larger registered organisations.
• Geographic variation in market structures.
Claiming data shows convergence at price limits with limited variation based on service context. Provider feedback identifies margin pressure for those supporting participants with complex needs, workforce retention challenges. It also shows viability concerns for service models needing higher infrastructure investment.
1.5 Quality Support Program
The Quality Supports Program is part of the NDIA’s work to reform pricing for:
• NDIS supports
• Providers of high quality with value-for-money services to participants.
There’s more than $45 million in funding as part of a program to support quality providers of disability services. Providers delivering the following supports will share this money:
• NDIS therapy support providers
• Supported Independent Living (SIL)
• Support coordination
The program will help the NDIA identify the best price settings for quality disability support services and the long-term viability of quality providers. The NDIA will work with selected providers to evaluate quality service provision. This includes costs and outcomes from providing quality services to NDIS participants.
• The SIL Pilot started in August 2025.
• 44 providers are working with the NDIA over 12 months to identify features of quality service provision and the costs of delivering these services.
• The SIL Pilot is also working with providers to hear from participants receiving SIL assistance.
We intend to commence a new pilot in early 2026 for NDIS therapy providers as part of the Quality Supports Program. Data from this will help future NDIS therapy pricing.
Find more information on the NDIS Quality Supports Program webpage.
1.6 Broader NDIS reforms
The Australian Government is improving the NDIS for everyone. This includes participants, their families and carers. The NDIS is also undergoing large-scale reforms to ensure:
• People with disability are at the centre
• The Scheme’s sustainability for future generations.
The NDIA is intending to introduce a new planning framework. This includes support needs assessments as part of the planning process. These will be a consistent and reliable information gathering step to create fairer budgets in NDIS plans. Find out more on the NDIS website.
To support NDIS reforms, the government has introduced changes to the National Disability Insurance Scheme Act 2013 (NDIS Act). The amended NDIS Act provides the framework for new rules to make the NDIS better, fairer and more sustainable.
• Find out more about the proposed changes and process on the DHDA website.
• These changes are also on the NDIS website.
The NDIS QSC is also making changes to regulation. This is to improve the quality and safety of support for NDIS participants. This includes:
• Reviewing the NDIS Practice Standards and proposed legislative changes
• Implementing mandatory registration for platform providers, SIL and support coordination providers.
• Read more on the NDIS QSC reform hub.
2. Current economic conditions
Labour market conditions
Australia’s labour market has remained resilient over the past year. This is despite some easing in labour market indicators.
• Employment increased by 217,200 people over the year to August 2025 .
• The participation rate fell to 66.8% in August 2025 but remains near its record high .
• While the unemployment rate rose slightly to 4.2% in August 2025, it remains historically low .
The Health Care and Social Assistance (HCSA) industry was the largest employing and fastest growing industry in the Australian economy over the past year.
• Employment in the HCSA industry increased by 120,700 people over the year to August 2025. This represents over half (55.5%) of the total increase in industry employment .
• There were over 2.36 million people employed in the HCSA in August 2025. This represents 16.1% of total employment .
While job vacancies have fallen slightly in the HCSA industry over the past year, demand for workers in the industry remains strong. There were 55,300 job vacancies in the HCSA industry in August 2025. This is 85.6% higher than their level before the COVID-19 pandemic .
• The labour market is expected to remain broadly stable and not ease much further .
• The unemployment rate is forecast to stabilise around 4.3% over 2026 and 2027, which is low by historical standards .
• Employment growth is expected to ease from the strong growth rates seen over recent years, particularly in the non-market sector .
Inflation
The Australian economy has continued to experience an easing in inflationary pressures over the past year with inflation now at a 4-year low. Annual headline inflation fell from 3.8% in the June quarter 2024 to 2.1% in the June quarter 2025. It’s now back within the Reserve Bank of Australia’s (RBA) target band of 2–3% .
Health inflation also eased over the past year but remains above the headline inflation rate. Annual inflation for health goods and services fell from 5.7% in the June quarter 2024 to 4.1% in the June quarter 2025. This was driven by a 5.1% increase in the cost of medical and hospital services .
The RBA expects headline inflation to increase over the second half of 2025 to be above 3% through most of 2026, before returning to the midpoint of the target range in the second half of 2027 .
Wage growth
Wage growth has eased over the past year from its highs in recent years, alongside easing inflation and some labour market indicators. Wage growth was 3.4% over the year to the June quarter 2025, down from 4.1% in the year to June quarter 2024 .
The HCSA industry has also recorded an easing in wage growth over the past year. Wage growth in the HCSA industry was 3.9% over the year to the June quarter 2025, down from 5% in the year to June quarter 2024 . Despite easing, wage growth in the HCSA industry remains higher than the all-industries wage growth rate.
Wages are expected to grow over the remainder of 2025, supported by the renewal of several large public sector agreements and announced administered decisions for several large awards . Wages growth is then expected to remain steady at around 2.9% over 2026 and 2027, consistent with the stability in labour market conditions .
3. 2025–26 Annual Pricing Review scope
3.1 The NDIA’s approach to differentiated pricing
The NDIA is exploring differentiated approaches to pricing and market stewardship. This is to better reflect the diversity of supports, delivery contexts and participant needs across the NDIS. Differentiation does not mean setting multiple price limits for every service type. Rather, it has the broader principle that pricing, policy and regulatory settings should respond proportionately to differences in service complexity, quality, workforce capability and participant outcomes.
A differentiated approach allows the Agency to do the following:
• See where flexibility or targeted adjustments can improve market sustainability and participant experience.
• Maintain fairness, transparency and choice.
This may include using pricing, registration and payment mechanisms that better reflect the cost and value of delivering quality supports.
Through the APR and Quality Supports Program, the NDIA is gathering evidence on how pricing and regulatory settings interact to influence:
• Service quality
• Provider sustainability
• Participant outcomes.
This evidence will inform if differentiated approaches should be used in future pricing frameworks, and how they may work.
The NDIA is considering differentiation in several areas:
• Registration and assurance requirements: recognising the compliance and quality investments required of registered providers.
• Participant complexity and intensity: accounting for additional time, skill and workforce structures needed to support participants with complex needs.
• Provider capability and quality: supporting providers who invest in training, supervision and outcomes measurement.
• Market alignment and benchmarking: ensuring NDIS prices remain responsive to broader market conditions and workforce trends.
We encourage stakeholders to:
• Comment if these areas capture the main opportunities for differentiation,
• Suggest other considerations that may support a balanced approach to pricing and market sustainability.
3.2 Disability support worker related supports
Between January and June 2025, 137,599 providers delivered DSW supports to 309,460 participants with $15.5 billion in payments.
• Registered providers (10,993) averaged $1 million per provider.
• Unregistered providers (127,434) averaged $34,800.
Despite registered provider numbers growing 15%, their average claims fell 4%. Two thirds of claims occur at the price limits with registered providers claiming at the limit of 71% of the time compared to 64% for unregistered providers.
Market analysis suggests uniform price limits may influence provider behaviour. Low overhead models also expand more rapidly than those investing in workforce development and clinical governance.
The market continues to show signs of polarisation: growth among very small sole traders and large providers. Registered providers with higher quality and compliance investments operate under the same price limits as unregistered providers with lower overheads. This may affect sustainability for some service models.
The 2025–26 APR will examine if indexation arrangements reflect changes to the Social, Community, Home Care and Disability Services (SCHADS) Award, including the Fair Work Commission’s gender-based undervaluation case.
It will also consider if changes could better support diverse provider models that collectively serve the full spectrum of participant needs.
3.3 Therapy supports
Between January and July 2025, 52,299 providers delivered therapy to 436,065 participants with $2.4 billion in payments.
• Unregistered providers represent about 90% of the market but deliver only 38% of supports. This is an average of $19,700 in payments per provider.
• Registered providers deliver 61% of supports. This is an average of $207,900 in payments per provider.
The 2024–25 APR saw that current hourly price limits adopt a flat structure. Most therapy types receive $193.99 per hour regardless of discipline, participant complexity or service intensity. This may not:
• Distinguish between participants with routine needs and more complex or specialised support
• Recognise the extra investment some providers make in training, supervision and governance to maintain service quality.
The 2024–25 APR also found that 60-minute sessions have become the predominant claiming pattern across therapy types.
• Most claims are also billed at exactly 60 minutes.
• This suggests price limits may operate as default reference points rather than functioning strictly as ceilings, potentially influencing service delivery patterns.
Expanded benchmarking using the Medicare Benefits Scheme (MBS) and private health insurance data indicated some variation between NDIS price limits and broader health-market benchmarks. There were higher limits in some disciplines like physiotherapy and lower limits in others like psychology.
The 2025–26 APR builds on these findings to assess if current price settings remain appropriate. It will examine and consider the following:
• NDIS-specific cost drivers not captured in standard health benchmarks, including coordination, planning and multidisciplinary supports.
• How pricing could better reflect variations in service intensity, participant complexity and workforce structures as the market continues to mature.
3.4 Support coordination
Between January and July 2025, 10,498 providers delivered support coordination to 275,575 participants with $561 million in payments. Provider continuity differs dramatically:
• 56% of registered providers were active in all 6 half-year periods. This accounts for 86% of payments.
• Among unregistered providers, the largest group was active for only one half-year period.
This suggests a maturing market with a stable core of registered providers alongside a more transient cohort of smaller, unregistered providers allowing flexibility and choice.
The 2025–26 APR will assess if current price limits remain appropriate and continue to support participant outcomes and sustainable service delivery in these categories:
• Level 1 Support Connection
• Level 2 Coordination of Supports
• Level 3 Specialist Support Coordination.
3.5 Plan management
Between January and June 2025, 1,356 providers processed $14.2 billion in payments for 484,278 participants including $323 million in fees. The market is highly concentrated, with about 30% of payments processed by 5 large national providers, including in remote and very remote areas.
Plan management has evolved into an administrative function where technology, systems capability, and operational scale are key factors in service delivery. The current flat monthly fee approach may not distinguish between providers processing payments for a small number of participants and those managing large scale operations. This questions if pricing:
• Reflects the different operational models, technological investments and administrative capabilities across the provider base
• Continues to support a balanced mix of provider types that serve participant interests.
The 2025–26 APR will assess the following:
• If current pricing remains fit for purpose given market maturity.
• How provider scale and operating models affect costs and service quality.
• If other approaches may better align with administrative plan-management services.
3.6 Social, community and civic participation
Between July 2024 and June 2025, participant spending on Social, Community and Civic Participation (SCCP) was $10.8 billion.
• A distinct feature is the large group of unregistered sole traders. There were more than 116,000 individuals providing supports worth $2.07 billion (19% of total payments).
• In comparison, the entire registered market of sole traders (1,291) claimed $91 million (0.8% of payments). This highlights the prominence of unregistered sole traders in the SCCP market.
Unlike Assistance with Daily Living (ADL), SCCP activities generally involve lower intensity, community-based participation, rather than personal or complex care. This means the SCCP market operates with different cost drivers, supervision needs and risk profiles.
This market profile has unique challenges for pricing and stewardship:
• Sole traders, small businesses and larger organisations operate under different structures, compliance obligations and service models.
• Yet they’re subject to the same uniform price limits.
This APR will examine if this still supports a balanced mix of provider types and participant outcomes across the market.
Uniform pricing may not fully reflect the different costs and compliance investments between provider types. Registered providers invest in:
• Quality systems
• Workforce training
• Supervision
• Governance
• Safeguarding.
These are vital for participant safety and service quality. But they can create higher fixed costs compared with lower-overhead models.
For participants, provider choice reflects different priorities.
• Many value the flexibility and personal relationships of sole traders.
• Others, particularly with more structured or high-support needs, benefit from the assurance and governance of registered providers.
The 2024–25 APR will consider if current pricing supports both sides of the market. If it preserves the choice participants value, while ensuring providers can still invest sustainably in quality systems.
4. Engagement Questions
Please visit NDIS Engage to respond to these questions:
Differentiated Pricing
If the NDIA implements differentiated pricing (different price limits for different circumstances) what should be the primary basis for differentiation?
What is the single biggest risk of differentiated pricing the NDIA must address?
What participant support characteristics require different staffing, supervision or delivery approaches for DSW supports?
Compared to delivering similar supports in other sectors (for example, aged care, health or community services), what aspects of the NDIS environment make DSW service delivery more or less complex?
Compared to therapy in health/aged care settings, rate how much additional time/effort each aspect requires under the NDIS?
Therapy
How is your therapy workforce primarily employed?
What is the typical duration of a NDIS therapy session delivered by your organisation or practice?
What percentage of this session time is direct therapy, documentation, coordination or other?
Other Professionals
Do you deliver supports under ‘Other Professionals’ in the NDIS Price Limits and Price Arrangements?
What is your professional registration or membership body (if any)?
What is your highest relevant qualification?
How do you describe your role when working with participants?
Support Coordination
How is your Support Coordination workforce primarily employed?
Plan Management
What pricing structure would best align with Plan Management service delivery? What are the advantages and disadvantages of each approach?
Social, Community and Civic Participation
In what circumstances does SCCP delivery require substantially different pricing?
Should SCCP pricing differ between registered and unregistered providers?
If yes, what differential would appropriately reflect registration costs and obligations?
Would registration-based differentiation change your registration status?
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