C2026A00066NDIS Checker

Schedule 3, Part 1

Price caps, indexation and who may be paid above the cap

From 27 August 2026 the Minister may set a maximum amount for a support, the Agency must not pay above it, and an NDIS provider must not charge above it where the funding is managed by a plan manager or the Agency.

What does the provision require?

New section 45C allows the Minister to determine, by legislative instrument, a ceiling, or a formula for a ceiling, on what may be paid to obtain or deliver a support or class of supports. The determination only applies where the funding is managed by a registered plan management provider or by the Agency, so it does not reach a support that a participant manages themselves. The Agency must not pay above the maximum. If a claim exceeds it, the Agency may refuse to pay or pay only the maximum. Nobody is entitled to the excess, and the excess becomes a debt owed to the Agency. A provider may not charge above the ceiling where the determination applies.

The determination may require processes before a support is acquired, such as a number of quotes, and may differ by support, intensity, remoteness, remote or in person delivery, provider qualification or registration, and how funding is managed. The Agency must advise the Minister on pricing, with regard to cost, quality, value for money, market diversity and competition, and financial sustainability, and the advice or a summary must be tabled in each House within 5 sitting days of the determination. Sections 32KA, 32KB and 34B provide indexation of plan funding where a maximum amount rises, for new framework plans, flexible funding and old framework plans respectively.

Why does it matter to an insurer or a provider?

A price cap is a margin cap, and the Act makes an overcharge a debt rather than a disputed invoice. For an insurer the exposure is twofold: the provider's revenue is capped on the supports it delivers, and an overpayment demand can arrive years later as a debt. The indexation provisions are the offset, and they only operate where a determination raises a maximum, so a provider's revenue can fall without any change to its own prices.

What did the amendment change?

There was no general maximum price power in the Act. The Act creates it, limits it to funding managed by a plan manager or the Agency, makes the excess a debt, imposes the cap on the provider as well as the Agency, and adds indexation provisions for plans where a maximum rises.

Suggested evidence

These are the publisher's control suggestions, not statutory requirements. The provision's own requirement is above; an auditor or regulator decides what is sufficient.

  • The determination and the supports it covers
  • The price charged against the maximum, support by support
  • The quote process where the determination requires one
  • The reconciliation of any claim above the maximum and the amount repaid
  • The indexation determination and the day it applies

What should be done before the date?

  1. Map the insured's price list against each determination
  2. Add the cap check to the claims payment control
  3. Model the revenue effect of a cap with no offsetting indexation
  4. Check the policy for a debt recovery or overpayment cover

What the text does not say

The text does not set any maximum amount; each is in a determination. It does not say how the Agency will recover an excess already paid. It does not apply the cap where the participant manages their own funding.

Where this sits

sections 45C, 32KA, 32KB and 34B, inserted by items 3, 4 and 1A in Schedule 3, Part 1, Decision making on pricing (items 1 to 9). Read the official text at https://www.legislation.gov.au/C2026A00066/latest/text. The record was read on 21 October 2026.

Not legal advice; does not certify. This page is a reading of the provision in our own words, not a reproduction of it, and not advice on your own facts.

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