Ask DSC: Can you charge remote therapy rates for telehealth?

Question: I am a therapist who provides support to people living in remote areas. When appropriate, the participant and I may agree to sessions via telehealth or video-calls. In these situations, can I still charge the remote therapy rates?

Very good question! And a timely one too! There certainly feels like there has been an increase in options for therapeutic supports, since we all learned to adjust and adapt during Covid. Online support and telehealth are acceptable modes of delivering therapy for some NDIS participants, so let’s take a look at the fine print.

Remote and the NDIS

Before we dive in, let’s refresh our knowledge of how the NDIA defines ‘remote’. The NDIA uses a modification of the 2019 version of the Modified Monash Model (MMM) to determine whether a support is being delivered in a regional, remote (MMM6) or very remote (MMM7) area. In general, price limits are 40% higher in Remote areas.

Telehealth and the NDIS Pricing Arrangements and Price Limits

So, what does it say in the Pricing Arrangements and Price Limits Document?

• When a support is provided directly to a participant via telehealth, the price limit that applies to the support should, in general, be the price limit that would apply if the participant was receiving the support at the place that the person who is delivering the support is located at the time of service delivery.

One interpretation here is that the therapist ‘should’ charge the standard National rate if the therapist is located in a non-remote area (MMM1-5). However, if the participant is located in a remote area, ‘should’ is not the same as ‘must’.

A therapist can charge the remote rate if there has been an informed and mutual agreement with the participant to do so. And, as always, the participant has the right to negotiate prices and not agree to being charged remote rates for telehealth and video support (however, the therapist also has the right not to agree to provide supports below their price limit).  

Some other considerations may come into play:

• Although the therapist may be in a non-remote location when delivering the telehealth/videocall, they are likely having to navigate remote considerations. For example, if they are collaborating with an assistive technology provider, or another therapist in the person’s support team. The therapist may be having to negotiate ‘thin markets’ to assist with the delivery and implementation of their therapy plan.

• If living in a remote area, the participant has very likely had their plan built at the remote rate - so the funding is there to cover the hours that have been budgeted for, which may be one argument for that rate being charged. However, even if a participant’s therapy budget has been built using the remote rate, the participant may still be experiencing a tight therapy budget. This may further incentivise the participant to negotiate.

• Another consideration is whether charging remote rates will incentivise providers to deliver (or continue to deliver) supports in remote areas (where participants are commonly navigating ‘thin markets’).

Non face-to-face support rates

When a support is not provided directly (for example, Non-Face-to-Face report-writing), the price limit is based on the location of the therapist. If the therapist location is not remote, they can only charge the standard national rate, even if the participant is located in a remote setting. 

So, the short answer is: it is possible for the therapist to charge remote rates when delivering telehealth and online video supports from a non-remote location, if:

• the participant is located in a remote area,

• there has been an opportunity for the participant to do informed decision making, and

• there is mutual agreement to do so.