NDIS Service Agreement
Parties
This Service Agreement is for:
Client First Name
Client Surname Name
Client Date of Birth
NDIS Number
a participant in the National Disability Insurance Scheme (client), and is made between:
Therapist name Sacha Pitcher
Therapist occupation Speech Pathologist
Practice Name WA Speech Group
Date24/04/2024
2. The NDIS and this Service Agreement
This Service Agreement is made for the purpose of providing supports under the client’s NDIS plan.
A copy of the client’s NDIS plan is/is not attached to this Service Agreement. The parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme that aims to:
- support the social and economic independence of people with disability, and
- enable people with disability to exercise choice and control in the pursuit of their goals, and the planning and delivery of their supports.
3. Schedule of supports
WA Speech Group agrees to provide the client therapy services. The supports and their prices are set out in the attached Schedule of Supports. All prices are GST inclusive (if applicable) and include the cost of providing the supports. Additional expenses (ie., things that are not included as part of a client’s NDIS supports) are the responsibility of the client / client’s representative, and are not included in the cost of the supports.
4. WA Speech Group Responsibilities
WA Speech Group agrees to,
- Review the provision of supports at least annually with the client,
- Once agreed, provide supports that meet the client's needs, based off their goals, at the client' preferred times.
- Communicate openly and honestly in a timely manner.
- Treat the client with courtesy and respect.
- Consult the client on decisions about how supports are provided.
- Give the client information about managing any complaints or disagreements, and details of WA Speech Group cancellation policy.
- Listen to the client's / client's representative's feedback and resolve problems quickly.
- Wherever possible, give the client 24 hours' notice if WA Speech Group must change a scheduled appointment to provide supports.
- Protect the client's privacy and confidential information.
- Provide supports in a manner consistent with all relevant laws, including the NDIS Act 2013, and the Australian Consumer Law.
- Keep accurate records on the supports provided to the client. and,
- Will issue invoices and statements of the supports delivered to the participant as per the NDIA Terms of Business for Registered Providers, as requested.
5. Responsibilities of the client / client representative
The client / client representative agrees to,
- Inform WA Speech Group about how they wish the supports to be delivered to meet the client's needs,
- Treat WA Speech Group workers with courtesy and respect,
- Talk to WA Speech Group if the client has any concerns about the supports being provided,
- Give WA Speech Group the required notice if the client cannot attend a scheduled appointment, noting that if appropriate notice is not provided, the WA Speech Group cancellation policy will apply,
- Let WA Speech Group know immediately if the client's NDIS plan is suspended or replaced by a new NDIS plan, or the client stops being a participant of the NDIS.
6. Payments
WA Speech Group will seek payment for the provision of supports after the supports have been delivered.
- Self managed - the client / client representative has chosen to self-managed the funding for the NDIS supports provided under this Service Agreement. After providing those supports, WA Speech Group will send the client / client representative an invoice for those supports for the client / client representative to pay. The client / client representative will pay the invoice within 7 days. Should this not occur in a timely fashion, WA Speech Group reserves the right to suspend care to the client until accounts are settled.
- Plan managed - the client has nominated the Plan Management Provider to manage the funding for NDIS supports provided under this Service Agreement. After providing those supports, WA Speech Group will claim payment for those supports from,
Fee Schedule
| NDIS Participants | |
|---|---|
| Service Duration | Fee |
| 30 minutes | $96.99 |
| 45 minutes | $145.49 |
| 60 minutes | $193.99 |
| Plan Manager Provider Name: | |
|---|---|
| Plan Manager Email Address: |
7. Changes to this Service Agreement
If changes to the supports or their delivery are required, the parties agree to discuss and review this Service Agreement. The parties agree that any changes to this Service Agreement will be in writing, signed and dated by the parties.
8. Ending this Service Agreement
Should either party wish to end this Service Agreement they must give 2 weeks’ notice. If either party seriously breaches this Service Agreement the requirement of notice will be waived.
9. Feedback, complaints, and disputes
If the client / client representative wishes to give WA Speech Group feedback or is not happy with the provision of supports and wishes to make a complaint, the participant talk to WA Speech Group on 9274 1482 or email mail@waspeech.com.au.
If the client / client representative is not satisfied or does not want to talk to this person, at any time they can make a complaint to Sarah MacAlasdair at WA Speech Group on 9274 1482 or email sarah.m@wapg.com.au, OR can make a complaint to the NDIS Commission. Complaints to the NDIS Commission can be lodged online at www.ndiscommission.gov.au or by phone 1800 035 544.
10. Goods and Services Tax (GST)
For the purpose of GST legislation, the Parties confirm that,
a supply of supports under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33(2) of the NDIS Act in the client’s NDIS Plan currently in effect under section 37 of the NDIS Act.
the client’s NDIS Plan is expected to remain in the effect during the period the supports are provided, and
the client / client representative will immediately notify the provider if the client’s NDIS Plan is replaced by a new plan or the client stops being a participant in the NDIS.
11. Cancellation Policy
At WA Speech Group we value consistent and high-quality intervention. If you need to cancel an appointment, we ask for 24 hours’ notice where possible. Should you late notice cancel your appointment on multiple occasions, or you do not attend an appointment, the full cost of the appointment may be charged, inclusive of any travel fees that may be applicable if your appointment was due to be external to the WA Speech Group clinic. Where WA Speech Group cancels a support due to operational reasons, the service will be rescheduled at no penalty to either party. Where multiple cancellations or no-shows occur in a 12-month period, WA Speech Group will initiate contact with the client and their support network to establish the supports we are providing are best suited to the client and (where appropriate) family dynamics and the needs of the client.
If a client attends an appointment and has a fever, runny nose, cough, diarrhoea, vomiting, conjunctivitis, unknown rash, head lice or nausea, our clinicians will conduct the appointment and the client will be charged. If you are unable to attend due to sickness or personal issue, we may reschedule if given notice.
I have read & understood the cancellation policy
___________________________________________
12. Contact details of client representative or other contacts, *one set of details must be entered
If applicable, the Client Representative or emergency contact person for the client can be contacted on:
Emergency contact name:
Address:
Phone:
Email Address:
WA Speech Group be contacted on 08 9274 1482 7am-7pm weekdays; 9-12 pm weekends.
13. Schedule of supports
I / we agree to pay for the therapy sessions provided by WA Speech Group through claiming against the NDIS service plan. Working with the NDIS we have been allocated funding under Capacity Building – Improved Daily Living line item within the below plan date.
| Start Service Date | |
|---|---|
| Finish Service Date |
The provider agrees to provide the client therapy services for the duration of the agreement at the scheduled rate. These include,
- Speech Pathology assessment and treatment as appropriate,
- Clinically relevant communications including phone calls, written programs, communication with other health professionals, any task that takes more than ten minutes will be invoiced.
- Attendance at team meetings / case conferences as required,
- Assessment and trial of equipment as required and appropriate,
- Any reports, forms, or letters as required by the NDIS or requested by the client / client representative,
- Cancellation charges for late notice cancellation of appointments, or nonattendance charges for missed appointments.
WA Speech Group reserves the right to NOT provide a service, or to cancel any future appointments for the client if sufficient funds are not in their plan, their plan expires, or their outstanding fee amount is too high.
| Service | Support Item | Rate | Hours | Value |
|---|---|---|---|---|
| Capacity Building for Assessment, Recommendation, Therapy or Training – Speech Pathology | 15_622_0128_1_3 | $193.99 |
Price & Payment Information
Therapy will be charged at the rate under the code 15_055_0128_1_3 as appropriate in the NDIS Pricing Arrangements and Price Limitations guide. Unless specified as costing less as above, all other appointments are due to be charged at the NDIS rate of $193.99 per hour. Non-labour costs are charged under the coding 15_799_0128_1_3 at $0.97 per kilometre as all therapists use their own vehicles for transport.
All prices will be adjusted if there is any change in the NDIS price guide during the service agreement period. WA Speech Group will claim funding from the following support category: CB Daily Activity, if agency managed.
14. Agreement signatures
The parties understand and agree to the terms and conditions of this Service Agreement.
Signature of Client / Client Representative _______________________________________________
Name of Client / Client Representative ________________________________________________
Signed Date ________________________________________________
Signature of Therapist: Sacha Pitcher
Name of Therapist: Sacha Pitcher
Signed Date: 24/04/2024
