The TAC will consider entering into an individual funding agreement with a client who has a severe injury and would like to arrange the purchasable TAC funded services that they receive.
Transport Accident Act 1986 reference: s.61A and s.61C
Individualised Funding has been developed by the TAC to promote client choice and control over the disability and allied health services provided to them for the management of their accident related needs. Individualised Funding gives clients the flexibility to arrange their own services in a way that best meets their needs and lifestyle, and empowers them to work directly with their service providers.
Eligible clients who would like to be considered for Individualised Funding are required to complete the Life Area Needs Self-Assessment so that the TAC can determine their suitability. To commence Individualised Funding clients need to enter into an Individual Funding Agreement with the TAC.
While Individualised Funding can provide clients with the opportunity to flexibly self-manage their own services, it comes with extra responsibilities. The TAC has employees with specialised Individualised Funding knowledge who are available to assist clients and their families with making the move to Individualised Funding.
Individualised Funding – means clients receive their funding on a monthly basis and accept responsibility for sourcing and engaging providers, arranging services in a way that best meets their needs and lifestyle, and paying for the services they receive.
Individual Funding Agreement - is an agreement between a client and the TAC which enables the TAC to make payments to a client and for that client to use these payments to purchase TAC funded services.
Individualised Funding Allocation – refers to the amount ($) that is determined by the TAC to represent a reasonable estimate of the client's likely costs or expenditure each month in relation to purchasable services.
Life Area Needs Self-Assessment – is a form completed by the client that contains questions about their accident related support needs, including how much and how often they need support. It also contains questions for clients to identify their current abilities to undertake the tasks required to self-manage their Individualised Funding.
Purchasable Services – means any services which are approved services as that term is defined under section 61A of the Transport Accident Act 1986 (Vic).
Self-Management - refers to clients who are independently managing the responsibility for completing all Individualised Funding obligations according to the terms of the Individual Funding Agreement. Obligations including managing the funds allocated to them by the TAC to meet their needs, making self-determined decisions and self-efficacy in managing and paying for the services they receive.
Financial Intermediary – where the TAC deems reasonable and necessary, a Financial Intermediary Service may be approved for the purpose of providing support to pay invoices electronically from the clients IF bank account. Financial Intermediary Services are provided by a Financial Intermediary (FI). The FI may only act on the client and TAC's instructions and in accordance with the terms sheet for the provision of FI services. Refer to the Financial Intermediary services policy.
Who is eligible for Individualised Funding?
A client who is eligible for Individualised Funding:
- has a severe injury as a result of a transport accident; and
- has needs related to their accident injuries that can be predicted for up to 12 months; and
- is willing and able to enter into an Individual Funding Agreement with the TAC.
A client who has a guardian or administrator, or a child who is under the age of seventeen years, is eligible for Individualised Funding provided they meet the eligibility criteria noted above.
How is the Individualised Funding Allocation determined?
The TAC will calculate an Individualised Funding Allocation that is tailored to the client's predictable needs. The Individualised Funding Allocation is determined by considering a client's historical use of services. If there is inadequate history (e.g. relatively recent accident) the TAC will take reasonable steps to develop a suitable Allocation. This may include the use of other comparative measures like responses from the client's Life Area Needs Self-Assessment, and consideration of the client's level and severity of injuries, and the duration of time since the injury.
The Individualised Funding Allocation is a fixed amount of funding that will be deposited to an Individualised Funding bank account established by the TAC. This will enable a client to manage their services to their Allocation. The TAC will provide clients with a decision letter to confirm their annual and monthly Allocation.
What is an Individual Funding Agreement?
The Individual Funding Agreement is an agreement between a client and the TAC which enables the TAC to make payments to a client and for that client to use these payments to purchase TAC funded services.
The IFA specifies:
- what approved services the agreement covers
- how and when payments under the agreement are to be made
- information that must be reported to the TAC to enable the monitoring of the agreement
- all obligations of the parties under the agreement
- how the agreement may be amended, suspended or terminated
- if the agreement is terminated, any obligations that apply to the parties under the agreement
- that the agreement is covered by the law of Victoria
- how overpayments and payments not applied in accordance with the agreement will recovered
- how disputes will be resolved.
Transport Accident Act 1986 reference: s.61B
Which services may be purchased under an IFA?
Eligible clients may use their Allocation to purchase any of the following services they are entitled to under the Act, and may choose more of one type of service and less of another depending on their needs. If a client needs a service that is on the list the service is to be paid from the client's Individualised Funding allocation.
List of Purchasable Services:
- Attendant care (including overseas attendant care)
- Child care - only if eligible under section 60(2)(c) of the Transport Accident Act 1986
- Community group programs
- Continence equipment
- Equipment purchase or hire that costs less than $1000 per item inclusive of delivery
- Exercise physiology
- Gym and swimming programs - when certified by a medical practitioner or registered physiotherapist for the purpose of treatment or rehabilitation of transport accident injuries.
- Home services/ Domestic services (including gardening)
- Occupational therapy
- Social work
- Speech pathology
- Specialist disability laundry services - reasonable costs when required for 'soiling' as caused by the transport accident injuries.
Which services may not be purchased under the IFA?
A client may not use their Allocation to purchase any of the following services:
- services for a person other than the injured client (except for child care)
- services that cannot be funded by the TAC
- services for a condition that existed before a transport accident or that is not a direct result of a transport accident
- continence equipment when the client has a valid continence prescription form (refer to the Equipment policy)
- maintenance for equipment when the client has preventative maintenance approved (refer to the Equipment policy)
- TAC funded services that are infrequent, difficult to predict, high cost or cannot be substituted for another service, for example, home modifications or residential care services.
A client may still access these services however the TAC will continue to arrange them on the client's behalf.
Does entering into an IFA affect a client's income?
The TAC does not consider any payment made as part of a client's Individualised Funding to be income. If a client receiving TAC income benefits enters into an IFA this will have no impact on their TAC income payments.
Does entering into an IFA mean a client can choose any service provider?
The TAC requires clients on Individualised Funding to choose service providers who hold a certificate of business/incorporation registration and are appropriately qualified and experienced. This means service providers will be established as a business and hold the appropriate level of insurances and occupational health and safety certificates.
Health practitioners must hold the relevant professional registrations including registration with the Australian Health Practitioner Regulation Agency (AHPRA) where applicable. Disability service providers (e.g. Attendant Care and Community Group Programs) should comply with the relevant state or federal disability service industry standards.
For more information on choosing the right service provider, refer to Find an Individualised Funding purchasable service.
What happens if a client's needs or circumstances change during Individualised Funding?
If a client feels that something significant has happened, such as a change in their health or circumstances that would make it difficult for them to complete all of their tasks under the IFA, the client must contact the TAC to discuss these changes.
If the TAC becomes aware that there is a significant change in a client's health or circumstances that would make it difficult for them to complete all of their tasks under the IFA, the TAC may:
- offer additional TAC support (e.g. Individualised Funding Specialist)
- initiate a review
- maintain the current Individualised Funding Allocation
- vary the Individualised Funding Allocation to reflect the changed circumstances
- suspend or terminate payments of the Individualised Funding Allocation in accordance with the client's IFA
The TAC will discuss these options with the client and advise them in writing of the TAC's decision.
What happens if Individualised Funding is no longer required?
When payments are suspended or terminated in accordance with the client's Individual Funding Agreement, the TAC will resume managing all services to which a client is entitled. The client will be advised in writing of the contact details for their new claims employee.