The TAC Medical Excess may apply to these services
We can pay the reasonable costs of services delivered under Framework Occupational Therapy where required as a result of a transport accident injury under section 60 of the Transport Accident Act 1986 (the Act).
The TAC will periodically review a client’s entitlement to occupational therapy services to ensure that they remain reasonable for the transport accident injury and are payable under the Act.
Framework Occupational Therapy is a service model that recognises the importance of a client’s participation and independence in the everyday activities at home, at work, at school or within the community. Framework Occupational Therapy providers have specific experience in treating clients who have received an acquired brain injury or spinal cord injury as a result of a transport accident.
The TAC has developed the Clinical Framework for the Delivery of Health Services which is a set of guiding principles intended to support healthcare professionals in their treatment of an injury through:
- Measurement and demonstration of the effectiveness of treatment
- Adoption of a biopsychosocial approach
- Empower the injured person to manage their injury
- Implementing goals focused on optimising function, participation and return to work
- Base treatments on best available research evidence.
We expect that all health professionals providing services to clients will integrate the principles of the Clinical Framework into their daily practice.
What can the TAC pay for in relation to Framework Occupational Therapy?
We can pay the reasonable costs of Framework Occupational Therapy:
- required as a result of a transport accident injury
- provided by TAC Framework Occupational Therapists
- that is clinically justified
- that promote progress towards functional independence, participation and self-management
- that is reasonable, necessary or appropriate in the circumstances
- that is safe and effective
- in accordance with the TAC’s policies
- authorised by the TAC under the Transport Accident Act 1986
All services must be billed in accordance with the Framework Occupational Therapy Fee Schedule.
A Framework Occupational Therapy service is an individual one-on-one service that may be no shorter than 15 minutes and no greater than the maximum TAC approved amount as determined appropriate by the treater, client and the TAC.
The need for service will be reviewed at regular intervals. For more information, please see the TAC Framework Occupational Therapy Fee Schedule.
The TAC can pay the reasonable cost of travel on a pro-rata basis for Framework Occupational Therapy providers conducting services outside their clinic. Travel is defined as the Framework Occupational Therapy provider driving a registered motor vehicle from their clinic address to an approved consultation on the community.
The TAC expects the client to seek treatment from a Framework Occupational Therapy provider within their local area. Travel can only be paid where travel to the client is clinically justified.
Travel is only payable with prior written approval from the TAC.
For more information please refer to the Framework Occupational Therapy Fee Schedule.
Reports and assessments
Framework Occupational Therapy service providers can also be asked to provide advice to the TAC regarding an injured client’s need for services. These services include:
- Attendant care
- Post acute support
- Domestic services
- Home services
- Home modifications
- Vehicle modifications; and
Who may provide Framework Occupational Therapy?
Framework Occupational Therapy may be provided by an occupational therapist who:
- is registered with the Occupational Therapy Board of Australia
- has met the TAC eligibility requirements
- has signed a declaration committing to provide services in line with the Clinical Framework and the Framework Occupational Therapy model
- undertaken the compulsory Framework OT training; and
- has received confirmation of approval from TAC.
The TAC eligibility requirements are outlined in the Framework Occupational Therapy Application Form.
To be eligible to become a Framework Occupational Therapist, applicants are required to meet the criteria of one of the following categories:
- Three years experience as an OT, including 2 years experience providing services to people with an Acquired Brain Injury (ABI) and/or Spinal Cord Injury (SCI)*; OR
- Three years experience as an OT without experience providing services to people with an ABI and/or SCI. To be eligible for this category the applicant is required to declare that they will complete 50% of the required OT Continuing Professional Development (CPD) over the next two years on providing services to people with ABI/SCI. Each CPD must include clinical supervision specific to this client cohort; OR
- Two years experience as an OT including experience providing services to people with an ABI and/or SCI. In this case the applicant will be required to declare that they have arrangements in place for clinical supervision specific to this client group for the first year of practice as a Framework OT, and the applicant will be required to declare that they will complete 50% of the required CPD over the next two years on providing services to people with an ABI/SCI.
*If an applicant can demonstrate that they have three years experience practicing as an occupational therapist, including two years relevant experience providing services to people with an ABI and/or SCI, but cannot demonstrate that they have provided services to these cohorts in the previous five years, then they are eligible for application under the third category of criteria for eligibility and subject to the same conditions as that category.
Occupational therapists are required to provide details of their experience in treating people with an ABI and/or SCI with their application, including where they gained experience in the treatment of clients with ABIs and/or SCIs.
The TAC will not pay the cost of CPD, clinical supervision, training or fees associated with upskilling in order for an occupational therapist to meet the threshold required to provide services under the Framework OT Model.
The TAC will audit CPD undertaken by providers to ensure that they continue to meet the requirements to provide Framework Occupational Therapy services.
What information does the TAC require to consider paying for Framework Occupational Therapy?
For clients with a ‘severe injury’ treatment will be approved as part of the independence planning process. Where applicable, the occupational therapist will be required to submit initial baseline measures within 10 working days of approval of treatment from the TAC. Outcome measures are to be recorded throughout the treatment and provided to the TAC 6 weeks prior to the end date of the client’s independence plan and upon request.
For all other clients, Framework Occupational Therapy providers must seek prior approval from the TAC. The TAC may require the Framework Occupational Therapy provider to submit a fully completed Occupational Therapy Service Plan (OTSP) if requested. The TAC will pay the reasonable cost of a fully completed OTSP in line with the TAC Framework Occupational Therapy Fee Schedule.
The TAC may contact the client or the Framework Occupational Therapy provider for further information if required. The TAC may also request a copy of the referral to determine its liability for services.
When will the TAC respond to a request?
The TAC will respond to written treatment and service requests as set out in the TAC Service Charter
To assist the TAC to make a decision regarding a request for Framework Occupational Therapy services, a request may be reviewed by the TAC Clinical Panel. The Clinical Panel may contact the requesting medical practitioner to seek further information and/or discuss the proposed treatment prior to making a recommendation to the TAC regarding the request. The TAC will respond to the request when they have received the Clinical Panel’s recommendation.
What are the TAC’s invoice requirements?
Please refer to the How to Invoice the TAC information page.
What fees are payable for Framework Occupational Therapy?
Please refer to the Framework Occupational Therapy fee schedule.
In relation to Framework Occupational Therapy, what won’t the TAC pay for?
The TAC will not pay for:
- treatment or services for a person other than the client
- treatment or services not authorised by the TAC under the Transport Accident Act 1986
- treatment or services subcontracted to, or provided by a non-registered provider
- fees associated with cancellation or non attendance
- fees associated with clinical supervision, training, continuing professional development or upskilling
- treatment or services provided outside the Commonwealth of Australia
- treatment or services provided by telephone or other non face to face mediums
- separate telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
- treatment provided more than once on the same day to the same client
- treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1 or level 2 evidence that the treatment, service, prostheses or equipment is safe and effective. Refer to the Non-Established, New or Emerging Treatments and Services policy
treatment or services provided more than two years prior to the request for funding except where the request for payment is made within three years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy .