The TAC can pay the reasonable costs of the Multiple and Complex Needs Model (MACNM) service when required as a result of a transport accident injury as an authorised disability service under section 60 of the Transport Accident Act 1986 ("the Act").
The TAC will periodically review a client's entitlement to the MACNM service to ensure that the treatment and services remain reasonable for the transport accident injury and are payable under the Act.
The MACNM service is a time-limited specialist service for individuals 16 years and older identified as having multiple and complex needs, often including those individuals that pose a risk to themselves and to the community.
The MACNM service is a model of care for significantly complex TAC clients who have exhausted all other suitable service options and present with:
- Multiple and complex needs which consistently challenge existing service systems responses.
- Co morbidity and/or dual diagnosis.
- Poor service outcomes.
- Behaviours of concern which lead to repeated service failure.
- Behaviours of concern which pose a risk to self and/or others.
The MACNM service involves a coordinated approach to supporting individuals to achieve stability in health, housing, social connection and safety and to be linked into comprehensive ongoing support. The MACNM service provides assessment, care planning, service coordination across service systems (e.g. disability, mental health, justice and health) and behaviour support. Assessment and planning within the service will be aligned to goals identified in the independence planning process between the TAC client's support coordinator and treating team.
The objectives of the MACNM service are to:
- Support the client to increase stability, quality of life and independence.
- Achieve a measurable reduction in the frequency and severity of a client's behaviour of concern.
- Support a client to increase their independence and reduce 1:1 or 2:1 Attendant Care (AC) support, where appropriate.
This policy must be read in conjunction with the Intensive Outreach Service Policy.
In this policy:
- Behaviours of concern (BoC) are sometimes called challenging behaviours. They are behaviours which negatively impact the client and/or others. Examples include self-harm, violence towards others, risk taking and physical or verbal aggression.
- Co morbidity is the presence of one or more additional disorders. For example, clients who have an acquired brain injury may also have co-morbidities such as a diagnosed mental illness, intellectual impairment or alcohol/drug dependencies.
What can the TAC pay for in relation to MACNM services?
The TAC can pay the reasonable costs of MACNM services:
- required as a result of the transport accident injury;
- that are reasonable, necessary or appropriate in the circumstances;
- that are clinically justified, safe and effective;
- for up to 12 months or as otherwise agreed between the TAC and the provider;
- on more than one occasion if the service has not been not fully completed; andin accordance with the TAC's policies.
The MACNM service is only for very complex TAC clients who have exhausted all other applicable service options. The TAC can consider paying the reasonable costs of a MACNM service for a client who meets the following criteria:
- is over 16 years of age;
- has exhausted all applicable and suitable existing services and/or other support options;
- is in need of intensive supervision and support and would derive benefit from receiving coordinated services that may include welfare services, health services, mental health services, disability services, drug and alcohol treatment services or housing and support services; and
- satisfies two or more of the following:
- has a mental disorder;
- has an acquired brain injury;
- has an intellectual impairment;
- significant physical injury;
- is an alcoholic or drug-dependent person within the meaning of the Alcoholics and Drug-dependent Persons Act 1968; or
- has exhibited violent and dangerous behaviour that has caused serious harm either to the client or others or is exhibiting behaviour which is reasonably likely to place them or another person at risk of serious harm.
The TAC will pay for concurrent treatments while the client is part of the MACNM service.
The TAC will not pay for MACNM services where:
- it is well established that the client has no potential to achieve stability in health, housing, social connection and safety and to be linked into comprehensive ongoing support; and/or
- optimum care is already in place.
Who can provide Multiple and Complex Needs Model services?
MACNM services can only be provided by the Indigo Program through CoHealth, the primary state-wide provider of the Department of Health and Human Services (DHHS) Multiple and Complex Needs Initiative.
What information does the TAC require to consider paying for Multiple and Complex Needs services?
The TAC requires a request from the client's treater or treating team (neuropsychologist, occupational therapist or medical practitioner) to consider approval of MACNM services.
A request for MACNM services may be made as part of the independence planning process for clients with a 'severe injury' and an applicable independence plan. A client's need for MACNM services will then be discussed between CoHealth, the client's treating team and their TAC support coordinator prior to any approval being given. For more information about the TAC Independence model, refer to the Independence Plan – Information for providers brochure.
Prior approval in writing is required for all clients before MACNM services can be provided as this service is authorised under section 23 of the Act as a disability service.
MACNM services are provided in two stages:
- Care Plan Development (CPD) - this is based on a comprehensive Needs Assessment.
- Care Plan Coordination (CPC).
What information does the TAC require in the report(s)?
The service provider will report on the progress of the services at scheduled monthly meetings and provide the following reports in the timeframes below. Note that dates are indicative and subject to change by agreement between the TAC and the provider.
|CPD||Care Plan Rationale||3 months from the start of service|
|CPD||Care Plan||3 months from the start of service|
|CPC||Final Report||Marks the conclusion of the CPC phase and can be up to 12 months from the time the care plan is due or as per TAC agreement for each individual|
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.
The TAC 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 after they have received the Clinical Panel's recommendation.
What are the TAC's invoice requirements?
Refer to the How to Invoice the TAC information page.
What fees are payable for Multiple and Complex Needs services?
Fees for the MACNM service are agreed between the TAC and the service provider for each client.
In relation to Multiple and Complex Needs Model services, 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
- treatment or services provided by telephone or other non-face to face mediums
- a second MACNM service where a client has previously completed the program
- fees associated with non-attendance or cancellation
- treatment or services provided outside the Commonwealth of Australia
- non-hospital services 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.