The TAC can fund the reasonable cost of drug and alcohol services as a rehabilitation service for a client who has a drug and/or alcohol condition as a direct result of transport accident injuries.
All drug and alcohol services require prior approval from the TAC.
Transport Accident Act 1986 reference: s.3 'rehabilitation service', s.23 and s.60
The TAC recognises that a client may have developed a drug and/or alcohol condition as a direct result of transport accident injuries. The TAC has adopted a 'best practice approach' to the funding of drug and alcohol services in that these services are specifically tailored to the needs of the individual. The approach includes documenting measurable outcomes, monitoring, coordinating and reviewing the provision of these services.
In this policy:
- Drug and alcohol service - means any service or facility established or maintained primarily for the care, treatment or rehabilitation of alcoholics or drug-dependent persons whether conducted independently or in conjunction with any other service or facility. This definition is based on section 8A(1) of the Alcoholics and Drug-dependent Persons Act (1968).
- Episode of Care - An episode of care is defined as a completed course of treatment undertaken by a client under the care of a Drug and Alcohol worker which achieves significant agreed treatment goals.
Who is eligible for TAC funded drug and alcohol service?
Clients who have developed a drug and/or alcohol condition as a direct result of transport accident injuries are eligible for TAC funded drug and alcohol services.
What information does the TAC require in order to determine its liability for a drug and/or alcohol condition?
To consider its liability for a drug and/or alcohol condition, the TAC requires the following information to be provided in writing by the client's treating medical practitioner:
- Clinical rationale for the drug and/or alcohol condition being a direct result of transport accident injuries.
- Record of attendance at any medical practitioner, hospital, registered psychologist or any other drug and alcohol service provider for a drug and/or alcohol condition both before and after the transport accident.
- Details of drug and alcohol intake per day before and after the transport accident including the name, dosage, frequency and duration of all medications prescribed.
- Details of all attempts at and outcomes of drug and alcohol treatment including Network Pain Management Programs or Pain Management Services and any psychiatric in-patient stay before and after the transport accident.
- Details of referrals to any specialist medical practitioners or other providers for drug and/or alcohol condition including registered psychiatrists, registered psychologists and specialist drug and alcohol services before and after the transport accident.
- Details of any other relevant issues or factors including family history and unrelated precipitors.
Where the client's treating medical practitioner is unable to provide the information noted above, the TAC will consider funding an assessment by a drug and alcohol service provider who meets the TAC's eligibility criteria or a suitably qualified Consultant Physician or Specialist recognised by the Health Insurance Act (1973), at TAC rates.
This assessment provides the information required for the TAC to determine its liability to for a drug and/or alcohol condition. Funding of an assessment is not an acceptance of liability by the TAC for a drug and/or alcohol condition or for drug and alcohol services.
What information does the TAC require to consider funding drug and alcohol services?
To consider a request to fund drug and alcohol services to treat the drug and/or alcohol condition, the TAC requires a treatment plan from a drug and alcohol service provider that states:
- details of all episodes of care requested to treat the drug and/or alcohol condition including any post discharge and ongoing support services
- proposed objectives of the service, the measurable outcomes and proposed timelines for achieving these outcomes
- current assessment of the client 's readiness to participate in the recommended drug and alcohol services.
What drug and alcohol services will the TAC consider funding?
The TAC will consider funding the reasonable cost of the following episodes of care, to treat a drug and/or alcohol condition at TAC rates:
- Residential Withdrawal
- Home-Based Withdrawal
- Rural Withdrawal Support
- Specialist Methadone Service
- Counselling, consultancy and continuing care
- Residential rehabilitation
- Supported accommodation
- Youth outreach
- Koori Community Alcohol and Drug Worker
- Outpatient Withdrawal
- ABI Regional Alcohol & Drug Consultants
These services are described on the Department of Human Services website, Public Health - Drug and Alcohol Treatment Framework for Service Delivery.
The drug and alcohol services provider is required to inform the TAC of the proposed objectives of the service, the measurable outcomes and proposed timelines for achieving these outcomes to assist with the TAC's claims decision-making.
Will the TAC consider funding Network Pain Management Programs and Pain Management Services?
Pain Management is a separate rehabilitation service to drug and alcohol services. The TAC considers funding of Pain Management under the Network Pain Management Programs and Pain Management Services policy.
Can the TAC fund drug and alcohol services performed by a member of a client's immediate family?
In relation to drug and alcohol services what will the TAC not fund?
The TAC will not fund:
- services for a person other than the injured client
- services for an injury, condition or circumstance that existed before a transport accident or that is not a direct result of a transport accident
- treatment, services or equipment where there is no published evidence in a recent peer-reviewed journal article that the treatment, service or equipment is safe and effective. Refer to the Non-Established, New or Emerging Treatments and Services policy
- services that are of no clear benefit to a client
- the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
- services provided outside the Commonwealth of Australia
- services provided more than 2 years prior to the request for funding except where the request for payment is made within 3 years of the transport accident. Refer to the Time Limit to Apply for Payment of Medical and Like Expenses policy.