This policy must be read in conjunction with the Surgery Requests Elective policy.
The TAC will consider funding the reasonable cost of internal Functional Electronic Stimulation (FES) and associated procedures required as a result of transport accident injuries where the treatment is provided by an appropriately qualified medical specialist.
Transport Accident Act 1986 reference: s.3 'medical service' and s.60
Internal Functional Electronic Stimulation (FES) can be used to stimulate muscles in people with nerve damage. Its applications range from use in walking, arm and hand function and urinary function. It is not indicated for pain reduction.
"Functional Electronic Stimulation (FES)" is the artificial stimulation of muscles. This can be done by:
- internally through surgical implantation of an electrical stimulation system. The receiver-stimulator is implanted under the skin, and connected via electrodes to an external unit, or
- the external stimulation of muscles through the skin (see Functional Electronic Stimulation - External policy and the Equipment policy.
What will the TAC consider funding?
The TAC will consider funding internal FES where the procedure has been recommended by a medical specialist authorized to perform the procedure and there is clinical justification (i.e.expected functional gain) for the treatment (see also the Clinical Framework).
The TAC will pay the reasonable cost of hospitalisation, and any medical or surgical services associated with the FES procedure in line with the TAC fee schedule.
The TAC will pay the reasonable cost of the receiver-stimulator device in accordance with the Department of Health and Ageing's 'Prostheses List'. Refer to the Surgically Implanted Prostheses policy.
Is prior approval required from the TAC?
All elective surgery requires prior approval in writing from the TAC.
What information does the TAC require to consider funding FES and associated procedures?
The TAC requires a written request from the medical specialist including the following information:
- current function and expected functional gains of the procedure
- associated post-operative need for rehabilitation equipment or services (e.g. chair, hoist, physiotherapy, or carers)
- long term care needs (e.g. medical reviews, battery replacement etc.)
- details of other procedures or treatments which have been tried to date
- psychological suitability, (e.g. absence of psychological illness, level of motivation/understanding of procedure, compliance)
- general health
- availability of supportive care givers
- skeletal maturity
- level of spinal injury or severity of brain injury
- time post-injury
- associated need for rehabilitation equipment or services (e.g. chair, hoist, or carers)
- specific goals of the intervention.
See also 'What will the TAC not fund?' in the Surgery Requests Elective policy.