Hospitals - Public

ACCIDENT & EMERGENCY SERVICES

INPATIENT/ADMITTED PATIENT SERVICES
Casemix (Acute Inpatient)
Hospital In The Home (HITH)
Rehab In The Home (RITH)
Inpatient Rehabilitation
Alfred Health ABI Rehabilitation Centre
Overnight Bed Leave

OTHER INPATIENT/ADMITTED PATIENT SERVICES
Nursing Home Type
Geriatric Evaluation and Management (GEM)
Mental Health (Inpatient)
Palliative Care

OUTPATIENT/NON-ADMITTED PATIENT SERVICES
Outpatient Rehabilitation including
Spinal Community Integration Service (SCIC)
Sub Acute Ambulatory Care Services (SACS)
Victorian Paediatric Rehabilitation Services (VPRS)
Mental Health (Outpatient)

POST ACUTE CARE (PAC)

SPECIALTY CLINICS
Continence Clinics
Gait Analysis
Network Pain Management
Pain Management Services

AIDS AND EQUIPMENT
The first 30 days post discharge
After 30 days post discharge
Continence equipment
Surgical Supplies
Highly customised equipment

MISCELLANEOUS
Attendant Care Services Provided to Public
Hospital Inpatient

Medical Reports from Public Hospitals
Removal of Hardware (Inpatient)
ICD-10 AM
Payment of Interstate Public Hospital Account
Hospital Circular

HOSPITAL SERVICES THE TAC WILL NOT FUND

Policy

The TAC can pay the reasonable cost of hospital services in a public hospital required for a TAC client as a result of his/her transport accident injuries.

Transport Accident Act 1986 reference: s.3 'hospital service' and s.60

The conditions for payment are in accordance with an agreement between the Department of Health (DoH) fees and charges for acute health services in Victoria. Refer to www.health.vic.gov.au/feesman for an outline of the agreed rates payable.

Guidelines

ACCIDENT & EMERGENCY SERVICES

What services are payable when a client is treated in the accident and emergency department of a public hospital?

A facility fee is payable to cover material and administrative costs of services provided in an Accident and Emergency Department approved by the Department of Health Victoria.

A facility fee can be paid once per episode. A subsequent charge by the same hospital will only be paid if accompanied by documentation from the hospital explaining the circumstances for emergency treatment.

If the client is subsequently admitted, the admitting hospital is not entitled to the facility fee. If the client was seen at another hospital prior to being transferred to the admitting hospital, the transferring hospital is entitled to a facility fee.

If a client attends an Accident and Emergency Department for treatment for the first time after a period greater than 7 days following the transport accident, the hospital must provide documentation supporting the need for emergency treatment at that time so that a facility fee can be paid.

Treatment by registered medical practitioners employed by the hospital in an Accident and Emergency Department can be charged on a fee-for-service basis in accordance with the Medicare Benefits Schedule (MBS) fee. Fees are payable where the TAC client is admitted to the hospital on the same day. Refer to the TAC fee schedule of Medical Practitioners Rates.

INPATIENT/ADMITTED PATIENT SERVICES

Casemix (Acute Inpatient)

How does the TAC fund acute inpatient services in public hospitals?

The TAC can fund a client's accident related acute inpatient stay in a public hospital by funding an inpatient episode fee. The TAC will use the Casemix classification to pay for acute inpatient accounts at Victorian public hospitals.

Casemix funding covers all services and items provided to an inpatient, except for:

  • medical services provided by a medical practitioner with the right of private practice
  • prescribed accident related discharge medication(s) supplied within 48 hours of discharge.

The TAC can fund appropriate accident related discharge pharmacy items in accordance with Pharmaceutical Benefits Scheme (PBS) rates, including concession and safety net entitlements, or if a private prescription is required at reasonable community standard rates. Refer to the TAC Pharmacy (Chemist Medications) policy.

The acute inpatient episode (Casemix) fee excludes clients categorised under the following classifications (i.e. these types of clients are not funded through Casemix funding):

  • Rehabilitation
  • Sub-acute services:
    • geriatric evaluation and management
    • mental health services
    • nursing home type/non-acute care
    • palliative care: inpatient
    • pain management: inpatient/outpatient

Can the TAC fund transport for a client who is an inpatient to receive accident related medical services at another facility?

The TAC can fund the reasonable costs of transport/travel for inpatients to receive accident related medical services at another facility. This transport may be via ambulance, taxi or other suitable service.

Hospital In The Home (HITH)

What is Hospital in the Home?

Hospital in the Home (HITH) refers to acute hospital care services delivered to a client in his/her home. HITH can be provided subsequent to a period of acute care in a public hospital, or HITH can replace the need to go into an acute hospital. Participation in an HITH program is voluntary.

Casemix funding by the TAC, for an acute patient in a Victorian hospital, covers the cost of the episode of care irrespective of whether the client has been treated solely in a public hospital, as an HITH patient or a combination of both.

Casemix funding covers the cost of all services and items provided to an HITH patient, except for services provided by medical practitioners.

How are Hospital in the Home clients classified?

TAC clients who receive HITH are classified as inpatient clients (referred to by the DoH as admitted patients) with the same rights and responsibilities as other public hospital acute patients.

Notification of services

Prior approval is not a prerequisite for HITH services to commence, however the TAC requires notification five (5) working days prior to the cessation of HITH services if ongoing services are required.

The TAC should also be provided with the discharge summary detailing:

  • the injury/condition requiring services
  • the specific services being provided and how they relate to the client's transport accident injury, and
  • the expected duration of services provided.

Rehab In The Home (RITH)

What is Rehab in the Home?

Rehab in the Home (RITH) refers to rehabilitation hospital care services delivered to a client in his/her home.

How are Rehab in the Home clients classified?

TAC clients who receive RITH are classified as inpatient clients (referred to by the DoH as admitted patients) or outpatient clients (referred to by the DoH as non-admitted patients) with the same rights and responsibilities as other public hospital rehabilitation patients.

How will Rehab in the Home be funded?

Rehab in the home (outpatients) will be funded on a fee for service basis in accordance with the Department of Health (DoH) Fee Schedule for Compensable Non-admitted Patient Services.

Rehab in the home (inpatients) will be funded according to the fees listed by the DoH. Refer to www.health.vic.gov.au/feesman for an outline of the agreed rates payable.

Is prior approval required?

Prior approval is not a prerequisite for Rehabilitation in the Home treatment to commence. However the TAC should be provided with the discharge summary detailing:

  • the injury/condition requiring services
  • the specific services being provided and how they relate to the client's transport accident injury, and
  • the expected duration of services provided.

When should a Victorian public hospital refer onto community based services?

The TAC does not fund Victorian public hospitals for therapists to travel to a client's home to provide therapy. Therefore, if a client is assessed as unable to travel to receive therapy, the public hospital should refer the client to the appropriate community based services. A copy of the community referral letter(s) must be forwarded to the TAC officer. In such cases, the TAC can fund community based therapists to visit a TAC client in his/her home as long as the need for therapy is clinically justified.

Inpatient Rehabilitation

How does the TAC fund inpatient rehabilitation services in Victorian public hospitals?

The TAC can fund according to a system of payments (introduced by the Department of Health Victoria) based on two levels of care for inpatient rehabilitation services in Victorian public hospitals.

The per day rate covers all services and items provided to an inpatient, excluding medical services provided by a medical practitioner with the right of private practice.

Effective from 1 July 2004, the TAC will fund inpatient rehabilitation for clients treated at the Austin - Royal Talbot Rehabilitation Hospital Victorian Spinal Cord Services according to the per day rates for Level 1 or 2 Spinal Rehabilitation.

Bed days are calculated according to the number of nights spent in hospital. The day of admission and the day of discharge are counted as one day for the calculation of bed day fees.

Alfred Health ABI Rehabilitation Centre

The Alfred Health Acquired Brain Injury (ABI) Rehabilitation Centre provides rehabilitation services for people who have experienced a severe ABI. The ABI Rehabilitation Centre is located at Caulfield Hospital and will deliver extended periods of rehabilitation from early stages of care through to rehabilitation and return to the community.

The ABI Rehabilitation Centre will provide services in an interdisciplinary approach, with a focus on person centred rehabilitation to achieve functional goals and extensive family/carer and patient education and engagement in the process.

From September 2014, the ABI Rehabilitation Centre will commence providing inpatient rehabilitation services only. In the long term they will also deliver community rehabilitation and transitional living services.

Generally, clients will be referred directly from acute hospitals to the ABI slow stream rehabilitation service and they will then be assessed for their suitability of admission to the service.

Fees for the ABI Slow Stream Rehabilitation Service will be as per the agreement between Alfred Health and the TAC.

More information about the Alfred Health ABI Rehabilitation Centre can be found at http://www.alfredhealthabirehab.org.au

Overnight Bed Leave

Can the TAC fund taxi services for a client who is an inpatient for overnight leave?

The TAC can pay the reasonable cost of taxi services for clients to be transported directly to and from home for hospital approved overnight leave as part of an approved rehabilitation program.

The following conditions apply:

  • clients must be unable to use public transport due to their transport accident injuries and have no other mode of transportation, such as a relative or friend
  • travel must be directly between the hospital and the client's primary residence. No diversions or stop offs along the journey(s) are allowed
  • the leave must be overnight. Overnight leave may occur on a week night or a weekend night
  • such taxi services require prior approval from the TAC and the submission of a request from a medical practitioner outlining the need for taxi transport.

Can the TAC fund bed holding fees when a client undertakes overnight leave in the community?

The TAC does not fund bed holding fees to Victorian public hospitals for clients on overnight bed leave. Overnight leave may occur on a week night or a weekend night.

In all circumstances, the TAC must be notified by the hospital when a TAC client has overnight leave.

The TAC can fund the reasonable costs of services required by patients while they are on overnight bed leave from a public hospital (subject to the limitations relating to aids and equipment (see below)). When a client is on overnight bed leave from a public hospital, the client is no longer admitted and is therefore not an inpatient for that period. For example, the TAC can fund reasonable attendant care services required by a client for hospital approved overnight leave as part of a TAC approved rehabilitation program aiming to return the client to his/her home upon discharge, i.e. discharge planning. Prior approval for such services is required.

OTHER INPATIENT/ADMITTED PATIENT SERVICES

What sub-acute and mental health services can the TAC fund?

Nursing Home Type
The per day rate covers all services and items provided to an inpatient, excluding medical services provided by a medical practitioner with the right of private practice.

Nursing Home Type care applies to clients who are awaiting long-term placement either in supported accommodation or home based settings.

Geriatric Evaluation and Management (GEM)
Geriatric Evaluation and Management is the sub-acute care of:

  • chronic or complex conditions associated with ageing
  • cognitive dysfunction
  • chronic illness or disability.

Admissions are generally for a defined episode of care and involve management by a geriatrician and multidisciplinary team.

The per day rate includes all services and items provided to an inpatient, except for medical services provided by a medical practitioner with the right of private practice.

Mental Health (Inpatient)
The TAC can fund mental health inpatient care for a client who, as a result of his/her transport accident injuries, requires admission into the following inpatient services:

  • Adult Acute
    • provides for the short-term inpatient assessment, treatment and management of mentally ill adults aged 15-65. The focus is on intervention designed to reduce symptoms and promote recovery from mental illness. These units are located with acute general hospitals.
  • Aged Acute
    • provides short-term assessment and treatment for older persons aged 65 and over with acute symptoms of mental illness who cannot safely be cared for within the community.
  • Child and Adolescent Mental Health Services (CAMHS) Acute (0-18 years)
    • provides assessment and treatment of children and adolescents experiencing significant psychological distress and/or mental illness and their families. Treatment may include crisis assessment, case management, family therapy, parent support, individual therapy, group therapy and, when necessary, medication based treatment.
  • Acute Specialist
    • provides specialised assessment, treatment and consultancy services for clients with neuropsychiatric conditions, e.g. eating disorders
  • Adult Extended Care
    • provides medium to long-term inpatient treatment and rehabilitation to clients who have unremitting and severe symptoms of mental illness together with associated significant disturbances which inhibit their capacity to live in the community.

The per day rate covers all services and items provided to an inpatient, except for medical services provided by a medical practitioner with the right of private practice.

The TAC funds two different per day rates based on hospital location:

  • Melbourne Metropolitan area, or
  • rural Victoria.

Palliative Care
The per day rate paid for palliative care covers all services including:

  • pastoral/counselling
  • allied health
  • bereavement support to family members.

The cost of services provided by medical practitioners is paid in addition to the inpatient bed fee.

The TAC funds two different per day rates based on hospital location:

  • Melbourne Metropolitan area, or
  • rural Victoria.

In addition, the TAC can fund the reasonable cost of family counselling for a family member of a TAC client who dies or who is severely injured in a transport accident. See also the Family Counselling policy.

Family counselling must be provided by either a Medical Practitioner, a registered Psychologist or a qualified and accredited Social Worker, where the service does not exceed the maximum amount allowed which is indexed annually. Refer to the Indexation of Benefits for the current Family Counselling Allowance.

OUTPATIENT/NON-ADMITTED PATIENT SERVICES

What outpatient services can the TAC fund?

The TAC can fund services provided to outpatients (or non-admitted patients) in the course of their care.
Services include physiotherapy, occupational therapy, speech pathology, podiatry, orthotic and prosthetic services, orthoptics, dietitian services, pharmacy, psychology and social work.

Outpatient services are reimbursed on a fee-for-service basis and are based on 30 minute treatment sessions. Refer to www.health.vic.gov.au/feesman for an outline of the agreed rates payable.

Medical services provided by salaried medical practitioners to outpatients may be charged on a fee-for-service basis in accordance with the Medicare Benefits Schedule (MBS) rate.

The TAC can fund:

  • accident related prescribed medications provided to an outpatient. Funding is at Pharmaceutical Benefits Schedule (PBS) rates, including concession and safety net entitlements. Where a private prescription is required community standard rates will apply
  • interpreter services required by a client attending outpatient treatment. Interpreter services are reimbursed in line with fees listed by the DoH - Victoria
  • putty balls and other items/products listed under the Small Stock List purchased from public hospitals' Central Equipment Shops. A letter supporting the request is required from the treating doctor or therapist
  • custom-made splints (relating to limbs) provided to an outpatient.

Hospitals must obtain prior approval for funding from the TAC before requesting the manufacture of pressure garments for outpatients with burns or degloving injuries.

A facility fee is not payable for outpatient services.

Outpatient Rehabilitation - Includes Spinal Community Integration Service (SCIS), Sub Acute Ambulatory Care Services (SACS) and outpatient based Victorian Paediatric Rehabilitation Services (VPRS)

Where the Department of Health (DoH) criteria for admission as a same day patient are not met, a TAC client will be considered an outpatient. Fees for the SCIS will be as per the agreement between Austin Health and the TAC.  All other outpatient fees will be paid on a fee-for-service basis in accordance with the fees listed by the DoH Victoria. Refer to www.health.vic.gov.au/feesman for an outline of the agreed rates payable.

Spinal Community Integration Service (SCIS)

The Victorian Spinal Cord Service (Austin Health) offers a Spinal Community Integration Service (SCIS) designed to meet the transition and community integration needs of individuals with a Spinal Cord Injury (SCI).

The primary functions of the SCIS are to:

  • facilitate a client's transition from hospital and re-integration into the community
  • provide a coordinated approach for clients to receive trans-disciplinary support and education.

This program commences while a client is an inpatient at either the Royal Talbot Rehabilitation Centre or Caulfield Hospital and continues for an average of 12 months post discharge into the community.

This service does not substitute existing inpatient rehabilitation or community rehabilitation services.  It is a specialised service that aims to increase independence, self management and integration in the community after a spinal cord injury. The service works with hospital and community providers to provide specialist expertise related to the holistic management of a client after a spinal cord injury. Clients will still access existing community rehabilitation and disability providers through local community services.

The SCIS also focuses on enhancing the capacity of existing community rehabilitation and disability providers to better manage SCI specific issues faced by clients. The SCIS does this by providing a tailored approach to community transition and integration through the identification of individual goals, facilitating family support and social networks and providing specialised SCI consultation and support to existing community providers.

Prior approval is not required for clients to access the SCIS.

Sub Acute Ambulatory Care Services (SACS)

Sub Acute Ambulatory Care Services (SACS) is a form of outpatient rehabilitation in a public hospital environment, which provides community rehabilitation services that are time limited and delivered according to a care plan that is based on goals negotiated by the client and/or relevant guardian.

SACS for children and adolescents are referred to as Victorian Paediatric Rehabilitation Service (VPRS), see below.

Victorian Paediatric Rehabilitation Services (VPRS)

Victorian Paediatric Rehabilitation Service (VPRS) is for children and adolescents who, as a result of injury, medical/surgical intervention, or functional impairment, will benefit from a program of developmentally appropriate, time limited, goal focused interdisciplinary rehabilitation.

For further information on VPRS refer to the Department of Health web site http://www.health.vic.gov.au/vprs/.

See also the VPRS Communication guidelines PDF, 0.27MB and VPRS discharge summary DOC, 0.37MB .

What documentation is required for the TAC to consider a request to fund SACS/VPRS?

An Outpatient Rehabilitation Plan must be submitted by the appropriate SACS or VPRS facility to the TAC as soon as possible to notify the TAC of the commencement of the program. Approval of the Outpatient Rehabilitation Plan is not a prerequisite for outpatient rehabilitation treatment to commence, however, notification is encouraged prior to services continuing beyond the 12 week program timeframe to ensure the client’s needs are being met.

Mental Health (Outpatient)

The TAC can fund per occasion of service for a client who receives Mental Health Clinical Community Care.

Mental Health Clinical Community Care is a community based service which provides acute psychiatric/mental health crisis intervention, where a psychiatric/mental health nurse visits a client in his/her own home with occasional visits from a psychologist. This service is predominately provided to clients suffering from psychosis.

As a public hospital salaried psychiatrist will be involved in the client's treatment, a charge should not be raised for any associated medical treatment received from the psychiatrist overseeing the management of a client in Mental Health Clinical Community Care.

POST ACUTE CARE (PAC)

What are Post Acute Care programs?

Post Acute Care (PAC) programs are hospital services funded by the TAC and provided through the Department of Health (DoH). PAC programs provide short-term home based services services such as home help and personal care to patients who require short-term support to facilitate recuperation following discharge from an acute or sub-acute hospital.

DoH PAC providers work collaboratively with hospitals to ensure that public hospital patients who are referred to PAC are assessed and the required, short-term, services are arranged for all patients discharged from acute or sub-acute hospitals across Victoria.

All patients in public hospitals including TAC clients with accepted claims, patients who have not submitted their TAC claims or have claims awaiting a TAC eligibility decision at the time of discharge, are entitled to access short term PAC programs. PAC providers will co-ordinate services for TAC clients who, as a result of their transport accident injuries, are assessed as required PAC services following discharge from a public hospital.

In the event that a person receives a PAC program and the TAC does not accept a patient's claim, the patient will not be charged for the PAC program. PAC does not charge fees for providing this service, however, people may be asked to pay for consumables such as wound dressings.

For further information on Victoria's Post Acute Care program, refer to the Department of Health website.

How will the TAC fund PAC programs?

Where the TAC accepts liability for the client's claim, the PAC provider will be reimbursed for co-ordinating and arranging services at a daily rate. Refer to www.health.vic.gov.au/feesman/fees5.htm#other_tac_patients for an outline of the agreed rates payable.

Services such as child care, home services and gardening services which are not provided through PAC programs, can still be arranged and funded by the TAC concurrent to the PAC program in accordance with the Child Care for Services for Accidents on or after 1 January 2005 policy and the Home Services for Accidents on or after 1 January 2005 policy.

What happens after a PAC program ends and the client does not require ongoing care/assistance?

It is expected that the PAC provider completes a PAC Closure Summary to notify the TAC of the start and end date of the PAC program, including a summary of the types of supports that were provided.

What happens if the PAC program is due to end and the client requires ongoing care/assistance?

Where the PAC program is due to end and the TAC client requires ongoing services due to his/her transport accident injuries, then the TAC can fund the services that the client is eligible to receive under the Transport Accident Act 1986 (at TAC rates and on a fee for service basis). Refer to the following policies for further information:

It is expected that the PAC provider will complete a PAC Closure Summary to notify the TAC of the recommended service requirements for the client two weeks prior to the PAC program ending, to enable the TAC to make arrangements for alternative services to be put into place when these services are required.

Can the TAC fund a PAC program for an existing client who was receiving TAC funded care/assistance services immediately prior to their hospital admission?

Where the TAC was funding Home Services (excluding gardening and child care), Nursing services and/or Post Acute Support services immediately prior to admission to hospital, the TAC will reinstate the funded service after discharge and contact the client to arrange any additional services or supports that the client is eligible to receive under the Transport Accident Act 1896. The TAC requires that the hospital staff to contact the TAC to request the services needed prior to discharge so that the TAC can make the necessary arrangements. Refer to the following TAC policies for further information:

SPECIALTY CLINICS

What specialty clinics can the TAC fund?

Continence Clinics
The TAC can fund per occasion of service for a client to be treated at a continence clinic. A Continence Clinic is a multidisciplinary clinical service (nursing and physiotherapy) specialising in incontinence and other bladder and/or bowel function difficulties; providing assessment, education and support to improve continence for clients. The service also provides consultancy, education and support to carers, relatives and professional service providers.

Clinics operate on a mixture of clinic and home based services. Clinics particularly in rural areas also run outreach services. Travel time to homes and outreach services is included in the TAC rate.

Gait Analysis
The TAC can fund the cost of a gait analysis assessment for a client who has sustained a spinal cord or acquired brain injury in a transport accident. Currently the two public hospitals that have gait analysis laboratories are the Royal Children's Hospital and the Kingston Centre.

The provision of a report to the TAC following a gait analysis assessment is included in the rolled up fee.

Network Pain Management
The TAC can fund outpatient (Network PMPs) with providers who have signed a contract with the TAC to provide Network PMPs. Refer to the Network Pain Management Programs and Pain Management Services policy.


Pain Management Services
The TAC can fund inpatient Pain Management Services (PM Services) equivalent to the per day rate for Level 2 Rehabilitation. Refer to the Network Pain Management Programs and Pain Management Services policy for information on eligibility and request requirements.

Note that in the medical and rehabilitation community PM Services are referred to as Pain Management Programs.

The TAC can fund Pain Management Services according to the fees listed by the Department of Human Services. Refer to www.health.vic.gov.au/feesman for an outline of the agreed rates payable.

The TAC can fund medical treatment that a client receives as part of the pain management service, where the treatment is provided by a medical practitioner with the right of private practice.

AIDS AND EQUIPMENT

Bed fees paid in Victorian public hospitals (i.e. Acute, Sub-Acute, or Rehabilitation patients) cover the cost of aids and equipment (e.g. a walking frame) provided to a TAC client whilst an inpatient.

What aids and equipment will the TAC consider funding?

The First 30 Days Post-discharge
Victorian public hospitals are responsible for the provision of aids, equipment and domiciliary oxygen free of charge (no deposits or hire fees) to facilitate a safe and effective discharge for a period of 30 days post discharge following an Acute, Sub-Acute or Rehabilitation admission.

In the event that a TAC client requires equipment of a non re-usable nature, the TAC would expect that these items are purchased by the hospital and not provided on a hire basis.

After 30 Days Post-discharge
Following the initial 30 days after discharge, the TAC is responsible for providing aids and equipment once the claim is accepted. Victorian public hospitals must contact the TAC to determine whether the TAC will organise alternative provision of the hired aids and equipment or whether the current hire arrangements will continue.

Equipment hires or purchases required after the first 30 days post-discharge can be organised through the TAC's contracted equipment suppliers.

Continence Equipment
The TAC can fund continence products such as catheters, consumables and other related products required by a TAC client on discharge.

Public Hospital staff will need to complete a Continence Equipment Request and Order Form and refer to the accompanying Continence Equipment Request and Order Form Notes, prior to the client's discharge to ensure appropriate products can be ordered by the TAC. If a hospital supplies any continence items to a client for use on discharge, a full description of the item(s) must be included on the hospital invoice when billing the TAC.

Surgical Supplies
The TAC can fund surgical supply products such as wound care dressings required by a TAC client on discharge.

Highly Customised Equipment
For admitted TAC clients who have a certifiable permanent or long-term disability, the TAC will fund all equipment that is highly customised to be used for long-term purposes beyond 30 days post-discharge from a public rehabilitation hospital, e.g. a power wheelchair. This also includes prosthetic equipment (artificial limbs), including interim and definitive limbs. See also the Equipment (Medical) - Prosthetic Equipment and the Equipment policies.

To expedite payment of accounts and ensure the most appropriate equipment services are provided to the client, the TAC encourages prior approval to be sought by the public hospital.

Where there is confusion over the length of time a piece of equipment is required or whether the equipment is deemed to be permanent or temporary, it is expected that the public hospital will discuss this with the TAC.

Where an entitled person is in receipt of aids or equipment from the TAC prior to admission, the TAC will continue to provide those aids and equipment upon discharge, if required.

MISCELLANEOUS

Attendant Care Services Provided to Public Hospital Inpatient

Are hospital attendant care services funded within the public hospital inpatient fee?

In hospital, attendant care services are funded within the hospital inpatient fee. The TAC cannot fund separately attendant care services while a client is an inpatient or is in receipt of hospital in the home (HITH).

All care costs, including attendant care, are included in the inpatient bed fee and are not funded as separate services by the TAC.

The TAC can fund the reasonable cost for training public hospital clinical staff prior to the inpatient admission of a TAC client to ensure his/her specific care needs are met. Prior written approval is required from the TAC before training is to commence.

During an initial or subsequent inpatient episode it may be decided that training of attendant carers by clinical/allied health staff is required to ensure a safe client discharge. Training costs are deemed inclusive of the inpatient acute or rehabilitation fee and will not be funded separately by the TAC.

Medical Reports from Public Hospitals

Hospital Reports or Medical Officer Reports
A Hospital Report is a report prepared by clerical staff on behalf of the public hospital's medical officer and provides a summary of the medical record.

A Medical Officer's Report is a report prepared by the public hospital's medical officer.

Where a public hospital provides a hospital or medical officer report the amount reimbursed is in accordance with the fee as listed by the Department of Health (DoH). Refer to www.health.vic.gov.au/feesman for an outline of the agreed rates payable.

Medical Specialist Reports
Where the treating medical specialist/practitioner completes the medical report, payment will be in accordance with TAC fee schedule for 'Medical Reports - TAC Reimbursement'. However, the fees in this schedule can only be considered for payment where the treating medical specialist/practitioner raises the charges under his own private practice.

Freedom Of Information Requests Where the TAC makes a Freedom of Information (FOI) request in relation to accessing the Medical Records of a TAC client, a public hospital may charge the TAC for the reasonable cost incurred in making those arrangements as prescribed in the Victorian Freedom of Information Act 1982 and the Freedom of Information Access Charges (Regulations).

Discharge Summaries
The hospital should provide the TAC with a discharge summary within 5 days of receiving a request from the TAC. A charge cannot be raised by a public hospital for provision of a discharge report as the cost of a discharge summary is included in the bed fee rate.

Hospital Reports requested by a legal practitioner representing a TAC client
A legal practitioner can make a request for reimbursement of costs for medical and hospital reports obtained in support of their client's claim for compensation.

The same fee and payment arrangements will apply when a legal practitioner representing a TAC client requests a medical report from a public hospital. Prior to requesting hospital reports, legal practitioners are encouraged to check with the TAC as to whether a report has already been obtained to avoid unnecessary duplication.

Where a legal practitioner seeks reimbursement for a cost incurred in obtaining a medical report from a public hospital, reimbursement will be in accordance with the fees listed by the Department of Health, refer to www.health.vic.gov.au/feesman. The TAC has formally communicated this advice to the legal profession and requests that hospitals adhere to the fees.

Removal of Hardware (Inpatient)

Can the TAC fund the removal of hardware?

The TAC can fund the removal of hardware such as:

  • pins
  • rods
  • screws and plates implanted to treat fractures suffered in a transport accident.

The treating surgeon is not obliged to seek prior approval to admit a TAC client for these procedures. See also the Post Hospital Support Payments policy.

ICD-10 AM

All accounts for inpatient treatment/services must quote a primary International Classification Of Diseases -10th Revision, Australian Modification (ICD-10 AM) code.

The number is that which best describes the injury/condition being treated by the hospital. Other procedure codes may be quoted in addition to the primary code.

Payment of Interstate Public Hospital Account

Public Hospital fees and charges are reimbursed according to the gazetted rates for compensable patients made known to the public and publicised by each State or Territory Health Department.

Hospital Circular

For details of the TAC contractual arrangements with the Department of Health for the provision of public hospital services to TAC clients, refer to the Hospital Circulars page of the Victorian Government Health Information website.

In relation to medical reports requested by a legal practitioner relating to a client, refer to Hospital Circular 8 / 2005.

HOSPITAL SERVICES THE TAC WILL NOT FUND

In relation to hospital services what will the TAC not fund?

The TAC will not fund:

  • treatment or services for a person other than the injured client
  • treatment or 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 or services where there is no objective evidence that a treatment or service is safe and effective
  • treatment or services where liability has not been accepted
  • the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
  • incidental items that occur as part of a client's inpatient stay, eg. newspapers, telephone calls, television hire and general toiletries, eg. toothpaste and soap
  • treatment or services provided outside the Commonwealth of Australia
  • treatment or 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 the Payment of Medical and Like Expenses policy.

Can the TAC fund hospital services performed by a member of a client's immediate family?

Refer to the Funding Treatment by a Member of a Client's Immediate Family policy.


Public Hospitals

Fees for services provided by public hospitals to TAC claimants are agreed with the Victorian Department of Health and outlined in the Department's Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals.

To access the index for these fees please visit the Department of Health (Vic) website.

These fees should also be read in conjunction with the policy on Hospitals (public).

For further information about TAC policies contact the TAC on 1300 654 329. Alternatively, e-mail policy@tac.vic.gov.au.


View Hospital discharge checklist - preparing to go home

Hospital discharge checklist - preparing to go home

Summary:

Our attendant care providers support clients to achieve their independence goals in daily living activities, therapy support, personal and domestic skills retraining and community access skills.

View Rehabilitation - at the rehabilitation hospital

Rehabilitation - at the rehabilitation hospital

Summary:

This booklet provides information and assurance for clients moving into a rehabilitation facility about what to expect and how the TAC can assist. Topics include: how your rehabilitation program will help improve your ability to do things and increase independence; and preparing your Independence Plan of individual goals you want to achieve in the short and long term.

View Rehabilitation - preparing to go home

Rehabilitation - preparing to go home

Summary:

This booklet provides information and assurance for people with major injuries who are preparing to leave the rehabilitation hospital and return home. It explains the next stage of your rehabilitation and Independence Plan as well the support services that the TAC can fund to help with day-to-day tasks.

View Hospital direct equipment order form

Hospital direct equipment order form

Summary:

Hospitals must use this form to directly order from the TAC's contracted equipment suppliers up to $500 per item of equipment, required in order to facilitate the effective discharge of the TAC client. Only the items listed on the 'Hospital Direct Order Equipment list ' can be ordered using this form. TAC clients must have an accepted claim before orders can be made by hospitals.


The equipment listed in the 'Hospital Direct Order Equipment list are commonly required to ensure a patient's safe discharge. Requests for other equipment not on the list or over $500 need to be made in writing to the TAC. Please follow the instructions provided in the Hospital Direct Order Form notes to ensure that orders can be processed and delivered without delay. 

View Continence equipment prescription and order form: Hospital discharge

Continence equipment prescription and order form: Hospital discharge

Summary:

This form is used to request continence (and related) equipment for TAC clients who are making the transition from hospital to the community. It requires an assessment of the client's current continence issues and routine as well as suggested goals regarding their bowel and/bladder management in future. The separate 'notes' document in this section provides additional instructions and clarification to help complete the form.

View Outpatient Rehabilitation plan form

Outpatient Rehabilitation plan form

Summary:

This form is to be completed by a client's treating team within the rehabilitation facility they're staying to prepare for their outpatient therapy program. It sets goals for the client and outlines the action plan that will help them achieve these aims. The separate 'notes' document in this section provides additional instructions and clarification to help complete the form.

View Victorian Paediatric Rehabilitation Services (VPRS) discharge summary

Victorian Paediatric Rehabilitation Services (VPRS) discharge summary

Summary:

This form is to be completed when a TAC clients (of child/adolescent age) receiving care from the Victorian Paediatric Rehabilitation Services (VPRS) is being discharged. It records the patient's ongoing care and rehabilitation plans.

View VPRS and TAC Communication Guidelines

VPRS and TAC Communication Guidelines

Summary: These guidelines have been developed to enable a joint collaboration of the TAC and VPRS, and to assist both organsations to support TAC clients who are receipt of VPRS.