Network Pain Management Programs and Pain Management Services

Network Pain Management Programs and Pain Management Services are not subject to the medical excess.

POLICY

The TAC can pay the reasonable costs of Network Pain Management Programs and Pain Management Services where required as a result of a transport accident injury under the Transport Accident Act 1986 (the Act).

Transport Accident Act 1986 reference: s.3 'rehabilitation service', s.12(3), s.12(4), s.23 and s.60 

Who can refer into a Network Pain Management Program or Pain Management Service?

A request for a Network Pain Management can be referred by:

  • a medical practitioner
  • a physiotherapist; or
  • a psychologist.

A request for Pain Management Services requires a referral from the client's treating medical practitioner.

BACKGROUND

Network Pain Management Programs (NPMP) and Pain Management Services (PMS) are multidisciplinary, group based, education focused programs which are designed to assist clients with musculoskeletal injuries and persistent pain to manage their condition. 

NPMP and PMS focus on developing strategies to assist clients who are having difficulty managing their injuries and participating in functional activities due to their pain. NPMP and PMS aim to improve a client's health outcomes by:

  • educating the client about their pain
  • setting early expectations around returning to work
  • educating the client about the risks and benefits of treatments for pain
  • rationalising and reducing medications where possible
  • improving mental health and physical capacity
  • teaching self-management skills and supporting a timely transition to self-management.

For the purposes of this policy, persistent pain or chronic pain is defined as per theNational Pain Strategyas constant daily pain for a period of three months or more in the past six months

This policy must be read in conjunction with the following:

DEFINITIONS

In this policy:

Network Pain Management Program (NPMP) is an evidence-based outpatient program, conducted primarily in a group setting that provides multidisciplinary healthcare interventions and education to adult clients and is:

  • developed and delivered by a provider who has met specific service standards established by the TAC and agreed to comply with program and reporting requirements
  • provided by a multidisciplinary team of medical and allied healthcare providers that have skills and experience in delivering pain management treatment
  • a program to assist clients with persistent pain to increase their functional ability and improve their quality of life.

Pain Management Service (PMS) is an in-patient or outpatient program, generally conducted primarily in a group setting that provides multidisciplinary healthcare interventions and education to clients and is:

  • developed and delivered by a provider who has been authorised to provide rehabilitation services by the TAC
  • provided by a multidisciplinary team of medical and allied healthcare providers that have skills and experience in the management of clients and in delivering pain management treatment.

Pain education programs are 8-10 hour multidisciplinary group education programs designed to provide skills that focus on a transition to self-management for clients with persistent pain. Pain education programs are conducted as an outpatient public hospital service, do not involve individual treatment and must meet the same criteria as a PMS for consideration by the TAC.

GUIDELINES

What can the TAC pay for in relation to Network Pain Management Programs and Pain Management Services?

The TAC can pay the reasonable costs of NPMP and PMS:

  • required as a result of a transport accident injury
  • that are reasonable, necessary or appropriate in the circumstances
  • where the program or service is objectively safe and effective
  • in accordance with the TAC's policies/guidelines
  • authorised by the TAC under the Transport Accident Act 1986

The TAC considers it reasonable to fund only one NPMP or PMS for a client unless there is appropriate clinical justification provided for a subsequent program.

The TAC can pay the reasonable cost of travel nd/or accommodation for a client to attend an NPMP or a PMS where:

  • prior approval has been provided by the TAC
  • the need for travel has been clinically justified by the client/ treating medical practitioner.

For more information please refer to the Travel and Accommodation Expenses policy.

Who can provide Network Pain Management Programs and Pain Management Services?

A NPMP can be provided by a multidisciplinary team who has agreed to meet specific service standards, established by the TAC. For more information please refer to the Network Pain Management Program Providers' List.

PMS can be provided by a multidisciplinary team comprising of medical practitioners and allied health providers who are authorised to provide rehabilitation services by the TAC.

What information does the TAC require to consider paying for Network Pain Management Programs and Pain Management Services?

 Network Pain Management Programs

The NPMP provider must submit a 'Network Pain Management Program: Assessment Request' form to the TAC for consideration of a NPMP for the client. If approved, the NPMP provider can proceed with the assessment of the client and, if the provider and TAC deem the client appropriate, a Network Pain Management Program may be initiated.

Pain Management Services

The PMS provider must submit a 'Request for multidisciplinary assessment' form to the TAC for consideration of client's participation in PMS. If approved, the provider can proceed with a multidisciplinary assessment and determine if the client will be treated as an outpatient or inpatient.

Outpatient Program - The 'Outpatient multidisciplinary assessment' form must be submitted to the TAC if the client is to be treated as an outpatient. If approved, the PMS can proceed with the pain management program without submitting further documentation.    

Inpatient Program - The provider must submit a 'Request for In-patient Service' form to the TAC if the client is to be treated as an inpatient. If approved for admission, the provider will be required to submit an 'In-patient multidisciplinary assessment' form to the TAC to finalise the client's participation in the inpatient program.

Pain education program - The provider must submit a 'Public Hospital Pain Education Request' form to the TAC for consideration of a pain education program. Pain education programs can only be conducted by a public hospital as an outpatient PMS.

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.

A NPMP or PMS request may be reviewed by the TAC Clinical Panel to assist in making decision on the request. The Clinical Panel may contact the requesting provider to seek further information and/or discuss the proposed treatment prior to making a recommendation to the TAC about the request. The TAC will respond to the request when they have received the Clinical Panel's recommendation.

Will the TAC consider paying for concurrent treatment?

A client can continue to receive treatment from their treating medical and/or mental health practitioner during their participation in a NPMP or a PMS in line with any current approval that is in place.

The TAC will not pay for physical treatment (including physiotherapy, hydrotherapy, chiropractic services, osteopathy or acupuncture), or occupational therapy concurrently while a NPMP or a PMS is being conducted. This is because physical treatment is included as part of a NPMP or a PMS. 

If a client requires a Certificate of Capacity during the period in which a NPMP or a PMS is being conducted the TAC can pay for the services provided by a medical practitioner, physiotherapist, chiropractor, osteopath or occupational therapist necessary to complete the certificate. For more information please see the Certificate of Capacity policy.

What are the TAC's invoice requirements?

Please refer to the How to Invoice the TAC information page.

What fees are payable for Network Pain Management Programs and Pain Management Services?

The TAC will pay fees for NPMP at the agreed rate for providers who have met specific service standards established by the TAC.

The TAC will pay fees for PMS where clinically justified by a client treater.  Fees will be paid in line with the reasonable costs of medical and allied health services up to the maximum amount detailed in the fee schedules for public hospitals, private hospitals, private and allied health services. 

In relation to Network Pain Management Programs and Pain management 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
  • procedures such as surgery, spinal injection procedures, radiofrequency neurotomy/denervation or implantable pain therapies as part of an NPMP or a PM Service
  • treatment for a condition that existed before the client's transport accident injury or illness
  • where there is no objective evidence that the service is safe and effective
  • provided by single discipline providers
  • fees associated with cancellation or non-attendance
  • treatment or services provided outside the Commonwealth of Australia
  • treatment or services provided by telephone or other non face to face mediums, including telephone consultations between providers (including hospitals) and/or clients
  • any fines, fuel costs, toll charges, travel insurance or motor vehicle hire associated with travel costs
  • 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 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.

View Network Pain Management Programs - Helping you manage your pain

Network Pain Management Programs - Helping you manage your pain

Summary:

This information sheet discusses how Network Pain Management Programs can help TAC clients manage musculoskeletal injuries and persistent pain to improve enjoyment of life and increase independence at home, work and in the community. The programs focus on developing strategies to return to work, reduce dependence on medication and improve mental health.

View Network Pain Management provider list

Network Pain Management provider list

Summary:

This document lists the TAC's Network Pain Management providers and includes location and contact details.  You will need a referral from your GP to access these services.

View Network Pain Management Programs - Information for Medical Practitioners, Physiotherapists and Psychologists

Network Pain Management Programs - Information for Medical Practitioners, Physiotherapists and Psychologists

Summary: This information sheet for Medical Practitioners, Physiotherapists and Psychologists explains the benefits of using Network Pain Management services for TAC clients suffering from persistant pain, and the referral process. 

View Network Pain Management Program: Request for Assessment form

Network Pain Management Program: Request for Assessment form

Summary:

This form can be used by medical practitioners, physiotherapists and psychologists who are treating TAC clients to request an assessment for their patient by a Network Pain Management Program provider. Network Pain Management Programs can help TAC clients manage musculoskeletal injuries and persistent pain to improve enjoyment of life and increase independence at home, work and in the community.

View Pain management service: request for outpatient multidisciplinary assessment form

Pain management service: request for outpatient multidisciplinary assessment form

Summary:

This form is for requesting an assessment of  the pain management needs (by a multidisciplinary team) of a TAC client who is a hospital outpatient to help them manage their condition and reduce the disability associated with pain.

View Pain management service: outpatient multidisciplinary assessment form

Pain management service: outpatient multidisciplinary assessment form

Summary:

This form is for completion by the multidisciplinary team assessing the pain management needs of a TAC client who is a hospital outpatient to help them manage their condition and reduce the disability associated with pain, where no cure is expected. The assessment takes into account the patient's physical and emotional functioning.

View Pain management service: request for inpatient service form

Pain management service: request for inpatient service form

Summary:

This form is for requesting pain management services for TAC clients who are hospital inpatients, so they can manage their condition. The assessment takes into account the patient's pain level, medications and proposed goals and service plans.

View Pain management service: inpatient multidisciplinary assessment form

Pain management service: inpatient multidisciplinary assessment form

Summary:

This form is for completion by the multidisciplinary team assessing the pain management needs of a TAC client who is a hospital inpatient to help them manage their condition and reduce the disability associated with pain, where no cure is expected. The assessment takes into account the patient's physical and emotional functioning.

View Independence Plan - Information for providers

Independence Plan - Information for providers

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.