The TAC can pay for the reasonable costs of neurobehavioural rehabilitation services authorised under section 23 of the Transport Accident Act 1986, required as a result of the client's transport accident injuries, where prior approval has been obtained from the TAC.
Transport Accident Act 1986 reference: s.3 'rehabilitation service', s.12(3), s.12(4), s.23 and s.60
Neurobehavioural rehabilitation services are provided by a multidisciplinary team of allied health and support staff that have been trained in and deliver the Brain Injury Rehabilitation Trust (BIRT) model of rehabilitation. Neurobehavioural rehabilitation services refer to a non-medical model of rehabilitation that has an emphasis on behaviour management. All client goals are directed towards assisting an individual to maximise his/her independence in activities of daily living by reducing the incidence of challenging behaviours.
Clients assessed as being suitable for neurobehavioural rehabilitation will be required to live in the rehabilitation centre during the program. The client's progress will be regularly reviewed to ensure that the program is meeting the client's goals.
In this policy:
Neurobehavioural rehabilitation services refer to:
- programs that are delivered by providers who have signed a contract with the TAC with agreed reporting requirements and timeframes
- programs that are provided under sections 12(3) and 12(4) of the Transport Accident Act 1986, which oblige the TAC to develop programs for the rehabilitation of persons injured as a result of a transport accident
- a non-medical model of rehabilitation that has an emphasis on behaviour management. All client goals are directed towards assisting an individual to maximise his or her independence in activities of daily living by reducing the incidence of challenging behaviours arising from their acquired brain injury (ABI)
- services that are delivered by a multidisciplinary team of allied health and support staff who have been trained in and deliver the Brain Injury Rehabilitation Trust (BIRT) model of rehabilitation.
Contracted neurobehavioural rehabilitation service provider refers to an organisation that has signed a contract with the TAC to perform neurobehavioural rehabilitation services.
Who is eligible for neurobehavioural rehabilitation services?
To be eligible for neurobehavioural rehabilitation services the TAC client must:
- be an adult who is aged 18-65 years old (exceptions to this will be considered on a case by case basis)
- have an ABI as a result of their transport accident
- not have any space occupying lesions in their brain
- be medically stable
- primarily have cognitive problems
- have significant problems in:
- social interaction
- have challenging behaviour as a result of their ABI
- require lifelong support as a result of their ABI
- have the realistic prospect of being able to return home or to a less dependent environment.
TAC clients are not suitable for the service if they:
- have a tracheostomy tube
- require additional funded attendant care support within the service
- exhibit pre-meditated violence or require physical restraint as the primary prescribed method of intervention
- have unstable drug, alcohol or mental health issues.
Who can refer a TAC client for neurobehavioural rehabilitation services?
The TAC requires a written referral to the service from a neuropsychologist or occupational therapist outlining:
- the current presenting problems:
- behaviours of concern
- severity of the behaviour
- frequency of the behaviour
- impact of the behaviour on the TAC client and their family
- current level of functioning
- participation in everyday activities
- the level and amount of funded and unfunded supports that are being provided to the TAC client; and
- whether this service is expected to increase the TAC client's independence.
If approved, the contracted neurobehavioural rehabilitation service provider will perform a Pre-Admission Screen to assess the TAC client's potential and suitability for neurobehavioural rehabilitation services.
Following this screen, the contracted neurobehavioural rehabilitation service provider will submit a 'Mental Health Neurobehavioural Rehabilitation: Treatment Plan' and recommendations to the TAC for consideration.
Who can provide neurobehavioural rehabilitation services?
Neurobehavioural rehabilitation services must be provided by a contracted neurobehavioural rehabilitation service provider.
What neurobehavioural rehabilitation services can the TAC pay for?
The TAC can pay for the:
- cost of a Pre Admission screen, and
- reasonable cost of neurobehavioural rehabilitation services.
What services and therapies will the contracted neurobehavioural rehabilitation provider include as part of the program?
The contracted neurobehavioural rehabilitation provider will provide the following services during the program:
- 24 hour nursing care and attendant care (ABI residential support has active overnight care)
- Allied health (occupational therapy, neuropsychology, physiotherapy, speech therapy)
- An individually structured program for each TAC client
- Standard consumables (basic dressing and continence supplies)
- Equipment requirements considered necessary for the safe and effective management of ABI clients
- Transportation to and from recreational activities, appointments and therapeutic home visits directly linked to the TAC client's neurobehavioural rehabilitation program
- All accommodation costs (including facility management and daily living expenses)
- Dietary requirements, including PEG feeds
- Training of Attendant Care Agency Staff and /or family in the Brain Injury Rehabilitation Trust (BIRT) model for transition into the community
Will the TAC pay for concurrent treatment?
The TAC will not pay for physical treatment (including physiotherapy, hydrotherapy, chiropractic treatment, osteopathy or acupuncture), or occupational therapy, speech pathology or psychology concurrently, when a neurobehavioural rehabilitation service has commenced following the initial assessment.
However, if a delay occurs between the initial assessment and commencement of the approved neurobehavioural rehabilitation service and physical treatment or other allied health services (e.g. speech pathology, physiotherapy, occupational therapy, psychology) are required during this period, the TAC can pay for the reasonable cost of this treatment. Refer to the clinical justification guidelines.
Can the TAC pay for other treatment and services for a client while he/she participates in the program?
The TAC can continue to pay for the transport accident related treatment and services that are reasonably required by the client, while participating in the program including:
- medical treatment provided by a registered medical practitioner
- pharmacy items
- allied health services that are not provided by the contracted neurobehavioural rehabilitation service provider.
- travel expenses in order for the client to receive medical, rehabilitation and disability services that are not included as part of the neurobehavioural rehabilitation program.
Requests for any treatment, services or travel will be considered under the guidelines for their respective policy.
What bed leave/hold fees can the TAC pay for when a client undertakes overnight leave in the community or is transferred to an acute hospital?
The TAC can pay for the maximum bed hold fee for clients that are transferred to an acute hospital, or for community overnight leave. This is capped at a maximum total of 14 days per client.
The TAC will pay bed leave fees for each day that a client is absent past midnight.
Where a Facility is funded bed leave days, the number of days funded will count towards the next step-down period for that client.
Can the TAC pay for services/treatment performed by a member of a client's immediate family?
In relation to neurobehavioural rehabilitation services, what will the TAC not pay for?
The TAC will not pay for services or treatment:
- for a person other than the injured client
- for a condition that existed before a transport accident or that is not a direct result of a transport accident
- where there is no clinical justification for the program or service
- where there is no objective evidence that a service is safe and effective
- provided by single discipline providers
- provided outside the Commonwealth of Australia
- 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.
The TAC will also not pay for:
- 1:1 attendant care costs in addition to the daily bed fee
- fees associated with non-attendance
- costs of telephone calls and telephone consultations between providers and clients, and between providers, including hospitals
- incidental items that occur as part of a client's in-patient stay, e.g. telephone calls, television hire and general toiletries, e.g. toothpaste or soap.