Nursing Services

Policy

The TAC can pay the reasonable costs of nursing services when required as a result of a transport accident injury under section 60 of the Transport Accident Act 1986 (the Act).

The TAC will periodically review a client's entitlement to nursing services to ensure that the treatment and services remain reasonable for the transport accident injury and are payable under the Act.

This policy is for home nursing services delivered by a service provider other than a hospital. For nursing services provided by a hospital, refer to the following policies:

Definitions

In this policy:

  • A nursing service is the performance of nursing tasks by a nurse other than at a hospital or as a member of the nursing staff of a hospital. 
  • A nursing episode refers to a single nursing service in which the nurse attends the client's place of residence.
  • Long-term nursing is a program of multiple home-based nursing services provided to clients with complex medical needs who require ongoing nursing care.
  • A specialist nursing assessment is an assessment of a client's ongoing medical care needs, for example, in a specialist area such as bladder/bowel management or pressure care. This may include an assessment and a report.

Guidelines

What can the TAC pay for in relation to nursing?

The TAC can pay the reasonable costs of nursing services:

  • required as a result of the transport accident injury
  • that are reasonable, necessary or appropriate in the circumstances
  • that are clinically justified, safe and effective
  • in accordance with the TAC's policies. 

Nursing episode
The TAC can pay the reasonable costs of a nursing episode to provide nursing services to a client in their home. A nursing episode, irrespective of duration, is inclusive of all penalties, allowances, consumables (e.g. syringes, bandages) and travel associated with the nursing episode.

Long-term nursing
The TAC can pay the reasonable costs of a program of long-term nursing:

  • for clients with complex medical needs who require a significant amount of ongoing nursing care that is not reasonably able to be paid at the episodic rate (for example, several hours of care are needed, where the required care tasks are beyond those that can be provided by an attendant carer)
  • where paid at an hourly rate, inclusive of all penalties and allowances associated with the nursing service provision
  • following an independent specialist nursing assessment recommending long term nursing
  • with prior written approval from the TAC
  • where the service provision is reviewed at least annually by the TAC.

The TAC will determine the reasonable costs of a program of long term nursing based on the frequency, duration and type of nursing tasks identified in the independent nursing assessment. Factors to be considered include:

  • the time of day that the nursing care is predominantly required, i.e. during the day versus the full 24 hour period
  • the type of nursing tasks the client needs. Where nursing tasks are required that are separate to routine direct care tasks, the TAC can consider paying for nursing care coordination as a component of the long-term nursing program. Nursing care coordination includes:
    • liaison with other providers about the complex medical needs of the client
    • planning, delegation, and oversight of a detailed program of care.

Please note that the TAC can pay for case management under a separate policy where this is required. Refer to the Case Management Policy.

Specialist nursing assessment
The TAC can pay the reasonable costs of a specialist nursing assessment and report when requested by the TAC to review the management of a client's condition. This may include reviewing management of particular nursing tasks such as:

  • bladder and bowel management
  • pressure care
  • wound management.

Specialist training
The TAC can consider paying the reasonable costs of specific training in a specialist area provided by a nurse:

  • to others involved in the client's care, such as attendant care workers
  • following a specialist nursing assessment or for support with other personal care tasks
  • with prior written approval from the TAC.

Specialist training will only be paid in exceptional circumstances where the client has specific complex medical care issues related to their transport accident injury. Specialist training is not intended to replace standard staff training provided by attendant care agencies.

Travel
The TAC can consider paying the reasonable costs of travel time for a nurse who is undertaking a specialist nursing assessment or providing specialist training where prior written approval has been provided by the TAC. Travel is billed separately and is reimbursed on a time only basis at a pro rata rate.

Travel time can be claimed only for travel to and from the practitioner's practice address and the assessment or training location. The total travel costs should be apportioned equally to those clients to whom services have been provided where more than one client is visited in a single travel period commencing and ending at the practitioner’s practice address.

Bush nursing hospitals
Refer to the relevant TAC Hospitals policy for information about payment for nursing services provided by Bush Nursing Hospitals.

The TAC can pay the reasonable costs for a nurse from a Bush Nursing Hospital to attend the scene of a transport accident to provide assistance while waiting for an ambulance to arrive. As these cases involve variation in attendance time, this nursing service is payable on a pro-rata basis in intervals of 15 minutes.

Who can provide nursing services?

Services can be provided by a nurse who is registered under the Health Practitioner Regulation National Law to practice in the nursing profession (other than as a midwife or student).

While nursing services may be provided by Division 1 and/or Division 2 nurses, the TAC expects that services will be provided by nurses with qualifications and experience appropriate to the nursing care needs of the client.

What information does the TAC require to consider paying for nursing services?

A request for nursing services must be supported by the client's treating health professional who must provide the TAC with information about:

  • clinical justification of the client's need for nursing services for their transport accident injury (such as a need for dressing changes and admission of prescribed medications)
  • the type and duration of nursing services recommended.

For those clients with a ‘severe injury’ this information may form part of the independence planning process in consultation with the client’s medical practitioner. For all other clients prior approval must be sought from the TAC for long-term nursing, specialist training and travel.

The TAC will arrange an independent nursing assessment to recommend an appropriate program of care where a request is received for long-term nursing.

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.

What are the TAC's invoice requirements?

Refer to the How to invoice TAC section of this website.

For long-term nursing, in addition to the information specified in the billing standards, the nursing service provider must specify on their account:

  • the time/s of day and duration of nursing services provided
  • the qualification of the nurse providing the service.

What fees are payable for nursing services?

Refer to the TAC Nursing Services Fee Schedule.

In relation to nursing services what won't the TAC pay for?

  • treatment or services for a person other than the client
  • long-term nursing during periods of time when active nursing tasks are not required, for example when attendant care services would be able to provide the required care
  • nursing services provided to a hospital inpatient (including bush nursing) as these are included within the bed fee
  • treatment or services subcontracted to, or provided by a non-registered provider
  • 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
  • the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
  • 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.

Nursing Services

Effective 1 July 2017

Registered for GST Not Registered for GST
Service Description Public Hospital Corresponding Item Number TAC Item Number 2017/18
Maximum
Payment
Rate
2016/17 Maximum Payment RateTAC Item Number 2017/18
Maximum
Payment
Rate
2016/17 Maximum Payment Rate
Nurse Care
Nursing Episode   NS650 $87.67 $86.39    
The Episodic fee is NOT to be used as an hourly rate. The Episodic fee is for each visit by the Community Nurse to the TAC client. The fee is inclusive of all penalties and allowances, consumables and travel associated with the nursing episode.  Extended visits, complex care and high cost consumables require prior TAC approval.
Nursing Attendance at the scene of a transport accident (pro rata per hour)   NS655 $87.67 $86.39    
This fee is inclusive of all penalties & allowances, consumables and travel associated with attendance and nursing assistance rendered at the scene of a transport accident.
Specialist Assessment
Specialist assessment by a nurse to review client's medical care needs (per hour) PUB670 NS670* $96.54 $95.13 NS670F $87.77 $86.49
Travel with prior approval (per hour)  PUB675 NS675* $96.54 $95.13 NS675F $87.77 $86.49
Travel time can be claimed only for travel to and from the nurse's practice address and the TAC client's residence.  Where more than one client is visited in a single period, total travel costs should be apportioned equally between those clients to whom services have been provided.
All travel is to be billed in blocks of 15-minutes.      
Report (per hour)  PUB680 NS680* $96.54 $95.13 NS680F $87.77 $86.49
When submitting an account for payment, details of the time taken to complete the report must be recorded on the account.
Training provided by a nurse with prior approval (per hour) PUB685 NS685 $87.67 $86.39    
Long Term Nursing
General nursing when Nursing Care Coordination is also being paid - 24 hr care   NS201 $94.60 $93.22    
General nursing when Nursing Care Coordination is also being paid - Daytime only   NS202 $89.89 $88.58    
General nursing when Nursing Care Coordination is NOT being paid - 24 hr care   NS204 $96.84 $95.43    
General nursing when Nursing Care Coordination is NOT being paid - Daytime only   NS205 $92.26 $90.91    
Nursing Care Coordination   NS203 $87.19 $85.92    

GST

*The TAC maximum fee includes a 10% allowance for GST for items which TAC believes are taxable supplies.  If you are a provider not registered for GST:

  • You are not legally permitted to charge GST
  • You should indicate on all invoices submitted your status as 'not registered for GST purposes'
  • The TAC will only reimburse you an amount which excludes the GST component for items billed where the maximum fee includes a 10% allowance for GST

If you are not registered for GST please state on all invoices the TAC item number listed for providers not registered.