Continence equipment

Policy

The TAC can pay the reasonable costs of equipment and related services where required as a result of a transport accident injury under section 60 of the Transport Accident Act 1986.

The TAC may periodically review a client's ongoing entitlement to equipment to ensure that it continues to promote recovery and/or function following a transport accident injury and is reasonable and appropriate in the circumstances.

This policy must be read in conjunction with the following:

• Medical Excess policy
• Hospitals - Public policy
• Schedule 1 Authorised Rehabilitation Services
• Equipment Policy Summary table

DEFINITIONS

In this policy:

• Medical equipment is required to treat or stabilise a medical condition (for example, optical devices, dentures, room temperature control, life support equipment) and may be subject to the Medical Excess.
• Prescribing therapist refers to a registered medical practitioner or health professional who uses their expertise to recommend and clinically justify the most appropriate equipment to maximise a client's rehabilitation or medical function.
• Supplier refers to a manufacturer or retailer that provides equipment and related services to a client.
• The TAC Contracted Supplier Equipment List is a guide to equipment available through TAC's contracted suppliers. The Equipment List is a resource for treating health professionals to use when recommending equipment.
• The Equipment Brokerage Team source specialised and/or custom made equipment for clients through non-contracted suppliers.
• The Community Integration Program (CIP) is an initiative that provides specialist care for eligible catastrophically injured workers in partnership with the Transport Accident Commission (TAC). Eligible workers are defined as those who have an accepted claim for compensation for a spinal injury resulting in quadriplegia/paraplegia or an acquired brain injury rated as severe or moderately severe.

GUIDELINES

What can the TAC pay for in relation to equipment?

The TAC can consider paying the reasonable costs of supply (purchase/hire), delivery and installation of equipment where:

• required as a result of a transport accident injury
• there is clinical justification that the equipment will measurably improve a client's:
• • function
  • independence
  • level of pain or discomfort
  • mobility
  • community involvement (through vocational, educational or leisure activities)
  • communication
  • safety.

Hire of equipment should only be considered when the client is likely to require the item for short term use (usually 6-12 weeks).

Maintenance

The TAC can pay the reasonable costs of maintenance for some high cost equipment items paid for by the TAC, such as:

• Electric adjustable medical beds
• Alternating air mattresses
• Wheelchairs (powered, manual and tilt is space)
• Electric scooters
• Room temperature control units
• Electric ceiling or standing hoists
• Commodes (shower or transporter varieties)
• Feed pumps

Repairs and Replacement

The TAC can pay the reasonable costs of repairs and replacement arising from normal wear and tear to TAC paid equipment or modifications where the equipment is adaptive or disability-specific, for example wheelchairs, commodes, electric scooters.

It is expected that equipment either partially or entirely paid for by the TAC is used in a responsible manner consistent with its intended use. Equipment should be maintained appropriately, stored responsibly and in no way wilfully damaged. Clients should take out an appropriate level of insurance at their own cost.

Standard household items, such as cleaning or gardening equipment, are usually considered a one-off purchase and will not be repaired or replaced.

The TAC can pay the reasonable costs of repair, adjustment or equivalent replacement of medical or rehabilitation equipment that has been broken, damaged or lost in a transport accident. Equipment will be restored strictly according to the client's pre-accident prescription. This applies to medical equipment such as dentures, orthotics, mobility aids and/or optical equipment that was required prior to the accident.

Client contribution

A client will be required to contribute to the cost of equipment where:

• the client selects equipment that is more expensive than a suitable standard model
• the equipment would be required regardless of the transport accident injury
• the equipment is only partially related to a client's transport accident injury.

Capital Services Agreements

If the TAC's contribution exceeds $5000, a Capital Services Agreement (CSA) will be required. This applies to room temperature control, life support, ventilators, special lighting and the resources required to operate, run, maintain or repair these items.

A CSA establishes the responsibilities of the client and the TAC in relation to ownership and ongoing costs associated with the equipment.  Unless otherwise specified in the CSA, the equipment is owned by the client.

Who can provide equipment?

Equipment requests

The TAC can pay the reasonable costs of equipment when requested by a registered medical practitioner or health professional with relevant expertise. Depending on the type of equipment, a range of medical practitioners and health professionals may be able to request certain items.

Refer to the sections on specific equipment categories below for information about which items medical practitioners and health professionals can request.

Supply of equipment

Equipment can be obtained from a range of suppliers through the TAC, private hospitals, medical practitioners or health professionals, depending on the type of equipment and the client's circumstances.

Standard items are provided by TAC's contracted equipment suppliers and are included in the TAC Contracted Supplier Equipment List. Customised or specialised items can also be provided by the contracted equipment suppliers. Customised or specialised equipment items include customised wheelchairs, beds, ceiling hoists or communication devices.

Where equipment items are to be provided by non-contracted suppliers this must be organised via the TAC Equipment Brokerage Team.

In certain circumstances equipment can also be supplied by:

Public hospitals

Bed fees paid in Victorian public hospitals cover the cost of aids and equipment, including surgical supplies, provided to a client whilst an inpatient.

For information about equipment supplied on discharge by public hospitals, refer to the Hospitals - Public policy.

Private Hospitals

Bed fees paid in private hospitals cover the cost of aids and equipment provided to a client whilst an inpatient. Theatre fees cover the costs of surgical supplies provided during operating room procedures. Refer to the Private Hospitals policy.

For equipment up to $500 required for inpatient discharge and outpatients only, private hospitals can order directly from the supplier and send the invoice to the TAC. A list of approved equipment can be found on the Hospital Direct Order form (up to $500) and in the approved items list up to $150 (below).  Standard items not on the Hospital Direct Order Form or on the approval items list require written clinical justification and should be ordered from the TAC Contracted Supplier Equipment List .

Clients must have an accepted claim before orders can be made by private hospitals.

Health Professionals

For equipment up to $150 on the approved items list (below), health professionals can order directly from the supplier and send the invoice to the TAC.

This list has been developed to allow clients to quickly access items that may assist them to recover from their transport accident injury by:

• stabilising the injury
• assisting with self-management
• allowing the client to perform activities of daily living more independently.

In relation to the supply of these items, please note the following:

• the TAC accepts that the reasonable costs of these items is the recommended retail price
• the TAC expects that health professionals will not invoice the TAC for consumables used as a part of in-rooms treatment - the approved items are intended to be supplied for the client to take home to assist with the management of their transport accident injury
• the TAC will undertake periodic reviews of invoicing patterns of providers and may audit providers from time to time to ensure supply of these items is clinically justified.

Approved items list

The following items can be supplied to clients by either private hospitals (for inpatient discharge and outpatients only) or health professionals, without prior approval from the TAC:

• taping (zinc oxide, Fixomull, strapping etc)
• bandages (compression, Tubigrip, gauze products, etc)
• oedema control and dressing bandages
• thermal supports, pressure garments and gloves
• soft collars
• lumbar rolls
• hand putty/Theraputty, Digi-flex, exercise foam, Thera-band, etc
• walking aids (sticks, crutches, etc)
• triangular slings
• plaster
• ice packs, heat packs
• Hibitane, Iso-wipes, Skin-prep, applicators, etc
• adaptive cutlery
• dressing aids
• pick up sticks
• hand weights up to 3kg
• silicone gel sheeting (one 10x13cm sheet only) or in equivalent liquid form
• non-electrical adapted cleaning equipment (up to $150 per item only).

Refer to the orthoses section of the External Prostheses and Orthoses policy for the following:

• orthoses supplied by hand therapists
• braces/splints/supports supplied by physiotherapists, occupational therapists, chiropractors, osteopaths and podiatrists.

What information does the TAC require to consider paying for equipment?

Equipment that is not listed on the Hospital Direct Order Form or included on the approved items list (above) requires written clinical justification from a client's treating medical practitioner or therapist. The request should include:

• a summary of the client's injuries and equipment needs
• the relationship between the equipment and transport accident injury
• details of the specific item, function and intended use
• the duration and expected use of the equipment
• the costs of the equipment.

Where the TAC has accepted that payment of standard equipment items is reasonable, it is expected that the items will be ordered from the TAC Contracted Supplier Equipment List. Written clinical justification is required if an equivalent item is being requested from an alternative supplier.

For certain high cost equipment items (manual and powered wheelchairs, pressure cushions, powered conversion kits, scooters, hoists, medical beds and related items, standing frames, tilt tables, treatment couches, lounge chairs, custom toilet/shower/commode chairs, mainstream multifunction technology, large exercise equipment, bikes and recumbent trikes, the Equipment Prescription Form must be completed and submitted.

It is expected that trials of items from the Equipment List (if available) will occur before recommending an equivalent item from an alternative supplier. Health professionals/Occupational therapists will only be paid for completing the Equipment Prescription Form for these items.

For those clients with a 'severe injury', where the cost of an equipment item is less than $1,000, the information above may form part of a client's independence planning process in consultation with their treating health practitioner and TAC coordinator. Please note that requests for mainstream multifunctional technology will continue to require an Equipment Prescription Form to be completed and submitted to the TAC.  The TAC may contact the client or the client's treating health practitioner to request further information where required.

For further information about supporting documentation for equipment requests, please refer to the Equipment Policy summary table below.

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.

For urgent equipment and related services, the TAC will respond promptly to ensure that, where payment of equipment is accepted as reasonable, the equipment will be supplied within the following timeframes from receipt of the request:

• Level 1: within 8 business hours – the client's mobility or safety is at risk requiring urgent equipment service or supply (for example respiratory or mobility items)
• Level 2: 8-16 business hours – the client's mobility, hygiene or pain management is compromised but there is no risk
• Level 3: 3-10 business days – a non-customised equipment item is required to enhance a client's rehabilitation or independence
• Level 4: customised (delivery by notification) – the equipment item requires customisation to suit the client's needs, for example particular specifications or enhancements.

In relation to equipment, what won't the TAC pay for?

The TAC will not pay for:

• equipment, treatment or services for a person other than the client
• equipment required for a pre-existing condition or that is not related to the client's transport accident injury
• equipment items provided to an in-patient as part of a hospital bed fee- refer to the Private Hospitals policy and the Public Hospitals policy
• equipment which provides no clear benefit to the client
• insurance to cover equipment paid for by the TAC
• fees associated with non-attendance at consultations or fittings
• treatment or services provided by telephone or other non face to face mediums
• treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1 or 2 evidence that the treatment, service, prostheses or equipment is safe and effective- refer to the Non-Established, New or Experimental Treatments and Services policy
• equipment or services provided more than two years prior to the request for paying except where the request for payment is made within three years of the transport accident- refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy
• equipment or services provided outside the Commonwealth of Australia.

Please see below for further information about specific equipment items. This information applies in addition to the policy guidelines above:

Beds and Mattresses
Clothing, including compression garments
Continence
Footwear
Life Support Equipment
Mainstream Multifunction Technology
Optical
Personal Alarms and Monitoring Services
Room Temperature Control
Sport and Recreation

Beds and mattresses

The TAC can pay the reasonable costs of medical beds and related items. For example:

• adjustable beds
• specialist or pressure care mattresses
• pressure care overlays
• moving or positioning supports.

There is currently no conclusive National Health and Medical Research Council level 1 or 2 evidence to show that sleeping on a particular type of bed or mattress can help back pain compared to other mattress types.  Refer to the Non-established, New or Emerging Treatments and Services policy.

Any TAC contribution will be determined after considering the following factors:

• The extent to which the bed or mattress is necessary to manage the client's transport accident injury beyond the ordinary requirements of an average person.
• The age and condition of the client's current bed or mattress. The TAC will not contribute to the cost of a new bed or mattress where the client's bed or mattress is of an age or condition where it would have reasonably required replacement irrespective of the transport accident injury.
• The size of a client's current bed or mattress. The TAC will only contribute towards beds or mattresses that are the same size as the pre accident/injury bed/mattress and will also take into consideration the client's transport accident injury needs.
• Whether the client requires the recommended bed or mattress due to a pre-existing condition.

In relation to standard beds and mattresses, the TAC will not pay for:

• new items where a client's existing bed or mattress will support their transport accident injury
• anything other than standard basic models
• waterbeds or waterbed heaters
• antique bed replacements or repairs
• linen or bedding.

Clothing: including compression garments

The TAC can pay the reasonable costs for clothing only where required for:

• body temperature control (thermoregulation). For example thermal undergarments, thermal gloves, mittens or mitts
• reducing the risk of re-injury or deterioration. For example, wheelchair gloves
• minimising hypertrophic scarring, oedema or other similar conditions, for example, compression garments prescribed by a treating health professional for the management of wounds or burns.

The TAC can pay the reasonable costs of modifications/alterations to standard retail clothing and/or clothing paid for by the TAC where this is required to facilitate independence, safety or return to work.

In relation to clothing, the TAC will not pay for:

• off the shelf clothing
• custom made clothing for a pre-existing condition
• clothing normally issued by an employer
• replacement of clothing that was damaged at the time of the transport accident injury.

Continence

Continence equipment must be prescribed by a qualified continence nurse. The TAC will only accept a prescription for a maximum of two years. Continence equipment must be prescribed from the TAC Contracted Supplier Equipment List using the Continence Prescription (Hospital discharge) Form or the Continence Prescription (Community) Form.

Footwear

Footwear or modifications will only be considered where a client is unable to wear their pre-injury footwear because of their transport accident injury as footwear is an expense incurred regardless of a transport accident injury.

The TAC can pay the reasonable costs of:

• custom made or orthopaedic footwear that is required because standard off the shelf footwear or pre-injury footwear cannot be worn due to the transport accident injury or does not support a client's rehabilitation needs
• modifications to a client's pre-injury footwear or off the shelf footwear
• footwear that is required to accommodate an orthosis (where a therapist has demonstrated that every attempt has been made to accommodate the orthosis in the client's own footwear).

The TAC will only accept written requests for footwear from:

• an appropriately qualified medical specialist, e.g. orthopaedic surgeon
• an orthotist
• a podiatrist.

In relation to footwear, the TAC will not pay for:

• footwear normally issued by an employer
• non-orthopaedic or standard off the shelf footwear that is not required to fit custom modifications or orthotics as a result of a client's transport accident injuries, i.e. day to day sneakers, runners or work related footwear.

For further information about orthotics, please refer to the External Prosthetics and Orthotics policy.

Life Support Equipment

The TAC can pay the reasonable costs of life support equipment, including artificial respirators and ventilators, humidifiers and enteral feed pumps.

A Capital Services Agreement is required for life support equipment over $5,000.

In addition to life support equipment, the TAC can also make a contribution to the reasonable costs of provision, installation, maintenance and increased consumption of utilities associated with the running of life support equipment, such as electricity costs.

In relation to life support equipment, the TAC requires the following information:

• clinical justification based on the transport accident injuries supplied by a suitably qualified consultant physician or specialist recognised by the Health Insurance Act (1973)
• client's eligibility for  energy concessions (e.g. life support machine electricity concession)
• proportion of the electricity account related to the client prior to their transport accident (if available)
• demonstrated increase in electricity consumption (measured in kilowatts hours or cubic metres multiplied by the cost per unit, rather than the gross dollar increase), for example, copy electricity accounts.

Mainstream Multifunctional Technology

Standard Mainstream Multifunction Technology (MMT) devices such as personal computers, tablets and smart phones are considered to be a normal personal item and will not usually be paid for.

In this section of the policy:

• Mainstream multifunctional technology (MMT) means a device or service which is commercially available for everyday use by anyone, can perform multiple functions, and has not been especially designed for rehabilitative use or for disability purposes, but under this policy is being used for a rehabilitative or disability purpose.
• Devices refers to the hardware aspect of MMT, for example, touch screen tablet computers, smartphones, desktop or laptop computer hardware and related items.
• Software means programs or applications (apps) that are used on MMT devices and may require download from the internet to obtain and update.
• Internet services means an internet connection that allows the device to access software downloads and updates, as well as interact with online programs, websites, and other devices. An internet service is essential for downloading programs and updating the programs and applications, but is not necessarily essential for running software on the device

The TAC can consider paying the reasonable costs of MMT for clients who:

• require the MMT as part of a goal-oriented rehabilitation program in which the recommendation is that the MMT will:
• • measurably increase independence, for example, via a reduction in need for support workers, and/or
  • measurably improve a deficit in communication
• can demonstrate the ability to effectively use MMT (both device and prescribed software) for the reasons it has been recommended
• do not own or have reasonable access to the requested MMT or other equipment that meets the identified needs
• require a MMT device due an injury that means the client cannot communicate in a usual way, such as:
• • acquired brain injury
  • quadriplegia
  • significantly reduced arm function
  • upper limb/hand amputation
  • brachial plexus palsy.

The TAC can pay for the reasonable costs of:

• standard model MMT devices with the minimum requirements to run the prescribed program or software
• software or apps that are prescribed to meet a client's specific transport accident injury needs
• additional internet services only where required to access prescribed programs/apps.

The TAC considers the reasonable costs for MMT devices to be the recommended retail price, and will not pay above this amount.

Where the client requires the MMT equipment for a resolving condition the TAC will not purchase the item, and will only consider paying the reasonable costs of hiring the item for the period until the condition has resolved.

The TAC will only accept written requests for MMT on the Equipment Prescription Form. The form must be completed by an appropriately qualified and experienced speech pathologist, occupational therapist or Framework occupational therapist. Treating health professionals are strongly encouraged to contact the TAC to discuss the request before completing the form.

Consultations provided by speech pathologists and occupational therapists regarding MMT can be paid in line with the TAC fee schedules for speech pathology and occupational therapy.

The TAC will not pay for:

• MMT that is not part of a goal-oriented rehabilitation plan
• costs associated with accessing the internet if a client has sufficient existing internet services that will enable them to access and use the prescribed software
• insurance or warranty costs
• redeemable products, for example iTunes vouchers/cards
• consumables such as printer ink, paper, blank USBs and CD/DVDs
• telephone lines for the purpose of an internet installation
• costs of mobile telephone plans, telephone calls, or telephone services.

Optical

The TAC can pay the reasonable costs of:

• spectacles or contact lenses prescribed as a result of a transport accident injury
• optometry consultations (refer to  the TAC's Schedule of Fees for Optometry Services)
• one pair of basic non-prescription standard sunglasses when required as a direct result of the transport accident injury - sunglasses must meet Australian standards for UV protection.

Refer to the Optometry policy for information about services provided by an Optometrist.

Personal Alarms & Monitoring Services (Safety items)

Personal alarms and monitoring services can be useful for clients who would like greater independence but require daily monitoring and support for medical reasons. The type of service or device will depend on the client's needs and circumstances.

Personal alarms and monitoring services may include:

• A personal alarm which can be worn as a necklace pendant, watch or belt clip. Otherwise, a special sensitive button or 'blow switch' can be used where a client has limited or ataxic movements.
• A receiver unit and the required components that are plugged into the client's telephone line - this allows the signal to be received from the personal alarm and automatically dials the monitoring centre.
• The monitoring station, which provides the 24-hour monitoring by a third party. If the client needs assistance or if a regular 'check in' is missed, the nominated emergency contact/s will be notified.
• The Royal District Nursing Service (RDNS) Response Service - this service only applies to clients who have no nominated emergency contacts.
• Medical alert devices (such as a medical alert bracelet, pendant, vial of life and/or wallet card) are worn by a client, with details of their medical, supervision, and emergency instructions.
• Keysafes, which comprise the safe and mounting hardware. This could be the spin-dial or push-button version and mounted to a wall or located on a fence, railing or pipe. A keysafe can hold several keys and is accessed by entering a pin or combination.
• On-call attendant care, which is a remote service for clients who require a low level of care during the day and/or overnight, but do not require an attendant carer to be constantly present and/or sleep over in their home. Refer to the On-Call Service policy.

The TAC requires a written request from the client's medical practitioner and/or assessing or treating therapist confirming that a personal alarm and monitoring service is appropriate for the client's transport accident injury. The request should outline:

• the client's pre-accident functional ability
• the components of the monitoring system to be paid, e.g. initial set up and/or ongoing monitoring
• the estimated cost of the monitoring system
• if the client has a nominated contact person for the personal alarm and monitoring service
• the level of support within the household (excluding medical alert devices).

The TAC cannot pay for personal alarms that are not monitored by a monitoring station.

Room Temperature Control

The TAC can pay the reasonable costs of room temperature control equipment when required to address difficulty regulating body temperature as a result of a transport accident injury. In most cases this would be a spinal cord lesion at or above the level of T6. In other exceptional cases it must be medically confirmed that the transport accident injury has resulted in a permanent inability to regulate temperature.

The TAC can pay the reasonable costs of provision of equipment, installation, maintenance and increased consumption of gas or electricity associated with the running of an air conditioner, evaporative cooling unit or heater.

The TAC will only accept requests for room temperature control equipment from a consultant physician or specialist, as recognised by the Health Insurance Act (1973), who is able to confirm that the client's injuries meet the medical criteria outlined above.

In relation to room temperature control equipment, the TAC requires the following information:

• Documentation of a spinal cord injury at or above the level of T6 or other exceptional cases where the transport accident injury has resulted in a permanent inability to regulate temperature.
• Eligibility for energy concessions, such as the life support machine electricity concession.
• Electricity consumption prior to the installation of the equipment.  For example, supplying a copy of the electricity or gas account to demonstrate pre injury usage. This can be compared to electricity consumption after the installation of the room temperature control equipment to identify any increased usage.
• The proportion of the electricity account related to the client prior to their transport accident injury.

The TAC will not pay for equipment for areas of the home that the client cannot access or does not access for activities of daily living.

Sport and Recreation

The TAC can consider paying the reasonable costs of modified or adapted equipment to enable participation in a sporting or leisure activity. The client's individual circumstances will be taken into account in determining eligibility and reasonable costs. Client contributions may be required in some circumstances.

For a client who is able to return to their pre-injury activity the TAC can pay the reasonable costs of adaptions to the client's own equipment.

For a client who is unable to return to their pre-injury activity the TAC can pay the reasonable costs of:

• Hire of sporting or recreational equipment for three months.
• Purchase of entry level equipment for one sporting or leisure activity where a client can demonstrate commitment to continued participation.
• Purchase of equipment for subsequent sporting or recreational pursuits. Where the client has discontinued the previous activity in favour of another, it would be reasonable for the client to contribute the trade-in value of the TAC paid equipment toward the new equipment.
• Making a contribution towards elite or advanced equipment where required.

In relation to sporting and recreational equipment, the TAC requires the following information:

• demonstrated commitment to the sport or recreational activity such as club membership, regular attendance and/or evidence of participation
• reasons why basic entry level equipment will not be sufficient, when requesting elite or advanced equipment.

In relation to sporting and recreational equipment, the TAC will not pay for:

• vehicles required for sport or recreational use. For recreational vehicles, please refer to the Vehicle Modifications policy/Car Modifications policy for more information
• optional features (for example, metallic paint or tool kits)
• maintenance and repairs (except for sporting wheelchairs)
• replacement of sporting or recreational equipment that was damaged in the transport accident
• sport or recreational clothing
• participation costs such as court hire, entry fees or coaching.

For further information about sporting and recreational prostheses, please refer to the TAC External Prostheses and Orthoses policy.

Equipment Policy Summary