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Occupational Therapy Services

The TAC Medical Excess may apply to these services

Policy

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

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

Background

The TAC has developed the Clinical Framework for the Delivery of Health Services (Clinical Framework) to set out key principles for delivery of services to clients.

The Clinical Framework is based on the following principles:

  • Measurement and demonstration of the effectiveness of treatment
  • Adoption of a biopsychosocial approach
  • Empowering the client to manage their injury
  • Implementing goals focused on optimising function, participation and/or return to work/health
  • Base treatment on best available research evidence.

The TAC expects that all health professionals providing services to clients integrate the principles of the Clinical Framework into their daily practice.

Further information regarding the Clinical Framework can be found at www.tac.vic.gov.au.

This policy must be read in conjunction with the following:

Definitions

In this policy:

  • Occupational therapy (OT) services refers to attendance, examination or treatment by a registered occupational therapist that is designed to maximise a client's independence in activities of daily living and productive activities including paid work, study, volunteering and childhood play. OT services may include:
    • prescribing exercises to maximise a client's function and promote the recovery of or rehabilitation from their injury
    • prescribing adaptive and/or alternative techniques to make it easier for a client to perform activities, e.g. breaking strenuous tasks into smaller more manageable tasks
    • prescribing equipment that will facilitate and/or maximise a client's independence
    • prescribing modifications to an environment to maximise a client's independence and participation, e.g. installing a rail in a bathroom; or
    • undertaking assessments to assist in establishing what support services a client may require as a result of their transport accident injury, e.g. attendant care.

Guidelines

What can the TAC pay for in relation to occupational therapy services?

The TAC can pay for the reasonable cost of occupational therapy services:

  • with prior approval from the TAC
  • required as a result of a transport accident injury
  • that are reasonable, necessary or appropriate in the circumstances
  • where safe and effective
  • that are likely to achieve or maintain measurable functional improvement
  • that promote progress towards functional independence, participation and self-management in accordance with the TAC’s policies.

The TAC can also pay the reasonable costs of occupational therapy services required for:

Hand therapy

The TAC can pay the reasonable costs of the first two hand therapy consultations provided by an OT without prior approval if:

  • liability for the claim and injury being treated are ultimately accepted by the TAC, and
  • where hand therapy is provided:
    • within one week of the date of the transport accident, or
    • up to 72 hours post surgery, or
    • within 72 hours of the removal of a cast.

If more than two hand therapy consultations are required the OT must complete an Occupational Therapy Service Plan (OTSP). For clients with a 'severe injury' this requirement will form part of the independence planning process.

Group consultations

The TAC can pay the reasonable costs of group consultations provided by an OT. Group consultations involve two or more clients being treated in the same treatment sessions receiving constant overall supervision and intermittent individual attention.

Meeting attendance

The TAC can pay the reasonable costs for an OT to attend a meeting where:

  • attendance at the meeting has been requested by the TAC as part of the independence planning process or
  • prior written approval has been provided by the TAC or
  • the need for attendance is clinically justified.

Travel

The TAC can pay the reasonable costs of travel time for occupational therapists as a separate fee/item when:

  • prior written approval has been provided by the TAC
  • a medical practitioner has confirmed that the client is medically unfit to travel, or clinical justification  is provided by the treating therapist that the treatment should be delivered in a community setting, for example home, school or work
  • the health professional providing treatment is the most appropriate according to the geographic location of the client and the therapy specialty required
  • travel time is separately billed and is reimbursed on a time only basis at a pro rata rate.

Refer to the Occupational Therapy Fee Schedule for information about how to invoice travel.

Who can provide occupational therapy services?

OT services can be provided by an OT who is registered under the Health Practitioner Regulation National Law.

Framework Occupational Therapy Model

Framework Occupational Therapy is a service model that recognises the importance of a client’s participation and independence in the everyday activities at home, at work, at school or within the community. Framework Occupational Therapy providers have specific experience in treating clients who have received an acquired brain injury or spinal cord injury as a result of a transport accident.

For more information on enrolling, please refer to the Framework Occupational Therapy policy.

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

For clients with a 'severe injury' treatment will be approved as part of the planning process. Where applicable, the occupational therapist will be required to submit initial baseline measures within 10 working days of approval of treatment from the TAC. Outcome measures are to be recorded throughout the treatment and provided to the TAC upon request.

For all other clients, an OT must submit a fully completed Occupational Therapy Service Plan (OTSP) to the TAC:

  • for all requests for ongoing OT hand therapy services
  • at the request of the TAC for all other OT services.
The TAC may request a copy of the referral for OT services to determine its liability for them.
All fields on the OTSP must be completed in order for it to be reviewed by the TAC.

For all clients the TAC may contact the client or OT for further information if required.

Payment for completion of the OTSP is made in accordance with the TAC fee schedule.

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.

To assist the TAC to make a decision regarding a request for occupational therapy services, a request may be reviewed by the TAC Clinical Panel. The Clinical Panel may contact the requesting medical practitioner to seek further information and/or discuss the proposed treatment prior to making a recommendation to the TAC regarding the request. The TAC will respond to the request when they have received the Clinical Panel’s recommendation.

What are the TAC’s invoice requirements?

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

What fees are payable for occupational therapy services?

Please refer to the Occupational Therapy fee schedule.

In relation to occupational therapy 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
  • fees associated with cancellation or non attendance
  • treatment or services undertaken in hospital billed separately where the cost is included in the hospital bed fee
  • reports undertaken without the prior approval of the TAC
  • treatment or services provided outside the Commonwealth of Australia
  • treatment or services provided by telephone or other non face to face mediums
  • telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
  • treatment or services provided more than once on the same day to the same client
  • 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.

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