CGP – Community Group Programs

If a client has multiple physical, sensory and cognitive disabilities because of severe transport accident injuries, they may need extra help to access community activities.

Community Group Programs are delivered to a person with disability to enable that person to achieve maximum participation in community based recreational, leisure, peer support or common interest activities. These activities aim to enhance wellbeing, identify goals and develop skills, while creating a genuine sense of contribution and belonging.

Section 3, 23, and 60 of the Transport Accident Act 1986 (the Act) indicates that the TAC is responsible to pay the reasonable cost of a range of services, including medical, rehabilitation and disability services, for eligible persons who are injured as a result of a transport accident.

These services require written approval before they are provided.

These services must be received in Australia, meaning the client must be in Australia to be eligible.

Community group program (CGP) services have been authorised by the TAC as a Disability expense to support and assist a client with accident-related disability in circumstances where it is needed. For full details of the authorisation, please refer to Schedule 2 Authorised Disability Services c. Community Group Programs which includes what supports can be provided and the criteria for who can perform them.

Community Group Programs (CGP) are coordinated activities and support within a group setting, on a regular basis. There are programs and activities to help with new skills, accessing the community, recreation and leisure.

Community group programs offer coordinated activities and supports within group recreational, leisure, peer support or common interest community settings on a regular basis.  These programs:

• Are designed to aid clients engage in community based activities outside the home by providing shared support.
• Are flexible and responsive to client support needs, goals and interests.
• Facilitate client transition to mainstream community based leisure, recreational, peer support or common interest activities.
• Provide support to clients in a manner that respects privacy and dignity.
• Enhance client quality of life, community and authentic peer connections.

Community group programs are delivered to support clients to achieve maximum participation in community based recreational, leisure, peer support or common interest activities.  These activities aim to enhance wellbeing, identify goals and develop skills, while creating a genuine sense of contribution and belonging.

The TAC can help pay for community group programs to help clients get back into the community when they have a disability because of their transport accident injuries.

CGP can only be provided by a provider authorised and approved by the TAC. These services must be approved by the TAC in writing prior to provision.

The TAC requires a written request for community access support services from clients or their:

• family
• treating doctor or
• occupational therapist.

This request should include information as to how this service will assist clients in achieving their goals.  The TAC can pay for a client to visit their doctor or occupational therapist to discuss their needs. They may recommend some support to help clients join community activities.

They will ask the TAC if a client can participate in community access planning and/or a community access group program. The TAC will work with a client’s treating team to help arrange the provision of these services.

The TAC may contact a client’s recommending doctor or occupational therapist to discuss progress against the goals outlined in the client’s Program of Support or request an assessment, to make sure that clients:

• have access to the right services and support.
• are moving towards getting a client’s life back on track and achieving their goals.

There is a limit to how much the TAC will pay to a community group program provider. If a service costs more than the TAC rate, clients might need to pay the difference.

For a list of rates, see Community Group Program fees

The TAC pays for these services:

• Directly to the service provider, when a client has provided them with the client’s TAC claim number, or
• If a client has to pay, they can use myTAC to send a copy of the receipt to the TAC to repay the client.

The TAC can’t pay for services that:

• Are not reasonable, necessary or appropriate

• Are not authorised under TAC legislation

• Are for someone other than a client

• Have not been approved by TAC prior to commencement

• Are provided outside Australia

• Are not contributing to achieving client goals and delivering client outcomes

• Are activity costs associated with participation in community activities including:
  • entry fees, e.g. to an art gallery
  • activity costs, e.g. the purchase cost of roller skates
  • materials, e.g. wood for woodworking
  • hire of equipment and/or hire of facility component of activity, teaching or instruction of the activity, e.g. bowling balls or bowling shoes.

The TAC may contact a client’s recommending doctor or occupational therapist to discuss progress against the goals outlined in the client’s Program of Support or request an assessment, to make sure that the client:

• has access to the right services and support
• is moving towards getting their life back on track and achieving their goals.

All providers

Community group programs (CGP) provide coordinated activities whilst delivering support to a person within a group recreational, leisure, peer support or common interest community setting on a regular basis.  The program:

• is typically run for 6 months, then reviewed
• is designed for people with a disability who require shared support to engage in community based activities outside of the home
• is flexible and responsive to a person’s support needs, goals and interests
• facilitates a person’s transition to mainstream community based leisure, recreational, peer support or common interest activities
• provides support to a person with a disability in a manner that respects their privacy and dignity
• enhances a person’s quality of life by building community and authentic peer connections
• covers a range of programs and activities in the area of skill acquisition, recreation and leisure
• is provided within community based facilities at community based locations to support the development of community living, and social skills and peer support networks; and
• offers respite to family members who provide large amounts of gratuitous care.

Involvement in a CGP is appropriate for clients who are likely to have a long-term need for support to participate in community based social and leisure activities and are amenable to sharing support in a small group situation. CGP sizes usually range from 1 - 5 people.

Conditions

Community Group Program (CGP) can only be delivered by a provider authorised and approved by the TAC. These services must be approved by the TAC in writing prior to provision.

CGP providers will be expected to complete a Program of Support in consultation with the client to outline proposed service delivery that includes client goals and ratio of support.

The TAC can pay for services in line with the  published fees schedule. If an item is not on the fees schedule, it cannot be paid for.

There is a limit to how much the TAC will pay to a community group program provider. If a service costs more than the TAC rate, the client may need to pay the difference.

Authorisation

All Community Group Program providers must meet and maintain the TAC’s disability provider registration requirements in order to deliver services to a client with disability. The requirements outlined in the policy and provider guidelines for each service type must be adhered to as part of TAC’s provider registration requirements.

Safeguarding

TAC Safer Services provides TAC clients and the community a pathway to raise concerns or complaints about the quality and safety of TAC funded services.

The TAC uses the following principles to aid socially and economically responsible decision-making in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to Community Group Programs if:

• The TAC client has a disability
• The TAC has accepted liability for the accident-related injury and the client requires shared support to achieve maximum participation in community based recreational, leisure, peer support or common interest activities.

2. Reasonable

When determining if Community Group Program services are reasonable, the TAC considers whether the cost of the service is reasonable in relation to the Community Group Program Fee Schedule

When determining whether the Community Group Program is a reasonable cost in the circumstances, the TAC considers:

• if the Community Group Program service is necessary because:
  • the clients transport accident goal has identified shared support to engage in community-based activities outside of the home

3. Clinically Justified

When deciding if Community Group Programs is clinically justified, the TAC considers whether:

• Community Group Programs is clinically appropriate for the client’s transport accident injuries and presentation
• the treatment complies with the principles of the Clinical Framework
  • treatment should result in a measurable benefit to the injured person
  • the treatment adopts a biopsychosocial approach
  • the treatment empowers the client to self-manage their injury
  • the treater implements goals focused on optimising function, participation and return to work/health
  • the treatment is based on the best available research evidence.
• Treatment should be discontinued, and the client discharged when:
  • There is no measurable benefit from continued treatment
• the duration and frequency of treatment is appropriate in relation to the client’s condition and their recovery progress. These factors are assessed on a case-by-case basis. Treatment sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.

4. Outcome Focused

When deciding if Community Group Programs is outcome focused, the TAC considers whether the service is progressing toward or achieving individualised recovery or care outcomes relating to approved transport accident injury goals.

For more information on TAC decision making, see the ‘How we make decisions’ page.

For clients

• TAC Website Overview of Community Group Programs

For providers

• TAC Website How to invoice the TAC under Invoice requirements
• Community Group Program Fee Schedule