In this policy:

• Community nurses are health professionals who come to your home after your accident. They provide general nursing care and will help with things like catheter changes, changing dressings, and wound management.
• 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.

Under the Transport Accident Act 1986 (the Act) the TAC can pay for the reasonable cost of a range of specified types of services. This includes community nursing services that enable the client to participate in their rehabilitation and recovery (including disputes, common law claims and impairment). These services must be performed and received in Australia, meaning the client and the provider must be in Australia to be eligible.

Community nursing services are considered by the TAC as a medical expense to facilitate rehabilitation and recovery in circumstances where it is needed.

Section 60 of the Act allow the TAC to pay for these community nursing services.

For accidents that occurred prior to 14 February 2018 a Medical Excess may apply.

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 hospital treatment policy.

Refer to the attendant care policy for periods of time when active nursing tasks are not required, such as when attendant care services would be able to provide the required care.

Community nurses come to a client’s home and provide nursing services needed because of transport accident injuries. This includes care after a hospital stay, general nursing care and wound management. To access community nursing services, TAC clients should:

• Talk to their doctor, occupational therapist or physical therapist to recommend a nursing service.
• Call the nursing service and make an appointment, telling the provider they are a TAC client.
• Give the community nurse their TAC claim number at the first visit.

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.

The TAC can help pay for:

• Nursing consultations in the client’s home.
• Specialist training to others involved in the client’s care, such as attendant care workers.
• Nursing from a Bush Nursing Hospital to attend the scene of an accident while waiting for an ambulance to arrive.
• Travel to conduct specialist nurse assessments or training. Travel time can be paid for travel to and from a provider’s practice address and the client’s residence. Where more than one client is visited in a single travel period, total travel costs should be apportioned equally between clients.

The TAC will pay for treatment and services according to the fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

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 and travel associated with the nursing episode.

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

• 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 long-term nursing program based on the frequency, duration and type of nursing tasks identified in the independent nursing assessment. Factors may include:

• The time of day that a client requires nursing care.
• The type of nursing tasks the client needs.

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.

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 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 the TAC has provided prior written approval. Travel is billed separately and 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 and assist at the scene of a transport accident 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.

The TAC cannot pay for:

• Treatment or services for a person other than the client.
• Specialist training intended to replace standard staff training provided by attendant care agencies.
• Long-term nursing during periods of time when active nursing tasks are not required, such as 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.
• The cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals.

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.

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 a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical Justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions maybe more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome Focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

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

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.

The TAC may contact the client or their provider to check client progress and see if the client is getting the support they need. This will help the TAC make sure treatment helps client recovery. It will allow the TAC to make decisions about what treatment can be paid for and how long the TAC can pay for it.

Community Nursing services can support TAC clients with services that fulfil the following conditions:

• Are required as a direct result of a transport accident injury (not for a pre-existing condition).
• Are safe and effective.
• Promote recovery, functional independence, or self-management.
• Are reasonable.
• Comply with all responsibilities relating to your profession or service.
• Comply with all relevant legislative requirements, including the Transport Accident Act 1986, the Health Records Act 2001, the Disability Act 2006, the Income Tax Assessment Act 1997 and the Charter of Human Rights and Responsibilities 2006.

To provide TAC-funded community nursing services, a practitioner must:

• Be registered to practice as a nurse under the Health Practitioner Regulation National Law (AHPRA) with the Nursing and Midwifery Board of Australia (other than as a midwife or student).
• Comply with the TAC Community Nursing Services policy.
• Adhere to the principles of the Clinical Framework for the Delivery of Health Services.

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.

Before providing service, a provider can confirm that the client has an accepted TAC claim by either:

• Asking them to share their TAC claim number (found on their claim acceptance letter or the myTAC app).
• Calling the TAC so the claim can be confirmed.

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

Community nursing services can be billed through HiCAPS Digital Claims which is TAC’s online payment portal. For more information, please refer to Essentials for TAC providers.

Conditions

If a provider intends to continue treating a TAC client beyond 90 days after the client’s transport accident, the provider will need to send the TAC a request in writing or a copy of the client’s treatment plan. The TAC will review the client’s treatment to ensure it’s reasonable, clinically justified, outcome focused and in line with the Clinical Framework. The TAC will assess the request and let the provider and client know the decision about what the TAC can help pay for and for how long.

If the client has not received treatment in 6 months, they will need to seek approval from the TAC before the TAC will pay for further treatment. Providers should ask the client for a copy of their approval if the provider hasn’t seen the client in 6 months.

Authorisation

If a TAC client has a severe injury, their TAC support coordinator will work with the client and their treating team to understand client care needs. This may include:

• Long-term nursing.
• Specialist nursing assessment and reports to review the management of a client’s condition.
• Reviewing management of nursing tasks such as bladder and bowel management.
• Pressure care and wound management.

If a TAC client already has an individualised funding package, nursing services may be included as part of that.

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 or complex care.

The TAC expects community nurses to integrate the following principles of the Clinical Framework for the Delivery of Health Services (Clinical Framework) in their daily practice:

This includes:

• Measuring and demonstrating the effectiveness of services.
• Adopting of a biopsychosocial approach.
• Empowering the client to manage their injury.
• Implementing goals focused on optimising function, participation and/or return to work/health.
• Basing services on best available research evidence.

Professional standards should be followed according to requirements of the Nursing and Midwifery Board of Australia.

Providers are expected to deliver services in line with the TAC’s policy on Funding Treatment by a Member of the Client's Immediate Family.

The TAC provides TAC clients and the community with a pathway to raise concerns or complaints about the quality and safety of TAC funded services. Refer to Concerns and complaints - TAC - Transport Accident Commission

• Working with the TAC
• Nursing Services Fee Schedule
• Healthcare and support at home - Better Health Channel
• Community nursing - Health Direct