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.

Occupational Therapy Services

Effective 1 July 2017

Registered for GST Not Registered for GST
Service Description TAC Item Number 2017/18 Maximum Payment Rate 2016/17 Maximum Payment Rate TAC Item Number 2017/18 Maximum Payment Rate 2016/17 Maximum Payment Rate
Occupational Therapy Treatment
Individual Treatment       
Initial Consultation OT0005 $58.15 $57.30    
Standard Consultation: 
     Up to 30 minutes
OT0006 $46.53 $45.85    
Long Consultation:
     > 30 minutes - 45 minutes
OT0007 $69.54 $68.53    
Prolonged Consultation:
     > 45 minutes - 60 minutes
OT0008 $92.93 $91.57    
Occupational Therapy Service Plan
OTSP (flat rate) OT0050* $76.62 $75.50    
Group Treatment
Group Consultation (per person) OT0001 $27.99 $27.58    
Travel (with prior approval): Travel time from practitioner's prior consultation to the client's residence and from the client's residence to the practitioner's next appointment OT0010 $92.93 $91.57    
Other Occupational Therapy Services
Home Inspection, Education, Equipment Prescription Note:  An initial home inspection may include both evaluation of the home for modifications and assessment of service requirements.
Undertake inspection, education and complete report (per hour) OT0020* $102.11 $100.62 OTGF20 $92.82 $91.47
Co-ordinate modifications and organise equipment (per hour) OT0021* $102.11 $100.62 OTGF21 $92.82 $91.47
Travel time from previous appointment to claimant's residence and from claimant's residence to next appointment (per hour) OT0022* $102.11 $100.62 OTGF22 $92.82 $91.47
Driving Assessment. Funding request must specify the amount of time allocated for each of the different driving assessment components including the on-road assessment, off-road assessment and report writing (per hour) OT0030* $102.11 $100.62 OTGF30 $92.82 $91.47
Home Services Needs Assessment (Home Help, Domestic Services, Attendant Care)
Undertake review of services and complete report (per hour) OT0040* $102.11 $100.62 OTGF40 $92.82 $91.47
Travel time from the practitioner's prior consultation to the claimant's residence and from the claimant's residence to the practitioner's next appointment (per hour) OT0041* $102.11 $100.62 OTGF41 $92.82 $91.47
Functional Independence Review
FIR Report (flat rate) OT0100* $255.10 $251.38 OTG100 $231.92 $228.54
FIR Assessment/Liaison (per hour)  OT0105* $102.11 $100.62 OTG105 $92.82 $91.47
FIR Travel (per hour) OT0110* $102.11 $100.62 OTG110 $92.82 $91.47
Single Discipline Vocational Services
Worksite Assessment/Job Analysis VOC005* $102.11 $100.62    
An assessment and report evaluating the suitability of the worksite and job specifications for a claimant (per hour).
A full report will contain an analysis of the worksite and recommendations regarding critical work demands; the ability of the claimant to perform particular duties; suitable alternative duties; modifications to the workplace and other relevant issues.
This may include recommendations for the grading of hours and duties and other requirements for the establishment of a TAC return to work program. Time allocated is to include liaison with all relevant parties.
Post Placement Support VOC010* $102.11 $100.62    
This service involves the monitoring of a TAC return-to-work program to ensure progress is occurring and, in consultation with the TAC Rehabilitation Officer, address any problems which arise (per hour).
The service is an adjunct to the establishment of a TAC return-to-work program which may form part of the Worksite Assessment and could apply to claimants returning to their pre-accident employment or commencement in new employment.
Travel  VOC015* $102.11 $100.62    
Travel time from practitioners prior appointment to the relevant location (place of employment, residence, etc) and from this location to the practitioner's next appointment (per hour).
Note:  Single Discipline Vocational Services are only payable when undertaken by an appropriately qualified practitioner as follows:
>  Worksite Assessment/Job Analysis
    -  Ergonomist, Occupational Therapist
>  Post Placement Support
    -  Occupational Therapist, Rehabilitation Counsellor, Vocational Counsellor, Ergonomist

For information about our invoicing requirements, please see How to invoice the TAC.

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.


View Certificate of Capacity form

Certificate of Capacity form

Summary:

The Certificate of Capacity form is for authorised providers to provide information about their TAC patient's transport accident conditions and to assess and certify their capacity for work as a result of these injuries.

IMPORTANT NOTICE:
It is an offence under the legislation to provide false or misleading information. A person who provides a false or misleading certificate of capacity could be liable to prosecution.

Please provide feedback about the Certificate of Capacity to medicalcertificatefeedback@tac.vic.gov.au

View Occupational Therapy services plan (for Provider use only)

Occupational Therapy services plan (for Provider use only)

Summary:

This form is to be completed by occupational therapists to gain approval from the TAC to fund treatment of patients who have been injured in transport accidents. Approval needs to be obtained from the TAC prior to services being provided. The service plan also needs to be discussed with the client before he/she signs it.

View Occupational Therapy: Functional Independence Review form (for Provider use only)

Occupational Therapy: Functional Independence Review form (for Provider use only)

Summary:

Our attendant care providers support clients to achieve their independence goals in daily living activities, therapy support, personal and domestic skills retraining and community access skills.

View Occupational Therapy: Home services needs assessment report form (for Provider use only)

Occupational Therapy: Home services needs assessment report form (for Provider use only)

Summary:

This form is to be completed by occupational therapists assessing the functional capacity and needs of clients seeking TAC-funded homes services because they're unable to perform their usual household responsibilities due to their accident injuries.

View Occupational Therapy: Home services needs assessment referral form (for Provider use only)

Occupational Therapy: Home services needs assessment referral form (for Provider use only)

Summary:

This form is to be used when requesting an assessment by an occupational therapist regarding the home services support needs of TAC clients who are unable to perform their usual duties around the household due to their accident injuries.

View Occupational Therapy: Home services needs review report form (for Provider use only)

Occupational Therapy: Home services needs review report form (for Provider use only)

Summary:

This form is to be completed by occupational therapists reviewing the functional capacity and needs of clients currently receiving TAC-funded homes services and evaluating their progress towards independence. The assessment also takes into account feedback form the client's General Practitioner and other relevant treaters.

View Occupational Therapy: Supported Accommodation Functional Independence Review form (for Provider use only)

Occupational Therapy: Supported Accommodation Functional Independence Review form (for Provider use only)

Summary:

This form is to be completed by occupational therapists when requested by the TAC to review the functional capacity (i.e. physical, cognitive and emotional functions as well as communication skills) of clients living in supported accommodation and evaluating their progress towards increased independence.

View Functional Independence Assessment: Accommodation and Allied Health Service Recommended form (for Provider use only)

Functional Independence Assessment: Accommodation and Allied Health Service Recommended form (for Provider use only)

Summary:

This form is to be completed by the TAC'client's occupational therapist in consultation with other treating therapists and their Early Support Coordinator in preparation for leaving hospital. To ensure the client makes a smooth transition from hospital to the community, the assessment considers the most suitable accommodation as well as the allied health/therapy services they will need. The separate 'notes' document in this section provides additional instructions and clarification to help complete the form.

View Functional Independence Assessment: Attendant Care and Allied Health Service Recommendations form (for Provider use only)

Functional Independence Assessment: Attendant Care and Allied Health Service Recommendations form (for Provider use only)

Summary:

This form is to be completed by the TAC client's occupational therapist in consultation with other treating therapists and their Early Support Coordinator in preparation for leaving hospital. To ensure the client makes a smooth transition from hospital to the community, the assessment considers the attendant care and allied health/therapy services they will need. The separate 'notes' document in this section provides additional instructions and clarification to help complete the form.

View Home modifications assessment form (for Provider use only)

Home modifications assessment form (for Provider use only)

Summary:

This comprehensive form is for completion by occupational therapists (OTs) providing assessment services for clients who are applying for TAC-funded home modifications to ensure safety and accessibility.

Please note, there are seperate forms for Hospital based OTs and for Community based OTs.

View Australian Holiday Support Request form (for Provider use only)

Australian Holiday Support Request form (for Provider use only)

Summary:

Our attendant care providers support clients to achieve their independence goals in daily living activities, therapy support, personal and domestic skills retraining and community access skills.

View Overseas Attendant Care Request form (for Provider use only)

Overseas Attendant Care Request form (for Provider use only)

Summary:

Our attendant care providers support clients to achieve their independence goals in daily living activities, therapy support, personal and domestic skills retraining and community access skills.

View Transport needs assessment form (for Provider use only)

Transport needs assessment form (for Provider use only)

Summary:

This form is used to assess the transport needs of TAC clients as a result of their accident injuries. It considers the client's transport requirements in relation to travelling to work, school, treatment/rehabilitation, recreational activities and day-to-day tasks (e.g. shopping, banking) as well as providing recommendations for how the TAC can assist.

View Independence Plan - Information for providers

Independence Plan - Information for providers

Summary:

Our attendant care providers support clients to achieve their independence goals in daily living activities, therapy support, personal and domestic skills retraining and community access skills.

The Transport Accident Commission pursuant to section 23 (1)(aaa) of the Transport Accident Act 1986 hereby authorises the services described in this Schedule to be attendances, examinations or treatments by a registered occupational therapist for the purposes of the Act.

Authorised Services

Occupational therapy (OT) services refers to clinical assessment and treatment services provided by an occupational therapist to assist an individual to maximise his/her independence in activities of daily living and productive activities including paid work, study, volunteering and childhood play.

OT Services require prior approval in writing before the services can be provided.

Authorised OT services include:

  • prescribing exercises to maximise a TAC client's function and promote the recovery of or rehabilitation from his/her injury
  • prescribing adaptive and/or alternative techniques to make it easier for a TAC client to perform activities, e.g. breaking strenuous tasks into smaller more manageable tasks
  • prescribing equipment that will facilitate and/or maximise a TAC client's independence and participation, e.g. installing a rail in a bathroom
  • conducting assessments to assist in establishing what support services that a TAC client may require as a result of his/her injury/illness, e.g. attendant care, and
  • to complete and issue Certificates of Capacity for TAC clients.

OT Services must be provided by occupational therapists who are registered with the Occupational Therapy Board of Australia.