Chiropractic

Policy

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

The TAC will periodically review a client's entitlement to chiropractic 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 about the Clinical Framework can be found at www.tac.vic.gov.au

Guidelines

What can the TAC pay for in relation to chiropractic services?

The TAC can pay the reasonable costs of chiropractic services:

• required as a result of the transport accident injury
• that are clinically justified, safe and effective
• that have a clear rehabilitative purpose and are not for non-transport accident injury rehabilitative purposes
• that are likely to achieve or maintain a measurable functional improvement
• that promote progress towards functional independence, participation and self-management.

The TAC will not pay for more than one initial consultation by the same provider or clinic unless there are exceptional circumstances, for example following a hospital admission or surgery, or where a significant period of time has elapsed since the client last received chiropractic treatment. 

Supervised exercise programs

The TAC can pay the reasonable costs of supervised exercise programs provided by a chiropractor. For unsupervised exercise programs, please refer to the Gym and Swimming Programs policy.

Out of rooms consultations

The TAC can pay the reasonable costs for out of rooms consultations to provide home visits to a client where a request has been made by a medical practitioner which states that the client is medically unfit to travel. Refer to the Chiropractic Fee Schedule.

Radiological services

Radiological investigations undertaken by chiropractors can only be paid by the TAC when performed by an appropriately licensed practitioner who will be paid in accordance with the Chiropractic Fee Schedule.

Who can provide chiropractic services?

Services can be provided by a chiropractor who is registered under the Health Practitioner Regulation National Law to practice in the chiropractic profession (other than as a student).

What information does the TAC need?

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

For all other clients the TAC does not require any information from a chiropractor before commencement of initial treatment for a client's transport accident injury. After initial treatment has commenced, the chiropractor will be required to submit information to the TAC where the chiropractor expects to provide more than five session of treatment. This also applies to clients who have previously:

• been treated at another chiropractic clinic, or 
• received chiropractic treatment and it is more than 12 months since the last treatment session.

In these circumstances, the chiropractor must submit information to the TAC about the:

• client's transport accident injury and clinical diagnosis
• client's reported symptoms and findings from physical assessment
• current objective and measurable functional limitations and goals of treatment with expected time frame for achievement
• proposed treatment plan including commencement and anticipated end dates
• functional outcome measures to be used including baseline measures - these measures need to be recorded regularly but only require submission to the TAC on request
• previous chiropractic treatment (if any) received by the client prior to the transport accident, including details of the condition treated, when it was treated and for what period of time.

For all clients the TAC may contact the client or chiropractor for further information, if required. In some circumstances a Chiropractic Treatment Questionnaire may be requested by the TAC. Chiropractors should not submit a TAC Chiropractic Treatment Questionnaire or written reports unless specifically requested by the TAC.

In relation to chiropractic services, what will the TAC not pay for?

The TAC will not pay for:

• treatment or services that are not in line with the Clinical Framework
• concurrent treatment by chiropractors, physiotherapists, osteopaths and acupuncturists
• treatment or services of the same type provided more than once on the same day to the same client
• pharmacy items such as creams and gels supplied by health professionals – see the Pharmacy (Chemist Medications) policy
• treatment or services for a person other than the client
• 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
• 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 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.