Implantable Therapy for Neurological Disorders (ITND)

Requests for specific surgical procedures. This needs to be read in conjunction with the Surgery Requests Elective policy.

POLICY

The TAC can fund the reasonable cost of implantable therapy for neurological disorders (ITND) for injuries sustained in a transport accident.

Transport Accident Act 1986 reference: s.3 'medical service' and s.60

DEFINITION

In this policy, implantable therapies for neurological disorders includes, but is not limited to:

• Intrathecal Baclofen Infusion: Baclofen (or Lioresal) is an antispasmodic medication which is delivered into the intrathecal space (the area surrounding the spinal cord) by way of a surgically implanted pump.
• Deep Brain Stimulation (DBS): Electrodes in this technique are placed deeply into the brain to decrease the involuntary movements, spasticity and/or tremors the client experiences. It works to interrupt the abnormal electrical circuit within the brain that is causing the abnormal movements by delivering fast electrical stimulation (130 times per second) to specific target sites.

BACKGROUND

Neurological injury can lead to severe limb spasticity, rigidity, involuntary movements and tremors. Most patients can be managed with physical therapy, oral medication and/or local injections, however sometimes the treatment is intolerable or ineffective. In such cases an implant may be considered by the treating doctors.

Implantable therapies for neurological disorders are techniques that aim to reduce the effects of a client’s involuntary movements, spasticity and/or tremors. ITND procedures do not aim to cure a disorder but may improve movement and mobility, increase participation in activities of daily living (ADLs), increase participation in work, decrease medication use and other healthcare costs.

The TAC recognises that as a consequence of injuries sustained in a transport accident some clients may experience or develop neurological disorders.

GUIDELINES

Who is eligible to receive implantable therapies for neurological disorders?

Clients who have sustained transport accident injuries causing neurological sequelae may be eligible for implantable therapies where conservative measures have not been successful and alternative options have been fully explored.

The TAC strongly encourages prior approval to be sought prior to the treatment being provided. This allows the TAC to determine whether the treatment is related to the transport accident, is a reasonable treatment option and is the most appropriate service for the client. It will also facilitate prompt payment of accounts for accident-related treatment.

Who is not eligible to receive implantable therapies for neurological disorders?

Clients who have not trialled other, more conservative measures may not be eligible for implantable therapies. Such alternatives will need to be evaluated before a client can be considered for an implantable therapy.

Clients who have had neurological symptoms for less than 6 months may not be eligible due to the potential for improvement with time.

Other pre-existing or unrelated conditions may also render a person unsuitable for ITND, and advice regarding such conditions and ITND is best discussed with a medical practitioner.

In relation to implantable therapies for neurological disorders, what will the TAC consider funding?

The TAC can fund:

• the reasonable cost of an assessment for suitability for an ITND procedure
• the cost associated with an independent review prior to the procedure being performed if necessary
• the reasonable cost of an ITND procedure where clinically justified by the treating doctor and/or the independent examiner
• the reasonable cost of internal and external devices associated with the procedure
• only one ITND for a client unless a subsequent procedure is required for technical purposes, e.g. battery replacement.

The rates payable for such items are listed in the Prostheses List, as published by the Commonwealth Department of Health and Aged Care.

The TAC will pay the reasonable costs of hospitalisation and associated medical services in relation to the surgical implantation of the device. The current Medical Benefits Schedule (MBS) item numbers pertaining to these procedures range through:

Deep Brain Stimulation: 40850 - 40862.
Intrathecal Baclofen Infusion: 39125 – 39129

The TAC strongly encourages prior approval to be sought prior to the treatment being provided to allow the TAC to determine whether the treatment is related to the transport accident, is a reasonable treatment option and is the most appropriate service for the client. See also "What information does the TAC require to consider funding implantable therapies for neurological disorders?"

Who can provide implantable therapies for neurological disorders?

Implantable therapies for neurological disorders can be provided by specialist medical physicians who have developed expertise in the area of implantable therapy for neurological disorders.

What information does the TAC require to consider funding implantable therapies for neurological disorders?

Following completion of an assessment, the requesting medical physician must submit information that addresses the following points:

1. The condition(s) being treated.
2. How the condition/s relate to the transport accident injuries.
3. The procedural item numbers and the prosthesis item numbers to be used.
4. The effect the ITND will have on all the client’s conditions.
5. Information about previous treatments/surgery that have been tried. The use of other medications/treatments/surgery and the impact of these. Other treatment that will be considered if the ITND fails.
6. Comment on psychological preparedness for ITND of the client (and their carer if applicable). Whether there are any psychological risk factors that may negatively impact on the success of ITND. If a Psychologist or Psychiatrist is involved.
7. The expected outcomes at 3 months following ITND insertion, in particular, the functional gains (ADLs, work) expected.
8. The outcome measures that will be used to determine success post-ITND insertion.
9. The proposed treatment plan following ITND insertion. The modality of therapy this will include, if any.
10. Who will do the implant and evidence of their expertise.
11. Who will provide the long-term care, including refills (if applicable) and re-programming.

If a treating Psychologist or Psychiatrist is involved, the following information is also required:

The treating provider must submit information that addresses the following points:

1. The condition/s being treated by the Mental Health Practitioner.
2. How the condition/s relate to the transport accident injuries.
3. Qualification for implantable therapies, i.e. if there is an overt psychiatric condition, substance abuse disorder or incompatible psychological disorder that may exclude them.
4. Please outline the client’s (and, if applicable, his/her carer’s) expectations of implantable therapy with regard to reduction in symptoms and increased abilities.
5. Whether there is a demonstrated understanding from the client (and his/her carer if applicable) of the procedure, the commitment required post-implant and whether compliance is likely.
6. The likely impact of ITND if successful on mood, medications and function (ADLS, work).
7. The likely impact of ITND if unsuccessful (no improvement or worse) on mood, medications and function.
8. The proposed treatment plan post-implant.

Can the TAC fund surgically implanted prostheses?

Refer to the Surgically Implanted Prostheses policy.

In relation to implantable therapies for neurological disorders, what will the TAC not fund?

The TAC will not fund:

• treatment or services for a person other than the injured client
• any trial without written approval
• treatment or services by a practitioner without evidence of expertise in the procedure
• ITND procedures where more conservative measures have not been trialled or alternative options have not been fully considered
• treatment or services for a condition sustained before a transport accident or that is not a direct result of a transport accident
• treatment or services where there is no objective evidence that a treatment or service is safe and effective
• treatment or services where there is no clinical justification for this service
• the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
• fees associated with non-attendance
• treatment or services subcontracted to a non-registered provider
• treatment or services received by the injured person outside the Commonwealth of Australia
• 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.

Where the TAC does not agree to fund an ITND procedure for a client, the TAC will notify both the client and the referrer of this decision in writing.