Rehabilitation at home service standards

These Service Standards provide information on what is expected of a TAC Rehabilitation at Home (RAH) provider in the provision of RAH services under Section 23 of the Transport Accident Act 1986 (Vic) (TAA 1986). The Service Standards are to be read in conjunction with the Rehabilitation at home provider guidelines. Compliance with the Service Standards is required to meet and maintain provider registration requirements.

1. TAC Clinical Framework

The provider agrees to provide the services in accordance with the 5 principles outlined in the Clinical Framework for the Delivery of Health Services as published by the TAC. By following the Clinical Framework, health professionals can ensure the treatment our clients receive is goal-orientated, evidence-based and clinically justified.

2. Referral to RAH services

The provider agrees to provide the RAH services to TAC clients who are:

  • Referred by the client’s treating medical team and discharged from either acute and/or an in-patient rehabilitation hospital facility

It is the responsibility of the hospital to assess the client’s needs for discharge, ensuring they are safe to go home. Where RAH is identified as an appropriate and safe discharge option, any equipment and supports for the client’s safe transition home should be provided by the hospital in the first 30 days post discharge. The discharging hospital will refer the client to the RAH provider where possible with a discharge plan outlining the client’s rehabilitation goals and clinical needs, ensuring the RAH provider has accepted the referral before discharging the client.

3. Service inclusion

The RAH provider must be able to provide all of the following services:

  • RAH coordination
  • Occupational therapy
  • Physiotherapy
  • Nursing
  • Rehabilitation physician
  • Social work

The Rehabilitation at home provider guidelines outline the full-service description for each of the services.

4. Client suitability for RAH services

RAH is a multi-disciplinary inpatient rehabilitation substitute model of service for the provision of rehabilitation treatment services. Clients will largely access the service as a discharge option from acute hospital care and as a rehabilitation treatment option following elective surgery.

The Rehabilitation at home provider guidelines outline the inclusion and exclusion criteria and those clients best suited to RAH services.

5. RAH Service Requirements

The provider will provide the services in accordance with the following RAH Service Requirements:

a) Approval

If RAH services begin within the first 90 days of a client’s accident we can pay for the services:

  • without the need to contact us for approval first, and
  • up to a maximum duration of 8 weeks or a fee cap of $3,000, whichever is reached first

The services must be recommended by a health professional or hospital treatment team, related to the client’s accident injuries and delivered in line with the RAH Service Standards. The provider must complete these forms:

If a client needs RAH services to begin 90 days after the date of the client’s accident, we can consider an RAH program. The following steps will apply:

  • If you receive a referral from a health professional or hospital treatment team, you must send us a written request which is to include the initial referral from the discharging hospital for approval.
  • After submitting a written request, please contact the TAC Claims Manager to discuss timeframes on approval.
  • We will review and assess the request to ensure it is reasonable, clinically justified, outcome focused and in line with the RAH Service Standards.
  • We will let you and the client know our decision about what we can or can’t pay for.

RAH services are authorised under Section 23 of the Transport Accident Act 1986.

b) Initial timeframes

The provider must agree and comply with the initial timeframes to accept/reject the referral for RAH services within 24 business hours and must make phone or in-person contact with the TAC client within 48 business hours of accepting the referral from the discharging hospital.

c) Documentation

The RAH provider must provide the TAC with the following documentation and share these documents with the client’s general practitioner and any other relevant clinicians. These reports will be provided and billed under the Rehabilitation Coordination fee.

d) Service outcomes

The RAH initial assessment form should be completed in full including rehabilitation goals and all outcome measure scores. The TAC will monitor application of goals and outcome measures for benchmarking and evaluation. At discharge, the RAH provider will again report on clinical performance measures, to demonstrate improvement in the client’s function and health status.

It is also expected that the provider completes the RAH provider dashboard and submits this to the TAC on a monthly basis.

The TAC will also collect and report on client experience / client satisfaction measures and provide an analysis on all data provided to the RAH provider on a bi-annual basis.

e) Service extension

The RAH treatment program will have a maximum pre-approved duration of 8 weeks and fee cap of $3,000, whichever is reached first. It is the expectation of the provider to track the $3,000 spend and, if approaching the limit, to submit a service extension request. In some cases, the RAH provider may request a program duration extension and/or an increase to the funding fee cap. The provider should complete a RAH extension request form and send it to the TAC as early as possible to avoid delays in approvals and any risk to continuity of service.

To ensure RAH services are not disrupted, and extension approvals are timely, the provider should also call the TAC Claims Manager to inform them of their submission of the extension request and to discuss the requirements.

The TAC Claims Manager will assess client progress in the program and the request for additional services. The TAC Claims Manager will consider the extension request in the context of client entitlement, reasonable provision of the service, clinical justification and the outcome focus of further treatment. The benefit of  the RAH program over community-based programs must be clearly articulated.

f) Service design

The RAH program must be an integrated multidisciplinary approach, and transition to community treatment programs must be completed and documented in a timely manner. The TAC will only consider the provision of a single-discipline RAH service in exceptional circumstances where the client is unable to access the community and the home-based therapy is clinically justified. The Rehabilitation Coordination fee would not be chargeable where the client receives single-discipline service.

If the client only requires minimal input from a RAH program, then discharge to community providers should be considered at the outset.

6. Provider treatment team qualifications

The treatment team must be multidisciplinary and comprised of clinicians who can assess and manage clients with physical and functional rehabilitation needs. The Rehabilitation at home provider guidelines outline who can provide RAH services.

The provider must be registered with the TAC and deliver services consistent with these TAC RAH Service Standards, the RAH Provider Guidelines and the requirements and conditions as outlined in the RAH Registration Form.

7. RAH service expectations

RAH services must be provided:

  • In consultation and collaboration with other medical and health practitioners and community and vocational service providers involved in the management and treatment of the client. The approach should form part of an integrated model of care where client outcomes drive the delivery of services.
  • With all due skill, diligence and care that would reasonably be expected from a prudent and experienced provider of services which are similar to the RAH services.
  • In a manner that ensures all deliverables, milestones, Key Performance Indicators and reports are completed and delivered within the timeframes outlined in these Service Standards.
  • In a manner consistent with the provisions of the Transport Accident Act 1986, which determines what the TAC is and is not required to pay as compensation due to TAC clients.
  • Without bias or prejudice, including by ensuring that TAC clients are not treated in any manner which disadvantages them because of their origins, background, sex, physical, mental or intellectual impairment or in any manner that contravenes the Equal Opportunity Act 2010 (Vic), the Charter or other anti-discrimination legislation.
  • In accordance with all applicable laws.
  • In accordance with reasonable directions and instructions provided by the TAC from time to time.

8. Performance management

8.1 Requirements

  • The provider acknowledges that its performance is measured by the TAC quarterly in accordance with the service requirements, expectations and Key Performance Indicators as set out in these Service Standards.
  • The provider agrees it must ensure the continuous improvement of the quality of the RAH services it provides by participating in appropriate quality improvement activities in response to any performance recommendations made by the TAC about the quality of the services it is providing.
  • The provider agrees it will work collaboratively and come together as a 'community of practice' with other providers if required, to engage and assist in evolving and continuously improving the RAH model of operation.
  • The provider must collect and report on client outcomes / Key Performance Indicators on a quarterly basis as outlined below.

8.2 Failure to meet Key Performance Indicators

If the TAC considers that the provider is not performing the RAH services for TAC clients to the standards required under these Service Standards when measured under paragraph 8.1 above, then:

  • The TAC will in writing confirm this with the provider contact manager named in the Registration Form, setting out the reasons why the TAC has concluded this.
  • The provider will provide any requested documentation reasonably required by the TAC and, within the next 10 working days the provider must meet with the TAC to discuss the provider’s performance of the RAH services.
  • After the meeting with the TAC, the provider in ongoing consultation with the TAC must implement any solutions or strategies as reasonably directed by the TAC which are intended for improving the provider’s performance of the RAH services and outcomes. The provider will also use its best endeavours to improve its performance of the RAH services to achieve the standards required under these Service Standards; and
  • If after one month the TAC still reasonably considers that the provider is not performing the RAH services to the standard required under these Service Standards, the TAC may under paragraph 1.13(a)(if) of Part 7 of the Registration Form at any time either immediately discontinue the provision of RAH services by the provider to TAC clients by withdrawing the provider’s registration, or may suspend the provider from providing RAH services to TAC clients (for any period) by suspending the provider’s registration and the TAC may proceed as permitted under paragraph 1.13 accordingly.

9. Complaints and critical incidents

The provider must have in place a critical incidents and complaints management policy (or similar) which complies with the Australian Safety and Quality Framework for Healthcare and the Australian Council of Healthcare Standards (ACHS) accreditation requirements. See the Australian Commission on Safety and Quality in Health Care website.

The Victorian Health Complaints Commissioner provides guidance and a best practice approach to complaints handling standards.

The TAC takes a zero-tolerance approach to the abuse, neglect and exploitation of TAC clients and will treat all allegations seriously. Rehabilitation services conducted in the home should be delivered in a way that makes the client feel safe and respected. Refer to the TAC Your Care webpage.

10.  Service discontinuance or suspension

The TAC will promptly on or after the discontinuance or suspension of the provision of RAH services to TAC clients by the provider, notify the RAH Provider of the discontinuance or suspension (and any period of suspension) and the grounds for the discontinuance or suspension in accordance with the Registration Form.

11. RAH Key Performance Indicators

KPI: Clients achieve optimal health outcomes

ObjectiveTargetDescriptionData source
RAH program is client centred and rehab goal focused.All RAH initial assessment forms have rehab goals and specific outcomes/measurements that are related to the client’s function and activities they wish to achieve.80% of rehab goals were achieved by client population. Treatment plans from RAH initial assessment form.
Client's health status is measured and patient reported outcome measures (PROMS) and clinician reported performance measures both demonstrate improvement in health status.Overall health and treatment is measured through standard patient and clinician reported outcomes.Clinically significantly improvement from start to end of program.PCAM and EQ-5D-5L captured at commencement and discharge.
Appropriate clinical management prevents avoidable hospital admissions.Hospital re-admissions within 30 days of referral acceptance are minimised.Annual rate <2.5% admission rate. Case by Case discussion of re-admission as required.RAH discharge form.
Client is successfully discharged from home-based rehabilitation.RAH program concludes with discharge from services within appropriate timeframes and safely to community services.>95% clients are discharged from RAH into community services or from therapy entirely.RAH discharge form.

KPI: Clients are satisfied with the service

ObjectiveTargetDescriptionData source
Clients receive a high-quality service and are satisfied with their experience.Client survey reflects a positive experience and being satisfied with the overall quality and responsiveness of the service.85% of clients are satisfied with the service they received.TAC patient reported experience measure survey.

KPI: Clients receive timely services

ObjectiveTargetDescriptionData source
Client receives early and appropriate intervention that allows a seamless transition from hospital to home.Timeframe measures outlined within the service standards are meet by providers.
  • Timeframes met 95%
  • Provider submits RAH provider dashboard >90% of times each month
  • <10% referrals declined
  • RAH initial assessment form
  • Provider reported

KPI: Program delivery aligns to TAC Service Standards

ObjectiveTargetDescriptionData source
Successful outcome is delivered within the pre-approved limited of the service model.Number of clients discharged from RAH within the $3,000 cap and under 8-week timeframe.>80%Internal TAC billing data.
Data is collected and provided to the TAC.For all clients, TAC-specific RAH forms (initial, extension and discharge) are filled out completely and sent to TAC.>90%Internal TAC data.
Billing information provided to the TAC.Invoices for client RAH programs submitted within 4 weeks of completion.>90%Provider reported.
Face-to-face treatment prioritised.Services within programs are conducted face to face. Telehealth to be utilised with discretion.>80% of services delivered face to faceInternal TAC billing data.
Model of care is integrated to meet client's physical, psychological and wellbeing needs.Client's RAH program is integrated across disciplines and reflects physical and psychosocial services required.>85% of programs have 2 or more disciplines. (Case co-ordination is not considered a discipline.)Internal TAC billing data.

Data and metrics will be collected on the RAH provider dashboard and sent to the TAC on the 1st of every month for analysis and to allow client surveys to be sent.