Community access services policy

What WorkSafe will pay for

In this policy, Community Access includes Community Group Programs and Community Access Planning.

The WorkSafe Agent (the Agent) can pay the reasonable costs of community access services where required as a result of a work-related injury or illness under Victorian workers compensation legislation (the legislation), who as a result of severe work-related injury or illness, have acquired multiple physical, sensory and cognitive disabilities and need support to access and participate in recreational and leisure activities.

Eligible workers are Community Integration Program (CIP) workers who have been approved by the Agent as eligible for community access services due to the severity of their work-related injury or illness.

Background

The Agent can pay for community services that are identified as being the most appropriate for the needs of the worker. Community access services must be provided in a way which promotes independence and functional skills.

Definitions

In this policy:

• Community Access refers to Community Access Planning and/or Community Group Program services.
• Community Access Planning is a service provided to a worker to:
  • maintain and enhance peer support networks
  • facilitate sharing of Agent funded support services
  • assist with independent access to the community
  • assess and review the support needed to enable a worker to participate in community based leisure or recreation activities
  • link workers into mainstream or supported community-based leisure or recreational activities
  • monitor worker participation in community activities to ensure programs continue to appropriately address worker needs
• Community Access Planner is a person who provides Community Access Planning.
• Community Group Programs are individually tailored programs of supported group activities for workers which:
  • are specifically designed for workers who require shared support to maximise their independence in leisure or recreational activities outside the home
  • are provided within community-based facilities at community-based locations
  • are flexible and responsive to a worker's support needs, goals and interests
  • cover a range of programs and activities which address skill acquisition, recreation and leisure
  • support the development of community living, social skills and peer support networks
  • facilitate a worker's transition to mainstream community-based leisure and recreational activities
  • provide support to workers with a disability in a manner that respects their privacy and dignity
  • enhance a worker's quality of life
• The Community Integration Program (CIP) is an initiative that provides specialist care for eligible catastrophically injured workers in partnership with the Transport Accident Commission (TAC). Eligible workers are defined as those who have an accepted claim for compensation for a spinal injury resulting in quadriplegia/paraplegia or an acquired brain injury rated as severe or moderately severe.
• Attendant care is a support service provided to workers at home or in the community to optimise their independence and enable them to participate more fully in all aspects of their lives.
• Shared Travel is travel provided by the Community Group Program provider in their organisational vehicle for two or more workers to and from activities as part of the worker's approved Community Group Programs.

Guidelines

What can the Agent pay for in relation to Community Access?

The Agent can pay for an eligible individual worker to attend a registered/approved Community Group Program and/or receive Community Access Planning Services at the request of a medical practitioner:

• support and/or supervision
• community access activities

These services may be provided to a worker separately or in combination depending on the needs of the worker.

1. Community Group Programs

• the reasonable support costs and any other costs, i.e. fee for staff to support workers to attend and participate in registered/approved Community Group Programs
• the reasonable travel expenses associated with attendance at a registered/approved Community Group Program in the worker's local area. Travel expenses are expenses for travel by private motor vehicle, public transport (bus, train or tram) or taxi (with prior approval). Refer to the Travel Expenses Policy for more information. Shared travel may also be considered and provided by the approved Community Group Program and can be paid for in line with the fee schedule

The Agent will consider paying for a Community Group Program where a worker:

• requires support to participate in recreational and leisure activities in a community setting
• requires short term support in community activities to develop skills and assist in the transition to mainstream community participation

A worker is expected to have the capacity to engage in shared support environment as Community Group Programs are an alternative to 1:1 attendant care.

2. Community Access Planning Services

The Agent can pay for the Community Access Planning Services consisting of:

• a Community Access Planning Assessment
• ongoing support as required to carry out the goals of the Community Access Plan
• the reasonable travelling expenses associated with the travel necessary for a Community Access Planner to complete a Community Access Planning Assessment and provide ongoing support

The Agent will consider paying for a Community Access Planner where a worker:

• has significant motivational or behavioural issues that are likely to impact on the success of the worker's engagement in social or leisure pursuits either independently or within a Community Group Program
• requires support to identify, plan and resume participation in social, leisure or recreational activities to facilitate community access
• requires support to participate in community-based activities of their choice following short term graded support

Who may provide Community Access Programs?

1. Community Group Programs

Community Group Programs can be provided by disability services organisations that are approved by WorkSafe.

WorkSafe can approve Community Group Program providers with qualifications and experience that satisfy industry requirements.

2. Community Access Planning

WorkSafe can approve a person to provide Community Access Planning for workers where the person has qualifications and experience that satisfy industry requirements.

What information does the Agent require to consider paying for Community Access?

1. Community Group Programs

In order for the Agent to consider a request for community group program services the following information needs to be provided:

• a request from a medical practitioner
• the reason/reasons that the worker requires community group program services for the rehabilitation of their work-related injury or illness.
• a completed Activities of Daily Living (ADL) assessment or Benefit and Support Services Assessment (BASSA) by an approved Occupational Therapist

On receipt of this request, if the request is deemed reasonable and appropriate, the Agent will liaise with the relevant community group program provider to arrange for the provider to complete the Community Group Programs Hours Request form before the start date of the requested program.

Any changes to a community group program for additional hours must have written approval by the Agent before the commencement of the variation in a program.

2. Community Access Planning

In order for the Agent to consider a request for community access planning services the following information needs to be provided:

• a request from a medical practitioner
• the reason/reasons that the worker requires community access planning for the rehabilitation of their work-related injury or illness
• a completed Activities of Daily Living (ADL) assessment or Benefit Support Service Assessment (BASSA) by an approved Occupational Therapist

On receipt of this request, if the request is deemed reasonable and appropriate, the Agent will liaise with the relevant approved community access planning provider to arrange for the provider to complete the Community Access Plan: Initial Plan and Request for Funding form before the start date of the requested program.

When will the Agent respond to a request?

Within 10 working days of receiving the community access services request, the Agent will advise whether:

• the request has been approved
• the request has been denied, or
• further information is required to make a decision

Where further information is required, the Agent will advise whether the request has been approved or denied within 10 working days of receiving the additional information.

In relation to Community Access, what won't the Agent pay for?

The Agent will not pay for:

• treatment or services for a person other than the worker
• services that are of no clear benefit to a worker
• treatment or services provided by a health professional not registered and approved by WorkSafe under Victorian workers' compensation legislation
• treatment or services subcontracted to, or provided by a non-registered provider
• fees associated with cancellation or non attendance
• services where prior approval has not been sought from WorkSafe
• treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent
• services that are not provided in the community, such as hospital based groups
• activity costs associated with participation in community activities including:
  • entry fees, e.g. to an art gallery
  • activity costs, e.g. the purchase cost of roller skates
  • materials, e.g. wood for woodworking
  • hire of equipment and/or hire of facility component of activity, teaching or instruction of the activity, e.g. bowling balls or bowling shoes
• treatment or services provided by telephone or other non face to face mediums
• telephone calls and telephone consultations between providers and workers, and between other providers, including hospitals

Note: This policy is a guideline issued by WorkSafe Victoria under Victorian workers compensation legislation in respect of the reasonable costs of services, and services for which approval should be sought from the WorkSafe Agent or self insurer (as the case may be) before the services are provided.