Occupational therapy services policy

Background

Occupational therapists can make an important contribution to improving the independence and return to work outcomes of workers.

This policy outlines guidelines for the provision of occupational therapy services under the Victorian workers compensation scheme (WorkCover).

This policy must be read in conjunction with the following:

Guidelines

Occupational therapy (OT) services take two forms:

• treatment
• assessment

Occupational therapy treatment services WorkSafe will pay for

WorkSafe (either directly or through one of its authorised agents) can pay the reasonable costs of occupational therapy services that are:

• required as a result of a work-related injury or illness
• performed by a clinician registered by WorkSafe to provide occupational therapy services
• clinically justifiable, safe, and effective
• for a clear rehabilitative purpose, and are not for non-work-related injury rehabilitative purposes
• likely to achieve or maintain a measurable functional improvement
• likely to achieve progress towards functional independence, participation, and self-management

The agent will periodically review an injured worker's entitlement to occupational therapy services to ensure the treatment and services remain reasonably applicable to the work related injury and/or illness, and payable under the WorkCover scheme.

Occupational therapy assessment services WorkSafe will pay for

Occupational therapists may undertake assessments to review a worker's needs for:

• household help
• equipment items
• attendant care support
• home modifications
• car modifications (if an accredited Vic Roads assessor or equivalent)

What WorkSafe will not pay for

WorkSafe or an agent will not pay for:

• treatment or assessment services for a person other than the worker
• treatment or assessment services provided by a treating health professional (THP) not registered and approved to provide occupational therapy services under the WorkCover scheme
• treatment or services provided by telephone or other non face to face mediums that do not align with WorkSafe's telehealth policy
• more than one initial consultation by the same provider or clinic unless exceptional circumstances apply (e.g. hospital admission, or significant time has passed since the injured worker last received treatment)
• more than one treatment consultation per day for the same injured worker
• consumable prostheses, aides, and appliances used in the course of the consultation
• pharmacy items such as creams and gels supplied by THPs
• fees associated with cancellation or non-attendance
• treatment or services provided outside the Australia without prior written approval from the agent
• treatment, services, prostheses, or equipment where there is no National Health and Medical Research Council level 1, or level 2 evidence of safety and efficacy

WorkSafe expectations for the delivery of occupational therapy services to injured workers

WorkSafe expects all occupational therapists providing services under the Victorian workers compensation scheme to adopt the principles of the Clinical Framework for the Delivery of Health Services (Clinical Framework) in their daily practice.

The Clinical Framework is based on the following principles:

• measure and/or demonstrate the effectiveness of treatment
• adopt a biopsychosocial approach
• empower the injured person to manage their injury
• implement goals focused on optimising function, participation, and return to work
• base treatment on best available research evidence

Occupational therapy treatment expectations

After treatment has commenced, the occupational therapist must submit an Allied Health Recovery Management Plan (AHRMP) to the managing Agent by the fifth consultation.

WorkSafe registered allied health practitioners are also expected to communicate and collaborate with other parties involved in the worker's support team to facilitate continuity of care and return to work.

Return to Work Case Conferences (RTWCC) bring together the worker, referring medical practitioner, employer, WorkSafe agent, occupational rehabilitation provider, and other relevant parties. They can be used to discuss the worker's capacity, any barriers affecting recovery, set goals, and agree on timeframes for recovery at/return to work.

Typically, a RTW case conference will be requested by an agent or the occupational rehabilitation consultant however, a treating health practitioner can request a case conference by contacting the agent or the occupational rehabilitation consultant directly. RTWCCs will be remunerated as outlined in the occupational therapy services fee schedule.

Occupational therapy assessment expectations

All occupational therapy assessments are to take a reablement focus, focussing on types of assistance required to assist a worker to maximise their independence.

Certain types of assessments, such as occupational therapy driving assessments, may require specific credentialing. An occupational therapist should only accept referrals to conduct an assessment where they have appropriate expertise and knowledge of relevant WorkSafe policy.

Occupational therapists prescribing equipment must comply with relevant WorkSafe policy and ensure no conflict of interest exists when prescribing items to injured workers.

Required information for agents

Referral requirements

WorkSafe considers occupational therapy a referred service. Occupational therapy services must be referred by a medical practitioner and approved by the agent before treatment commences.

Invoicing requirements

All services must be invoiced per WorkSafe's Occupational Therapy Services fee schedule.

For further information, refer to instructions for invoicing WorkSafe.

Concerns about unpaid or returned invoices should be directed to the agent case manager. Unresolved queries can be escalated by submitting an online complaint form.

Agent processing times

The agent will advise the outcome of a request for payment within 10 working days, or they may request extra information before making a decision.

If extra information is requested, the agent will confirm the request outcome within 10 working days of receiving the extra information.

Suspended from providing services to WorkSafe clients

If WorkSafe gives notice to a provider advising them that they are suspended from providing services to WorkSafe clients, WorkSafe will notify the Australian Health Practitioner Regulation Agency and Medicare Australia of the suspension and the grounds on which the suspension has been issued.