Community Access Policy
The Victorian Workcover Authority (VWA) will pay the reasonable cost of community access which is required as a result of a work-related injury or illness.
- What are Community Access Services?
- Who is eligible for Community Access Services?
- Are there any exceptions?
- Who can provide Community Access Services?
- How are community group programs approved?
- When will the VWA pay for Community Access Services?
- When will the VWA not pay for Community Access Services?
- Is prior approval required for the payment of Community Access Services?
What are Community Access Services?
Community Access Services are designed to assist eligible workers to increase their participation in the community by identifying and responding to their individual needs through community access planning and community group programs.
Community access comprises of community access planning and community group programs. These services may be provided to an eligible injured worker separately or in combination depending on the needs of the injured worker.
a. community access planning is the service provided by a community access planner to an eligible injured worker which aims to:
- maintain and enhance peer support networks, and facilitate sharing of authorised support services.
- assess and review the support needed to enable an injured worker to participate in community based social or recreational activities.
- link injured workers into community based social or recreational activities.
- monitor an injured worker’s participation in community activities to ensure programs continue to appropriately address the injured worker’s needs
b. community group program is an individually tailored program of supported group activities which:
- is provided within community based facilities
- is specifically designed for eligible injured workers who require support to engage in social or recreational activities outside the home
- supports the development of peer support networks, community living and social skills
Who is eligible for Community Access Services?
Community Access services may be considered for injured workers who are eligible (for eligibility criteria see Section 7.13 in Online Claims Manual) for and participating in the Community Integration Program (for CIP definition see Section 7.13 in Online Claims Manual) (authorised by the VWA).
Approval for an individual injured worker to receive community access services will be based on:
- the injured worker's assessed needs for support and/or supervision
- a need for community activity.
Are there any exceptions?
A request for Community Access Services for injured workers with injuries that do not meet the VWA’s eligibility criteria or injured workers not participating in the Community Integration Program may be considered by the VWA on a case by case basis.
Who can provide Community Access Services?
Providers with qualifications and experience that satisfy industry and VWA provider registration requirements can provide Community Access Services.
How are community group programs approved?
Community group programs are approved where the following criteria are met:
- program providers must be approved by the VWA and be provided by disability services organisations with relevant experience;
- program providers must act in accordance with the Disability Services Act 1991 (Vic); the Intellectually Disabled Persons Services Act 1986 (Vic), and the Disability Services Act 1986 (Cth);
- the program must be designed to meet the individual needs of the worker with the aim of increasing the worker’s participation in social and recreational activities;
- the WorkCover Agent must be advised of the costs of the supported group activities within the program and prior written approval must be obtained from the Agent before a group activity is commenced; and
- program managers must submit reports at specified intervals which meet the VWA's reporting requirements.
When will the VWA pay for Community Access Services?
The VWA recognises that some eligible injured workers may acquire multiple physical, sensory and cognitive disabilities, which may impact on their ability to access and participate in their social and recreational activities. Community Access Services may be considered, at the request of a medical practitioner, for eligible injured workers participating in the Community Integration Program, where such services are authorised by the VWA.
(Definition of eligibility criteria, Community Integration Program see Section 7.13 in Online Claims Manual)
a. Community access planning services
The VWA will pay for the involvement of a community access planner taking into account:
- the injured worker's current ability and wish to participate in social or recreational activities; and
- the injured worker's needs for support to identify, plan and resume participation in leisure or recreational activities.
b. Community group programs
The VWA will consider paying for:
- the reasonable support costs, i.e. the program fee for staffing, planning and co-ordination, associated with an injured worker's attendance at approved community group programs
- the reasonable travel expenses associated with attendance at approved community group programs in the injured worker's local area in accordance with the VWA's travel policy.
When will the VWA not pay for Community Access Services?
a.Community access planning services
The VWA will not pay for:
- services that are required for an injury, condition or circumstance existing before the work related injury was suffered
- services that are not required as a direct result of the work related injury
- services that are of no clear benefit to an injured worker
- fees associated with non-attendance or phone consultations
- services where prior approval has not been sought.
b. Community Group Programs
The VWA will not pay for:
- services that are required for an injury, condition or circumstance existing before the work related injury was suffered
- services that are not required as a direct result of the work related injury
- the staffing component of the program fee where a injured worker is accompanied to the group by a VWA authorised attendant carer
- services that are of no clear benefit to an injured worker
- services where prior approval has not been sought
- services that are not provided in the general community such as hospital based groups
- services provided by providers that do not meet the VWA's provider registration criteria
The VWA cannot pay for activity costs associated with participation in social and recreational activates including but not limited to:
- entry fees, eg. to an art gallery
- activity costs, eg. roller skating,10 pin bowling
- materials, eg. wood for woodworking
- hire of equipment and/or hire of facility component of activity, teaching or instruction of the activity, eg. hire of bowling balls or bowling shoes.
Is prior approval required for the payment of Community Access Services?
Prior approval for Community Access Services is required. A request for the provision of Community Access Services must come from a Medical Practitioner.
