What WorkSafe will pay for

The WorkSafe Agent can pay the reasonable costs of the Acquired Brain Injury (ABI) rehabilitation services provided by the Alfred Health ABI Rehabilitation Centre where required as a result of a work-related ABI under Victorian workers compensation legislation.

Background

Workers who sustain an ABI may have particular rehabilitation needs with their transition from hospital to the community. The ABI rehabilitation services provided by the Alfred Health ABI Centre have been developed to address these needs.

Definitions

In this policy:

  • An Acquired Brain Injury is any type of brain damage that happens after birth.
  • The Alfred Health ABI Rehabilitation Service is a service provided at the Caulfield Hospital ABI Rehabilitation Centre that will deliver extended periods of rehabilitation for people who have experienced a severe ABI. The ABI Rehabilitation Centre provides an interdisciplinary approach, with a focus on person centred rehabilitation to achieve functional goals, and extensive family/carer and patient education and engagement in the process.

Guidelines

What can the Agent pay for in relation to the Alfred Health ABI Rehabilitation Service?

The Agent can pay the reasonable costs of the Alfred Health ABI Rehabilitation Service:

  • required as a result of a work-related injury or illness
  • that are reasonable, necessary or appropriate in the circumstances
  • where safe and effective
  • in accordance with the WorkSafe's policies
  • for a worker who has been diagnosed with a severe acquired brain injury and meets the criteria for admission into the Alfred Health ABI Rehabilitation Centre. Prior approval is required for a worker to receive ABI rehabilitation services provided at the Alfred Health ABI Rehabilitation Centre.

What information does the Agent require to consider paying for the Alfred Health ABI Rehabilitation Service?

Generally workers will be referred directly from acute hospitals to the Alfred Health ABI Rehabilitation Centre.

The worker will then be assessed by the Centre to determine if they are suitable for admission. In rare circumstances, a worker living in the community may be referred to the ABI rehabilitation centre if they require inpatient rehabilitation services and meet the admission acceptance criteria.

The ABI rehabilitation centre will notify the Agent if a worker meets the admission criteria for the program and provide the clinical justification in writing. The Agent should request further information if required.

When will the Agent respond to a request?

Within 10 working days of receiving the written request from the ABI Rehabilitation Centre, 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.

The WorkSafe Clinical Panel may review the information provided to assist the Agent to decide whether admission to the Alfred Health ABI Rehabilitation Centre is appropriate.

The Clinical Panel may contact the ABI Rehabilitation Centre to seek further information and/or discuss the proposed treatment before making a recommendation to the Agent about the request.

The Agent will respond to the request after they have received the Clinical Panel's recommendations

What are WorkSafe's invoicing requirements?

Refer to the How to invoice WorkSafe guidelines.

What fees are payable for the Alfred Health ABI Rehabilitation Service?

Fees for services performed with the Alfred Health ABI Rehabilitation Centre are based on the Department of Health fees and charges.

In relation to the Alfred Health ABI Rehabilitation Service, what won't the Agent pay for?

The Agent will not pay for:

  • treatment or services for a person other than the 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
  • treatment or services provided by telephone or other non-face to face mediums
  • telephone calls and telephone consultations between providers and clients/workers, and between other providers, including hospitals
  • treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1 or level 2 evidence that the treatment, service, prostheses or equipment is safe and effective. Refer to the Non-Established, New or Emerging Treatments and Services Policy
  • any service/item stated as forming part of the hospital bed fee as listed in the agreement (i.e. pharmacy items intrinsic to the hospital admission, allied health services intrinsic to the admission etc.)
  • additional attendant and personal care outside what is included within the daily bed fee
  • rehabilitation and other types of care and equipment provided after the acute discharge that have not received prior approval from the Agent
  • disposables and consumables items
  • goods and services unrelated to the work-related injury or illness, including medications extrinsic to the hospital admission
  • incidentals such as newspapers, telephone and television rental and other charges, visitor's meals and personal toiletries (e.g. toothpaste, soap)
  • nursing or medical personnel to escort a worker when travelling from one hospital to receive medical services or to attend an approved outpatient service at another facility for their work-related injury or illness, unless the escort is clinically necessary and approval has been given by the Agent.

Further information

Contact the referring Agent or email [email protected].