Early Intervention Physiotherapy Framework (EIPF) services guidelines

The provision of Early Intervention Physiotherapy services

These guidelines are in line with the Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act) and the Accident Compensation Act 1985 (AC Act).

WorkSafe will have regard to these guidelines when making decisions for the provision of early intervention physiotherapy services under the Early Intervention Physiotherapy Framework service model, to people who have an accepted claim under the Victorian Workers Compensation Scheme.

Throughout these guidelines, any reference to WorkSafe includes WorkSafe’s agents and self-insurers.

Physiotherapy services can be provided without pre-approval from the agent. However, in order to attract the higher service fees under the EIPF fee schedule, the physiotherapist must be registered with WorkSafe as an EIPF Provider.

Early Intervention Physiotherapy Framework services

WorkSafe can fund services delivered under the Early Intervention Physiotherapy Framework (EIPF) to assist people to effectively recover from workplace injuries and safely return to work and normal life.

The EIPF is a service model that recognises the importance of early treatment in facilitating return to work and return to health outcomes, and seeks to support practitioners through the provision of training, tools and resources, and more service options. Physiotherapists registered by WorkSafe to deliver services under the EIPF can be paid fees in accordance with the EIPF fee schedule.

Any physiotherapist can enrol in the EIPF by completing the required online training modules and signing a declaration to provide services in line with the WorkSafe Victoria developed Clinical Framework for the Delivery of Health Services.

This framework is a set of guiding principles intended to support healthcare professionals in their treatment of an injury through the following.

• Measurement and demonstration of the effectiveness of treatment.
• Adoption of a biopsychosocial approach.
• Empowering the injured person to manage their injury.
• Implementing goals focused on optimising function, participation and return to work.
• Basing treatment on best available research evidence.

What we can pay for

WorkSafe can pay the reasonable costs of early intervention physiotherapy services a person needs as a result of a work-related injury or illness under Victorian workers compensation legislation.

The treatment or service must meet the following criteria.

• Be clinically justified, safe and effective.
• Be likely to achieve measurable improvement in a person’s functioning.
• Promote progress toward a person’s functional independence, participation and self-management.
• Be for rehabilitation purposes for a work-related injury only.
• Be delivered in line with the Clinical Framework.
• Be required as a result of an accepted work-related injury or illness.
• Be provided by WorkSafe EIPF registered physiotherapists.
• Have a satisfactory level of evidence to support they are effective and achieve or maintain a measurable functional improvement.
• Be focused on achieving recovery and return to work outcomes.
• Be reasonable, necessary and appropriate in the circumstances.
• Be billed in accordance with the EIPF fee schedule.

WorkSafe will periodically review a person’s entitlement to physiotherapy services to make sure treatment and services remain reasonable, clinically justified, outcome focused and payable under the legislation.

Post-operative physiotherapy

Physiotherapists providing services under the EIPF are eligible to be paid in accordance with the EIPF fee schedule for treatment occurring after endorsed surgical and procedural interventions, see Post-operative physio eligible procedure list. This post-operative rate recognises that certain procedures return the injury to an acute state, and that more intensive treatment and greater communication between stakeholders is required to achieve optimal rehabilitation and return to work outcomes.

The post-operative item number can be billed for a maximum of 3 months of treatment following an endorsed procedure, provided the procedure occurs within 2 and a half years of the date of the work-related injury.

The 3-month eligibility period commences from the first post-operative physiotherapy service following an endorsed procedure.

Workplace assessment and report

Physiotherapists can play a key role in safe and sustainable return to work and health. Accordingly, WorkSafe encourages physiotherapists providing services under the EIPF to consider whether conducting a workplace assessment would help a worker.

A workplace assessment is a proactive intervention that can be used to facilitate better return to work and health outcomes for workers. Some general guidelines for when a workplace assessment may be appropriate include the following.

• As an early intervention tool to initiate a return to work.
• To confirm the availability and/or suitability of modified or alternative duties.
• To confirm timeframes for a worker to return to work if certified totally or partially unfit for work.
• To discuss suitable work duties and hours to support a return-to-work plan.
• If the worker has reported difficulties in sustaining employment.
• To discuss and address any identified return to work barriers.

WorkSafe recognises that workplace environments and conditions vary greatly. Accordingly, workplace assessment reports submitted to the agent will differ according to the individual circumstances of the workplace.

A workplace assessment report completed by an EIPF provider should contain the following basic information.

• Worker details (name, claim number, employer, DOB, date of injury, nature of injury and/or diagnosis).
• Workplace assessment details (date of visit, location, attendees).
• Pre-injury duties and hours (brief description).
• Current status of worker (including certified capacity, work status, and RTW goals).
• Identified barriers and proposed solutions and/or alternatives.
• Suitable duties identified.
• Conclusions (duties and positions identified, current capacity and how this relates to identified duties, recommendations for future RTW supports).
• Other, such as follow-up discussions with GP, worker, employer and other stakeholders.

The Workplace Assessment and Report item is billed on an hourly basis, to a maximum of 3 hours. The fee for a Workplace Assessment and Report includes:

• time spent arranging the assessment
• travel time to the worker's workplace
• time spent undertaking the assessment
• report writing.

Prior approval from the worker's employer is required before a Workplace Assessment is conducted on premises.

Extended consultations

WorkSafe can pay the published fee schedule rate for extended consultations where the physiotherapist, using the appropriate request form, has submitted written clinical justification of the need for direct patient contact time of greater than 30 minutes for each session for workers who have the following injury or illness.

• A moderate to severe acquired brain injury.
• A spinal cord injury.
• Extensive burns.
• Multiple orthopaedic fractures
• Limb amputations.
• Crush injuries.

Prior written approval (see link below to access form) is required for all extended consultations. Consultations can only be billed as a single consultation on any one day.

Extended consultations can be for periods of either:

• 31 to 40 minutes
• greater than 40 minutes.

Services we will not pay for

Under the Victorian workers compensation legislation, WorkSafe cannot pay for the following EIPF services.

• Services that are not required as a result of a worker’s accepted injury or illness.
• Services for a person other than the person with an accepted claim.
• Services that are not a reasonable cost as determined in accordance with the Victorian workers compensation legislation.
• Services provided outside of Australia without prior written approval from WorkSafe.
• Services provided by a person who is not registered under the Health Practitioner Regulation National Law to practice in the physiotherapy profession.

Under WorkSafe’s determination of reasonable costs, WorkSafe will not pay for costs relating to the following.

• More than one initial consultation by the same provider or clinic unless there are exceptional circumstances. For example, following a hospital admission or surgery, or where a significant period of time has elapsed since the worker last received treatment.
• Items that are not billed in accordance with the EIPF Fee Schedule.
• The provision of multiple disciplines or concurrent physical treatments or consultations (for example, early intervention physiotherapy, physiotherapy, chiropractic, osteopathy, or acupuncture), with exceptions such as group exercise or group hydrotherapy.
• Group consultations which do not involve 2 or more patients receiving constant overall supervision and intermittent attention. The maximum number of patients in a group should not exceed 6.
• Multiple certificates of capacity within 28 days unless there is a change in the functional tolerances and/or capabilities of the worker which will influence the hours or duties they are able to perform at work (applies to subsequent certificates).
• Where there are multiple EIPF certifiers, WorkSafe will pay for only one EICERT/EICERTT item number within 28 days, unless there has been a change in capacity (as defined above).
• Pharmacy items such as creams and gels supplied by health professionals.
• Fees associated with cancellation or non-attendance or services not provided to the worker.
• Services where their rendering cannot be substantiated by contemporaneous clinical records and/or attendance records.
• Treatment or services provided by telephone or other non-face to face mediums that do not align with WorkSafe's telehealth policy.
• Telephone calls and telephone consultations between providers and workers, and between other providers, including hospitals, that do not align with WorkSafe's telehealth policy.
• Multiple claims for travel to and from the practice for community consultations provided consecutively.
• Consumable prosthetics, aides and appliances used in the course of the consultation.

• Services provided more than once on the same day to the same worker.
• A single service billed to more than one claim held by the injured worker.
• Unsolicited treatment or consultation with a worker.
• 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.

How much we can pay

WorkSafe can pay for early intervention physiotherapy in line with our fee schedules.

You can find past fees online:

Sometimes there is a difference between what a provider charges and what WorkSafe will pay as the reasonable cost. If the provider charges more than what WorkSafe will pay, workers will need to pay the difference. In this instance, WorkSafe recommend the provider advise the worker prior to providing any services.

WorkSafe's invoice requirements

There are defined instructions for invoicing WorkSafe for EIPF services.

Who can provide these services

Any physiotherapist can enrol in the EIPF by completing the required training and signing a declaration to provide services in line with the Clinical Framework.

WorkSafe will only fund services through the Early Intervention Physiotherapy Framework delivered by providers that meet the following conditions.

• Registered with the Physiotherapy Board of Australia, other than as a student.
• Registered with WorkSafe for billing purposes
• Satisfactorily completed the WorkSafe training modules.
• Signed a declaration committing to provide services in line with the Clinical Framework and related Service Standards.
• Received confirmation from WorkSafe of enrolment in the EIPF.
• Provided evidence of current professional indemnity insurance coverage of at least $1 million.

Join the EIPF

WorkSafe provides information on how to join the EIPF.

Accessing services

Where there is an accepted WorkSafe claim, workers can access EIPF services for a work-related injury or illness without prior approval from WorkSafe or a referral from a medical practitioner.

WorkSafe does not require any information from a physiotherapist before commencement of initial treatment for a work-related injury.

However, once treatment has commenced, the physiotherapist must complete a WorkSafe Allied Health Recovery Management Plan (AHRMP), including baseline measures and a psychosocial risk screening questionnaire.

Allied health recovery management plan

An initial AHRMP must be completed and submitted to WorkSafe advising that treatment has commenced. This provides information regarding the goals, strategies, proposed outcomes and timelines of treatment.

The initial AHRMP must be submitted within the first 5 consultations.

• If the worker has previously attended a different physiotherapy clinic, an initial AHRMP is expected from the new clinic within the first 5 consultations.
• The initial consultation fee includes the time taken to complete the initial AHRMP for submission to WorkSafe.
• A copy of the initial AHRMP must be retained in the worker’s clinical records.
• For workers that are part of the Community Integration Program, the request, approval and submission of outcome measures for services will form part of the independence planning process.

WorkSafe may request a subsequent AHRMP as part of a Clinical Panel treatment review. A worker’s employer may also request a copy of an AHRMP.

Subsequent AHRMPs must include updated outcome measures and treatment goals. Standardised outcome measures are preferred as they are reliable, valid and sensitive to change. Consistent use of relevant standardised outcome measures helps track progress over time and determine whether the worker’s condition is improving, worsening, or remaining unchanged.

12-month treatment review

WorkSafe conducts regular reviews of allied health services provided to workers. These reviews ensure treatment is clinically justified, aligns with the Clinical Framework, and supports recovery and return to work outcomes.

When a worker’s EIPF treatment reaches 9 months from their date of injury, the provider must submit an updated AHRMP to WorkSafe if intending to continue treatment beyond 12 months. The cost of preparing the AHRMP submitted for the 12-month treatment review can be reimbursed as a one-time payment in accordance with the EIPF services fee schedule.

Information provided in this AHRMP supports appropriate future management decisions, including whether treatment beyond the first 12 months from the date of injury is:

• reasonable
• necessary, and
• aligned with the principles of the Clinical Framework.

After submitting an AHRMP, the provider can continue to deliver their proposed treatment plan until WorkSafe advises that a decision on the worker’s entitlement to EIPF services has been made. WorkSafe will advise any outcome of the 12-month treatment review in writing. The treating provider and the worker will both receive a copy.

Before the end date of this AHRMP, or before the approved number of services in this AHRMP is reached, the provider must submit a further AHRMP to WorkSafe if additional services are requested. The cost of preparing this further AHRMP cannot be reimbursed.

Whilst it is expected that physiotherapists submit an updated AHRMP proactively, WorkSafe may also send a written request for the AHRMP with a response from the provider expected within 14 days. Where a completed AHRMP is not received, WorkSafe may be unable to determine whether services provided are reasonable and necessary, which may affect ongoing payment for EIPF services.

Clinical Support Service

WorkSafe recognises that treating people with a work-related injury or illness often comes with challenges for providers.

The Clinical Support Service provides direct access to WorkSafe’s Clinical Panel experts, a group of highly experienced and qualified allied health and medical professionals. The service provides free support and advice for medical and health service providers related to the treatment of workers with an accepted claim.

Get in touch with the Clinical Panel for support with:

• completing certificates of capacity, Allied Health Recovery Management Plans, treater questionnaires, treatment plans and reporting
• applying the principles of the Clinical Framework and using outcome measures
• managing complex treatment and recovery barriers, and addressing concerns you may have
• preparing for, and having difficult conversations with workers
• brainstorming discussions around treatment pathways and available support when progress starts to plateau.

Response timeframes

For services that do require prior approval, the agent will respond within 10 working days to advise if:

• the request has been approved
• the request has been denied
• 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 receipt of the additional information.

To assist in making a decision regarding a request for further physiotherapy services, a request may be reviewed by a WorkSafe Medical Advisor and/or Clinical Panel. The Clinical Panel and/or Medical Advisor may contact the requesting physiotherapist to seek further information and/or discuss the proposed treatment prior to making a recommendation to the agent regarding the request.

The agent will respond to the request when they have received the recommendations.

Service delivery expectations

WorkSafe expects that all providers delivering early intervention physiotherapy services as part of the Victorian Workers Compensation Scheme follow the below principles.

• Provide culturally safe and respectful services.
  • Protect the person’s human rights and report any concerns of abuse, neglect or discrimination to the appropriate regulatory body or complaints body.
  • Support the person to maximise their independence, promote recovery and self-advocacy.

WorkSafe also expects that any treatment provided is reasonable, clinically justified, outcome focused, and in line with the Clinical Framework.

WorkSafe has reporting and engagement expectations for all providers delivering physiotherapy services to workers. WorkSafe expects providers to communicate, collaborate and provide information to WorkSafe and other relevant parties as required.

For example:

• Providers should work with treating health practitioners or other providers, such as medical practitioners to enable the most appropriate treatment.
• Providers should work with occupational rehabilitation providers, treating health practitioners and employers in relation to return to work.

Providers are required to comply with the requirements set out in these guidelines and in the Application for registration to provide services to workers.

If a provider does not meet these requirements or WorkSafe has concerns about the provider’s conduct or services delivered, WorkSafe may take appropriate action in accordance with the legislation.