Framework occupational therapy services policy

Guidelines for providing framework occupational therapy to injured workers.

Shape

Introduction

The WorkSafe Agent (the Agent) can pay the reasonable costs of services delivered under Framework Occupational Therapy where required as a result of a work-related injury or illness under Victorian workers' compensation legislation (the legislation), following the provision of a written request from a medical practitioner.

The Agent will periodically review a worker's entitlement to occupational therapy (OT) services to ensure that they remain reasonable for the work-related injury or illness and are payable under the legislation.

Background

Framework Occupational Therapy is a service model that recognises the importance of a injured worker's participation and independence in the everyday activities at home, at work, at school or within the community. Framework Occupational Therapy providers have specific experience in treating injured workers who have received an acquired brain injury or spinal cord injury as a result of a work-related injury or illness.

WorkSafe have developed the Clinical Framework for the Delivery of Health Services which is a set of guiding principles intended to support healthcare professionals in their treatment of an injury through:

  • measurement and demonstration of the effectiveness of treatment
  • adoption of a biopsychosocial approach
  • empower the injured person to manage their injury
  • implementing goals focused on optimising function, participation and return to work
  • base treatments on best available research evidence

WorkSafe expects that all health professionals providing services to injured workers will integrate the principles of the Clinical Framework into their daily practice.

This policy must be read in conjunction with the following:

What can the Agent pay for in relation to Framework Occupational Therapy?

The Agent can pay the reasonable costs of Framework Occupational Therapy:

  • with prior approval from WorkSafe
  • required as a result of a work-related injury or illness
  • provided by WorkSafe Framework Occupational Therapists
  • that are clinically justified
  • that promote progress towards functional independence, participation and self-management
  • that are reasonable, necessary or appropriate in the circumstances
  • that are safe and effective
  • in accordance with the WorkSafe's guidelines
  • approved by WorkSafe under Victorian workers' compensation legislation

All services must be billed in accordance with the WorkSafe Framework Occupational Therapy Fee Schedule.

Services

A Framework Occupational Therapy service is an individual one-on-one service that may be no shorter than 15 minutes and no greater than the maximum Agent approved amount as determined appropriate by the treater, injured worker and the Agent.

Prior written approval is required for all Framework Occupational Therapy services and services can only be billed as a single service on any one day.

Travel

The Agent can pay the reasonable cost of travel on a pro-rata basis for Framework Occupational Therapy providers conducting services outside their clinic.

Travel is defined as the Framework Occupational Therapy provider driving a registered motor vehicle from their clinic address to an approved consultation in the community.

The Agent expects the injured worker to seek treatment from a Framework Occupational Therapy provider within their local area. Travel can only be paid where travel to the worker is clinically justified. Travel is only payable with prior written approval from the Agent. For more information please refer to the Framework Occupational Therapy Fee Schedule.

Reports and assessments

WorkSafe may request that a Framework Occupational Therapy provider complete an Activities of Daily Living (ADL) assessment. An ADL assessment provides advice to the Agent about the type of services that may be required to maximise an injured worker's independence and participation in everyday activities and in returning to work.

Other services

Framework Occupational Therapy service providers can also be asked to provide advice to WorkSafe regarding an injured worker's need for other services including:

  • attendant care
  • post-acute support
  • household help
  • home modifications
  • car modifications
  • equipment and related services

Who may provide Framework Occupational Therapy?

Framework Occupational Therapy may be provided by an occupational therapist who:

  • is registered with the Occupational Therapy Board of Australia,
  • has met the WorkSafe eligibility requirements (outlined in the Framework Occupational Therapy Application Form available on the WorkSafe webpage),
  • has satisfactorily completed the WorkSafe training modules,
  • has signed a declaration committing to provide services in line with the Clinical Framework and the Framework Occupational Therapy model
  • undertaken the compulsory Framework OT training; and
  • has received confirmation of approval from WorkSafe.

Eligibility to provide Framework Occupational Therapy

To be eligible to become a Framework Occupational Therapist, applicants are required to meet the criteria of one of the following categories:

  1. Three years' experience as an OT, including 2 years' experience providing services to people with an Acquired Brain Injury (ABI) and/or Spinal Cord Injury (SCI)*; OR
  2. Three years' experience as an OT without experience providing services to people with an ABI and/or SCI.

    To be eligible for this category the applicant is required to declare that they will complete 50% of the required OT Continuing Professional Development (CPD) over the next two years on providing services to people with ABI/SCI. Each CPD must include clinical supervision specific to this injured worker cohort; OR

  3. Two years' experience as an OT including experience providing services to people with an ABI and/or SCI. In this case the applicant will be required to declare that they have arrangements in place for clinical supervision specific to this injured worker group for the first year of practice as a Framework OT, and the applicant will be required to declare that they will complete 50% of the required CPD over the next two years on providing services to people with an ABI/SCI.

*If an applicant can demonstrate that they have three years' experience practicing as an occupational therapist, including two years’ relevant experience providing services to people with an ABI and/or SCI, but cannot demonstrate that they have provided services to these cohorts in the previous five years, then they are eligible for application under the third category of criteria for eligibility and subject to the same conditions as that category.

Occupational therapists are required to provide details of their experience in treating people with an ABI and/or SCI with their application, including where they gained experience in the treatment of injured workers with ABIs and/or SCIs.

WorkSafe will not pay the cost of CPD, clinical supervision, training or fees associated with upskilling in order for an occupational therapist to meet the threshold WorkSafe requirements necessary to provide services under the Framework OT Model.

WorkSafe will audit CPD undertaken by providers to ensure that they continue to meet the requirements to provide Framework Occupational Therapy services.

Information the Agent requires

To consider paying the reasonable cost of Framework Occupational Therapy, the Agent requires a request from a medical practitioner, physiotherapist, chiropractor or osteopath which states that the injured worker requires the service for the rehabilitation of their work-related injury or illness. The Agent may contact the medical practitioner or other referring health provider for further information regarding the request.

When will the Agent respond to a request?

Within 10 working days of receiving the Framework Occupational Therapy 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.

To assist the Agent to make a decision regarding a request for Framework Occupational Therapy services, a request may be reviewed by the WorkSafe Medical Advisor. The Medical Advisor may contact the requesting medical practitioner 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 Medical Advisor's recommendation.

Fees and invoicing information

What won't the Agent pay for?

The Agent will not pay for:

  • treatment or services for a person other than the injured worker
  • treatment or services provided by a health professional not registered and approved by WorkSafe under Victorian workers’ compensation legislation
  • fees associated with cancellation or non- attendance
  • fees associated with clinical supervision, training, continuing professional development or upskilling
  • treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent
  • treatment or services provided by telephone or other non face to face mediums
  • separate telephone calls and telephone consultations between providers and workers, and between other providers, including hospitals
  • treatment provided more than once on the same day to the same 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. Refer to the Non- Established, New or Emerging Treatments and Services Policy.

Further information

Contact the referring Agent, or email [email protected]