What WorkSafe will pay for
The WorkSafe Agent (the Agent) can pay the reasonable costs of Outreach Services 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 Outreach Services to ensure that the treatment and services remain reasonable for workrelated injury or illness and are payable under the legislation.
Outreach Services are non-clinical, time limited and recovery orientated services for injured workers with a work-related primary or secondary mental injury who are experiencing barriers to returning to work and/or health due to their condition. The service aims to provide practical solutions to help workers overcome these barriers.
Outreach Services provide a range of flexible psychosocial interventions targeted to address the individual needs of a worker that may include assistance with:
- Implementing self-management strategies.
- Implementing practical strategies recommended during clinical treatment.
- Independently accessing work, medical and other appointments.
- Learning or relearning activities of daily living, which reduce the need for external support such as shopping assistance, carer support and household help.
WorkSafe has developed the Clinical Framework for the Delivery of Health Services (Clinical Framework) to set out key principles for delivery of services to injured workers.
The Clinical Framework is based on the following principles:
- Measurement and demonstration of the effectiveness of treatment.
- Adoption of a biopsychosocial approach.
- Empowering the client to manage their injury.
- Implementing goals focused on optimising function, participation and/or return to work/health.
- Base treatment on best available research evidence.
WorkSafe expects that all health professionals providing services to clients integrate the principles of the Clinical Framework into their daily practice. Further information about the Clinical Framework.
In this policy:
- An Assessment and Initial Support Packageis a package of 10 hours to assess the worker, conduct initial support services and submit the Outreach Services Plan.
- A primary mental injury is a diagnosed mental disorder that has occurred without a physical injury.
- A secondary mental injury is a mental disorder that has developed as a result of a physical injury.
- Psychosocial means a combination of psychological and social factors.
- Subsequent Support is hourly support following the completion of the Assessment and Initial Support Package.
- An Outreach support worker is a person employed by an Outreach Services provider approved by the WorkSafe who adheres to the Victorian Government Standards for the function of Mental Health Community Support Services.
- An Outreach Services Plan is a document that is submitted after the conclusion of the Assessment and Initial Support Package by the Outreach Services provider and which is updated at the conclusion of any Subsequent Support provided. The Outreach Services Plan includes assessment findings, baseline outcome measures, SMART goals and recommendations which are agreed to by the worker.
What can the Agent pay for in relation to Outreach Services?
The Agent can pay the reasonable costs of Outreach Services:
- required as a result of a work-related injury or illness;
- where prior approval has been given by the Agent;
- that are reasonable, necessary or appropriate in the circumstances;
- where safe and effective;
- focused on achieving return to health and/or return to work outcomes;
- provided by a service provider approved by WorkSafe under Victorian workers compensation legislation; and
- for a limit of 9 months, unless circumstances occur which disrupt the injured worker's engagement with the service (e.g. a breakdown of social supports).
Who may provide Outreach Services?
Outreach Services may be provided by WorkSafe approved service providers that are nongovernment organisations who are party to a service agreement with the Victorian Department of Health to deliver Mental Health Community Support Services (Individual Client Support Packages), previously referred to as Psychiatric Disability Rehabilitation and Support Services (PDRSS) before July 2014.
The Agent expects that the injured worker will obtain services from an Outreach Service provider in their local area where appropriate.
What information does the Agent require to consider paying for Outreach Services?
To consider paying the reasonable costs of Outreach Services, the Agent requires a signed and dated medical practitioner request agreeing to support the referral for the worker.
a) Assessment and Initial Support Package
The Agent will decide whether to approve an Assessment and Initial Support Package after receiving the treating medical practitioner request letter referred to above. Approval is given when the Agent sends an Outreach Service referral form. An Initial Support Package consists of 10 hours made up of:
- a face to face assessment
- delivery of psychosocial support/interventions, and
- the completion and submission of an Outreach Service Plan following initial assessment.
Please note that all direct and indirect support such as telephone calls, report writing and travel time are included in the assessment and initial support package.
The Outreach Services provider must complete an Outreach Services Plan at the conclusion of the Assessment and Initial Support Package and submit this form to the Agent. The Outreach Services Plan must include:
- clear goals that are specific, measurable, achievable, realistic and with timeframes (SMART goals) related to overcoming any barriers identified to support the workers return to health and/or work
- the workers progress/outcomes achieved towards these goals
- any future recommendations for further referrals or actions to support the workers return to health and/or work, and
- any further requests for additional services.
Payment for services will only be made following receipt of the Outreach Service Plan and invoice for services provided.
b) Subsequent Support
Following the completion of the Assessment and Initial Support Package, the Outreach Service provider may submit a request for Subsequent Support for the worker via the Outreach Service Plan. Prior approval is required for an injured worker to receive Subsequent Support. For the Agent to consider a request for Subsequent Support, the Outreach Service Plan must be updated to include information regarding:
- the reasons for Subsequent Support and why the worker's goals were not met in the Assessment and Initial Support Package;
- areas of support the Outreach Service provider will focus on; and
- the number of Subsequent Support hours required.
The Outreach Service Plan must be submitted to the Agent at the end of any approved Subsequent Support hours.
When will the Agent respond to a request?
Within 10 working days of receiving an Outreach Service related 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.
What are the WorkSafe's invoice requirements?
Please refer to the how to invoice WorkSafe guidelines.
What fees are payable for Outreach services?
Fees for the Assessment and Initial Support Package are inclusive of all components of the service, including liaising with the injured worker's treating health practitioners, administrative costs, completion of the Outreach Services Plan or request for Subsequent Support and provider travel expenses.
Please refer to the outreach services fee schedule.
In relation to Outreach Services 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 without a signed and completed medical practitioner request
- treatment or services where there is no clinical justification for the program
- treatment or services where there is no objective evidence that the program is reasonable and/or necessary
- treatment or services provided by an Outreach Service provider without a WorkSafe Outreach Service referral or written approval of any subsequent hours requested;
- treatment or services that are unrelated to the work-related injury or illness
- 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-approved provider;
- any fees associated with contacting or liaising with the injured worker's treating team, outside the scope of the agreed package
- treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent; or
- treatment or services provided by telephone or other non-face to face mediums.