Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Variation Regulations 2004 (SA)

South Australia

Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Variation Regulations 2004

under the Workers Rehabilitation and Compensation Act 1986

Contents

Part 1—Preliminary

Short title
Commencement
Variation provisions

Part 2—Variation of Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Regulations 1995

Variation of regulation 3—Interpretation
Insertion of regulation 10
10WorkCover may issue guidelines
Substitution of Schedule 5
Schedule 5—Scales of charges—Registered occupational therapists

Part 1—Preliminary
1—Short title
These regulations may be cited as the Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Variation Regulations 2004.
2—Commencement
These regulations will come into operation on 11 November 2004.
3—Variation provisions
In these regulations, a provision under a heading referring to the variation of specified regulations varies the regulations so specified.

Part 2—Variation of Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Regulations 1995
4—Variation of regulation 3—Interpretation
Regulation 3—after its present contents (now to be designated as subregulation (1)) insert:
(2)A reference in these regulations to specified schedule guidelines is a reference to the guidelines of the specified name issued by WorkCover, as in force from time to time.

5—Insertion of regulation 10
After regulation 9 insert:
10—WorkCover may issue guidelines
WorkCover may issue guidelines from time to time for the purposes of these regulations.

6—Substitution of Schedule 5
Schedule 5—delete the Schedule and substitute:
Schedule 5—Scales of charges—Registered occupational therapists

Item No

Service Description

Charge

OCCUPATIONAL THERAPY CORE SCHEDULE SERVICES

Refer to the Occupational Therapy Fee Schedule Guidelines for requirements regarding the delivery of core schedule services.

INITIAL AND SUBSEQUENT CONSULTATIONS (INDIVIDUAL CLIENT)

The following services may be delivered as a component of an initial and subsequent consultation:

       •       clinical assessment

       •       clinical treatment

       •       graded activity/exercise

       •       pain management

       •       stress management

       •       relaxation training

       •       biomechanical education

       •       independent living skills training.

Refer to section 1 of the Occupational Therapy Fee Schedule Guidelines for further details regarding the provision of the initial and subsequent consultations.

Initial consultation (individual client)

OT 105

Initial consultation, history, examination and treatment

$105.60 per hour

Subsequent consultations (individual client)

OT 205

Subsequent consultations and treatment

$105.60 per hour

CORRECTIVE/SERIAL SPLINTING

Refer to section 2 of the Occupational Therapy Fee Schedule Guidelines for the types of splints available to the occupational therapist and the conditions associated with the provision of these splints.

OT 300

Fabrication/fitting/adjustment of splint

$105.60 per hour

OT 390

Materials used to construct or modify a splint

derived fee

TREATMENT REVIEW

OT 780

Independent clinical assessment (ICA)

$107.80 per hour

Includes a review of medical history, functional capacity and a clinical examination to provide a differential diagnosis and/or make recommendations regarding ongoing treatment goals, return to work and/or any other criteria as appropriate.

The report must be requested in writing and may be requested by:

       •       a claims agent or self-insured employer; or

       •       a worker or worker’s representative.

This service is NOT to be performed by the treating occupational therapist.

Refer to section 3 of the Occupational Therapy Fee Schedule Guidelines for service standards and indicators for use regarding independent clinical assessment.

OT 785

Occupational therapy functional estimation form (FEF)

$15.00 per form

The Functional Estimation Form (FEF) will be initiated by the treating occupational therapist when information is identified from a clinical consultation which impacts upon the worker’s capacity to return to work. This form must be forwarded directly to the certifying medical practitioner.

This form must only be completed when it complies with the criteria specified within the Occupational Therapy Fee Schedule Guidelines, Section 4.

PAIN MANAGEMENT (GROUP PROGRAM)

Pain management, group program, minimum of 2 clients, maximum of 5 clients.

OT 602

Pain management, group program, per client

$30.00 per hour

Refer to section 5 of the Occupational Therapy Fee Schedule Guidelines for further details regarding the delivery of pain management services.

ACTIVITIES OF DAILY LIVING ASSESSMENT

OT 760

Activities of daily living assessment (ADL)

$107.80 per hour

An activities of daily living assessment is an assessment of the worker’s level of functioning in regard to personal care, household tasks, and recreational and social activities. Generally conducted in the worker’s home environment, an activities of daily living assessment is utilised to reduce the impact of the injury, and facilitate early return to normal activity. Assessed levels of performance in daily activities can be used as an indicator of functional tolerances for determining work capacity.

Refer to section 6 of the Occupational Therapy Fee Schedule Guidelines for further details regarding the provision of an activities of daily living assessment.

REPORTS

OT 810

Comprehensive report

$103.40 per hour

A claims agent, self-insured employer or worker’s representative may request a comprehensive report. A report will be taken to be comprehensive when re-examination of the patient is a pre-requisite for the preparation of the report.

All reports referred to under this item are chargeable on an hourly basis with a maximum time chargeable of 1.5 hours.

Refer to section 7 of the Occupational Therapy Fee Schedule Guidelines for further detail regarding comprehensive reports.

OT 820

Standard report

$103.40 per hour

A claims agent, self-insured employer or worker’s representative may request a standard report. A report will be taken to be standard when re-examination of the worker is not required and the report is based on a transcription of existing clinical records.

All reports referred to under this item are chargeable on an hourly basis with a maximum time chargeable of 1 hour.

Refer to section 8 of the Occupational Therapy Fee Schedule Guidelines for further detail regarding standards required for report writing.

TELEPHONE CALLS

OT 552

Telephone call

$15.00 each

Calls of a case specific nature made to or received from the worker’s referring/treating medical expert, rehabilitation provider, claims agent or self-insured employer, WorkCover provider consultant or worker’s representative.

Excludes calls made during consultation and calls to or from the worker.

Telephone calls of a duration of 3 minutes or less are not chargeable.

Refer to section 9 of the Occupational Therapy Fee Schedule Guidelines for further details regarding telephone calls.

TRAVEL

All travel items refer to an approved return trip from the treating occupational therapist’s rooms for the purpose of a home, hospital or worksite visit or case conference.

OT 905

Travel in area 100km or less from Adelaide GPO

$90.00 per hour

OT 900

Travel in area more than 100km from Adelaide GPO

$100.00 per hour

Refer to section 10 of the Occupational Therapy Fee Schedule Guidelines for further details regarding travel.

CURAP

Therapeutic aids and appliances

derived fee

Includes an appliance or aid for reducing the extent of a compensable disability or enabling a patient to overcome in whole or in part the effects of a compensable disability.

Refer to section 11 of the Occupational Therapy Fee Schedule Guidelines for details regarding therapeutic appliances.

OCCUPATIONAL THERAPY SUPPLEMENTARY SCHEDULE SERVICES

REHABILITATION AND RETURN TO WORK SERVICES

Refer to section 12 of the Occupational Therapy Fee Schedule Guidelines for service requirements and indicators for use of each rehabilitation and return to work service listed within the supplementary schedule.

WORK SIMULATION - OFF SITE (GROUP PROGRAM)

A graduated program of supervised activities used to simulate work conditions and the physical demands of duties. It is highly structured, goal-orientated and individualised and is designed to maximise the worker’s ability to return to work. The program is usually contracted with the worker so that attendance patterns and work behaviours are normalised.

Work simulation, at rooms, group program, minimum of 2 clients, maximum of 5 clients.

OT 502

Work simulation, group program, per client

$30.00 per hour

OT 519

Work simulation, materials

derived fee

OT 700

FUNCTIONAL CAPACITY EVALUATION (FCE)

$107.80 per hour

Maximum time – 7 hours including report preparation with an executive summary form outlining the major components of the service and relevant findings.

Functional capacity evaluation is an assessment of the worker’s physical capabilities. The evaluation consists of a series of standardised tests focussed on selected work tolerances. Work tolerances are the observed and measured physical capabilities that affect the individual’s ability to perform the physical demands of specified work tasks. They are assessed as the ability to sustain a given work effort, i.e. work capacity at a prescribed frequency over a given period of time, and ability to maintain a specified rate of production at a pace compatible with the specified job. Work capacity is inferred based upon the work tolerance data gathered.

OT 730

WORKSITE ASSESSMENT (WSA)

$107.80 per hour

A visit to the workplace to determine the availability of duties for an injured worker and/or comment on the suitability of the workplace for that worker.

OT 740

JOB ANALYSIS (JA)

$107.80 per hour

The service includes the preparation of a report with an executive summary form outlining the major components of the service and relevant findings.

A job analysis involves analysis of the critical physical demands of a task, tasks or occupations to ascertain if they are within the worker’s capacity. The job analysis is undertaken based on available medical guidelines or given the medical expert’s knowledge of the worker’s diagnosis, pathology and prognosis.

The occupational therapist will also provide recommendations regarding modifications to elements of the job to enable the worker to safely and effectively perform the task, the provision of aids or equipment which will assist the worker to perform the task and work practice guidelines to ensure that appropriate body mechanics are utilised by the worker in the performance of the task.

OT 750

WORK HARDENING ON SITE

$107.80 per hour

Work hardening (on-site) is the process of increasing on a graduated basis the physical tolerances of a worker through the use of actual and productive work duties. This process is essential in assisting the worker to maintain his/her employment through the period of rehabilitation, by ensuring that identified duties are within the worker’s capacity and guidelines relevant to the nature of the injury.

OT 870

CASE CONFERENCE

$103.40 per hour

This service must be authorised by the claims manager or self-insured employer.

Case conferences are used for the purpose of determining:

       •       details of limitations/recommendations relating to a sustainable return to work

       •       options for management of a worker’s recovery

       •       other related information

A case conference may be requested by:

       •       a treating medical expert

       •       an employer

       •       a worker or worker’s representative

       •       a claims agent or self-insured employer

       •       a rehabilitation provider contracted by WorkCover.

Refer to section 13 of the Occupational Therapy Fee Schedule Guidelines for further details regarding case conferences.

NON SCHEDULED ITEMS

OT 999

NON SCHEDULED SERVICES

$103.40 per hour

The use of this item number requires the approval of the claims agent or self-insured employer prior to the delivery of the service.

This item is used when the provision of services not listed on the Core or Supplementary Fee Schedule is necessary, appropriate and reasonably required.

Refer to section 14 of the Occupational Therapy Fee Schedule Guidelines for further details regarding non scheduled services.

INTERPRETATION

In this Schedule—

derived fee means that each claim under that item will be considered on its merits.

Item No	Service Description	Charge
OCCUPATIONAL THERAPY CORE SCHEDULE SERVICES
Refer to the Occupational Therapy Fee Schedule Guidelines for requirements regarding the delivery of core schedule services.
INITIAL AND SUBSEQUENT CONSULTATIONS (INDIVIDUAL CLIENT)
The following services may be delivered as a component of an initial and subsequent consultation: • clinical assessment • clinical treatment • graded activity/exercise • pain management • stress management • relaxation training • biomechanical education • independent living skills training. Refer to section 1 of the Occupational Therapy Fee Schedule Guidelines for further details regarding the provision of the initial and subsequent consultations.
Initial consultation (individual client)
OT 105	Initial consultation, history, examination and treatment	$105.60 per hour
Subsequent consultations (individual client)
OT 205	Subsequent consultations and treatment	$105.60 per hour
CORRECTIVE/SERIAL SPLINTING
Refer to section 2 of the Occupational Therapy Fee Schedule Guidelines for the types of splints available to the occupational therapist and the conditions associated with the provision of these splints.
OT 300	Fabrication/fitting/adjustment of splint	$105.60 per hour
OT 390	Materials used to construct or modify a splint	derived fee
TREATMENT REVIEW
OT 780	Independent clinical assessment (ICA)	$107.80 per hour
Includes a review of medical history, functional capacity and a clinical examination to provide a differential diagnosis and/or make recommendations regarding ongoing treatment goals, return to work and/or any other criteria as appropriate.
The report must be requested in writing and may be requested by: • a claims agent or self-insured employer; or • a worker or worker’s representative.
This service is NOT to be performed by the treating occupational therapist.
Refer to section 3 of the Occupational Therapy Fee Schedule Guidelines for service standards and indicators for use regarding independent clinical assessment.
OT 785	Occupational therapy functional estimation form (FEF)	$15.00 per form
The Functional Estimation Form (FEF) will be initiated by the treating occupational therapist when information is identified from a clinical consultation which impacts upon the worker’s capacity to return to work. This form must be forwarded directly to the certifying medical practitioner.
This form must only be completed when it complies with the criteria specified within the Occupational Therapy Fee Schedule Guidelines, Section 4.
PAIN MANAGEMENT (GROUP PROGRAM)
Pain management, group program, minimum of 2 clients, maximum of 5 clients.
OT 602	Pain management, group program, per client	$30.00 per hour
Refer to section 5 of the Occupational Therapy Fee Schedule Guidelines for further details regarding the delivery of pain management services.
ACTIVITIES OF DAILY LIVING ASSESSMENT
OT 760	Activities of daily living assessment (ADL)	$107.80 per hour
An activities of daily living assessment is an assessment of the worker’s level of functioning in regard to personal care, household tasks, and recreational and social activities. Generally conducted in the worker’s home environment, an activities of daily living assessment is utilised to reduce the impact of the injury, and facilitate early return to normal activity. Assessed levels of performance in daily activities can be used as an indicator of functional tolerances for determining work capacity.
Refer to section 6 of the Occupational Therapy Fee Schedule Guidelines for further details regarding the provision of an activities of daily living assessment.
REPORTS
OT 810	Comprehensive report	$103.40 per hour
A claims agent, self-insured employer or worker’s representative may request a comprehensive report. A report will be taken to be comprehensive when re-examination of the patient is a pre-requisite for the preparation of the report.
All reports referred to under this item are chargeable on an hourly basis with a maximum time chargeable of 1.5 hours.
Refer to section 7 of the Occupational Therapy Fee Schedule Guidelines for further detail regarding comprehensive reports.
OT 820	Standard report	$103.40 per hour
A claims agent, self-insured employer or worker’s representative may request a standard report. A report will be taken to be standard when re-examination of the worker is not required and the report is based on a transcription of existing clinical records.
All reports referred to under this item are chargeable on an hourly basis with a maximum time chargeable of 1 hour.
Refer to section 8 of the Occupational Therapy Fee Schedule Guidelines for further detail regarding standards required for report writing.
TELEPHONE CALLS
OT 552	Telephone call	$15.00 each
Calls of a case specific nature made to or received from the worker’s referring/treating medical expert, rehabilitation provider, claims agent or self-insured employer, WorkCover provider consultant or worker’s representative.
Excludes calls made during consultation and calls to or from the worker.
Telephone calls of a duration of 3 minutes or less are not chargeable.
Refer to section 9 of the Occupational Therapy Fee Schedule Guidelines for further details regarding telephone calls.
TRAVEL
All travel items refer to an approved return trip from the treating occupational therapist’s rooms for the purpose of a home, hospital or worksite visit or case conference.
OT 905	Travel in area 100km or less from Adelaide GPO	$90.00 per hour
OT 900	Travel in area more than 100km from Adelaide GPO	$100.00 per hour
Refer to section 10 of the Occupational Therapy Fee Schedule Guidelines for further details regarding travel.
CURAP	Therapeutic aids and appliances	derived fee
Includes an appliance or aid for reducing the extent of a compensable disability or enabling a patient to overcome in whole or in part the effects of a compensable disability.
Refer to section 11 of the Occupational Therapy Fee Schedule Guidelines for details regarding therapeutic appliances.
OCCUPATIONAL THERAPY SUPPLEMENTARY SCHEDULE SERVICES
REHABILITATION AND RETURN TO WORK SERVICES
Refer to section 12 of the Occupational Therapy Fee Schedule Guidelines for service requirements and indicators for use of each rehabilitation and return to work service listed within the supplementary schedule.
WORK SIMULATION - OFF SITE (GROUP PROGRAM)
A graduated program of supervised activities used to simulate work conditions and the physical demands of duties. It is highly structured, goal-orientated and individualised and is designed to maximise the worker’s ability to return to work. The program is usually contracted with the worker so that attendance patterns and work behaviours are normalised.
Work simulation, at rooms, group program, minimum of 2 clients, maximum of 5 clients.
OT 502	Work simulation, group program, per client	$30.00 per hour
OT 519	Work simulation, materials	derived fee
OT 700	FUNCTIONAL CAPACITY EVALUATION (FCE)	$107.80 per hour
Maximum time – 7 hours including report preparation with an executive summary form outlining the major components of the service and relevant findings.
Functional capacity evaluation is an assessment of the worker’s physical capabilities. The evaluation consists of a series of standardised tests focussed on selected work tolerances. Work tolerances are the observed and measured physical capabilities that affect the individual’s ability to perform the physical demands of specified work tasks. They are assessed as the ability to sustain a given work effort, i.e. work capacity at a prescribed frequency over a given period of time, and ability to maintain a specified rate of production at a pace compatible with the specified job. Work capacity is inferred based upon the work tolerance data gathered.
OT 730	WORKSITE ASSESSMENT (WSA)	$107.80 per hour
A visit to the workplace to determine the availability of duties for an injured worker and/or comment on the suitability of the workplace for that worker.
OT 740	JOB ANALYSIS (JA)	$107.80 per hour
The service includes the preparation of a report with an executive summary form outlining the major components of the service and relevant findings.
A job analysis involves analysis of the critical physical demands of a task, tasks or occupations to ascertain if they are within the worker’s capacity. The job analysis is undertaken based on available medical guidelines or given the medical expert’s knowledge of the worker’s diagnosis, pathology and prognosis.
The occupational therapist will also provide recommendations regarding modifications to elements of the job to enable the worker to safely and effectively perform the task, the provision of aids or equipment which will assist the worker to perform the task and work practice guidelines to ensure that appropriate body mechanics are utilised by the worker in the performance of the task.
OT 750	WORK HARDENING ON SITE	$107.80 per hour
Work hardening (on-site) is the process of increasing on a graduated basis the physical tolerances of a worker through the use of actual and productive work duties. This process is essential in assisting the worker to maintain his/her employment through the period of rehabilitation, by ensuring that identified duties are within the worker’s capacity and guidelines relevant to the nature of the injury.
OT 870	CASE CONFERENCE	$103.40 per hour
This service must be authorised by the claims manager or self-insured employer.
Case conferences are used for the purpose of determining: • details of limitations/recommendations relating to a sustainable return to work • options for management of a worker’s recovery • other related information
A case conference may be requested by: • a treating medical expert • an employer • a worker or worker’s representative • a claims agent or self-insured employer • a rehabilitation provider contracted by WorkCover.
Refer to section 13 of the Occupational Therapy Fee Schedule Guidelines for further details regarding case conferences.
NON SCHEDULED ITEMS
OT 999	NON SCHEDULED SERVICES	$103.40 per hour
The use of this item number requires the approval of the claims agent or self-insured employer prior to the delivery of the service.
This item is used when the provision of services not listed on the Core or Supplementary Fee Schedule is necessary, appropriate and reasonably required.
Refer to section 14 of the Occupational Therapy Fee Schedule Guidelines for further details regarding non scheduled services.
INTERPRETATION
In this Schedule— *derived fee* means that each claim under that item will be considered on its merits.

Note—
As required by section 10AA(2) of the Subordinate Legislation Act 1978, the Minister has certified that, in the Minister's opinion, it is necessary or appropriate that these regulations come into operation as set out in these regulations.

Made by the Governor

with the advice and consent of the Executive Council

on 11 November 2004

No 237 of 2004

04WKC003CS