Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Variation Regulations 2005 (SA)
South Australia
Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Variation Regulations 2005
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
Substitution of regulation 4
3AScales of charges—public hospitals
4Scales of charges—private hospitals
Variation of regulation 5—Scales of charges—physiotherapy services
Substitution of regulation 6
6Scales of charges—psychology services
Variation of regulation 7—Scales of charges—speech pathologists
Variation of regulation 8—Scales of charges—occupational therapists
Substitution of regulation 9
9Increase in charges for GST
Substitution of Schedule 1 and Schedule 1A
Schedule 1—Scales of charges—private hospitals
Variation of Schedule 2—Scales of charges—physiotherapy services
Substitution of Schedule 3
Schedule 3—Scales of charges—psychology services
Variation of Schedule 4—Scales of charges—speech pathologists
Variation of heading to Schedule 5
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 2005.
2—Commencement
These regulations will come into operation on 16 January 2006.
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(1), definition of Claims Agent—delete the definition and substitute:
claims agent means a private sector body that is a party to an authorised contract or arrangement under section 14 of the WorkCover Corporation Act 1994 involving the conferral of powers to manage and determine claims;
Regulation 3(1), definition of Self-Managed Employer—delete the definition and substitute:
occupational therapist means a person registered as an occupational therapist under the law of this State;
physiotherapist means a person registered as a physiotherapist under the law of this State;
psychologist means a person registered as a psychologist under the law of this State;
self-insured employer means exempt employer;
5—Substitution of regulation 4
Regulation 4—delete the regulation and substitute:
3A—Scales of charges—public hospitals
Pursuant to section 32(11) of the Act, the scales of charges set out in the South Australian Health Commission (Compensable and Non-Medicare Patients Fees) Regulations 2004 as in force at 16 January 2006 are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 for the provision of services in recognised hospitals and incorporated health centres (within the meaning of the South Australian Health Commission Act 1976).
4—Scales of charges—private hospitals
Pursuant to section 32(11) of the Act, the scales of charges set out in Schedule 1 are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 for the provision of services in private hospitals.
6—Variation of regulation 5—Scales of charges—physiotherapy services
Regulation 5—delete "subsection (11) of section 32" and substitute:
section 32(11)
Regulation 5—delete "regulation 9(1)" and substitute:
regulation 9
Regulation 5—delete "that section" and substitute:
section 32
7—Substitution of regulation 6
Regulation 6—delete the regulation and substitute:
6—Scales of charges—psychology services
Pursuant to section 32(11) of the Act, the scales of charges set out in Schedule 3 are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 for the provision of services by a psychologist.
8—Variation of regulation 7—Scales of charges—speech pathologists
Regulation 7—delete "subsection (11) of section 32 of the Act, the fees" and substitute:
section 32(11) of the Act, the scales of charges
Regulation 7—delete "regulation 9(1)" and substitute:
regulation 9
Regulation 7—delete "that section" and substitute:
section 32
9—Variation of regulation 8—Scales of charges—occupational therapists
Regulation 8—delete "subsection (11) of section 32" and substitute:
section 32(11)
Regulation 8—delete "regulation 9(1)" and substitute:
regulation 9
Regulation 8—delete "that section" and substitute:
section 32
Regulation 8—delete "registered"
10—Substitution of regulation 9
Regulation 9—delete the regulation and substitute:
9—Increase in charges for GST
If a service for which a charge is prescribed in a scale of charges is subject to GST, the amount prescribed as the charge is increased by the amount of the GST.
11—Substitution of Schedule 1 and Schedule 1A
Schedule 1 and Schedule 1A—delete the Schedules and substitute:
Schedule 1—Scales of charges—private hospitals
Item No
Service description
Maximum charge
(excl GST)
SERVICES OTHER THAN PSYCHIATRIC SERVICES OR REHABILITATION SERVICES
Accommodation
Advanced surgical—shared room
PR100
1 or more days but not more than 7 days
$523.20 per day
PR105
8 or more days but not more than 14 days
$449.75 per day
PR110
15 or more days
$308.50 per day
Surgical—shared room
PR120
1 or more days but not more than 7 days
$446.35 per day
PR125
8 or more days but not more than 14 days
$384.20 per day
PR130
15 or more days
$259.90 per day
Medical—shared room
PR180
1 or more days but not more than 7 days
$437.30 per day
PR185
8 or more days but not more than 14 days
$385.35 per day
PR190
15 or more days
$261.05 per day
Other
PR300
High dependency unit
$715.30 per day
PR310
Advanced dependency
$898.35 per day
PR330
Intensive care—no ventilator
$1 593.30 per day
PR340
Intensive care—ventilator
$2 262.25 per day
PR400
Private room allocated on the basis of medical need
The private room charge only applies where the private room has been allocated on the basis of a medical need, as determined by the treating/admitting medical practitioner. In all other cases, the shared room rate applies.
Extra $12.45 per day
Inpatient pain assessment/management
PR700
1 or more days but not more than 7 days
$409.05 per day
PR705
8 or more days but not more than 14 days
$384.20 per day
PR710
15 or more days
$249.75 per day
Same day services
PR410
Band 1: including gastrointestinal endoscopy, some minor surgical and non surgical procedures not normally requiring anaesthetic.
$218.10
PR420
Band 2: including procedures other than Band 1 performed under local anaesthetic with no sedation.
Theatre time less than 1 hour.
$322.05
PR430
Band 3: including procedures other than Band 1 performed under a general or regional anaesthesia or intravenous sedation.
Theatre time less than 1 hour.
$376.30
PR440
Band 4: including procedures other than Band 1 performed under general or regional anaesthesia or intravenous sedation.
Theatre time 1 hour or more.
$398.90
Theatre
Only 1 theatre fee is payable per session.
The band into which services fall will be determined in accordance with the Procedure Banding List published by the Australian Private Hospitals Association Limited, 1 November 2005.
PRT1A
Band 1A
$96.05
PRT01
Band 1
$310.75
PRT02
Band 2
$396.65
PRT03
Band 3
$551.45
PRT04
Band 4
$797.80
PRT05
Band 5
$1 023.80
PRT06
Band 6
$1 348.10
PRT07
Band 7
$1 844.15
PRT08
Band 8
$1 968.45
PRT9A
Band 9A
$2 289.40
PRT09
Band 9
$2 626.10
PRT10
Band 10
$3 437.45
PRT11
Band 11
$4 878.20
PRT12
Band 12
$5 237.55
PRT13
Band 13
$4 952.80
PRT50
Dental minor
$293.80
PRT55
Dental major
$529.95
HOSPITAL REHABILITATION SERVICES
Rehabilitation orthopaedic program
An orthopaedic program involves referral and assessment by the rehabilitation coordinator of the program. It is a defined program with intense service provision. Rapid improvement is expected and there are specific outcome goals. The program includes physiotherapy, hydrotherapy, occupational therapy, case conferences and discharge planning.
PR600
1 or more days but not more than 21 days
$447.50 per day
PR605
22 or more days
$375.15 per day
Rehabilitation trauma program
A trauma program involves referral and assessment by the rehabilitation coordinator of the program. It is a defined program with intense service provision. Rapid improvement is expected and there are specific outcome goals. The program includes physiotherapy, hydrotherapy, occupational therapy, speech therapy, case conferences and discharge planning.
PR610
1 or more days but not more than 50 days
$555.95 per day
PR615
51 or more days
$501.70 per day
PSYCHIATRIC SERVICES
Inpatient services
PR800
1 or more days but not more than 14 days
$475.75 per day
PR803
15 or more days but not more than 28 days
$366.10 per day
PR813
29 or more days but not more than 42 days
$280.25 per day
PR815
43 or more days
$213.55 per day
PR822
Electro-convulsive therapy (ECT)
$152.55 per day
PR850
Private room allocated on the basis of medical need
The private room charge only applies where the private room has been allocated on the basis of a medical need, as determined by the treating/admitting medical practitioner. In all other cases, the shared room rate applies.
Extra $12.45 per day
Drug and alcohol programs—inpatient
This program provides specialised treatment and care for patients with alcohol or drug dependencies (including analgesics/narcotics/opiates and Benzodiazepine). The program is managed by a multi-disciplinary team including a Medical Director and consultant psychiatrists. Where required, the program involves a medically controlled, safe withdrawal of drugs or alcohol.
PR990
1 or more days but not more than 14 days
$507.00 per day
PR991
15 or more days but not more than 35 days
$371.00 per day
PR992
36 or more days
$206.00 per day
Assessment treatment services
PR993
Multidisciplinary assessment treatment services
$600.00 per day
Same day services
A day program is usually available to provide ongoing support and care to patients after discharge for treatment as inpatients. It is managed by a multi-disciplinary team of health care professionals, and is tailored to the individual needs of the patient. It can include specialised therapy modules including cognitive behavioural therapy, relaxation, assertiveness skills and anxiety management.
Outreach is treatment or care provided by the hospital to a non-admitted patient at a location outside the hospital premises (being treatment or care provided as a direct substitute for treatment or care that would normally be provided on the hospital premises).
For billing purposes, the 'O' in item numbers for same day services is an alphabetical letter not the number zero.
PRO81
Group session
$61.00
PRO82
Electro-convulsive therapy day program
$318.00
PRO83
Half-day program
$162.70
PRO84
Day program
$257.65
PRO95
Outreach
$147.00
12—Variation of Schedule 2—Scales of charges—physiotherapy services
Schedule 2—delete "Self-Managed Employer, Exempt Employer or Claims Agent" wherever occurring and substitute in each case:
self-insured employer or claims agent
Schedule 2—delete "Self-Managed Employer, Exempt Employer, Claims Agent" wherever occurring and substitute in each case:
self-insured employer, claims agent
Schedule 2, Item No PT552—delete "self-managed employer or self insured (exempt) case manager,"
13—Substitution of Schedule 3
Schedule 3—delete the Schedule and substitute:
Schedule 3—Scales of charges—psychology services
This Schedule supersedes the scale of charges for medical services delivered by a registered psychologist fixed by notice under section 32 of the Act and published in the Gazette on 10 March 1994 at page 709.
This Schedule must be read in conjunction with the Psychology Fee Schedule Guidelines.
Item No
Service description
Maximum charge
(excl GST)
Psychological assessment
Assessment by a psychologist involving the psychologist's attendance on the client.
W0111
An attendance of not more than 15 minutes duration
$39.00
W0112
An attendance of more than 15 minutes duration but not more than 30 minutes duration
$58.50
W0113
An attendance of more than 30 minutes duration but not more than 45 minutes duration
$97.50
W0114
An attendance of more than 45 minutes duration but not more than 75 minutes duration
$156.00
W0115
An attendance of more than 75 minutes duration but not more than 105 minutes duration
$234.00
W0116
An attendance of more than 105 minutes duration but not more than 135 minutes duration
$312.00
W0117
An attendance of more than 135 minutes duration
$353.60
Consultations
Treatment and intervention by a psychologist involving the psychologist's attendance on the client.
Initial attendance
W0101
An attendance of not more than 15 minutes duration
$39.00
W0102
An attendance of more than 15 minutes duration but not more than 30 minutes duration
$58.50
W0103
An attendance of more than 30 minutes duration but not more than 45 minutes duration
$97.50
W0104
An attendance of more than 45 minutes duration but not more than 75 minutes duration
$156.00
W0105
An attendance of more than 75 minutes duration
$195.00
Subsequent attendance
W0121
An attendance of not more than 15 minutes duration
$39.00
W0122
An attendance of more than 15 minutes duration but not more than 30 minutes duration
$58.50
W0123
An attendance of more than 30 minutes duration but not more than 45 minutes duration
$97.50
W0124
An attendance of more than 45 minutes duration but not more than 75 minutes duration
$156.00
W0125
An attendance of more than 75 minutes duration
$195.00
Group therapy
Group therapy under the continuous direct supervision of a psychologist.
Group therapy (minimum of 2 clients, maximum of 9 clients)
W1704
Group therapy of more than 45 minutes duration and not more than 75 minutes duration
$30.75 (each client)
W1705
Group therapy of more than 75 minutes duration and not more than 105 minutes duration
$47.25 (each client)
W1706
Group therapy of more than 105 minutes duration and not more than 135 minutes duration
$62.65 (each client)
W1707
Group therapy of more than 135 minutes duration
$69.75 (each client)
Family group therapy (2 clients)
W1724
Family group therapy of more than 45 minutes duration and not more than 75 minutes duration
$78.00 (each client)
W1725
Family group therapy of more than 75 minutes duration and not more than 105 minutes duration
$117.00 (each client)
W1726
Family group therapy of more than 105 minutes duration and not more than 135 minutes duration
$156.00 (each client)
W1727
Family group therapy of more than 135 minutes
$176.10 (each client)
Family group therapy (3 or more clients)
W1714
Family group therapy of more than 45 minutes duration and not more than 75 minutes duration
$52.00 (each client)
W1715
Family group therapy of more than 75 minutes duration and not more than 105 minutes duration
$78.00 (each client)
W1716
Family group therapy of more than 105 minutes duration and not more than 135 minutes duration
$104.00 (each client)
W1717
Family group therapy of more than 135 minutes duration
$117.00 (each client)
Interview of a person other than a client
Interview by a psychologist of a person other than a client (eg spouse, employer, supervisor) for the purposes of obtaining information crucial to the treatment and management of the injury. The psychologist must be able to provide clear justification for this service, if requested.
W0131
Interview of a person other than a client, not more than 15 minutes duration
$39.00
W0132
Interview of a person other than a client, more than 15 minutes duration but not more than 30 minutes duration
$58.50
W0133
Interview of a person other than a client, more than 30 minutes duration but not more than 45 minutes duration
$97.50
W0134
Interview of a person other than a client, more than 45 minutes duration but not more than 75 minutes duration
$156.00
W0135
Interview of a person other than a client, more than 75 minutes duration
$195.00
Independent clinical assessment
Services provided by a psychologist other than the treating psychologist comprising—
• a review of the worker's psychological/medical history; and
• clinical assessment of the worker; and
• preparation of a report,
for the purpose of clarifying the worker's current psychological/psychosocial status and barriers to return to work, and providing advice on appropriate treatment or management.
The report may be requested in writing by—
• a claims agent or self-insured employer; or
• a worker or worker's representative.
W0780
Independent clinical assessment
$156.00 per hour
Vocational assessment
A vocational assessment of a worker by a psychologist to identify potential and alternative career and employment options carried out by means of integrated clinical and standardised assessment procedures and instruments.
WV111
Vocational assessment, an attendance of not more than 15 minutes duration
$39.00
WV112
Vocational assessment, an attendance of more than 15 minutes duration but not more than 30 minutes duration
$58.50
WV113
Vocational assessment, an attendance of more than 30 minutes duration but not more than 45 minutes duration
$97.50
WV114
Vocational assessment, an attendance of more than 45 minutes duration but not more than 75 minutes duration
$156.00
WV115
Vocational assessment, an attendance of more than 75 minutes duration but not more than 105 minutes duration
$234.00
WV116
Vocational assessment, an attendance of more than 105 minutes duration but not more than 135 minutes duration
$312.00
WV117
Vocational assessment, an attendance of more than 135 minutes duration
$353.60
Reports
Vocational report
A vocational report by a psychologist providing advice on factors affecting occupational options following a vocational assessment. These factors may include—
• psychosocial factors such as beliefs, motivation, attitude and personality
• skills and abilities
• cultural, religious or ethnic factors
• socio-economic context
• medical status
• education
• advice on strategies to assist in the return to work process.
The report may include responses to specific questions asked by the claims agent or self-insured employer.
WRV20
Vocational report, to provide advice on factors affecting occupational options following vocational assessment—First page
$125.00
Second and subsequent pages
$62.00
Other reports
Report by a psychologist, other than a report of an independent clinical assessment or a vocational report, requested by a claims agent, self-insured employer, worker or worker's representative.
Comprehensive report
A report will be taken to be comprehensive when re-examination of the patient is a prerequisite for the preparation of the report.
WR020
Comprehensive report—first page
$125.00
Second and subsequent pages
$62.00
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.
WRT20
Standard report—first page
$93.00
Second and subsequent pages
$47.00
For the purposes of the charges for vocational and other reports—
(a) a page means a page of A4 paper that complies with the following:
(i) a top margin of no more than 2 centimetres;
(ii) a bottom margin of no more than 2 centimetres;
(iii) side margins of no more than 2.5 centimetres;
(iv) line spacing of no more than 1.5 centimetres;
(v) more than 75% of the lines on the page contain text; and
(b) if a page complies with (a) except (a)(v), the charge will be reduced as follows:
(i) if 25% or less of the lines on the page contain text, the charge is 25% of the charge otherwise payable;
(ii) if more than 25% but not more than 50% of the lines on the page contain text, the charge is 50% of the charge otherwise payable;
(iii) if more than 50% but not more than 75% of the lines on the page contain text, the charge is 75% of the charge otherwise payable.
Telephone calls
Calls of a case specific nature made by a psychologist to, or received by a psychologist from, the worker's referring/treating medical expert, worker's employer, rehabilitation provider, claims agent or self-insured employer, WorkCover provider consultant or worker's representative, excluding—
(a) calls made during a consultation; and
(b) calls of a duration of 3 minutes or less.
There is no charge for a telephone call to or from a worker.
W0180
Telephone calls greater than 3 minutes
$2.60 per minute
Travel
A return trip approved by a claims agent or self-insured employer by a treating psychologist from the treating psychologist's rooms to another place for the purpose of a home, hospital or worksite visit or case conference.
WT001
Travel time
$156.00 per hour
Case conference
Case conference, attended by a psychologist and authorised by a claims agent or self-insured employer, 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.
W0130
Case Conference
$156.00 per hour
The hourly rate excludes travelling time from rooms or other appropriate departure point to the venue and return. Travel may be charged separately.
Non-scheduled services
A service of a kind not listed above provided by a psychologist and authorised by a claims agent or self-insured employer prior to the delivery of the service as being necessary, appropriate and reasonably required.
W9999
Non scheduled services
$156.00 per hour
14—Variation of Schedule 4—Scales of charges—speech pathologists
Schedule 4—delete ", Self-Managed Employer, or Exempt Employer" wherever occurring and substitute in each case:
or self-insured employer
Schedule 4—delete "Self-Managed Employer or Exempt Employer" wherever occurring and substitute in each case:
or self-insured employer
Schedule 4—delete "an Exempt Employer" wherever occurring and substitute in each case:
a self-insured employer
Schedule 4—delete the item headed "ACCOUNTS/RECEIPT PREPARATION STANDARDS" (including Notes 1 to 4 under that heading)
15—Variation of heading to Schedule 5
Heading to Schedule 5—delete "Registered"
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 Administrator
following consultation as required under section 32(13) of the Workers Rehabilitation and Compensation Act 1986 and with the advice and consent of the Executive Council
on 15 December 2005
No 276 of 2005
05WKC010CS & 05WKC013CS
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