service schedule for physiotherapy services contract …€¦ · contract no: «contract_» part a....

Service Schedule for Physiotherapy Services of 17

SERVICE SCHEDULE FOR PHYSIOTHERAPY SERVICES CONTRACT NO: «Contract_»

PART A. QUICK REFERENCE INFORMATION

1. TERM FOR PROVIDING PHYSIOTHERAPY SERVICE

1.1. The Term for the provision of Physiotherapy Service is the period from 16 November 2009 (“the Start Date”) until the close of 31 May 2020 (“End Date”) unless terminated earlier in accordance with this Contract.

1.2. Clause 20.1 of the Standard Terms and Conditions is amended by substituting six months for three months as the notice period for the termination of this Service Schedule.

2. CLINICAL DIRECTOR (PART B, CLAUSE 8)

The following Service Provider has been named as the clinical director under this Service Schedule:

Name:

3. NAMED PHYSIOTHERAPY SPECIALIST (PART C)

3.1. Applicable only if the Supplier is contracted to provide Part C Services.

Name:

Specialist Area:

4. SPECIFIED AREA AND SERVICE LOCATION (PART B, CLAUSE 5, AND/OR PART C CLAUSE 4 (IF APPLICABLE)

Physiotherapy Services may be delivered at sites listed below:

Supplier Name:

Main Site Satellite Site Physiotherapy Service Location City


5. PHYSIOTHERAPY SERVICE ITEMS AND PRICES (PART B, CLAUSE 12)

Table 1 – Physiotherapy Service Items and Prices Service

Item Code

Service Item Description

Service Item Definition Price (excl GST)

Pricing Unit

PT01 Initial consultation

Initial consultation – assessment, treatment and completion of documentation, in accordance with Part B, clause 6.2.3.2.

$50.38 Per Consultation

PT02 Follow up consultation

Follow-up consultation in accordance with Part B, clause 6.2.3.3.


PTCG Group Consult Rate (Elective Surgery Clients)

Follow-up group exercise consultation in accordance with Part B, clause 6.2.3.4.

$23.71 Per Participant Per Consultation

PTTH Telehealth Follow up consultation

Follow up Telehealth consultation in accordance with Part B, clause 6.2.3.3.


PT21 Offsite Initial Offsite initial consultation– assessment, treatment and completion of documentation, in accordance with Part B, clause 6.2.3.2.


PT22 Offsite Follow up

Offsite follow-up consultation in accordance with Part B, clause 6.2.3.3.


PTE1 Crutches Hire Crutches hire in accordance with Part B, clause 6.2.3.5.1

Hire up to $20.00

Maximum Contribution

PTE2 Moon Boot Moon boot prescription and supply in accordance with Part B, clause 6.2.3.5.2

Actual and reasonable cost up to $100.00


PTE3 Knee Brace Knee brace prescription and supply in accordance with Part B, clause 6.2.3.5.3

Actual and reasonable cost up to $100.00


PT14 Written Report and Liaison

Case review and written report in accordance with Part B, clause 6.2.3.6

$50.38 Per Report

Note: Items PT01, PT02, PTCG, PTTH, PT21, and PT22 cannot be invoiced concurrently.

Table 2 – DHB Physiotherapy Service Items and Prices Service

Item Code



Pricing Unit

PT31 Initial consultation DHB

Initial consultation – assessment, treatment and completion of documentation, in accordance with Part B, clause 6.2.3.2.



Service Item Code



Pricing Unit

PT32 Follow up consultation DHB

Follow-up consultation in accordance with Part B, clause 6.2.3.3.


Note: Items PT31, PT32, PTCG, PTTH, PT21, and PT22 cannot be invoiced concurrently.

6. PHYSIOTHERAPY SPECIALIST SERVICE ITEMS AND PRICES (PART C, CLAUSE 10)

Table 3 – Physiotherapy Specialist Service Items and Prices Service

Item Code



Pricing Unit

PTS1 Initial consultation

Initial consultation – assessment, treatment and completion of documentation, in accordance with Part C, clause 5.2.2

$400.00 Per Consultation flat fee

PTS2 Follow up consultation

Follow up consultation in accordance with Part C, clause 5.2.3 & 5.2.4

$200.00 Per Consultation flat fee

Price Review ACC will review pricing when, at ACC’s sole discretion, we consider a review necessary. The factors ACC may take into account during a review include, but are not limited to: • general inflation • changes in service component costs • substantial changes in the market If ACC finds that the factors we take into account have not had a significant impact on price, the prices will remain unchanged. If ACC provides a price increase, the supplier must agree any adjustment in writing. The price increase will take effect from a date specified by ACC.

7. KEY PERSONNEL FOR PHYSIOTHERAPY SERVICE (STANDARD TERMS AND CONDITIONS, CLAUSE 11)

NOTICES FOR ACC TO: ACC Health Procurement (for delivery) Justice Centre 19 Aitken Street Wellington 6011 ACC Health Procurement (for mail) P O Box 242 Wellington 6140 Marked: “Attention: Procurement Specialist” Phone: 0800 400 503 Email: [email protected]

mailto:[email protected]


NOTICES FOR SUPPLIER TO: (insert street address including postcode) (for delivery) (insert postal address including postcode) (for mail) Marked: “Attention (contact person)” Phone: Mobile: Email:


TABLE OF CONTENTS

PART B

1. SERVICE OBJECTIVES 6 2. SERVICE PHILOSOPHIES (SPECIFIC TO PHYSIOTHERAPY SERVICES) 6 3. QUALITY STANDARDS AND PRACTICE CERTIFICATION 6 4. SERVICE ELIGIBILITY 7 5. SERVICE LOCATION 7 6. SERVICE REQUIREMENTS 7 7. SERVICE EXIT 10 8. CLINICAL DIRECTOR 10 9. EXCLUSIONS 11 10. PERFORMANCE AND SERVICE EVALUATION 11 11. REPORTING 12 12. COMMUNICATION 12 13. PAYMENT AND INVOICING 12 14. ADDITIONAL PAYMENT (STANDARD TERMS AND CONDITIONS, CLAUSE 10.3) 12 15. DEFINITIONS AND INTERPRETATION 13

PART C

1. SERVICE OBJECTIVES .......................................................................................................... 15 2. SERVICE PHILOSOPHIES (SPECIFIC TO PHYSIOTHERAPY SPECIALIST SERVICES) ............................................................................................................................... 15 3. SERVICE ELIGIBILITY .......................................................................................................... 15 4. SERVICE LOCATION ............................................................................................................. 15 5. SERVICE REQUIREMENTS .................................................................................................. 16 6. SERVICE EXIT ........................................................................................................................ 17 7. EXCLUSIONS .......................................................................................................................... 17 8. REPORTING ............................................................................................................................ 17 9. PERFORMANCE AND SERVICE EVALUATION ............................................................... 17 10. PAYMENT AND INVOICING ................................................................................................ 17


PART B. SERVICE SPECIFICATION FOR PHYSIOTHERAPY SERVICES

1. SERVICE OBJECTIVES

1.1. The objective of the Physiotherapy Service is to provide Clients with timely access to a quality physiotherapy treatment service that facilitates a prompt, cost-effective and sustainable return to independence and/or work or education.

2. SERVICE PHILOSOPHIES (SPECIFIC TO PHYSIOTHERAPY SERVICES)

2.1. The primary focus of physiotherapy treatment is to restore a Client’s health to the maximum extent practicable.

2.2. Treatment must be necessary and appropriate, match the quality required, be given the appropriate number of times at the appropriate time and place and be of a type normally provided by Physiotherapists.

2.3. Treatment effectiveness is measured using outcome measures that are reliable, valid, responsive to change, related to the functional goals of treatment and relevant to the Client’s injury.

3. QUALITY STANDARDS AND PRACTICE CERTIFICATION

3.1. ACC is committed to purchasing services from Suppliers who through their Service Providers can provide and demonstrate a quality service. The Supplier must ensure that a Service Provider always works in accordance with the requirements of the NZS 8171:2005 Allied Health Services Sector Standard or in the case of a DHB the requirements of NZS8134:2008 New Zealand Health and Disabilities Services [Core] Standard.

3.2. The Supplier will:

3.2.1. provide Physiotherapy Services through a practice that: 3.2.1.1. is certified by a Conformity Assessment Body approved by ACC and 3.2.1.2. is and remains certified against NZS8171:2005; or 3.2.1.3. in the case of a DHB is and remains certified against NZS8134:2008; or 3.2.1.4. is and remains certified against the ACC requirements for Physiotherapy

Services. 3.2.2. notify ACC of any change in certification status within 5 Business Days of receipt of notice

from the Conformity Assessment Body or change in certification status. 3.2.3. provide physiotherapy telehealth follow up consultations that:

3.2.3.1. meets the requirements outlined by the Physiotherapy Board’s Telehealth Standard;

3.2.3.2. comply with the relevant New Zealand regulations, standards, and guidelines for Telehealth;

3.2.3.3. are provided to a Client residing in New Zealand by a provider residing in New Zealand at the time of the consult; and

3.2.3.4. are provided using videoconferencing technologies.


4. SERVICE ELIGIBILITY

4.1. This Service description outlines Physiotherapy Services to be provided for Clients with a Personal Injury. A Client is entitled to Physiotherapy Services under this Service Schedule if:

4.1.1. The Client has suffered a personal injury in terms of the Accident Compensation Act 2001 (AC Act) for which a claim for cover has been accepted, or is likely in the Service Provider’s experience to be accepted (“Personal Injury”); and

4.1.2. The Physiotherapy Services are required in respect of that Personal Injury.

4.2. Under the AC Act ACC is not liable to pay for services to treat non-injury related issues and/or pre-existing health related conditions. The Supplier will ensure that all Physiotherapy Services provided are for the purposes of directly treating the Client’s covered Personal Injury.

4.3. ACC will not pay the Supplier for time spent by a Service Provider with a Client who does not fulfil the criteria listed in clause 4.1 above.

4.4. To be eligible for a telehealth follow up (as described in Part B, clause 6.2.3.3) an initial consultation must have been completed in person.

5. SERVICE LOCATION

5.1. The Supplier will ensure that Physiotherapy Services are provided at the location(s) specified in Part A, clause 3 (“Service Location”). The Supplier will ensure that these services provided at these locations are certified as specified in Part B, clause 3.

5.2. The Supplier may provide Physiotherapy Services at the following locations in addition to the Service Location(s) in the following circumstances:

5.2.1. Home or domiciliary visits to a Client where the Client is unable to attend a Service Location;

5.2.2. The Client’s workplace where a Client is unable to attend a Service Location and there are appropriate facilities at the workplace to provide a consultation;

5.2.3. Via telehealth video link where the Client is unable to attend a service location and the service meets the requirements outlined in Part B, clause 3.2.3. and Part B, clause 6.2.3.3.

5.3. Additional Off-Site services may be provided at a site not specified in Part A, clause 5 or clause 5.2 of this service schedule, however this can only be remunerated at the rate outlined in Part A, clause 6 - offsite initial and offsite follow up rates.

5.4. If the Supplier has offsite practices listed on its accreditation certificate prior to 1 August 2018, the Supplier is exempt from clause 5.3 above for the listed location(s) and able to bill onsite rates but will comply with the accreditation requirements by the date of their next audit or 31 May 2020 (whichever is first).

6. SERVICE REQUIREMENTS

6.1. For Service Providers

6.1.1. The Supplier will ensure that clinically necessary Physiotherapy Services (as per Part B, clause 6.2) are only carried out by Service Providers who: 6.1.1.1. hold a current Annual Practising Certificate issued by the Physiotherapy Board

of New Zealand; 6.1.1.2. are a current member of Physiotherapy New Zealand. This requirement will be

met by 31 May 2020;


6.1.1.3. normally provide treatment of that type; and 6.1.1.4. are registered with ACC to provide Physiotherapy Services.

6.2. For Physiotherapy Services

6.2.1. The Supplier will ensure that all Physiotherapy Services provided under this Service Schedule: 6.2.1.1. are provided by Service Providers who ensure that all Services provided under

the Service Schedule are necessary, appropriate, timely, of the required quality, and not excessive in number or duration, and follow evidence based guidelines (or current accepted best practice where evidence based guidelines are unavailable or insufficient), and that clinical records will demonstrate this; and

6.2.1.2. are provided by Service Providers using modalities which fall within their scope of practice as defined by the Physiotherapy Board of New Zealand.

6.2.2. The Supplier may allow Physiotherapy students studying towards a Bachelor of Health Sciences in Physiotherapy or Bachelor of Physiotherapy degree to provide Physiotherapy treatment to Clients where the student is directly supervised by the Service Provider. Direct supervision means a Service Provider entitled to provide Services under this Service Schedule is overseeing and, where appropriate, instructing the student. The Service Provider must retain full responsibility for the treatment being provided.

6.2.3. Physiotherapy Services provided under this Service Schedule will include: 6.2.3.1. Arranging any necessary appointments with the Client; and 6.2.3.2. An Initial Consultation (including initial offsite consultation) which includes:

6.2.3.2.1. completion of clinical records; and 6.2.3.2.2. development and documentation of a treatment plan that includes

the anticipated number of visits, goals and objectives of treatment, timeframes; and

6.2.3.2.3. recording baselines and outcomes from treatment delivered using an evidence-based outcome measures; and

6.2.3.2.4. Client education on self-management of the injury and injury prevention (including use of ACC’s injury prevention resources where appropriate); and

6.2.3.2.5. documentation of clinical records. 6.2.3.3. Providing follow-up Physiotherapy consultations (including offsite follow up,

and telehealth follow up) in accordance with the treatment plan developed at the Initial Consultation. This includes: 6.2.3.3.1. ensuring that there is clinical evidence that the treatment directly

relates to the covered Personal Injury; and 6.2.3.3.2. recording outcomes from treatment delivered using an evidence-

based outcome measure; and 6.2.3.3.3. referring the Client to other services where clinically necessary and

appropriate, including seeking ACC’s prior approval for such referrals if prior approval is required; and

6.2.3.3.4. when applicable, submitting a Request for Prior Approval of Further Treatment form (as published on the ACC website) for treatment beyond the applicable Physiotherapy Treatment Profile Trigger Number; and

6.2.3.3.5. documentation of clinical records. 6.2.3.4. Group consultations in accordance with the treatment plan. This includes:

6.2.3.4.1. Group consultations may be provided to Clients who are receiving post-surgical physiotherapy treatment for a covered Personal Injury.


6.2.3.4.2. Ensuring that there is clinical evidence that the group treatment directly relates to the covered Personal Injury and is personalised where needed.

6.2.3.4.3. Recording outcomes from treatment delivered using an evidence based outcome measures; and

6.2.3.4.4. Referring the Client to other services where clinically necessary and appropriate, including seeking ACC’s prior approval for such referrals if prior approval is required; and

6.2.3.4.5. When applicable, submitting a Request for Prior Approval of Further Treatment form (as published on the ACC website) for treatment beyond the applicable Physiotherapy Treatment Profile Trigger Number; and

6.2.3.4.6. Documentation of clinical records. 6.2.3.5. Equipment and Orthotics

6.2.3.5.1. Crutches Hire which includes: (a) Providing crutches where it is identified that their need

directly relates to the covered Personal Injury; (b) that the crutches are regularly assessed and maintained to a

safe standard; (c) that the Client is assessed and fitted for these in accordance

with their specifications and best practice guidelines; and (d) that the Client is educated on the safe use.

6.2.3.5.2. Moon Boots which includes: (a) Providing a moon boot where it is identified that the need

directly relates to the covered personal injury; (b) That the Client is assessed and fitted with a moon boot that is

in accordance with the manufacturer’s specifications and is in accordance with best practice guidelines.

6.2.3.5.3. Knee Braces which includes: (a) Providing a Knee brace where it is identified that the need

directly relates to the covered personal injury; (b) That the Client is assessed and fitted with a Knee brace that is

in accordance with the manufacturer’s specifications and is in accordance with best practice guidelines.

6.2.3.6. Written Report and Liaison 6.2.3.6.1. Where additional oversight is identified as being required, a review

of the claim may be completed and reported in the Client’s comprehensive clinical record.

6.2.3.6.2. A review of the claim must be undertaken prior to the 16th visit. 6.2.3.6.3. The report under clause 6.2.3.6 above must contain the following:

(a) A review of the Mechanism of Injury; (b) A review of the injury and clinical diagnosis; (c) A statement on causation considering (a) and (b) above; (d) A review of the current Treatment Plan; (e) Documentation of any recommendations and actions that the

treatment provider will need to consider. (including changes to the treatment plan, onward referral or investigation);

(f) Expected outcome with consideration of any recommended changes;


(g) It is expected that the clinical director is available to discuss the findings with the treating physiotherapist.

6.3. ACC Prior Approval

6.3.1. Suppliers must submit a Request for Prior Approval of Further Treatment form to ACC (as published on the ACC website) and have ACC’s prior approval for treatment beyond the applicable Physiotherapy Treatment Profile Trigger Number of treatments for a Personal Injury.

6.3.2. All requests for additional treatment will be submitted to ACC electronically via the ACC web form or through a Practice Management System. This is effective from 1 August 2018.

6.3.3. ACC will not pay for treatment provided without prior approval beyond the applicable Physiotherapy Treatment Profile Trigger number.

6.3.4. Where: 6.3.4.1. prior approval for treatment is required; and 6.3.4.2. the Supplier provides treatment and invoices ACC for such treatment without

prior approval; and 6.3.4.3. ACC pays the Supplier for such treatment, ACC may recover that payment from

the Supplier by deducting the amount overpaid from any future payment owing to the Supplier by ACC.

6.3.5. On request in writing from ACC, the Supplier will provide to ACC in respect of a Client: 6.3.5.1. the clinical records and the Request for Prior Approval of Further Treatment

form electronically to ACC using the form prescribed by ACC; and/or 6.3.5.2. the electronic Referral form prescribed by ACC; and/or 6.3.5.3. any other electronic forms as prescribed by ACC.

6.4. The Supplier will ensure that all clinical records are completed on a practice management software system. This requirement will be met by 31 May 2020.

7. SERVICE EXIT

7.1. The service is completed for a Client when:

7.1.1. The Client has been discharged from care; or 7.1.2. The Client has been transferred to another provider to continue the Client’s care.

7.2. At the completion of Services the following information will be collected and supplied to ACC on request:

7.2.1. Client discharged with goals met (Yes/No, Based on the outcome of the Patient Specific Functional Scale);

7.2.2. Client discharged by Service Provider, Client self-discharged, Client lost to follow up, or referred onto another service;

7.2.3. Numerical Pain Rating Scale at baseline and discharge; 7.2.4. 11 Point Global Rating of Change Scale at discharge.

8. CLINICAL DIRECTOR

8.1. The Supplier will appoint a clinical director who is named at. Part A, clause 3.


8.2. The named clinical director will have a minimum of 5 years of experience in the area of clinical practice and a minimum of a post graduate certificate in an area relevant to the clinics practice. This requirement will be met by 31 May 2020.

8.3. The Clinical Director will:

8.3.1. Conduct internal audits of the quality of clinical record keeping against the requirements outlined in Physiotherapy standards, code of ethics and practice thresholds; and

8.3.2. Provide clinical oversight, assist with diagnosis, establishment of causation and treatment planning where required for Service Providers providing Services under this Service Schedule;

8.3.3. Check the clinical records and provide a clinical review in accordance with Part B, clause 6.2.3.6. prior to the 16th consultation for each Client. This review will include review of the diagnosis, treatment plan and opinion regarding causation. Documentation of the review is required and will form a part of the Client’s comprehensive clinical record;

8.3.4. Ensure that ACC specific induction and orientation is provided to all staff at the Clinic before they commence independent practice or – in the case of administration staff – before they work unsupervised;

8.3.5. Induct and assess each Service Provider on the quality and safety of their practice; 8.3.6. Ensure that all Service Providers have read the ACC Partnership Agreement and a signed

copy of the declaration is kept on file at the clinic; 8.3.7. Ensure that the 6 monthly ACC in-service training requirements are undertaken by all

Service Providers and administrative staff; 8.3.8. Work with ACC to resolve any clinical performance concerns that are identified; 8.3.9. The clinical director may delegate the activities listed in clauses 8.3.1-8.3.7 above to a

suitably qualified staff member who meets the education and experience criteria listed in clause 8.2 above.

9. EXCLUSIONS

9.1. The following services are not to be provided or paid for under this Service Schedule (but may be provided and paid for under other service contracts with ACC, or under regulations if required and applicable):

9.1.1. Public Health Acute Services; 9.1.2. Elective services inpatient post-Surgical physiotherapy treatment; 9.1.3. Treatment that is not specified in Part B, clause 2 and Part B, clause 4; 9.1.4. Treatment that is provided to a Client that is part of another ACC contracted service the

Client is receiving.

10. PERFORMANCE AND SERVICE EVALUATION

10.1. In addition to the requirements outlined in the Standard Terms and Conditions, clause 13. The Supplier:

10.1.1. Will participate in the 6-monthly performance survey that will be sent out by ACC; and 10.1.2. Is required to make themselves available and participate in any performance meetings

which ACC arranges.


11. REPORTING

11.1. ACC will not be charged any additional fee for the provision of reports/notes/letters or summarised comprehensive letters when requesting, in accordance with clause 12 of the Standard Terms and Conditions, information contained within these documents following a consultation that has been performed under this Service Schedule.

12. COMMUNICATION

12.1. Unless otherwise specified in this Service Schedule, all communications between ACC and the Supplier in respect of the Physiotherapy Services will in the first instance be conducted through the Clinical Director listed in Part A, clause 3 of this Service Schedule.

12.2. ACC may provide Individual Feedback Reports (IFRs) to the Supplier and/or Service Providers at Supplier, clinic and/or Service Provider level.

12.3. IFRs are a self-audit tool for Service Provider education. ACC will not use IFRs for performance management

13. PAYMENT AND INVOICING

13.1. Service prices are defined for this Service in Part A, clause 6, Table 1 Physiotherapy Service Items and Prices and Table 2 DHB Physiotherapy Service Items and Prices.

13.2. ACC agrees to pay the prices set out in Part A, clause 6, Tables 1 and 2 for Services provided in accordance with this Agreement.

13.2.1. Services outlined in Table 2 are only available to contracted DHB suppliers.

13.3. In addition to the invoicing requirements outlined in clause 10 of the Standard Terms and Conditions the Supplier will provide an invoice that:

13.3.1. is provided on an applicable bulk billing schedule for all Physiotherapy Services provided under this Service Schedule; and

13.3.2. specify the Service Provider who was primarily responsible for the Services provided to the Client;

13.3.3. The Supplier must invoice ACC directly for Physiotherapy Services provided, and ACC will not accept invoices from subcontractors of the Supplier or from Service Providers (other than the Supplier);

13.3.4. Payments of complying schedules and invoices will be made in accordance with this Service Schedule and will be direct credited into the Supplier’s nominated bank account provided the Supplier has complied with all its obligations under this Service Schedule.

14. ADDITIONAL PAYMENT (STANDARD TERMS AND CONDITIONS, CLAUSE 10.3)

14.1.1. The Supplier may set and charge a Client co-payment for Physiotherapy Services provided. Charges must be clearly displayed and the Client must be made aware of the charges prior to receiving Services.

14.1.2. The Supplier may not charge ACC where the Client fails to attend an appointment. 14.1.3. The Supplier may charge a Client a “did not attend” fee if the Client does not attend a

scheduled appointment and does not advise the Service Provider in advance that they will not be attending the appointment. The Client must be made aware that there is a charge applicable for missed appointments if the Supplier intends charging for these.


14.1.4. The Supplier may charge a Client for materials used in treatment e.g. strapping or orthoses. The Client must be made aware of any charges prior to use or application of these materials.

14.2. The Supplier may charge a Client for travel to provide Physiotherapy Services for the Client. The Client must be made aware of any charges prior to travel being undertaken at the Client’s expense.

15. DEFINITIONS AND INTERPRETATION

In this Service Schedule unless the context otherwise requires:

“Conformity Assessment Body” means an organisation carrying out testing, inspection or certification that has been accredited by an accreditation authority.

“Initial Consultation” means the first Physiotherapy consultation for a covered Personal Injury.

“Main location” is a specific location where the allied health professional service is provided from and is the primary premises of that business. There are administration and support services (reception, cleaning, laundry etc) which form part of the business.

“Off site location” is an allied health professional service provided away from its main business site or satellite site as an extension of the services provided by that business and where these services are delivered for a prescribed population at another location which is not part of the practice certification outlined in 4.1.

“Physiotherapist” means a person who holds a current annual practising certificate and is a registered Physiotherapist under the Health Practitioners Competence Assurance Act 2003.

“Physiotherapy Treatment Profiles” means the description of physiotherapy rehabilitation and expected incapacity duration for a specified injury, as published by ACC from time to time.

“Physiotherapy Treatment Profile Trigger Number” is the number of treatments, as listed in the Physiotherapy Treatment Profiles, after which ACC requires prior approval for further treatment.

“Satellite Location” means an allied health professional service provided away from its main business site as an extension of the services provided by that business and where these services operate as a standalone clinic and are certified as outlined in 4.1.

“Telehealth” means the use of information or communication technologies to deliver health care when patients and care providers are not in the same physical location. There are three recognised components of Telehealth in New Zealand: Telemedicine, Telemonitoring, and Mobile Health. For this Service Schedule Telehealth relates to videoconferencing interactions.


PART C. SERVICE SPECIFICATION FOR PHYSIOTHERAPY SPECIALIST SERVICES

This Part C applies only if the Supplier has a Named Physiotherapy Specialist specified in Part A, clause 3.

1. SERVICE OBJECTIVES

1.1. The objective of the Physiotherapy Specialist Service is to provide Clients with timely access to a quality physiotherapy specialist assessment, rehabilitation, and treatment planning services that facilitates a prompt, cost-effective and sustainable return to independence and/or work or education.

1.2. The key objectives of Physiotherapy Specialist services include:

1.2.1. providing accurate assessment and diagnosis of injury and functional limitations; 1.2.2. accessing appropriate investigations to aid in assessment and treatment planning where

needed. 1.2.3. providing an Assessment, Rehabilitation and Treatment Plan (ARTP) and advice to Clients

informed by the evidence 1.2.4. liaising with referring providers or providing referral to an appropriate treatment provider

to implement the treatment plan;

2. SERVICE PHILOSOPHIES (SPECIFIC TO PHYSIOTHERAPY SPECIALIST SERVICES)

2.1. The primary focus of Physiotherapy Specialist treatment is to restore a Client’s health to the maximum extent practicable.

2.2. Treatment must be necessary and appropriate, match the quality required, be provided an appropriate number of times, at the appropriate time and place, and be of a type normally provided by Physiotherapist Specialists.

2.3. Treatment effectiveness is measured using outcome measures that are reliable, valid, responsive to change, related to the functional goals of treatment and relevant to the Client’s injury.

3. SERVICE ELIGIBILITY

3.1. A Client is entitled to Physiotherapy Specialist Services under this Service Schedule if:

3.1.1. the Client has suffered a personal injury in terms of the Accident Compensation Act 2001 for which a claim for cover has been accepted, or is likely in the Named Provider’s experience to be accepted (“Personal Injury”); and

3.1.2. the Client has been referred to Physiotherapy Specialist Services by a registered health practitioner.

4. SERVICE LOCATION

4.1. The Supplier will ensure that Physiotherapy Specialist Services are provided at the location(s) specified in Part A, clause 5.


5. SERVICE REQUIREMENTS

5.1. For Service Providers:

5.1.1. The Supplier will ensure that Physiotherapy Specialist services are carried out by a Named Provider specified in Part A, clause 4 who: 5.1.1.1. holds a current Annual Practising Certificate issued by the Physiotherapy Board

of New Zealand which includes the designation of Physiotherapy Specialist; and

5.1.1.2. is registered with ACC to provide Physiotherapy Services; and 5.1.1.3. provides services only within their designated specialty.

5.2. Physiotherapy Specialist Services provided under this Service Schedule will include:

5.2.1. Arranging any necessary appointments with the Client; and 5.2.2. An Initial Assessment which includes:

5.2.2.1. A clinical history and examination of the Client; and 5.2.2.2. Discussion between the Client and the Named Provider concerning suitable

treatment options; and 5.2.2.3. Completion of relevant baseline and outcome measures; and 5.2.2.4. Documentation of clinical records: and 5.2.2.5. Completing of an ARTP, or 5.2.2.6. Referral for any required investigations to support the assessment.

5.2.3. A follow up assessment may be undertaken for the purposes of: 5.2.3.1. Reassessment of the Client, and review of the result of any investigations

requested; and 5.2.3.2. Reassessment and reviewing Client progress following referral back from a

treatment provider for review. 5.2.4. A follow up assessment must include:

5.2.4.1. Reassessment of the Client and discussion with the Client outlining the results of any investigations received; and

5.2.4.2. Reassessment against reported outcome measures; and 5.2.4.3. Documentation of clinical records; and 5.2.4.4. Completion of an ARTP if it was not completed initially due to needing to

obtain further information or diagnostic tests for the Client.

5.3. Clinical records and reports generated under this Part C must be provided to ACC within 10 working days of an assessment.

5.4. ACC Prior Approval

5.4.1. Suppliers must submit a Request for Prior Approval of Further Treatment form to ACC (as published on the ACC website) and have ACC’s prior approval for treatment beyond the applicable Physiotherapy Specialist Treatment Profile Trigger Number of treatments for a Personal Injury.

5.4.2. All requests for additional treatment will be submitted to ACC electronically via the ACC web form or through a Practice Management System.

5.4.3. ACC will not pay for treatment provided without prior approval beyond the applicable Physiotherapy Treatment Profile Trigger number.

5.4.4. Where: 5.4.4.1. prior approval for treatment is required; and


5.4.4.2. the Supplier provides treatment and invoices ACC for such treatment without prior approval; and

5.4.4.3. ACC pays the Supplier for such treatment, ACC may recover that payment from the Supplier by deducting the amount overpaid from any future payment owing to the Supplier by ACC.

5.4.5. On request in writing from ACC, the Supplier will provide to ACC in respect of a Client: 5.4.5.1. the clinical records and the Request for Prior Approval of Further Treatment

form electronically to ACC using the form prescribed by ACC; and/or 5.4.5.2. the electronic Referral form prescribed by ACC; and/or 5.4.5.3. any other electronic forms as prescribed by ACC.

5.5. The Supplier will ensure that all clinical records are completed on a practice management software system. This requirement will be met by 31 May 2020.

6. SERVICE EXIT

6.1. The service is completed for a Client when:

6.1.1. The Client has been discharged from care; or 6.1.2. The Client has been transferred to another provider to continue the Client’s care.

7. EXCLUSIONS

7.1. The following services are not to be provided or paid for under this Service Schedule (but may be provided and paid for under other service contracts with ACC, or under regulations if required and applicable):

7.1.1. Public Health Acute Services 7.1.2. Elective services inpatient post-Surgical physiotherapy treatment 7.1.3. Treatment that is not specified in Part C, clauses 2 and 3 7.1.4. Treatment that is provided to a Client is part of another ACC contracted service the Client

is receiving.

8. REPORTING

8.1. ACC will not be charged any additional fee for the provision of reports/notes/letters or summarised comprehensive letters when requesting, in accordance with clause 12 of the Standard Terms and Conditions, information contained within these documents following a consultation that has been performed under this Service Schedule.

9. PERFORMANCE AND SERVICE EVALUATION

9.1. In addition to the requirements outlined in the Standard Terms and Conditions, clause 13. The Supplier is required to participate in any performance meetings which ACC arranges.

10. PAYMENT AND INVOICING

10.1. Service prices are defined for this Service in Part A, clause 7, Table 3 Physiotherapy Service Items and Prices.

10.2. ACC agrees to pay the prices set out in Part A, clause 7, Table 3 for Services provided in accordance with this Agreement.


10.3. In addition to the invoicing requirements outlined in clause 10 of the Standard Terms and Conditions the Supplier will provide an invoice that:

10.3.1. is provided on an applicable bulk billing schedule for all Physiotherapy Services provided under this Service Schedule, and:

10.3.2. specify the Service Provider who was primarily responsible for the Services provided to the Client

10.3.3. The Supplier must invoice ACC directly for Physiotherapy Services provided, and ACC will not accept invoices from subcontractors of the Supplier or from Service Providers (other than the Supplier).

10.4. The prices set out in Part A, clause 7, Table 3 are the entire amount chargeable to ACC in relation to the Physiotherapy Specialist Services and no additional amount may be charged to ACC, the Client or other person for Services under this Service Schedule.

service schedule for physiotherapy services contract …€¦ · contract no: «contract_» part a....

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