Summary of key changes made to the consultation draft Guidelines for the Provision of Health and Related Services

The names and numbers of the parts have changed and there are no longer sub-headings. The clause numbering has changed.

Each Part of the Guidelines now has a box at the beginning explaining which providers the Part applies to.   SIRA has decided that some parts will not apply to RSPs who must already comply with similar requirements.  For example, the code of conduct will not apply to RSPs who have similar requirements in their conditions of approval (e.g. approved allied health providers in the WC scheme, or health practitioners approved to give evidence in the CTP scheme).  While these requirements are usually very similar, there are some that are different, and applying the Code of Conduct will cause confusion.

SIRA has also decided to use the Motor Accident Guidelines to specify all matters related to invoicing for services (except for the invoicing for pharmaceutical services) provided under the motor accidents legislation.  As a result, Part 5 and Part 6 will not apply in the CTP scheme.  The Motor Accident Guidelines will be updated to make its invoicing requirements consistent with those in these Guidelines (where applicable).

Amended 3(a) to remove “in a manner that supports the principal objectives of SIRA as set out in section 23 of the Act” - see new wording at a).

Added sentence “Words defined in the Acts or the Regulations have the same meaning in the Guidelines.”

Application of the Guidelines

Purpose of the Guidelines

Compliance with the guidelines

Split sub-section titled ‘Application and purpose of the Guidelines’ into three sub-sections ‘Application of the Guidelines’, ‘Purpose of the ‘Guidelines’, and ‘Compliance with the Guidelines’. Each subsection has been substantially amended.

‘Application of the Guidelines’ now states that “RSPs must comply with applicable clauses in the Guidelines”. Each Part of the Guidelines now includes a green box which provides guidance on who each section applies to. A new ‘Part 8: Application of the Guidelines by relevant service/provider’ has also been introduced to assist RSPs to understand which sections apply to them.

A statement stating that “RSPs will be afforded procedural fairness by SIRA” has been added.

Renamed and moved the section to the end of the Guidelines (following Part 8).

Added the following definitions:  allied health mental health services, assessment of permanent impairment services, culturally safe practice, independent medical examination services, motor accident legislation, peer review services, workers compensation legislation.

Amended the following definitions: allied health service/s, direction, overservicing, relevant service provider, support team.

Removed the following definitions: insurance, compensation or health authorities; government agencies or statutory bodies; medico-legal services.

Part 1

1.2

The Code of Conduct has been changed as follows.
Added the following clause to the code of conduct:

• 1.2 (d) comply with relevant provisions of these Guidelines, and relevant provisions of the workers compensation and motor accident legislation and the regulations and guidelines made under those Acts,

Some provisions in the consultation draft were considered more appropriately located in the code of conduct. These were moved and amended (for clarification and simplification) from other Parts of the Guidelines into the following clauses of the Code of Conduct (see clause 1.2).

• a) be appropriately registered, accredited, or hold appropriate professional membership, qualified and experienced to provide the relevant service
• i) work collaboratively and communicate in an effective and timely manner with members of the injured person’s support team about the injured person's injury, treatment and recovery,
• j) participate in peer reviews of the injured person's injury, treatment and recovery, if the RSP is a provider of allied health services,
• k) respond to a request from SIRA for information relating to compliance with the Act, workers compensation legislation or motor accident legislation or the regulations or guidelines made under those Acts in the form, time and manner reasonably required and requested (including consistency with privacy legislation) by SIRA from time to time.

Amended clauses 19 a, b, d, e, and f in the code of conduct which now read as follows in clause 1.2:

• b) act in a professional, ethical, honest and impartial way
• c) treat an injured person with empathy, respect and culturally safe practice,
• f) not provide, bill or refer for relevant services, in a misleading or deceptive way intended to result in financial or personal gain of the RSP or another person or entity where the RSP or the other person is not entitled to the financial or personal gain,
• g) identify perceived, potential and actual conflicts of interest and manage them to ensure services provided best meet the needs of injured people. Where there is an actual conflict, declare it to the injured person concerned, the referrer and the insurer concerned (or the Lifetime Care and Support Authority of NSW in exercising functions under the Motor Accident Injuries Act 2017),
• h) comply with the applicable laws in protecting injured person’s personal and health information.

Removed clause 21 a), b) and c) which were requirements that RSPs could not have (in summary):

• Limitations, conditions, be suspended or disqualified in relation to their registration/licence etc
• Had a complaint upheld or action taken by an insurance, compensation, health, etc body
• Been convicted of a criminal offence or have criminal charges pending, or civil proceedings against them

These were removed as the Guidelines cannot provide SIRA with the necessary discretion in responding to issues that arise in relation to these requirements.

Removed clauses 26 a), b) and c) that relevant services be delivered in accordance with:

• the Clinical Framework for the Delivery of Health Services
• the Health Benefits of Work
• value-based health care and the quadruple aim.

This is in response to stakeholder feedback that inclusion would potentially be clinical overreach by SIRA, that many RSPs would not be aware of these documents/concepts, and other workability issues.

Added 2.1 defining telehealth as “services that use videoconferencing or telephone as an alternative to an in-person consultation.”

Removed 31 (a) which required a face-to-face consultation within the previous 12 months, following feedback that this is not workable.

Added 2.2, “a telehealth service must be conducted by videoconference unless that medium is unavailable or determined to be inappropriate following consideration of the factors outlined in clause 2.5…”

Added 2.3, “telehealth services must not be solely provided by email, SMS, or through an app…”

Added 2.4, “telehealth must be provided in combination with in-person services unless these services are psychiatric or allied health mental health services, or pre-approved by the insurer…”.

Amended 31 (b) and added 2.5, requiring that the injured person must request or consent to telehealth (2.5 (a)) and that the RSP considers telehealth appropriate after considering the factors outlined at 2.5 (b).  These same factors were listed at 31 (b), except for the addition of 2.5 (b) (ii) “whether it will compromise worker outcomes”.

Amended Part to apply to RSPs providing independent medical examination services under the workers compensation legislation only. The Part does not apply to assessments of permanent impairment services under the workers compensation legislation as these are covered by the Workers Compensation Guidelines for the Evaluation of Permanent Impairment. Part 4 does not apply to medico-legal services provided under the motor accident legislation, as these are covered by Part 8 of the Motor Accident Guidelines.

Amended and added clauses relating to the conduct of IMEs providing services under the workers compensation legislation.

Removed 34 (f) and (g) (conflict of interest - as this is covered by section 7.3 of the Workers Compensation Guidelines) and added 4.1 (e) (ethical behaviour), (f) (comply with privacy laws) and (g) (not ask for inducements, gifts or hospitality).

Amended clause 40 (a) to remove itemisation requirements (see 6.2)
Amended clause 40 (b) to (see 6.2) (in summary):

• clarify what information must be included in invoices
• add specifications for private hospital services (6.2 (b) vii)) and surgery (6.2 (b) viii),
• reorder some requirements.