Workers compensation workplace rehabilitation provider approval framework

This framework sets out the requirements for organisations delivering or seeking to deliver workplace rehabilitation services within the NSW Workers Compensation Scheme.

2. Part 2 Conditions of approval

Condition of Approval 1

Providers will be required to submit a service delivery model that outlines the services proposed and how they will be delivered. Providers should aim to ensure that every dollar spent delivers quality and value and optimises recovery.

Providers are encouraged to explore innovative approaches which respond to individual circumstances and addresses specific needs, including:

workers with psychological injury
workers who reside in rural and remote areas, and/or
workers from culturally and linguistically diverse backgrounds.

In developing a proposed service delivery model, providers must establish and implement a model aimed at early, safe and durable recovery at, or return to work for workers. The model must be aligned to evidence and demonstrate how services will be delivered in a cost effective, timely and proactive manner.

Table 2.1 Mandatory requirements for Condition 1

Services must be delivered in accordance with the approved service delivery model
a) Service delivery model requirements	The provider must submit its service delivery model with their application for approval. To be approved, the service delivery model must: ensure delivery of evidence-based services to achieve return to work or recovery at work outcomes for workers specify the service streams and how these will be delivered include supporting policies and procedures.
b) Service streams and practice standards	The provider is to deliver services in accordance with the permitted service streams (see Part 3) and adhere to the relevant practice standards (see Part 4) to SIRA's reasonable satisfaction.
c) Return to work planning requirements	The provider must develop a written recover at work plan or return to work plan with involved parties which outlines the workplace rehabilitation services required and include Specific, Measurable, Achievable, Relevant and Time-bound (SMART) goals. A copy must be provided to all involved parties (with the worker's consent). The provider must then deliver services according to the plan approved by the insurer and update the written plan when the worker's goals or circumstances change.

Condition of Approval 2

Staff must meet and should ensure they continue to meet the minimum qualifications, skills and experience for the workplace rehabilitation services they deliver.

Providers are required to advise qualifications and services delivered by each staff member who will deliver workplace rehabilitation services to workers on the staff details form to be submitted with their application for approval.

Providers should ensure staff continue to develop skills in recovery through work, the biopsychosocial approach and knowledge of personal injury schemes.

Table 2.2 Mandatory requirements for Condition 2

Staff who deliver services must be appropriately qualified
a) Workplace rehabilitation management services	To be appropriately qualified, the staff must have at least 12 months’ experience or work under the supervision of another staff member who is appropriately qualified and be one of the following: medical practitioner, occupational therapist, physiotherapist or nurse with Australian Health Practitioner Regulation Agency (AHPRA) general registration osteopath with AHPRA general registration AND graduated a tertiary osteopathy course completed at: Royal Melbourne Institute of Technology from 2018 onward Victoria University from 2016 onward Southern Cross University from 2016 onward psychologist with AHPRA provisional or general registration exercise physiologist (accredited member of Exercise and Sports Science Australia) speech pathologist (full member of Speech Pathology Australia) social worker (full member of the Australian Association of Social Workers) rehabilitation counsellor (full member of Rehabilitation Counselling Association of Australasia; or full, associate or affiliate member of the Australian Society of Rehabilitation Counsellors). For affiliate members, the provider must ensure the following supervision occurs: a formal learning plan is developed a supervision and training program is maintained for the entire affiliate member period a person who meets the qualifications to deliver services and has two years’ experience is appointed to supervise the affiliate member's service delivery and evidence of that supervision is retained. To be appropriately qualified, staff who deliver job-seeking assistance as part of workplace rehabilitation management services must: be a rehabilitation counsellor that is a full member of the Australian Society of Rehabilitation Counsellors or Rehabilitation Counselling Association of Australasia; or meet the minimum qualifications and experience to deliver workplace rehabilitation management services, have undergone training in job seeking and using labour market information, instructing job seekers in job-seeking skills, locating jobs, negotiating placement with employers and using vocational rehabilitation programs and other incentive programs for employers; or have at least 12 months’ experience in placing disadvantaged job seekers with a new employer and work under the supervision of a person who meets the minimum qualifications to deliver workplace rehabilitation management job-seeking services.
b) Workplace and /or functional assessments	To be appropriately qualified, the staff must have at least 12 months’ experience or work under the supervision of another staff member who is appropriately qualified, and be either an: occupational therapist or physiotherapist with AHPRA general registration; or osteopath with AHPRA general registration AND a graduate of a tertiary osteopathy course completed at; RMIT from 2018 onward Victoria University from 2016 onward Southern Cross University from 2016 onward. exercise physiologist accredited with Exercise & Sports Science Australia (ESSA) who has successfully completed an ESSA-approved university course and gained ESSA certification to deliver workplace/functional assessments. To be appropriately qualified to deliver workplace and/or functional assessments for workers with psychological or cognitive injury, behavioural, communication or hearing disorder, the staff must be either a psychologist with AHPRA general registration, a rehabilitation counsellor (full member) or speech pathologist (full member).
c) Vocational assessments and/or rehabilitation counselling	To be appropriately qualified, the staff must have at least 12 months’ experience or work under the supervision of another staff member who is appropriately qualified and be one of the following: psychologist with AHPRA general registration rehabilitation counsellor (full membership of Australian Society of Rehabilitation Counsellors (ASORC) or Rehabilitation Counselling Association of Australasia (RCAA)) Associate members of ASORC may also be appropriately qualified if they design and implement a learning plan to develop their vocational assessment and counselling skills as appropriate for the NSW workers compensation system and adhere to professional member requirements. ASORC associate members must also work under the supervision of a consultant who is appropriately qualified.
d) Workplace facilitated discussions	To be appropriately qualified, staff who deliver workplace facilitated discussion services must: meet the minimum qualifications to deliver workplace rehabilitation management services with two years' experience, or hold a tertiary qualification in human resources, law or medicine and demonstrate two years' relevant experience working within a personal injury scheme supporting workers to recover at work. The staff must also: have qualifications and two years’ experience in conflict resolution, mediation and/or dispute management; or be a member of an organisation that complies with the National Mediator Accredited Standards (NMAS).
e) Specialist job-seeking services	Staff who deliver job-seeking assistance within a specialist job seeking service must: be a rehabilitation counsellor that is a full member of ASORC or RCAA; or hold a tertiary qualification or a bachelor's degree or higher in human resources, management, marketing, communications, career development, health or social science, with two years’ experience in supporting people to obtain work; or hold a professional membership with an Australian industry-recognised career development association (e.g. Career Development Association of Australia, Association of the Career Professionals International; or have demonstrated evidence of five years' experience supporting disadvantaged job seekers with new employment. Where staff have less than the required experience delivering specialist job-seeking services, they can provide services if they undertake a comprehensive induction and learning development plan, under the professional supervision of someone who meets the minimum requirements for the provision of specialist job-seeking services, until the staff member acquires the relevant years of experience.

Condition of Approval 3

SIRA expects providers will implement an organisation-wide governance system to ensure reliable, consistent, safe and effective service provision to workers, employers, insurers and other relevant parties. Quality systems should be integrated with governance processes to enable organisations to actively manage and improve the safety and quality of their workplace rehabilitation service provision.

Table 2.3 Mandatory requirements for Condition 3

Quality management systems and governance
a)	The provider must deliver services in accordance with legislation and regulatory requirements, including relevant privacy and work health and safety legislation as well as the NSW workers compensation legislation, guidelines and applicable fees orders.
b)	The provider must comply with SIRA's workplace rehabilitation provider code of conduct.
c)	The provider is to ensure one person in their management structure has five years' experience in a direct line of supervision of workplace rehabilitation service delivery, in addition to ensuring staff have current checks and clearances (police, security, work health and safety and child protection) appropriate for the worker and employer requirements.
d)	The provider is to maintain appropriate insurances, including professional indemnity, workers compensation and public liability throughout the period of approval.
e)	The provider is not to offer or accept financial incentives for referral of workers, or accept any inducement, gift, or hospitality from individuals or companies, or enter into arrangements that could be perceived to provide inducements that may influence or be seen to influence service provision.
f)	The provider is to document and notify any real, perceived, or potential conflict of interest to the referrer and worker at the time of referral or, if a conflict or potential conflict of interest arises after referral, as soon as it arises.
g)	The provider must have a safety and quality improvement system in line with Australian Standard AS/NZS ISO 9001 – Quality Management Systems - Requirements.
h)	The provider must have a feedback and complaints management system that adheres to the SIRA customer conduct principles and must inform workers of the complaints process.

Condition of Approval 4

Providers must ensure that workplace rehabilitation services achieve desired outcomes. Workplace rehabilitation providers are to adopt an outcomes-focused approach to the delivery of services that matter to workers and undertake an annual evaluation of their service delivery with reporting to SIRA in relation to prescribed matters.

Recovery at work measures are the primary measure used to monitor outcomes related to workplace rehabilitation service provision. SIRA will prescribe minimum outcomes measures for services to be delivered.

Table 2.4 Mandatory requirements for Condition 4

Reporting and evaluation requirements
a) Data collection	The provider must collect accurate data as prescribed by SIRA. Data must be submitted to SIRA annually or upon request by SIRA.
b) Outcomes	The provider must maintain minimum outcome measures as prescribed by SIRA for the service stream/s delivered as per the approved service delivery model.
c) Provision of reports	The provider is required to submit reports to SIRA as requested, including but not limited to an annual evaluation report, staff details form and an annual report summarising: feedback and complaints raised, and action taken conflict of interest matters quality and continuous improvement plan/s risks and incidents privacy breaches. The provider will also be required to report on any remediation actions required to address non-conformance.
d) Notification to SIRA	The provider must inform SIRA as soon as reasonably practicable, but no longer than 30 calendar days after becoming aware of, any of the following: a breach or alleged breach of privacy a false or misleading statement made in or in connection with an application for the certificate of approval or amendment of the certificate of approval a breach of condition of the certificate conviction of an offence involving fraud or dishonesty punishable on conviction by imprisonment for three months or more where a provider that is not a corporation has become bankrupt, applied to take the benefit of any law for the relief of bankrupt or insolvent debtors, compounded with creditors or made an assignment of remuneration for their benefit, or where a provider that is a corporation— (i) is in the course of being wound up, or (ii) is under administration, or (iii) is a corporation in respect of the property of which a receiver or manager (or other controller within the meaning of the Corporations Act 2001 of the Commonwealth) has been appointed, or (iv) has entered into a compromise or arrangement with its creditors, or the provider has not provided workplace rehabilitation services for a continuous period of three months or more, or a provider that is a corporation—that any director of the corporation— (i) has been convicted of an offence referred to in paragraph (c), or (ii) for any other reason would not be a fit and proper person to hold a certificate, if the certificate were held by the person. Providers must notify SIRA within 30 days if: the business is sold, or the controlling interest in the business is taken over by a new shareholder(s), owner(s) or director(s) the business changes its trading name or location of premises a new chief executive officer or director, or head of management is appointed there is a major change in the service delivery model and/or staff which may impact the delivery of the workplace rehabilitation services there is any other change that affects, or may affect, the provider's service quality and procedures there are any professional misconduct proceedings being taken against the provider or any individuals employed or engaged by the provider.
e) Evaluation	The provider must perform an annual evaluation to SIRA's reasonable satisfaction and/or participate in a SIRA-initiated evaluation conducted in accordance with the legislation and approval framework. The evaluation is to be undertaken in accordance with SIRA's evaluation protocol.