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.
Chapters
Chapters
6. Part 6 SIRA's supervision process
Compliance with the conditions of approval
SIRA will actively monitor and supervise an approved provider's compliance with the conditions of approval.
Monitoring will be based on data SIRA holds and receives from other stakeholders (including insurers, employers and stakeholders) along with information directly from the provider.
Data may include:
- return to work measures, outcomes, duration and cost
- complaint records
- worker experience
- results from any evaluation
- corrective action plans
- any quality improvement plans resulting from the annual provider evaluations.
SIRA's supervision process aims to be evolving, preventative and corrective by working collaboratively with providers to:
- strengthen and build capability
- prevent harm and improve the quality of services
- resolve problems and provide oversight
- build systems of governance that provide value-based care
- ensure cost-effective services that produce person-centred health and recovery through work outcomes.
Response to non-compliance with conditions of approval
Where a provider identifies non-compliance with the conditions of approval and/or performance issues, they should advise SIRA of the non-compliance.
Providers should submit to SIRA evidence of communication to involved stakeholders and a quality improvement plan outlining how the non-compliance will be resolved.
SIRA's regulatory action will be dependent on the provider's actions, evidence, risk and the capacity of the provider to remediate the issue/s to comply with the conditions of approval.
Where SIRA identifies compliance and performance issues, dependent on evidence and risk assessment, SIRA may:
- request the provider submit a corrective action plan to SIRA within 30 days of the date SIRA advises the provider of the non-conformance
- initiate a SIRA evaluation
- ask the provider to show cause why the certificate of approval should not be cancelled or suspended. SIRA will give the provider a specific timeframe for a response or action set by SIRA according to the identified issue
- amend or revoke the conditions of approval, or add to those conditions
- refer the matter to another regulatory body.
Cancellation or suspension of a certificate of approval
SIRA may cancel or suspend a provider's certificate of approval at any time for non-compliance with any or all of the conditions of approval.
Grounds for cancellation or suspension of a provider's certificate of approval include those outlined in clause 33, Ppart 7 of the Regulation.
Where a provider has failed to meet any or all of the conditions of approval, SIRA will advise of its intention to suspend or cancel the certificate of approval.
SIRA will give the provider an opportunity to show cause why the certificate of approval should not be suspended or cancelled. SIRA will review the response to determine if suspension or cancellation of the certificate of approval should proceed. The provider will be notified by SIRA of any decision to suspend or cancel their certificate of approval in writing.
Providers must also ensure the continuity of care for both open and closed claims in consultation with the relevant insurer and email [email protected] to advise of these arrangements.