The Lifetime Support Scheme (LSS) Rules
The Lifetime Support Authority of South Australia
Table of Contents
Preamble
Part 1 – Introduction
- Philosophy
- Interpretation
- Use of ‘motor vehicle’ in the Rules
- Interaction with other legislative requirements
- Suspension of participation
- Use of interpreters in interactions with Participants or Decision Makers
- Sending documents to or from the LSA
- Documentation and other supporting material
- Medical documentation
- Approved providers
- Legal representation for Disputes
- Participant/ Decision Maker/ Applicant access to documents – Disputes
- Corrections of obvious errors in determinations/ Certificates
- Privacy and confidentiality/ release of information
- Commencement date
Part 2 – Eligibility for Participation in the Scheme
- Preliminary
- Application for participation
- Injury criteria
- Making an application
- Timing of FIM™ or WeeFIM® assessments – application to Scheme
- The LSA’s determination
- Interim participation timeframes
- Timing of assessments – Interim Participant
- Request for lifetime participation
- No request for lifetime participation
- Timing of FIM™ or WeeFIM® assessments – lifetime participation
Part 3 – Rules for Disputes about Eligibility for Participation
- Preliminary
- Lodging a dispute application
- Further information or documentation required
- Parties to a Dispute
- Disputes about non-medical matters
- Determination issued by the Review Officer
- Disputes about eligibility
- Expert Review Panel
Part 4 – Necessary and Reasonable Treatment, Care and Support Decision Making in the Scheme
- Background
- Treatment, care and support
- ‘Necessary and reasonable’ criteria
- Treatment, care and support service funding exclusions
Part 5 – Treatment, Care and Support Needs Assessments
- Preliminary
- Procedures for assessing Treatment, care and support needs
- LSA to require assessment
- Discharge Plan
- MyPlan
Part 6 – Treatment and Rehabilitation
- Preliminary
- Treatment and Rehabilitation services funded by the LSA
- Hearing Impairment
- Vision Impairment
- Treatment and Rehabilitation funding exclusions
Part 7 – Support, Attendant Care and Domestic Services
- Preliminary
- Support Services
- Attendant care services
- Domestic Services
- Support, attendant care and Domestic Services for Participants who are children
- Support and attendant care services for Participants who have caring responsibilities
- Alternatives to support and attendant care service provision
- Care training for Family members
- Support and attendant care services when the Participant is away from home
- Respite services
- Support, attendant care and Domestic Service funding exclusions
Part 8 – Accommodation
- Transitional accommodation
- Specialist Disability Accommodation
- Respite accommodation
- Accommodation exclusions
Part 9 – Assistive Technology
- Preliminary
- Assistive Technology prescription
- Assistive Technology requirements
- Assistive Technology funding exclusions
- Participant contribution to Assistive Technology
- Ownership of LSA funded Assistive Technology
- Modifications to existing household or leisure items
- Maintenance and repair of Assistive Technology
- Order of readily available Assistive Technology on discharge
- Continence products
- Beds/ mattresses
- Information and communication technology
- Environmental control technology
- Pressure care Assistive Technology
- Positioning and seated mobility Assistive Technology
- Orthoses, footwear and walking aids
- Respiratory Assistive Technology
- Assistive Technology for exercise and fitness
- Assistive Technology for recreation or leisure purposes
- Funding exclusions
Part 10 – Home Modifications
- Background
- Preliminary
- Consent for Home Modifications
- Ensuring the home can be modified
- Assessment of the need for Home Modifications
- Necessary and reasonable Home Modifications
- Minor modifications to home
- Modifications to a Rental Property
- Modifications to a home owned by the Participant or their Family
- Relocation if the home is not suitable for modification
- Assistance when relocating to or building a new home
- Service Providers for Home Modifications
- Home Modification to a secondary home that is lived in concurrently
- Subsequent Home Modification
- Repairs and maintenance on Home Modifications
- Room temperature control Assistive Technology
- Home Modifications funding exclusions
- Room temperature control Assistive Technology funding exclusions
Part 11 – Motor Vehicle Modifications
- Background
- Preliminary
- Motor Vehicle Modifications funded by the LSA
- Frequency of funding modifications to a motor vehicle
- Funding exclusions
Part 12 – Prosthetic and Orthotic Devices and Services
- Background
- Preliminary
- Prosthetic and Orthotic services funded by the LSA
Part 13 – Education Support Services
- Background
- Preliminary
- Approval of funded education support services
- Educational support service exclusions to funding
Part 14 – Vocational Support Services
- Preliminary
- Vocational support services
- Excluded vocational support (pre-vocational, vocational training and retraining)
Part 15 – Temporary International Travel and Participants Living in International Locations
- Preliminary
- Notice
- Temporary International Travel: Considerations for payment for TCS services
- Permanent residence: considerations for payment of TCS services for Participants residing in an international location
Part 16 – Self-Directed Support and Reimbursement Arrangements
- Preliminary
- Self-Directed Support
- Eligibility
- Unreasonable risk
- The Self-Directed Support Agreement
- Reimbursement Arrangements
Part 17 – Buying into the Scheme
- Preliminary
- Request to buy in
- How the LSA calculates cost to buy in
- What the buy in amount includes
- The LSA’s notification of the amount required to buy in
- Buy in as a Lifetime Participant
- Buy in funds reimbursement
Part 18 – Rules for Review of Participant’s Treatment, Care and Support Needs
- Preliminary
- Reassessment
- Process
- Certificate issued by Assessor
- Application to Expert Review Panel
- Expert Review Panel
Part 19 – Ambulance Services
- Necessary and reasonable ambulance services
- Method of assessment and criteria
Part 20 – Dental Treatment
- Necessary and reasonable dental treatment
- Method of assessment and criteria
- Dentures
- Exclusions
Part 21 – Medical Treatment including Pharmaceutical Products
- Necessary and reasonable medical treatment
- Method of assessment and criteria
- Necessary and reasonable pharmaceuticals
- Assisted fertility treatment
- Method of assessment and criteria
- Exclusions
Part 22 – Workplace and Education Facility Modifications
- Preliminary
- Modifications to a workplace or education facility
- Method of assessment and criteria
- Repairs and maintenance to workplace or education facility modifications
- Exclusions
Page last updated: 16 September 2022