1.1 The Lifetime Support Authority of South Australia (the LSA) is a statutory authority established under the Motor Vehicle Accidents (Lifetime Support Scheme) Act 2013 (the Act). The LSA is responsible for the administration of the Lifetime Support Scheme (the Scheme).
1.2 The Scheme provides treatment, care and support for participants (adults and children) who have sustained a serious spinal cord injury, brain injury, amputations, burns or blindness (eligible injury) resulting from a motor vehicle accident in South Australia, that occurs on or after 1 July 2014, or for persons accepted under section 6 of the Act.
1.3 The Lifetime Support Scheme Rules (the Rules) are to be read as a whole and in conjunction with the Act.
1.4 Throughout these Rules, any reference to treatment, care and support benefits is a reference only to treatment, care and support benefits that:
1.4.1 are necessary and reasonable in the circumstances; and
1.4.2 relate to the motor vehicle injury, as defined by these Rules.
1.5 A person is eligible to participate in the Scheme if their motor vehicle injury occurred in South Australia and satisfies the eligibility criteria in Part 2 of these Rules and Part 3 of the Act.
1.6 Words and expressions used, but not defined in these Rules, have the same meanings as in the Act.
1.7 The LSA may, as it thinks appropriate, waive compliance with a Rule (or a part of a Rule).
2.1 As far as is practicable, the Rules are to be interpreted in a manner that is consistent with the following principles:
2.1.1 For the benefit of all South Australians, the LSA is committed to achieving and delivering a financially responsible and sustainable Scheme, so it can continue to support people over the course of their lives and be available to people who are not yet injured, but may be injured in the future.
2.1.2 The LSA provides necessary and reasonable treatment, care and support through a person-centred approach, enabling participants and their families to choose and control evidence-based support and service arrangements that enhance quality of life and provide opportunities to participate and contribute to social and economic life.
2.1.3 The LSA works to respect the individuality and diversity of participants.
2.1.4 In the case of participants who are children, the LSA works to respect the centrality of the family to children’s lives and well-being.
2.1.5 The LSA acknowledges:
“Recognising the importance for persons with disabilities of their individual autonomy and independence, including the freedom to make their own choices.”
“Considering that persons with disabilities should have the opportunity to be actively involved in decision-making processes about policies and programmes, including those directly concerning them 1” .
2.1.6 The delivery of effective treatment, care and support services involves communication and collaboration between the participant, their family, service providers and the LSA.
. United Nations General Assembly, Convention on the Rights of Persons with Disabilities, 13 December 2006, A/RES/61/106, Annex I
3.1 In the Rules, these words and phrases have the following meanings:
Act means the Motor Vehicle Accidents (Lifetime Support Scheme) Act 2013. A reference in these Rules to a section “X” is a reference to a section of the Motor Vehicle Accidents (Lifetime Support Scheme) Act 2013.
AHPRA is the Australian Health Practitioner Regulation Agency.
AMA is the Australian Medical Association.
Applicant is a person applying, or on behalf of whom an application was made, to be part of the Scheme.
Application Form means the form developed by the LSA to enable application to the Scheme and made available on its website.
Appropriately qualified for the purposes of these Rules, any reference to “appropriately qualified” is an assessment of the LSA with respect to the specialist skills that a person has in assessing, prescribing or recommending.
ASIA Impairment Scale score refers to the published scale of the American Spinal Injury Association: International Standards for Neurological Classification of Spinal Cord Injury, revised 2011, Atlanta, GA.
Assessed care needs means the LSA’s assessment of the participant’s treatment, care and support needs which relate to the motor vehicle injury and are necessary and reasonable in the circumstances, as defined in section 4(1) of the Act.
Assessor means a person appointed or engaged as an assessor under section 30(4) of the Act for the purposes of Part 3 of the Act.
Attendant care worker means an employee of, or person engaged by an approved provider of attendant care services to perform services or assist the participant, such as (but not limited to):
- personal care (assistance to move around and take care of basic personal needs such as bathing, dressing, eating, toileting, grooming, fitting and use of aids and appliances, hearing and communication devices); or
- therapy support to implement a therapy program under the guidance and supervision of a health professional.
Certificate means a certificate issued:
- for original assessment under section 30(3) of the Act; or
- for reassessment after review, under section 38(5) of the Act.
DES means Domiciliary Equipment Services.
Discharge Plan is the plan that usually documents a participant’s assessed treatment, care and support needs required post-discharge from an inpatient facility. It is prepared by the LSA, in consultation with the participant and their treating team. The Discharge Plan represents the certification of treatment, care and support needs as required under section 30 of the Act.
Dispute means a dispute about a non-medical matter or any aspect of a non-medical matter under Part 5 Division 1 of the Act or a dispute about eligibility under Part 5 Division 2 of the Act.
Domestic services include a variety of household services such as cleaning, cooking, laundry, and ironing.
Eligible injury means the injury assessed as eligible under Part 2 of the Rules.
Expenses means expenses incurred for the purposes of the Scheme by or on behalf of the participant while a participant in the Scheme.
Family includes a key person who is identified by a participant to be a member of the participant’s family or an integral part of the participant’s close personal support network. Family also includes parents and/or the legal guardian of a participant. Where used in these Rules, parent, guardian, legal guardian will imply ‘family’.
Functional Independence MeasureTM – FIMTM is a tool used to assess a person’s function. Where referred to in these Rules the version used is published on the LSA’s website.
The FIM™ assessment is an assessment of a person’s function conducted by an assessor approved by the LSA who has been trained in FIM™ and is credentialed through the Australasian Rehabilitation Outcomes Centre.
Glasgow Coma Score (GCS) is a neurological scale that aims to deliver a reliable, objective way of recording the conscious state of a person for initial, as well as subsequent assessment.
Greenwood Burns Scale is the assessment for burns designed by Professor John Greenwood, and published on the LSA’s website.
Home is a domestic structure, which is a participant's principal place of residence, for example, a house or a unit.
Home modification is a modification to the structure, layout or fittings of a home where the motor vehicle injury restricts or prevents the ability to utilise the home’s standard fittings or facilities.
International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) is the standard published by the American Spinal Injury Association and International Spinal Cord Society documenting the remaining autonomic functions following spinal cord injury.
International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the sensory and motor examination used to determine the neurological level of the injury and whether the injury is complete or incomplete. The completeness of the injury is graded according to the ASIA Impairment Scale Score A to E.
MBS is the Medicare Benefits Schedule.
Motor vehicle injury means any injury caused by or arising from the motor vehicle accident that caused the eligible injury, and includes the eligible injury.
Motor vehicle modification is any modification to the structure or fittings of a vehicle where the motor vehicle injury restricts or prevents the use of the motor vehicle without modification.
MyPlan is the plan that documents the participant’s assessed treatment, care and support needs and is prepared by the participant and the LSA. The MyPlan represents the certification of treatment, care and support needs as required under section 30 of the Act.
Prosthesis is an artificial substitute for a missing body part, such as a leg, used for functional or cosmetic reasons, or both.
Review means a review of a:
- dispute about non-medical matters (sections 33-34 of the Act) or eligibility (section 36); or
- determination of treatment, care and support needs (section 38).
Rehabilitation includes placement in employment and all forms of social rehabilitation such as family counselling, leisure counselling and training for independent living.
Rental property is a home lived in by a participant whereby rent is paid to a private owner, Government or Public Authority or a Community Housing Association.
Return to Work Corporation of South Australia (RTWSA) is a statutory authority established pursuant to the Return to Work Act 2014 to administer the South Australian Return to Work Scheme.
Schedule of Fees for Approved Attendant Care Providers is the list of fees published in the Government Gazette and published on the LSA’s website.
Scheme refers to the Lifetime Support Scheme.
Snellen Scale is used by eye care professionals to measure visual acuity.
Support services are those services that complement rehabilitation services and focus on interventions that engage natural and community supports.
For example, this might include assistance in learning to use public transport, accessing community facilities or engaging with informal networks.
Treatment, care and support needs - for the purposes of these Rules and the Act, any reference to “treatment, care and support needs” and “treatment, care and support services” are references to such needs and services that are (section 27(2)):
- necessary and reasonable in the circumstances; and
- relate to the injury or injuries that have been determined to be eligible under Part 2 of these Rules.
WeeFIM® is the paediatric version of the FIM™. It is a similar tool to the FIM™ though it differs in its scoring processes taking into account the child’s developmental stages. The WeeFIM® has norms and a different scoring system to the adult FIM™.
WeeFIM® assessment is an assessment of a child’s function conducted by an assessor approved by the LSA who has been trained in WeeFIM™ and is credentialed through the Australasian Rehabilitation Outcomes Centre.
WeeFIM® Age Norm any reference to the age norm of any item on the WeeFIM® is a reference to the normative data published in the WeeFIM® Version 6.0 issued by Uniform Data System for Medical Rehabilitation.
Westmead PTA Scale measures the period of post-traumatic amnesia and is used in South Australian health services and is available on the LSA’s website.
Workplace modifications are modifications to fittings of a workplace beyond the requirements of the Disability Discrimination Act 1992 (Cth).
4.1 Pursuant to section 3(2) of the Act (but without derogating from the operation of section 5(2) of the Act), and subject to 4.2 below, a reference in the Act and these Rules to a motor vehicle is a reference to:
4.1.1 a motor vehicle that is subject to a policy of insurance under Part 4 of the Motor Vehicles Act 1959; or
4.1.2 a motor vehicle which is required to be subject to a policy of insurance under Part 4 of the Motor Vehicles Act 1959 and is driven on a road; or
4.1.3 a motor vehicle that is registered under a law of some other State or Territory which corresponds to the Motor Vehicles Act 1959 (if the motor vehicle accident occurred in South Australia).
4.2 Pursuant to section 3(4) of the Act, a motor vehicle injury will only be regarded as being caused by or arising out of the use of a motor vehicle that is a tractor, agricultural machines such as quad bikes, mobile fork lifts or self-propelled lawn care machine, if:
4.2.1 the relevant motor vehicle is conditionally registered under section 25 of the Motor Vehicles Act 1959; and
4.2.2 the motor vehicle is being used on a road.
5.1 Pursuant to section 27(3)(c) of the Act, the following treatment, care or support needs are excluded from the operation of section 27:
5.1.1 treatment, care or support that a government department or another government agency is liable to provide, or to pay for; or
5.1.2 treatment, care or support that must be provided under a requirement imposed under another Act or any regulations (including under an Act or subordinate legislation of the Commonwealth).
For example, a requirement to provide disability access to work premises.
6.1 The LSA reserves the right to extend or abridge any time limit in these Rules that affects a participant, an applicant, the LSA or an Assessor. The LSA may extend any of the time periods in these Rules, whether or not a request is made to extend any time limit.
7.1 The LSA may suspend a participant from the Scheme by notice in writing in accordance with the relevant section of the Act and these Rules.
7.2 Where a participant is suspended from the Scheme the LSA will not pay for any treatment, care or support provided during the period of the suspension.
7.3 If a suspension ceases, the participant will not be entitled to recover any costs incurred during the period of suspension.
8.1 Interpreters accredited by National Accreditation Authority for Translators and Interpreters (NAATI) should be used if an interpreter is required.
8.2 If a NAATI interpreter is not available, a non-NAATI interpreter may be used at the discretion of the LSA. Any person accompanying the participant/ applicant, such as a family member, carer or support person, cannot act as an interpreter
9.1 To deliver or send documents to the LSA, the postal address is:
Lifetime Support Authority
PO BOX 1218
Adelaide SA 5000
9.2 It is also possible to send documents to the LSA via its email address, which is firstname.lastname@example.org.
9.3 Documents sent to the LSA via its email address will be taken to be received on the same day as they were sent.
9.4 Documents sent to or from the LSA via mail will be taken to be received five days after the date they were posted.
10.1 Except for the Application Form, the participant or applicant should only submit copies of documents to the LSA, not original documents.
11.1 Any medical documentation:
11.2 provided to the LSA with an application, must be listed in the application; or
11.3 provided to the LSA at any other time must clearly state the participant’s name and date of birth.
11.4 In the case of X-rays, Computerised Tomography (CT or CAT scans), Magnetic Resonance Imaging or other radiological or similar investigations, only the resulting report should be sent to the LSA. No original films or scans should be submitted to the LSA. These can be brought to any examination by the participant.
12.1 The LSA reserves the right to audit service providers from time to time.
13.1 If the participant/applicant has legal representation in respect of any dispute, the LSA will send copies of any document required to be sent to the participant/applicant to their legal representative.
14.1 f a participant/applicant has applied for a determination in a dispute to a review officer, or referred a dispute/review to an expert review panel, they are entitled to:
14.1.1 view and receive a copy of all assessment documents held by the LSA in relation to the dispute;
14.1.2 make written submissions about any aspect of the dispute or issues in dispute which will be forwarded to the review officer or expert review panel; and
14.1.3 receive the written determination issued by the review officer, or the certificate issued by the expert review panel.
15.1 If a party considers that an assessor, a review officer or an expert review panel has made an obvious error in a determination/certificate, that party may apply to the LSA to have the error corrected within 14 days of the date on the determination/certificate.
15.2 The application to have the error corrected must be made in writing, including the details of the considered obvious error and the suggested correction. An obvious error may only include an obvious clerical or typographical error in a determination/certificate.
15.3 The LSA will forward this request to any other party within five days of receipt, after which time that party has five days in which to make a submission to the LSA on the application to have the error corrected.
15.4 The assessor/review officer/expert review panel may issue a replacement determination/certificate that corrects any obvious error and that will replace the previous determination/certificate. If a replacement determination/certificate is issued, it is to be titled as a replacement determination/certificate and will supersede the previous determination/certificate.
16.1 When dealing with participant/applicant information, the LSA will adhere to the privacy and confidentiality obligations contained in the Department of the Premier and Cabinet Circular PC012 ‘Information Privacy Principles’ (IPPs).
16.2 The LSA will make appropriate information available to service providers where consent has been obtained from the participant/applicant. When information is shared with service providers or other external agencies, those service providers and agencies will be required to adhere to obligations contained in the IPPs or other equivalent privacy principles.
17.1 In accordance with section 56(5) of the Act this updated version of the Rules will commence on the day of publishing in the South Australian Government Gazette.