1.1 This Part applies in relation to equipment referred to in section 4(1) of the Act.
1.2 The LSA will pay for equipment for participants where it is assessed as necessary and reasonable to meet a treatment, care and support need in relation to the motor vehicle injury.
1.3 Equipment may be provided to:
1.3.1 sustain or increase autonomy;
1.3.2 sustain or increase participation in community and economic life;
1.3.3 improve mobility;
1.3.4 facilitate communication;
1.3.5 relieve pain or discomfort;
1.3.6 maintain health or prevent ill-health;
1.3.7 sustain or facilitate a return to vocational, educational, or leisure activities; or
1.3.8 increase the safety of the participant, their family, carers or service providers.
2.1 Equipment prescription is the process of assessing a participant's needs, selecting, trialling, modifying, evaluating and eliminating equipment to determine the most appropriate equipment item(s). Equipment prescription is more detailed than a referral for equipment provision or the identification of need for equipment.
For example, a medical specialist may refer or recommend a participant be assessed for a wheelchair. However, the specifications of the wheelchair would be detailed by the equipment prescriber, for example an occupational therapist working at a seating clinic.
2.2 Any proposal for equipment must be developed in consultation with the LSA.
2.3 Any recommendations for equipment, other than those prescribed by inpatient facilities under rule 9 below, must be provided to the LSA for approval. The equipment must be prescribed by a health professional or team of professionals appropriately qualified in prescribing that category of equipment. The level of experience required to prescribe equipment is determined by the complexity of equipment and the participant’s abilities and care needs.
2.4 The recommendation must be accompanied by the following information:
2.4.1 identification of the specific model, type, costs and where relevant, maintenance and/or servicing requirements;
2.4.2 written confirmation that the participant/guardian has been consulted and agrees with the provision of the proposed equipment;
2.4.3 an implementation plan, including any associated training requirements, to ensure appropriate and safe use by the participant or other users; and
2.4.4 detailed specifications and corresponding supplier quote for the prescription of customised equipment items.
3.1 Before equipment is prescribed, it should be assessed as more appropriate than alternative therapies, treatments or management options.
3.2 The LSA will pay the necessary and reasonable cost of equipment if the LSA is satisfied that:
3.2.1 the participant's need for the equipment has been assessed by reference to their abilities and needs as related to the motor vehicle injury;
3.2.2 the equipment has been successfully trialled, where possible, and the participant is able to safely use the equipment within the intended environment of use;
3.2.3 where a cost is involved a trial of equipment, must be approved by the LSA before commenced; and
3.2.4 the prescribed equipment is consistent with the participant’s Discharge Plan or MyPlan.
3.3 Once an equipment recommendation has been approved, the LSA will order equipment from DES in the first instance or other equipment/product suppliers if equipment is unavailable from DES.
4.1 The LSA is not responsible for the provision of equipment if, in the opinion of the LSA, the item is considered to be a general household or leisure item, for example, a vacuum. However, the LSA may consider the purchase where the item is required for therapeutic or disability management purposes,
4.2 The LSA may pay for the cost difference of any modification to the item or any additional features that are considered necessary and reasonable due to the motor vehicle injury.
For example, extension handle for an existing vacuum.
4.3 The LSA is not responsible for the provision of equipment if, in the opinion of the LSA:
4.3.1 the equipment requires replacement due to neglect, abuse or misuse; or
4.3.2 the piece of equipment is more expensive than an item that is required to meet the participant’s identified needs.
4.3.3 The provision of the item is included in a bed fee for participants who are inpatients or receiving residential care.
5.1 Participants may be required to contribute to the cost of equipment in cases where the equipment is only partially related to the participant's motor vehicle injury, or the item requested is beyond what is necessary and reasonable in relation to the participant’s motor vehicle injury.
5.2 Where a participant makes a financial contribution towards the purchase of the equipment, the participant may become the owner of the equipment, at the discretion of the LSA.
6.1 Equipment funded by the LSA, either directly or through an agreement, remains the property of the LSA, or the equipment hirer, unless an agreement is made with the participant regarding ownership.
6.2 The equipment will be made available to the participant for their sole use for as long as the participant needs the item, however, it must be returned to the LSA, or the equipment hirer, when no longer necessary.
7.1 The LSA will pay for the necessary and reasonable cost of upgrading or modifying equipment that was owned by a participant prior to the motor vehicle accident, to enable the participant to access the equipment.
7.2 In circumstances where the cost of modification of existing equipment exceeds the cost of purchase, and the equipment is necessary and reasonable, the LSA may fund the purchase of new equipment.
7.3 Where a modified household item or leisure equipment needs to be replaced due to normal wear and tear, the LSA will pay for the replacement of any injury-specific modifications or extras that cannot be transferred from that old equipment.
For example, a modified tennis racquet.
8.1 The LSA may require the participant enter into an agreement that details the conditions of use, maintenance, insurance and ownership of equipment.
8.2 The LSA will pay for the cost of equipment:
8.2.1 maintenance and repairs resulting from normal wear and tear, if the equipment is funded and owned by the LSA, or DES;
8.2.2 routine maintenance as recommended by the manufacturer or to meet industry standards;
8.2.3 adjustments due to growth, or other change in the participant’s abilities and need; and
8.2.4 repairs where the LSA has accepted partial liability for the purchase or modification of equipment, consistent with the level of the LSA's contribution to the purchase or modification of the equipment.
8.3 The LSA will replace necessary and reasonable equipment worn out as a result of normal use, if it is still required by the participant.
9.1 On inpatient discharge a hospital/rehabilitation facility may order or provide certain types of equipment from DES, up to a pre-approved value per item. The pre-approved value and DES prescription form will be available on the LSA’s website.
9.2 The prescription must be made in accordance with the requirement that equipment must be necessary and reasonable.
9.3 The prescriber must have the appropriate training to prescribe the item(s).
9.4 The LSA must be notified where prescriptions have occurred.
10.1 The LSA will provide continence supplies that relate to a continence need caused by the motor vehicle injury.
10.2 The prescription of continence supplies must be completed by a medical practitioner or registered nurse appropriately qualified for continence prescription. The continence prescription should include the continence aid, the frequency of provision as per the recommended usage levels and the period of time for which the prescription applies. A review date based on the participant’s needs should be set at the time of each prescription.
10.3 The LSA may appoint suppliers to provide approved continence equipment and supplies directly to the participant. In these circumstances a participant may order continence supplies as they are needed, providing the orders are within the usage recommended in the equipment prescription. If an item is ordered by a participant that is outside the prescribed list or the quantity recommended, the equipment supplier will need to seek approval prior to supplying the item. Clinically appropriate product substitutions may be ordered without prior approval if the prescribed item is unavailable at the time of ordering.
10.4 The LSA will not pay for continence equipment where the participant is an inpatient, or where a bed fee includes the provision of this equipment.
11.1 The LSA funds the necessary and reasonable cost or contribution to the cost of the purchase of a bed (and linen) where the need for the replacement mattress/bed is due to the participant's motor vehicle injury.
11.2 In deciding whether the LSA funds the total cost of a bed or, to determine the extent of contribution towards the reasonable cost of a bed, the LSA may consider:
11.2.1 the age of the participant's current bed;
11.2.2 the condition of the participant's current bed;
11.2.3 the extent to which the need for a new bed is related to the motor vehicle injury; or
11.2.4 whether the participant has obstructive sleep apnoea resulting from the motor vehicle injury.
For example, the LSA may pay for the cost of a hospital bed.supporting participants to co-sleep with partner by supplying a suitable bed/mattress.
11.3 Where the LSA has previously supplied a bed/mattress and a replacement is required, the LSA will consider funding it at its discretion.
11.4 The LSA will not pay for antique bed replacements or repairs, waterbeds or waterbed heaters.
12.1 The LSA will pay for electronic equipment recommended by an appropriately qualified professional with relevant experience including modifications to electronic equipment that, in the opinion of the LSA, are required as a result of the motor vehicle injury.
12.2 Where a participant has a substantially reduced capacity with speech, writing or reading as a result of their motor vehicle injury, the LSA will pay for communication devices.
12.3 The LSA will pay for a personal device, when the participant does not currently own or have access to a personal device, and the need is directly related to the motor vehicle injury.
12.4 The LSA will pay for an upgrade to a participant’s personal device when it is necessary and reasonable to assist with independent communication.
12.5 The LSA may also pay for a personal device, including computer equipment, to enable the participant to return to work or for a vocational retraining or education program.
For example, working remotely until they can access their workplace.
12.6 The LSA may also provide a personal device to increase a participant’s functional autonomy in activities of daily living,
For example, shopping and money management.
where the participant:
12.6.1 lives in a remote location;
12.6.2 has a severe physical impairment; or
12.6.3 has a condition that inhibits the participant’s access to the community; or
12.6.4 has a condition that inhibits the participant’s social inclusion.
12.7 The LSA will pay for the necessary and reasonable cost of internet access, where it is not otherwise available to the participant, or the current service is inadequate in meeting the participant’s needs related to the motor vehicle injury:
12.7.1 during a hospital inpatient stay when the participant is temporarily unable to make use of their regular internet access (unless this is provided by the hospital);
12.7.2 to access a telerehabilitation program/telemedicine;
12.7.3 to access a short-term return to work program;
12.7.4 for an educational program; or
12.7.5 where it demonstrably reduces reliance on support or attendant care services.
13.1 The LSA will pay for the necessary and reasonable cost of equipment for the purpose of environmental control. This includes equipment that requires physical or structural modification to the participant’s home, which is outlined in Part 10 of these Rules.
14.1 The LSA will pay for the necessary and reasonable cost of pressure care equipment where a participant has been assessed as being at risk of pressure ulcer development or currently has a pressure ulcer, and this risk is directly related to their motor vehicle injury.
15.1 The LSA pays for the necessary and reasonable cost, including the replacement cost, of wheelchairs and other mobility aids to enable participants to safely access their home, their workplace and the community.
15.2 The LSA will pay for positioning and seated mobility equipment when there is a motor vehicle injury related need to increase the participant’s capacity or safety to participate in an activity. This includes activities such as: accessing the community, eating and drinking, sleeping, showering, toileting, study, travel by car, sitting or mobilising, and communicating.
16.1 The LSA will pay for the necessary and reasonable cost, including the replacement cost, of orthoses, specialist footwear and walking aids to enable participants to safely access their home, their workplace and the community.
17.1 The LSA will pay for the necessary and reasonable cost of respiratory equipment. Types of respiratory equipment may include:
17.1.1 invasive ventilation (tracheostomy);
17.1.2 non-invasive ventilation; and
17.1.3 associated electro-medical equipment and supplies.
17.2 The LSA may appoint a supplier to provide approved ventilation, tracheostomy or another ostomy equipment directly to the participant.
17.3 In these circumstances a participant may order supplies as they are needed, providing the orders are within the usage recommended in the equipment prescription. If an item is ordered by a participant that is outside the prescribed list or the quantity recommended, the equipment supplier will need to seek approval prior to supplying the item.
18.1 The LSA will pay for the necessary and reasonable costs of exercise and fitness equipment when the equipment is prescribed by an appropriately qualified health practitioner. Justification should be provided as to why the exercise and fitness equipment is required and what other options have been considered and discounted, such as a gym membership.
18.2 To determine whether the costs are necessary and reasonable the LSA may require that:
18.2.1 the equipment is hired while the participant trials the activity; and
18.2.2 the purchase of exercise or fitness equipment only occurs once a successful trial has taken place and the participant has demonstrated commitment through regular use over a period of time.
19.1 The LSA will not pay for:
19.1.1 equipment that is available for use in another setting (such as a gymnasium) that is appropriate for the participant to access; or
19.1.2 equipment that is used by the participant solely in other environments.
For example, physiotherapists’ rooms.
20.1 The LSA will pay for the necessary and reasonable cost of specialised equipment and/or adaptations to equipment, to:
20.1.1 return a participant to a pre-accident recreational activity;
20.1.2 substitute a pre-accident recreational activity for a new recreational activity; or
20.1.3 to commence a developmentally appropriate activity.