- 1.1The purpose of the LSS Rules is to facilitate the LSA’s statutory function of administering the Scheme in accordance with the purposes of the Act by providing:
- 1.1.1Clear and efficient processes for supporting Participants;
- 1.1.2A clear understanding of how applications to the Scheme are assessed, as well as how Treatment, care and support (TCS) needs are assessed;
- 1.1.3A clear understanding of what TCS needs are offered under the Scheme;
- 1.1.4Clear and efficient processes for review of the LSA’s decisions; and
- 1.1.5Recognition of the need to be responsive to Participant’s individual needs and capacities.
- 1.2As far as is practicable, the Rules are to be interpreted in a manner that is consistent with the following:
- 1.2.1Based on the impact of the Motor Vehicle Injury – TCS is focused on supporting the Participant’s health and wellbeing that has been impacted by the Motor Vehicle Injury.
- 1.2.2Providing necessary and reasonable TCS – TCS must be necessary and reasonable, as defined by these Rules and the Act in order to be approved.
- 1.2.3Financial sustainability – The Scheme is in place for the benefit of all South Australians now and into the future and the LSA seeks to manage the Scheme in a manner that is financially sustainable and affordable for the community – so the Scheme 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. The LSA manages the Lifetime Support Scheme Fund in accordance with the Act.
- 1.2.4Person-Centred Approach – The LSA provides approved TCS through a Person-Centred Approach, enabling the Participant or Decision Maker or both, as the case may require, to be involved in choosing and controlling support and service arrangements within the requirements of these Rules and other relevant legislation. Early intervention to optimise long term benefits for the LSS participant and LSS is an important consideration in the LSA’s person-centred approach.
- 1.2.5Choice and independence – The LSA supports the Participant or Decision Maker or both, as the case may require, to make or be involved in the decisions that affect their lives. This includes medical treatment, rehabilitation, supports that impact on the quality of their life, as well as assisting their participation in and contribution to social and economic life. Choice and independence can be exercised within the requirements of these Rules and other relevant legislation.
- 1.2.6Local Government, State, Commonwealth or other jurisdictional supports – the Scheme does not pay for supports that are paid for by Local, State or Commonwealth Government departments (or other jurisdictions/ schemes) which are available to the community (wholly or in part) for which the Participant remains eligible. The Scheme may provide support, from time to time, to assist a Participant in accessing those benefits where their Motor Vehicle Injury hinders them from doing so.
- a child Participant would receive education supports available to all children with disability and the LSA would fund additional TCS services that were needed.
- a Participant who is an NDIS Participant due to other injuries or disabilities would continue to receive support from the NDIS for that injury or disability and the LSA would fund the TCS services related to the Motor Vehicle Injuries.
- a Participant who is eligible for aged care supports would receive services and supports required due to their ageing, whilst the LSA would continue to fund supports related to the Motor Vehicle Injuries.
- 1.2.7Co-contribution – where a Participant or Decision Maker or both, as the case may require, prefers a service that, whilst it is related to the Motor Vehicle Injury, exceeds what the LSA considers to be necessary and reasonable, the Participant or Decision Maker or both, as the case may require, may be offered the opportunity to receive the desired service by contributing the additional costs.
- 1.2.8The LSA will be respectful of the dignity, the individuality and diversity of Participants, families and their Decision Makers.
Editorial Notes –
- (1)Irrespective of the interpretation of the various principles outlined in Rule 1.2, sections 58A of the Civil Liability Act 1936 (SA) outlines the impact of being a Participant in the Lifetime Support Scheme on CTP settlements:
58A—Limitations on damages for participants in lifetime support scheme
- (1)No damages may be awarded to a person who is a participant in the Scheme under the Motor Vehicle Accidents (Lifetime Support Scheme) Act 2013 in respect of any of the treatment, care and support needs of the person, or any excluded treatment, care and support needs, as defined or determined under that Act (whether being past or future needs), that relate to the motor vehicle injury (as defined by that Act) in respect of which the person is a participant in that Scheme and that arise (or will arise) during the period in respect of which the person is a participant in the Scheme.
- (2)Subsection (1) applies –
- (a)whether or not the treatment, care and support needs are assessed treatment, care and support needs under the Motor Vehicle Accidents (Lifetime Support Scheme) Act 2013; and
- (b)whether or not the Lifetime Support Authority is required to make a payment in respect of the treatment, care and support needs concerned; and
- (c)whether or not any treatment, care, support or service is provided on a gratuitous basis.
- (3)A reference in subsection (1) to a person who is a participant in the Scheme under the Motor Vehicle Accidents (Lifetime Support Scheme) Act 2013 will be taken to include a reference to a person who has been an interim participant in that Scheme (and who has received any treatment, care and support needs under that Act).
- 2.1 Definitions:
In the Rules, these words and phrases have the following meanings:
Act means the Motor Vehicle Accidents (Lifetime Support Scheme) Act 2013 (SA). 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 (SA).
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, recommending or providing services.
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 2019, Richmond, VA, USA.
Assessed Care Needs means the LSA’s assessment of the Participant’s TCS needs which relate to the Motor Vehicle Injury and are necessary and reasonable in the circumstances, as defined in subsection 4(1) of the Act and these Rules.
Assessor means a person appointed or engaged as an Assessor under section 30(4) of the Act.
Assistive Technology means products, equipment and systems that enhance learning, working and daily living for people with disabilities, and represents aids and appliances referred to in section 4(1) 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):
- a.personal care (assistance to move around and take care of basic personal needs such as bathing, dressing, eating, toileting, grooming, fitting and use of Assistive Technology, hearing and communication devices); or
- b.therapy support to implement a therapy program under the guidance and supervision of a health professional.
Australian Standards means standards published by Standards Australia.
Brachial Plexus Avulsion means avulsion of the nerve roots of the brachial plexus from the spinal cord, as assessed by an Appropriately Qualified Medical Specialist.
Brachial Plexus Rupture means a disruption of the roots, trunks or cords of the brachial plexus, as assessed by an Appropriately Qualified Medical Specialist.
Business Day means any day except Saturday, Sunday or a Public Holiday.
Calendar Day means each day of the Calendar, including Saturday, Sunday or a Public Holiday.
Certificate means a Certificate issued:
- a.for assessment under section 30(3) of the Act (Discharge Plans and MyPlans); or
- b.for reassessment or Review, under the Rules and section 38(5) of the Act.
Community Access Support are support services relating to the completion of daily living tasks, social activities and community participation.
Decision Maker means a person with legal authority to take an action or give an authorisation under the Act or LSS Rules on behalf of the Participant to whom their legal authority relates. Where used in these Rules, parent or legal guardian will imply ‘Decision Maker’. The Decision Maker must take reasonable steps to involve the Participant in the decision making process.
Editorial Notes –
- (1)See Section 54 of the Act
- (2)Legal authority may be conferred by any lawful means, including:
- a.Appointment by the Participant, including under a general or enduring power of attorney under the Powers of Attorney and Agency Act 1984 (SA),
- b.Appointment by SACAT as guardian (either partial, full or full with special powers) under the Guardianship and Administration Act 1993 (SA),
- c.Appointment by SACAT as administrator under the Guardianship and Administration Act 1993 (SA),
- d.Appointment under a Family Court order,
- e.Appointment under the Advanced Care Directives Act 2013 (SA),
- f.Appointment as guardian under a Will, where probate or letters of administration have been granted,
- g.The parent(s) of a child (as defined by subsection 3(1) of the Act as a person under the age of 18 years).
Discharge Plan is the plan that usually documents a Participant’s assessed TCS 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 TCS 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.
Expert Review Panel (ERP) means an Expert Review Panel constituted under Schedule 1 of the Act.
Family includes key people who are identified to be a member of the Participant’s Family or an integral part of the Participant’s close personal support network.
Functional Independence Measure™ – FIM™ 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™ is an assessment of a person’s function conducted by a Service Provider or Service Providers who are trained in FIM™ and are credentialed through the Australasian Rehabilitation Outcomes Centre or equivalent international jurisdictions.
Fund means the Lifetime Support Scheme Fund established under Part 7 of the Act.
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.
Home Environment is the Participant's principal place of residence.
Home Modification is a modification to the structure, layout or fittings of the Home Environment where the Motor Vehicle Injury restricts or prevents the ability to utilise the home’s standard fittings or facilities.
In Writing means when a notification, Certificate, letter or document is provided to the LSA, a Participant or Decision Maker by post or email.
Interim Participant refers to a person accepted for interim participation in the Lifetime Support Scheme, as provided for under the Act.
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.
Lifetime Participant refers to a person accepted for lifetime participation in the Lifetime Support Scheme, as provided for under the Act
MBS is the Medicare Benefits Schedule.
Medical Specialist means doctors and medical practitioners who have completed advanced education and clinical training in a specific area of medicine (their specialty area) as per the AHPRA revised list of specialties, fields of specialty practice and related specialist titles.
Metacarpophalangeal Joint means the joints between the metacarpal bones and the Proximal phalanges of the fingers.
Model Litigant means the duties of the Crown to act as a Model Litigant, as specified in Legal Bulletin No. 2, issued on 10 June 2011 by the Attorney General of the South Australian Government, as or amended from time to time.
Motor Vehicle Accident has the same meaning as the definition in section 3(1) of the Act.
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 TCS needs and is prepared by the Participant or Decision Maker or both, as the case may require, and the LSA. The MyPlan represents the certification of TCS needs as required under section 30 of the Act.
Offeree means the Participant or Decision Maker provided with the offer by the LSA to enter into a Self-Directed Support Agreement.
Orthotic device means an externally applied device used to compensate for impairments of the structure and function of the neuro-muscular and skeletal systems.
Part means a Part of the LSS Rules or relevant legislative instrument.
Participant means a person accepted under the Act as a Participant in the Scheme (either as a Lifetime Participant or as an Interim Participant).
Participant Choice means the lawful preferences and decisions made by the Participant or their Decision Maker or both, as the case may require regarding the Participant’s goals, MyPlan, choice of provider as well as TCS where relevant.
Person-Centred Approach is the LSA’s approach in supporting Participants, that is respectful of, and responsive to the preferences, needs and values of Participants.
Pharmaceutical Products include prescribed and non-prescribed (over-the-counter) medications. Pharmaceutical Products also encompasses different mediums of Pharmaceutical Product administration including oral, intravenous and topical.
Prosthetic device is a device used to replace wholly, or in part, an absent or deficient limb segment. Any reference to a Prosthetic device in the Rules includes any associated componentry.
For example, socket, prosthetic joints, pylon, liner, valve, adaptor, foot.
Proximal means situated nearer to the centre of the body or the point of attachment.
Public Holiday has the same meaning as defined in the Holidays Act 1910 (SA).
Rehabilitation is a set of interventions designed to optimise functioning and reduce disability in individuals with Motor Vehicle Injuries in interaction with their environment. Rehabilitation helps a Participant to be as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles. This includes physical, cognitive, social, emotional, vocational and education support.
Reimbursement Arrangement means an arrangement under which the LSA agrees to reimburse the Participant or Decision Maker or both, as the case may require, for the cost of already incurred necessary and reasonable TCS.
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 (SA) to administer the South Australian Return to Work Scheme.
Review means a review of a:
- a.Dispute about non-medical matters (sections 33 and 34 of the Act) or eligibility (section 36); or
- b.determination of TCS needs (section 38).
Review Officer means those persons assigned or appointed by the Lifetime Support Authority to act as Review Officers under section 34(11) of the Act.
Rules means the Lifetime Support Scheme Rules.
Schedule of Fees refers to fees set by the LSA and published on the LSA’s website.
Scheme refers to the Lifetime Support Scheme.
Self-Directed Support means Treatment, care and support services that an eligible Participant or Decision Maker, engages, organises and funds themselves, from an amount agreed with, and paid over to the Participant or Decision Maker by the LSA, under a Self-Directed Support Agreement.
Self-Directed Support Agreement means an agreement (in a form determined by the LSA) that prescribes the terms and conditions for Self-Directed Support.
Service Order means the document issued to Service Providers to contract for the services provided to Participants.
Service Provider means a provider providing TCS services under the Motor Vehicle Accidents (Lifetime Support Scheme) Act 2013 (SA).
Snellen Scale is used by eye care professionals to measure visual acuity.
Standard Property means a home consisting of no more than four bedrooms, on land up to, but no greater than 1,000 square metres.
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 (TCS) means Treatment, care and support authorised by the Act.
Treatment, Care and Support needs (TCS needs) means the needs defined in section 4(1) of the Act (that have not been excluded under subsection 4(2) of the Act) and which have been assessed as necessary and reasonable in the circumstances of an individual Participant.
Treatment Care and Support services (TCS services) means any service that addresses an assessed TCS need.
TCS Travel Plan means the TCS Travel Plan referred to in Part 15.
TCS Permanent International Residence Plan means the TCS Permanent International Residence Plan referred to in Part 15.
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® is an assessment of a child’s function conducted by a Service Provider or Service Providers who are trained in WeeFIM® and are credentialed through the Australasian Rehabilitation Outcomes Centre or equivalent international jurisdictions.
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® 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.
Workplace Modifications are modifications to fittings of a workplace beyond the requirements of the Disability Discrimination Act 1992 (Cth).
- 2.2The Lifetime Support Scheme Rules (the Rules) are to be read as a whole and in conjunction with the Act but to the extent there any inconsistencies, the Act will prevail.
Editorial Notes –
These Rules are a “legislative instrument” within the meaning of the Legislation Interpretation Act 2021 (SA).
Subsection 14(1) of the Legislation Interpretation Act 2021 (SA) provides that, [I]n interpreting a provision of an Act or a legislative instrument, the interpretation that best achieves the purpose or object of the Act or the instrument (whether or not that purpose or object is expressly stated in the Act or instrument) is to be preferred to any other interpretation.
The principles of legislation interpretation apply to the interpretation of these Rules, including:
- a.The principle that an Act, and legislative instruments made under it, are read as a whole.
- b.The principle that to the extent there is an inconsistency between an Act, and legislative instruments made under it, the Act will prevail to the extent of the inconsistency.
- 2.3Throughout these Rules, any reference to Treatment, care and support or TCS services is a reference only to Treatment, care and support services that, as defined by these Rules and the Act:
- 2.3.1are necessary and reasonable in the circumstances; and
- 2.3.2relate to the Motor Vehicle Injury.
- 2.4A person is eligible to participate in the Scheme if their Motor Vehicle Accident and Motor Vehicle Injury satisfy:
- 2.4.1the eligibility criteria in Part 3 of the Act and Part 2 of these Rules, or
- 2.4.2the buy in eligibility criteria in section 6 of the Act and Part 17 of these Rules, and none of the exclusions in the Act or these Rules apply to their circumstances.
Editorial Notes –
Part 17, Rule 2.2 incorporates the eligibility criteria of Part 2 of these Rules.
Exclusions to participation are contained in subsection 24(5) of the Act and grounds of suspension from participation are Part 1, Rule 5.2 of these Rules.
- 2.5Words and expressions used, but not defined in these Rules, have the same meanings as in the Act.
- 2.6The LSA may, as it thinks fit, either on its own motion or on application:
- 2.6.1waive compliance with a Rule (or a Part of a Rule); or
- 2.6.2extend or abridge any time limit in the Rules that affects a Participant, Decision Maker acting on behalf of a Participant, an Applicant, the LSA, a Review Officer, a member of an Expert Review Panel or an Assessor.
Editorial Notes –
Subsection 56(3)(d) of the Act authorises Part 1 Rule 2.6.
- 3.1Pursuant to section 3(2) of the Act (but without derogating from the operation of section 5(2) of the Act), and subject to 5.2 below, a reference in the Act and these Rules to a motor vehicle is a reference to:
- 3.1.1a motor vehicle that is subject to a policy of insurance under Part 4 of the Motor Vehicles Act 1959 (SA); or
- 3.1.2a motor vehicle which is required to be subject to a policy of insurance under Part 4 of the Motor Vehicles Act 1959 (SA) and is driven on a road; or
- 3.1.3a motor vehicle that is registered under a law of some other State or Territory which corresponds to the Motor Vehicles Act 1959 (SA) (if the Motor Vehicle Accident occurred in South Australia).
- 3.2Pursuant 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:
- 3.2.1the relevant motor vehicle is conditionally registered under section 25 of the Motor Vehicles Act 1959 (SA); and
- 3.2.2the motor vehicle is being used on a road.
- 4.1Pursuant to section 27(3)(c) of the Act, the following TCS needs are excluded from the operation of section 27:
- 4.1.1TCS that a government department or another government agency is liable to provide, or to pay for; or
- 4.1.2TCS 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.
- 5.1The LSA may suspend a Participant from the Scheme by notice In Writing in accordance with the relevant section of the Act and these Rules.
- 5.2The LSA may suspend a Participant (whether lifetime or interim) if any of the following defaults occur:
- 5.2.1the Participant is convicted of fraud in connection to decisions relating to eligibility or TCS expenses; or
- 5.2.2the Participant or Decision Maker or both, as the case may require, fails to provide consent, impacting the LSA’s ability to undertake assessments; or
- 5.2.3the Participant or Decision Maker or both, as the case may require, fails to comply with a requirement to provide information for the LSA’s decision-making or functions in relation to the Participant’s TCS or eligibility; or
- 5.2.4the Participant fails to comply with a requirement to undergo a medical examination or a requirement to undergo a needs assessment for the purpose of determining eligibility or TCS needs or the Decision Maker, if relevant, fails to permit or assist the Participant to comply with either requirement; or
- 5.2.5the Participant or Decision Maker or both, as the case may require, fails to participate or cooperate with assessments required for the MyPlan process or assessments required for the delivery of the TCS services contained within the Participant’s MyPlan; or
- 5.2.6the Participant commences to reside internationally without complying with the requirements of Part 15 – Temporary International Travel and Participants Living in International Locations.
- 5.3The LSA will provide the Participant or Decision Maker or both, as the case may require, 28 Calendar Days notice In Writing (the notice period) of its intention to suspend.
- 5.4The notice must specify:
- 5.4.1The default giving rise to the intended suspension; and
- 5.4.2The steps, if any, the Participant or Decision Maker or both, as the case may require, must take in order to rectify the default during the notice period.
- 5.5During the suspension, the Participant or Decision Maker or both, as the case may require, may make good the default. In order for the suspension to be lifted, the Participant or Decision Maker or both, as the case may require, must inform the LSA, In Writing, of the rectification and if relevant provide documentary evidence.
- 5.6The LSA must evaluate the evidence of rectification provided under Rule 5.5 and:
- 5.6.1If the LSA is satisfied that rectification has occurred:
- 188.8.131.52The suspension will be taken to have ended on the day that the LSA received the written communication referred to in Rule 5.6; and
- 184.108.40.206The LSA will notify the Participant or Decision Maker or both, as the case may require, In Writing, that the suspension has ended.
- 5.6.2If the LSA is not satisfied that rectification has occurred:
- 220.127.116.11The LSA must notify the Participant or Decision Maker or both, as the case may require, In Writing, that it is not satisfied and the reasons why; and
- 18.104.22.168What further action, if any, the Participant or Decision Maker or both, as the case may require, may take to make good the default.
- 5.6.1If the LSA is satisfied that rectification has occurred:
- 5.7Participants will not be suspended from the Scheme if they reside outside Australia, provided the requirements under Part 15 - Temporary International Travel and Participants Living in International Locations are satisfied.
- 5.8In accordance with subsection 28(6) of the Act, the LSA is not liable to pay for any TCS or service provided during the period of the suspension.
Editorial Notes –
Subsection 28(6) of the Act authorises Part 1 Rule 5.8. A Participant is not entitled to recover from the LSA any costs incurred during the period of suspension.
- 5.9A suspended Participant remains a LSS Participant during the period of suspension.
- 5.10Suspension will run until the Participant rectifies the default or participation ceases due to death.
Editorial Notes –
Section 58A of the Civil Liability Act 1936 (SA) outlines the impact of being a Participant in the Lifetime Support Scheme on CTP settlements.
- 6.1Interpreters accredited by National Accreditation Authority for Translators and Interpreters (NAATI) should be used if an interpreter is required.
- 6.2If a NAATI interpreter is not available, a non-NAATI interpreter may be used at the discretion of the LSA. Any person accompanying the Participant or Decision Maker or both, as the case may require, or applicant, such as a Family member, carer or support person, cannot act as an interpreter.
- 7.1To deliver or send documents to the LSA, the postal address is:
Lifetime Support Authority
PO BOX 1218
Adelaide SA 5000
- 7.2It is also possible to send documents to the LSA via its email address, which is email@example.com.
- 7.3Documents sent to the LSA via its email address will be taken to be received on the same day as they were sent, or on the next Business Day if sent on a Saturday, Sunday or Public Holiday.
- 7.4Documents sent to or from the LSA via mail will be taken to be received six Business Days after the date they were posted.
- 8.1Except for the Application Form, the Participant, Decision Maker or Applicant should only submit copies of documents to the LSA, not original documents.
- 9.1Any medical documentation:
- 9.1.1provided to the LSA with an application, must clearly state the Applicant’s name and date of birth, and be identifiable as information relevant to the application process; or
- 9.1.2provided to the LSA at any other time must clearly state the Participant’s name and date of birth.
- 9.2In 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.
- 10.1Section 29 of the Act provides for the LSA to approve specified persons or persons of a specified class to provide TCS or services (“approved providers”).
- 10.2For the purposes of s29 of the Act, approved providers are:
- a.Medical practitioners (as defined by s3 of the Act).
- b.Health professionals (as defined by s3 of the Act).
- c.Persons or organisations currently registered by the LSA to provide TCS services and other services under s4 of the Act.
- d.Service Providers engaged as Assessors under s30(4) of the Act.
- 10.3The LSA reserves the right to, consistent with its responsibilities under the Act:
- a.Approve a provider at any time, subject to the provider satisfying the LSA’s requirements.
- b.Remove an approved provider.
- c.Impose limits or conditions on the LSA’s funding of services provided by an approved provider or a group of approved providers.
- d.Investigate, review the performance of, or audit approved providers from time to time.
- e.Investigate, review the performance of, or audit a provider who is not approved in the following circumstances:
- i.When previously an approved provider, for the purposes of reviewing quality, safety or invoicing practices in relation to services previously funded under the Scheme; or
- ii.As part of the process to approve a provider.
- f.Impose conditions on approved providers that permit information to be provided to the LSA regarding a provider’s compliance and performance, from other organisations, Government agencies or Schemes.
- 10.4Subject to section 48(2) of the Act, the South Australian Cabinet’s Information Privacy Principles Instruction (the IPPs), and the terms of any contract with a provider, the LSA may disclose information regarding a provider’s compliance and performance with other organisations, Government agencies or Schemes.
Editorial Notes –
The LSA may disclose or receive information in relation to a provider with relevant Commonwealth, State and Territory authorities (including the National Disability Insurance Agency, NDIA Quality and Safeguards Commission, AHPRA, Department for Child Protection, Aged Care Quality and Safety Commission, personal injury schemes, etc.) or other organisations, where required to manage quality and safety issues in the conduct of its business operations or when legislatively required to do so.
- 10.5If an approved provider is removed, they are no longer an approved provider. The LSA reserves the right to approve a provider again, at a later date.
- 10.6A Participant or Decision Maker or both, as the case may require, may choose a provider to provide TCS services from the list of approved providers, subject to the services being approved by the LSA as being necessary and reasonable.
- 10.7An approved provider must:
- a.Charge no more than the LSA’s Scheduled Fees, where published on the LSA’s website, unless the LSA has agreed otherwise.
- b.Comply with invoicing and contractual requirements, where relevant.
- c.Provide services in accordance with LSA Service Orders, where relevant.
- d.Comply with relevant State and Commonwealth legislative requirements.
- 11.1If the Participant/ Decision Maker/ Applicant has legal representation in respect of any Dispute, the LSA will send copies of any document required to be sent to the Participant/ Decision Maker/ Applicant to their legal representative.
- 12.1If a Participant/ Decision Maker/ 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:
- 12.1.1view and receive a copy of all assessment documents held by the LSA in relation to the Dispute;
- 12.1.2make submissions In Writing about any aspect of the Dispute or issues in Dispute which will be forwarded to the Review Officer or Expert Review Panel; and
- 12.1.3receive the determination In Writing issued by the Review Officer, or the Certificate issued by the Expert Review Panel.
- 13.1If 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 Calendar Days of the date on the determination/ Certificate.
- 13.2The 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.
- 13.3The LSA will forward this request to any other party within seven Calendar Days of receipt, after which time that party has seven Calendar Days in which to make a submission to the LSA on the application to have the error corrected.
- 13.4The 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.
- 14.1Subsection 48(1) of the Act authorises the LSA to disclose or release:
- 14.1.1information concerning the TCS needs of Participants (including the expenses that are paid or payable by the LSA under the Scheme in relation to those needs) to such persons, and subject to such conditions, as the LSA thinks fit; and
- 14.1.2other information under an authorisation (if any) prescribed by the regulations.
Editorial Notes –
For “other information” refer to Regulation 5 of the Motor Vehicle Accidents (Lifetime Support Scheme) Regulations 2014 (SA).
- 14.2The LSA is an agency to which the IPPs apply.
- 14.2.1In addition to any other condition imposed under Rule 14.1,1 it will be a condition of all disclosures or releases of information under subsection 48(1) of the Act that the person or body to whom the information is disclosed or released, will comply with the IPPs.
Editorial Notes –
The IPPs can be found on the Department of the Premier and Cabinet website as Circular PC012 “Information Privacy Principles”.
- 15.1In 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
- 15.2The updated version of the Rules will apply to all decisions made regarding Applicants and Participants from the date of commencement of the Rules, unless otherwise provided for in the Rules.