Part 18 – Rules for Review of Participant’s Treatment, Care and Support Needs

1.1This Part applies in relation to a Dispute or proceedings under Part 5 Division 3 of the Act.
1.2The LSA shall conduct itself as a Model Litigant in Dispute matters.

2.1If a Participant or Decision Maker or both, as the case may require, disagrees with an assessment or any aspect of an assessment of their TCS needs, they may request In Writing for one reassessment.
2.2On receipt of a request for reassessment, the LSA will appoint an Assessor who was not the original decision maker. The Assessor will follow the same procedures as for an original assessment.
2.3Prior to completing the reassessment, the Assessor will provide an opportunity for the Participant or Decision Maker or both, as the case may require, to explain why they disagree with the original assessment.
2.4The Assessor may either confirm or vary the original assessment. If the original assessment is varied, the LSA will provide a Certificate of the reassessment as if it were the original assessment under Part 5 of these Rules.
2.5The Participant or Decision Maker or both, as the case may require, will be provided with reasons for the outcome of the reassessment In Writing.
2.6The reassessment must occur as soon as practicable and in any event within 14 Calendar Days of receipt of the request.
2.7Where the LSA considers that the reassessment is unlikely to be completed within 14 Calendar Days of receipt of the request, the LSA will notify the Participant or Decision Maker or both, as the case may require, In Writing of the delay. The notification must include an alternative date for the reassessment to be completed.
2.8At any time, within 28 Calendar Days after notice of the Participant’s assessment of their TCS needs, and irrespective of whether a reassessment has been requested, the Participant or Decision Maker or both, as the case may require, can apply directly to the Expert Review Panel for review. When an Expert Review Panel application is made, any reassessment process will cease.
2.9The reassessment duration will be added to the relevant time period under subsection 38(3) of the Act, in relation to the Review.

3.1An application for reassessment must:
- 3.1.1be In Writing;
- 3.1.2include a clear statement that there is disagreement with the assessment or aspects of the assessment; and
- 3.1.3include reasons why there is disagreement with the LSA’s decision. If a treatment or service has not been approved by the LSA and is the subject of the Dispute, the Participant or Decision Maker or both, as the case may require, must outline the reasons as to why the request is necessary and reasonable.
3.2The LSA may request that additional information is provided before the request is reassessed if the reasons for the review are unclear.
3.3The LSA will send an acknowledgement of the application In Writing to the Participant or Decision Maker or both, as the case may require, within seven Calendar Days of receipt.

4.1The Assessor will issue a Certificate. The Certificate will include reasons for the decision In Writing and will be in the form approved by the LSA.
4.2The LSA will send the Certificate to the Participant or Decision Maker or both, as the case may require, within 14 Calendar Days of the reassessment decision.

5.1A request for review can be made by a Participant or Decision Maker or both, as the case may require, under subsection 38(3) of the Act.
5.2An application may be made to the LSA for review of an assessment as defined in subsection 38(1) of the Act in relation to TCS needs.
5.3The application must:
- 5.3.1include a clear statement regarding which aspects of the assessment or reassessment are in Dispute; and
- 5.3.2include clear and detailed reasons why there is disagreement with the LSA’s decision. If a treatment or service has not been approved by the LSA and is the subject of the review, the Participant or Decision Maker or both, as the case may require, must outline the reasons as to why it is ‘necessary and reasonable’ referring to the consideration factors outlined in Part 4 of these Rules.
5.4An application can only be made after the LSA has notified the Participant or Decision Maker or both, as the case may require, In Writing as to the LSA’s assessment of their TCS needs as certified under subsection 30(3) of the Act.
5.5An application for the LSA to refer the review under subsection 38(3) of the Act must be made by the Participant or Decision Maker or both, as the case may require, within 28 Calendar Days of receiving the LSA’s Certificate of assessment.

6.1An Expert Review Panel consists of between one and three medical experts appointed by the Convenor under Schedule 1 of the Act.
6.2The Expert Review Panel will give a Certificate as to its determination setting out the reasons.
6.3Further information on Expert Review Panels is found in Schedule 1 of the Act.