Assistive technology and consumables guideline

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Assistive technology and consumables guideline (PDF, 325KB)

MyGuide7: supports for everyday life (PDF, 165KB)

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• Definitions

  Defined terms are shown throughout in bold underlined text when they first appear.

  Allied health provider for this guideline, means allied health professionals regulated under the Health Practitioner Regulation National Law (Queensland) including:

  • occupational therapists
  • physiotherapists.

  Allied health provider also includes persons who are a part of a self-regulated allied health profession, which includes speech pathologists who are certified with Speech Pathology Australia.

  Health Practitioner Regulation National Law is Queensland’s modified application of Health Practitioner Regulation National Law (Queensland) under the Health Practitioner Regulation National Law Act 2009 (Qld).

  MyPlan means a support plan prepared by the NIISQ Agency and approved under the National Injury Insurance Scheme Act (Queensland) Act 2016.

  Public sector health service means any service provided by, or under any of the following:

  • Cairns and Hinterland Hospital and Health Service
  • Central Queensland Hospital and Health Service
  • Central West Hospital and Health Service
  • Children’s Health Queensland
  • Darling Downs Health
  • Gold Coast Hospital and Health Service
  • Mackay Hospital and Health Service
  • Metro North Health
  • Metro South Health
  • North West Hospital and Health Service
  • South West Hospital and Health Service
  • Sunshine Coast Hospital and Health Service
  • Torres and Cape Hospital and Health Service
  • Townsville Hospital and Health Service
  • West Moreton Health
  • Wide Bay Hospital and Health Service.

• Supporting a participant who needs assistive technology and consumables

  The NIISQ Agency will identify a participant’s needs for (or relating to) assistive technology and consumables and will fund these supports in accordance with the National Injury Insurance Scheme (Queensland) Act 2016, the National Injury Insurance Scheme (Queensland) Regulation 2016, this guideline, and other relevant guidelines.

  There is a plain language version of this guideline which is shorter and uses simpler words. To access it, view MyGuide 7 – Supports for everyday life.

  The National Injury Insurance Scheme (Queensland) Act 2016 defines treatment, care and support needs to include aids and appliances, other than ordinary personal or household items. For the purposes of this guideline, aids and appliances that are ordinarily funded under the NIISQ are referred to as assistive technology.

  This guideline should be read in conjunction with the:

  • Necessary and reasonable guideline
  • Home modifications guideline
  • Attendant care and support services guideline
  • Medical and pharmaceutical guideline
  • Rehabilitation guideline
  • Orthoses and prostheses guideline.

  Assistive technology

  Assistive technology is a broad term which can include assistive products that maintain or improve a person’s functioning and independence and enhances their wellbeing. Assistive technology includes products or devices that help a participant to do things which they cannot do because of their accepted injury (see: assistive technology).
  

  Consumables

  Consumables are generally lower-cost, disposable items that a participant needs because of their accepted injury. For example, consumables may include continence products and low-cost equipment (see: consumables).
  

  Ordinary personal or household items

  Assistive technology and consumables are different to ordinary personal or household items. Ordinary personal or household items include items which are unrelated to a participant’s accepted injury. For example, a laptop, linen, a mobile phone, a personal computer, or a washing machine.

  In limited circumstances, the NIISQ Agency may still decide to fund or contribute the cost of an ordinary personal or household item in accordance with section 26(1)(e) of the National Injury Insurance Scheme (Queensland) Act 2016. These decisions are based on the participant’s individual circumstances but are outside the scope of these guidelines (see: Guidelines limited to necessary and reasonable treatment, care and support in the Necessary and reasonable guideline).

• Approval for assistive technology and consumables

  For assistive technology and consumables to be funded under the NIISQ, the NIISQ Agency must provide written approval before any supports are provided to the participant.

• Assistive technology and consumables must be necessary and reasonable

  The National Injury Insurance Scheme (Queensland) Act 2016 and the National Injury Insurance Scheme (Queensland) Regulation 2016 describe how the NIISQ Agency decides whether the assistive technology and consumables are necessary and reasonable and can be funded.

  The NIISQ Agency has published a guideline which explains how it decides whether a support is necessary and reasonable, and is for a treatment, care and support need (see: Necessary and reasonable guideline).

  When the NIISQ Agency is assessing if a participant’s needs for assistive technology is necessary and reasonable, it will give particular attention to the following:

  • whether the assistive technology or consumable is likely to empower the participant to maximise their independence, participation in the community and employment, and any goals identified in their MyPlan
  • whether the assistive technology or consumable is appropriate for the participant, including whether the assistive technology is consistent with current clinical practice and other industry best practice. The NIISQ Agency will assess whether a participant’s needs for treatment, care and support is necessary and reasonable by considering whether the assistive technology and consumables adhere to the nationally-recognised Clinical Framework for the Delivery of Health Services (see: Necessary and reasonable guideline).
  • whether the assistive technology or consumable is provided by an appropriate provider (assistive technology must be compliant with Australian Government and state legislation – see Limitations on support for assistive technology and consumables)
  • whether the assistive technology or consumable is cost effective, after considering:
    • the benefit to the participant weighed against the cost of a support (significant benefits to a participant generally support a higher cost for assistive technology)
    • a comparison of alternative assistive technology or consumables (a lower-cost alternative will be generally preferred, unless there is an impact on the effectiveness or safety of the assistive technology or consumable)
    • whether there is a more cost-effective way to provide the support to the participant, including options such as hiring assistive technology for a shorter duration
    • whether the cost of the assistive technology is reasonable having regard to the period for which it is required (it is generally expected that higher-cost assistive technology would be used for a longer period of time by a participant).

• Assessment of needs for assistive technology and consumables

  In assessing a participant’s needs for assistive technology and consumables, the NIISQ Agency will ordinarily require information from a suitably-qualified provider to decide whether a support is necessary and reasonable.

  Identifying a participant’s treatment, care and support needs is done in collaboration with the participant, their family and/or other informal supports, and providers.

  Information required to assess a participant’s need for assistive technology and consumables

  The NIISQ Agency will generally require any existing information about the participant’s accepted injury and need for assistive technology or particular consumables, including information requested in the:

  • Equipment request form
  • Continence and consumables request form.

  The NIISQ Agency may require additional information, including an assessment by a suitably-qualified provider or medical specialist. The NIISQ Agency ordinarily requires a post evaluation and summary report once the assistive technology has been delivered, to assess whether the assistive technology has supported the participant to achieve any goals identified by the participant.
  

  Access to public sector health services

  A person’s participation in the NIISQ does not affect their entitlement to a broad range of support provided as part of a public sector health service. These services include in-patient services, outpatient services, transition care, outreach supports, and community-based rehabilitation.

  Basic assistive technology or consumables which are ordinarily provided in an inpatient and/or outpatient setting are the responsibility of Queensland Health and are funded by the NIISQ Agency through a direct Queensland Health payment.
  

  Assistive technology and consumables must be provided by an appropriate provider

  Providers of assistive technology and consumables do not need to be a registered provider under the National Injury Insurance Scheme (Queensland) Act 2016 nor the National Injury Insurance Scheme (Queensland) Regulation 2016. However, the NIISQ Agency will assess providers of assistive technology and consumables to determine whether they are appropriately qualified to provide the support.

  Assistive technology

  Assistive technology must be provided under the supervision of a suitably-qualified person who is an allied health provider. The allied health provider must ensure that the assistive technology is suitable for the participant.

  For more complex or higher risk assistive technology, the NIISQ Agency may require additional information from a medical practitioner (see: Medical and pharmaceutical guideline).

  Consumables

  Higher-risk consumables must be provided under the supervision of a:

  • registered nurse
  • clinical nurse or nurse practitioner.

• Specific types of assistive technology and consumables funded under the NIISQ

  There is a broad range of assistive technology and consumables which may be funded for a participant in the NIISQ. The supports described below are not exhaustive, and there may be other supports a participant may require.

  Consumables

  Examples of consumables that may be funded under the NIISQ include (but not limited to):

  • continence pads or absorbent pull-ups or briefs
  • continence aids
  • home enteral nutrition (HEN) and percutaneous endoscopic gastrostomy (PEG) equipment and maintenance
  • HEN and PEG consumables including feeding tubes, bags or bottles
  • bowel therapy equipment.

  Consumables covered in other guidelines

  Other guidelines which address specific treatment, care and support needs contain information about consumables which are related to those needs, including:

  • Orthoses and prostheses guideline: for consumables relating to a prosthesis (for example, gels, creams and stockings)
  • Attendant care and support guideline: for support workers to assist with continence needs and/or the management of HEN or PEG requirements
  • Medical and pharmaceutical guideline: for consumables including medical devices, bandages, medical gloves and continence care products which are ordinarily available at a chemist, or provided by a pharmacist. The medical and pharmaceutical guideline also provides for specially-formulated foods.

  Assistive technology

  Examples of assistive technology which may be funded under the NIISQ include (but are not limited to):

  • non-slip bath mats
  • large print labels
  • walking sticks
  • shower chairs
  • augmentative and/or alternative communication devices
  • manual wheelchairs
  • power wheelchairs
  • mobility devices (scooters)
  • ventilators (ventilators also require the support of a medical practitioner – see: Medical and pharmaceutical guideline)
  • mobile hoists.

  Hiring assistive technology

  The NIISQ Agency will fund the hire of assistive technology in certain circumstances including:

  • where the participant’s medical condition, functional status or circumstances will, or are likely to change in the near future
  • hiring assistive technology has been recommended by an allied health provider to assess the benefits over a longer-term period of time, before committing to the purchase of assistive technology
  • the participant’s need for the assistive technology is short term (for example, while the participant is away from home).

  Maintenance, repair and use of assistive technology

  The NIISQ Agency will fund the maintenance in accordance with manufacturer recommendations, and repair of assistive technology as the need arises.
  If the assistive technology is under a manufacturer warranty or the Australian Consumer Law, the NIISQ Agency will generally require the assistive technology to be replaced under warranty (see: Manufacturer warranties).

  The NIISQ Agency may also fund training the participant, family members and allied health workers in the use of assistive technology, particularly where such support is likely to ensure assistive technology is used correctly, and consistently, and reduce the likelihood of the abandonment of funded assistive technology.

  Non-standard and higher risk assistive technology

  The NIISQ Agency recognises that some participants may require advanced or specialised components or features and will consider funding non-standard assistive technology on a case-by-case basis.

  The NIISQ Agency will ordinarily require information (including assessments) from an allied health provider for non-standard assistive technology.

  For some types of assistive technology, the NIISQ Agency may require additional information to ensure the assistive technology is safe to use by a participant.

  Assistive technology covered in other guidelines

  Other guidelines which address specific treatment, care and support needs contain information about assistive technology which are related to those needs, including:

  • Home modifications guideline: for assistive technology which is required in the course of the home assessment, for example a ceiling track hoist to assist a participant to get in and out of bed
  • Orthoses and prostheses guideline: for orthoses (external devices to assist with mobility) and prostheses (replacement limbs for participants who have had an amputation)
  • Rehabilitation guideline: for assistive technology related to a rehabilitation support (for example, gym-based exercise).

  Recreational assistive technology

  A participant may identify a goal in their MyPlan which relates to a recreational activity that requires assistive technology.

  When this occurs, the NIISQ Agency will consider funding necessary and reasonable equipment, or modifications to equipment a participant already owns to support participation in a recreational activity that:

  • a participant did before the motor accident, or
  • a participant wants to do as a substitute for something they did before the motor accident, or
  • is a new activity which enhances a participant’s ability to participate in social and community activities.

  Support funded under the NIISQ may also include:

  • funding to support the participant to engage in the recreational activity safely
  • recommendations for suitable equipment for the participant, including modifications to standard equipment which is required for the participant
  • the trial or hire of equipment, where recommended or supported by an allied health provider.

• Partial funding for assistive technology

  The NIISQ Agency may agree to fund a part of assistive technology in circumstances where the total cost exceeds the participant’s treatment, care and support needs. For example, a participant has a certain preference for a cosmetic feature, which costs more than the assistive technology without the feature.

  A decision to partially fund assistive technology is made by the NIISQ Agency after having regard to the matters listed in section 26(1)(e) of the National Injury Insurance Scheme (Queensland) Act 2016. These kinds of decisions are outside the general scope of the treatment, care and support guidelines (see: Guidelines limited to necessary and reasonable treatment, care and support in the Necessary and reasonable guideline) However, when the NIISQ Agency is considering partial funding of assistive technology, it will generally require additional information, including (but not limited to):

  • cost difference
  • the participant’s agreement to meet the additional costs related to the assistive technology
  • confirmation by a suitably-qualified person that the assistive technology is otherwise safe for use by the participant.

• Manufacturer warranties

  Where repair or replacement of assistive technology is covered under a manufacturer warranty or the Australian Consumer Law, the NIISQ Agency will generally require a participant to pursue repair or replacement.

  If a participant requires assistive technology during a repair or replacement, the NIISQ Agency may fund the hire of a suitable, temporary assistive technology.

• Limitations on support for assistive technology and consumables

  The NIISQ Agency does not fund assistive technology and consumables which are required by a participant for a condition which existed prior to the event which caused their accepted injury.

  The NIISQ Agency does not fund assistive technology and consumables which are:

  • provided as part of a public sector health service (see: access to public sector health services)
  • the responsibility of another Australian Government or state scheme
  • inconsistent with relevant Australian Government or state legislation – for example:
    • standards set by the Australian Therapeutic Goods Administration (TGA)
    • Queensland road rules.

  The NIISQ Agency is not required to fund assistive technology provided on an experimental basis.

• Assistive technology and consumables generally not funded by the NIISQ Agency

  The NIISQ Agency will generally not fund:

  • costs associated with the repair or replacement of assistive technology funded under the NIISQ, as a result of intentional neglect, abuse, or misuse, and where there is no reasonable excuse for the neglect, abuse, or misuse
  • sport or recreational clothing, which is unrelated to a participant’s accepted injury
  • participation costs, such as event registrations, membership fees, court hire, entry fees or coaching (except where the activity is supported under the NIISQ – see Rehabilitation guideline)
  • replacement of an ordinary personal or household item, which would be owned and replaced by the participant or their household. This applies even if the ordinary personal or household item was initially funded under the NIISQ. Following the initial purchase, the NIISQ expects the general household or personal item will be replaced by the participant.