SERVICE SCHEDULE FOR RESIDENTIAL SUPPORT SERVICES CONTRACT NO:

Transcription

1 SERVICE SCHEDULE FOR RESIDENTIAL SUPPORT SERVICES CONTRACT NO: A. QUICK REFERENCE INFORMATION 1. TERM FOR PROVIDING RESIDENTIAL SUPPORT SERVICES The Term for the provision of Residential Support Services is the period from the date of signing ( Commencement Date ) until the close of 30 September 2017 (the Date of Expiry ) or such earlier date upon which the period is lawfully terminated or cancelled. 2. SPECIFIED AREA AND SERVICE LOCATION XXX 3. SERVICE ITEMS AND PRICES Table 1 - Service Items and Prices Service Service Level Service Item Description Price (excl. GST) Item Code RR100 RS1 Home for life environment within a community Not Generic setting RR200 RS2 Long term care with therapy inputs with a Not Generic community setting RR300 RS3 Long term care for Client with high physical or Not Generic cognitive needs. RR950 N/A Bed Retention Rate Not Generic RR350 N/A Temporary accommodation for spinal injured Client, in accordance with Schedule 8 RR350 price Note: Price refers to uninterrupted inpatient stay within the Facility, with the Client occupying a facility bed at midnight or when Part B, clause 16 is applicable in order to be deemed an Inpatient. Price Review ACC will review pricing when, at ACC s sole discretion, we consider a review necessary. The factors ACC may take into account during a review include, but are not limited to: general inflation; changes in service component costs; substantial changes in the market. If ACC finds that the factors we take into account have not had a significant impact on price, the prices will remain unchanged. If ACC provides a price increase, the supplier must agree any adjustment in writing. The price increase will take effect from a date specified by ACC.

2 4. RELATIONSHIP MANAGEMENT Table 2 - Relationship Management Level ACC Supplier Frequency Client ACC Client Service Staff Individual staff or As required operational contact Branch Branch Manager Operational contact As required Region Designated Supplier Manager As required Account Management As required 5. ADDRESSES FOR NOTICES NOTICES FOR ACC TO: ACC Health Procurement Justice Centre 19 Aitken Street Wellington 6011 ACC Health Procurement P O Box 242 Wellington 6140 Marked: Attention: Procurement Specialist Phone: health.procurement@acc.co.nz (for deliveries) (for mail) NOTICES FOR SUPPLIER TO: (insert street address including postcode) (insert postal address including postcode) marked: Attention (contact person) Phone: Mobile: Fax: (for deliveries) (for mail)

3 TABLE OF CONTENTS 1. PURPOSE REFERRAL OF CLIENT FACILITY WHERE ACC APPROVAL, PRICE OR COVER IS UNCERTAIN QUALITY STANDARDS SERVICE DESCRIPTION SERVICE PROVISION REHABILITATION STAFF QUALIFICATIONS RESOURCES EXCLUSIONS LEVELS OF CARE LINKAGES REPORTS AND DOCUMENTS REPORT FOR RESIDENTIAL SUPPORT PRICES PRICES PAYABLE DURING CLIENT ABSENCES RESULTS BASED ACCOUNTABILITY ACC CONTRACT MONITORING OBJECTIVE OF TEMPORARY ACCOMMODATION SPINAL SERVICE ELIGIBILITY FOR TEMPORARY ACCOMMODATION SPINAL SERVICES INCLUSIONS IN TEMPORARY ACCOMMODATION SPINAL SERVICE COMMUNITY ACTIVITIES MEAL PROVISION EXCLUSIONS TO TEMPORARY ACCOMMODATION SPINAL SERVICE DEFINITIONS APPENDIX 1 - CLINICAL CRITERIA FOR TRANSFER FROM ACUTE APPENDIX 2 ACC1155 FORM APPENDIX 3 ACC1156 FORM APPENDIX 4 MEDICAL CONSUMABLES

4 B. SERVICE SPECIFICATIONS FOR RESIDENTIAL SUPPORT SERVICES 1. PURPOSE 1.1. ACC wishes to purchase Residential Support Services. The purpose of the Services is to promote the Client s long term care in order to maximise a durable level of independence in a safe environment and, in particular, to provide Services that include: (a) Assistance for Client to a specified level of Direct Supervision with personal care and/or activities of daily living; (b) Access to a range of Rehabilitation Health Professionals; (c) Residential rehabilitation to maximise and maintain independence; (d) 24-hour Oversight Supervision, including staff being on site and awake at night to ensure Client safety; (e) Community integration; (f) Medical oversight, where required; (g) Integration into the community. This must be the focus of the Supplier Services; (h) Reduced or no use of crisis care; (i) Assessed Service Levels remain stable or reduce; and (j) Maximum independence for Client. The Supplier will take on a Lead Supplier role, which means being responsible for directing the rehabilitation needs of Client A person is entitled to Services from the Supplier under this Service Schedule if the person is a Client who: (a) (b) (c) (d) (e) (f) Is entitled to the Services to the extent and provided always that such Services are not provided or required as acute treatment or as a public health acute service within the meaning of Section 7 of the AC Act; and Has been assessed by a social rehabilitation assessment report as requiring residential support in a specialised setting, or The referring rehabilitation or geriatric Specialist has documented that the Client needs long term care in a residential environment; and Has been assessed by a social rehabilitation assessment as requiring residential support in a residential environment; and Has achieved Clinical Stability; and Has been referred to the Supplier by ACC in accordance with clause 2 of this Schedule ACC will not pay the Supplier for Services provided to a person or Client to which that person is not entitled. 2. REFERRAL OF CLIENT 2.1. ACC may, in its sole discretion, Refer eligible Clients to the Supplier using the Referral form provided by ACC. The need for Services will ordinarily be considered by the Case Owner where it is identified that the Client meets the criteria in clause 1.2 above and has been assessed as requiring residential support in a specialised setting, or requiring a period of respite care or care until housing modifications are completed.

5 2.2. ACC and the Supplier will discuss and agree on a Referral before the Referral is sent to the Supplier The Supplier will sign and return the Referral form to ACC to indicate that they have accepted the Referral The Supplier must Admit the Client within 2 Working days of receipt of the agreed Referral or as otherwise agreed by ACC The Supplier will notify the Case Owner immediately if they determine that their Services are inappropriate for the Client Despite anything to the contrary in this Service Schedule, if the Supplier has: (a) (b) (c) Not completed by the Date of Expiry or earlier date upon which the Term of this Service Schedule has come to an end ( Termination Date ) the provision of Services for a Client who was Admitted on or prior to that date; or Received a Referral from ACC but the Client is not Admitted prior to the Date of Expiry or earlier Termination Date; and Not entered into a further agreement with ACC that provides for residential support of that Client, then the Supplier will as soon as possible after the end of the Term of this Service Schedule ensure that the Client is, after consultation with the Case Owner, referred and transferred to a supplier who does have an agreement for services with ACC. 3. FACILITY The Supplier will provide Services for Clients at the facility or facilities specified in Part A, clause 2. The facility will be an integrated community focused facility, preferably in a community setting, specific to the client group, with provision for environmental management and appropriate safety measures. The Supplier will promote safety arrangements by the initiation of appropriate behaviour and environmental management. Environmental management includes exit alarms, keypads etc., appropriate for the level of service provided and must comply with the Health and Disability Services (Safety) Act WHERE ACC APPROVAL, PRICE OR COVER IS UNCERTAIN If there is uncertainty re a Client s eligibility the Supplier will continue to provide services while eligibility or Service Level is being determined. If, following a dispute, ACC accepts that the Client is eligible for Services or an increased Service Level a retrospective payment may be made from the date of the lodgement of the dispute. 5. QUALITY STANDARDS 5.1. The Supplier will ensure that particular Services are carried out only by persons who have the appropriate level of qualifications and expertise to meet the care needs of the Client, and receive the level of supervision as specified in clause The Supplier will conduct at least annual surveys of Client/family/whanau satisfaction.

6 5.3. New Suppliers will, within 6 months of the date of this Service Schedule, provide ACC with evidence to ACC s satisfaction that they: (a) (b) (c) Comply with Standard New Zealand NZ8134:2001, The Health and Disability Sector (Safety) Standards; or Have, and maintain, accreditation from an external agency approved by ACC which uses the Health and Disability Sector (Safety) Standards as their minimum benchmark for accreditation; or Are taking steps towards such accreditation from an external agency approved by ACC which uses the Health and Disability Sector Standards as their minimum benchmark for accreditation. 6. SERVICE DESCRIPTION 6.1. Commencement of Services for Client The Services that ACC purchases from the Supplier for the Client commence on the date the Client enters the facility (Part A, clause 2) following the Referral from the Case Owner as described in clause Service Exit The Services or a Service Level for a Client will end: (a) When expected rehabilitation outcomes/goals have been reached, as agreed by the Supplier and ACC; and/or (b) When a social rehabilitation assessment obtained by ACC identifies that the Client no longer needs the Services or current Service Level; and/or (c) When the Supplier is no longer able to meet the needs of the client due to high medical or behavioural needs; (d) Within seven Working days of a written request by the Case Owner; and/or (e) When a Case Owner agrees with the Supplier recommendation that the Client exits the Service Level as a result of a review; or (f) If the Client has self discharged; or (g) On the death of the Client; or (h) When the 14 Day Cap (as described in clause 16) for a Client has been reached; or (i) If the Client is no longer eligible for ACC funded services. In all cases the Case Owner must approve the exiting of the Service or Service Level and appropriate documentation must be completed by the Supplier (e.g. Referral and Discharge Reports) and received by ACC Significant Complication Transfer of Care (Interruptions to Services); (a) (b) (c) Client receiving Services may, on occasion, develop a Significant Complication that requires readmission to acute services. Where a Client requires readmission to acute services as a result of a Significant Complication, the Supplier will transfer the Client to the appropriate acute clinical team. Notification must be given to ACC within 1 working day giving an overview of the situation and why admission was needed (see clause 16.6). The Notice of Interruption of Services will include the following details: Client name and ACC number; Diagnoses related to the personal injury by accident; Cause of return to acute care; and Date of transfer to acute clinical team.

7 (d) (e) (f) Funding for acute treatment is not covered by this Service Schedule. Funding will be provided under the applicable arrangement (e.g. through Ministry of Health funding for acute treatment or public health acute services within the meaning of section 7 of the AC Act 2001). ACC will pay the Supplier during a Significant Complication Transfer of Care (Interruption to Services) in accordance with clause 16. The Supplier must inform the Case Owner when the Client returns to the Supplier s facility to receive Services following any Significant Complication Transfer of Care Services will be provided and/or arranged on a Lead Supplier basis by the Supplier who will provide all and any part of the Services to be provided for the Client subject to and in accordance with the provisions of this Service Schedule, including (without limitation): (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r) (s) (t) A pre-admission visit to the Client, if required; and Hotel Services; and Nutrition (includes dietetics and nutritional advice); and Hydration; and Personal care services; and Access to a General Medical Practitioner; and Specialist services, including medical assessment, (neuro)-psychiatry and physician services; and Pharmaceutical and laboratory services; and Delivery of all associated residential and rehabilitation support by a team of professionals including medical, nursing, physiotherapy, occupational therapy, speech therapy, social work, dietary, psychology (including behaviour management) and neuropsychology services, technical support to maintain equipment; and Referral to, and assessment by, other types of Specialists and health professionals related to the Client s personal injury, as required; and Client appropriate social rehabilitation programmes; and Working with the Case Owner to determine early in the Services if a period of active rehabilitation is indicated (such active rehabilitation is not funded under this Service Schedule); and Supervision, assistance and coaching provided by rehabilitation coaches and care assistants; and Reporting as required by clauses 13,14 and 18; and Medical Consumables in accordance with Appendix 4; and Written individual rehabilitation programmes to achieve outcome goals formulated by an interdisciplinary team and will include recreation and outings with associated transport. Individual rehabilitation programmes must be made available to Case Owner s and external assessors contracted by ACC, on request; and Availability and use of a range of equipment appropriate to the Service being provided, (this includes but is not limited to beds, hoists, manual handling equipment, and environmental controls such as sensor mats. ACC will only provide equipment that is customised to suit the individual client such as seating and sleeping systems); and Interpreter and advocacy services; and Maori health and Pacific Island liaison workers; and Any necessary administrative matters required by this Service Schedule including such administrative matters as would normally be required to allow the Supplier to: Monitor the outcome of rehabilitation (e.g. achievement of agreed goals), Record Service outcomes in file notes and/or through internal information systems Record to the National Minimum Data Set, Allow the Supplier or ACC to evaluate the Service; and

8 (u) (v) All incidental services which a reasonable and responsible supplier of similar services would provide to meet the physiological, cultural, spiritual and social needs of Client while in the care of the Supplier; and Access to education about injury prevention focused on rehabilitation consistent with the goals and strategic directions of ACC. 7. SERVICE PROVISION 7.1. The Supplier will provide Services, which show a commitment to: (a) (b) (c) (d) Rehabilitation principles and evidence based best practice; The principles of community focussed rehabilitation, with linkages to community based services to promote integration of Client; Goal directed, outcome focussed and time framed rehabilitation which are Client and family/whanau directed; Providing reasonable education for caregivers and/or family, to enable them to give support and care for the Client on Discharge The Supplier will employ an inter-disciplinary team who have a shared philosophy and focus of shared outcome-centred goals. The Supplier inter-disciplinary team will: (a) (b) (c) (d) Provide appropriate level of rehabilitation to the Client taking in to account the Clients individual needs and ability; Develop Client focused individualised programmes of rehabilitation that are outcomebased with short and long term goals. Each programme must be made available to ACC on request; Use appropriate outcome measurement tools to monitor and plot the progress of each Client. The outcome measurement tool will be evidence based and specific to the Client group. Meet as a team regularly, at least monthly, to review each Client s plan and progress to date, with attendance by medical, nursing and therapy staff The Supplier will have a customer satisfaction process for each facility, the results of which may be made available to the interdisciplinary team The Supplier will involve Client (and whanau/ family with the Client s approval) in the planning of their rehabilitation programme and Discharge planning The Supplier will facilitate access for Case Owners to Client so that Client receive information about services and entitlements provided by ACC. 8. REHABILITATION STAFF QUALIFICATIONS Staffing Type Care Assistant or Rehabilitation Coaching Assistant Supervisor Minimum Staff Qualifications Non-qualified and trained care assistant staff who are given oversight by a Supervisor. Supervisors must: 1. Be Rehabilitation Health Professionals ie: (a) Registered nurses; or (b) Registered allied health professionals comprising; dieticians, physiotherapists, speech language therapists, clinical psychologists, neuropsychologist and occupational therapists who are members of their relevant

9 Staffing Type Medical Practitioners Minimum Staff Qualifications professional association, and hold current practising certificates; or (c) Social workers who are members of their professional association; and 2. Have a disability/rehabilitation qualification or evidence to support specialist competency; and 3. Be expert in Traumatic Brain Injury ( TBI, ) where appropriate, and 4. Have demonstrated behaviour management expertise. Includes General Practitioners and registered medical Specialists. 9. RESOURCES The Supplier must have: (a) A residential rehabilitation interdisciplinary team with appropriately qualified Rehabilitation Health Professionals; and (b) Skilled Care Assistants, and Rehabilitation Coaching Assistants who have a qualification or have been given education by the Supplier in the care of their particular Client group; and (c) Medical Practitioners and Specialists, technical and allied registered health professionals with appropriate specialty experience and qualifications; and (d) Access to Specialist staff for consultation and second opinion; and (e) Ongoing staff education programmes or access to education programmes aimed at keeping staff up to date with developments in specialised rehabilitation (including supporting staff to attend regular conferences, education and training). The Supplier will keep a record of ongoing training undertaken by its staff and this will be made available to ACC on request; and (f) Access to twenty-four hour emergency care; and (g) A contingency plan to maintain continuity of Service in the event of temporary or permanent loss to the Supplier of any key personnel. 10. EXCLUSIONS The following services are not to be provided or paid for under this Service Schedule (but may be provided and paid for under other service contracts with ACC, or under Regulations, if required and applicable): (a) Acute and elective secondary care services; (b) Diagnostic imaging services; (c) Outpatient services and community services not covered by this Service Schedule; (d) Long term equipment for independence or orthotics; (e) Vocational rehabilitation services; (f) Dentistry; (g) Optometrist; (h) Podiatry; (i) Audiology; (j) Escort or transport costs to treatment; (k) Transport which is not part of the Client s rehabilitation programme (e.g. family outings). (l) Independent external assessment services e.g. Serious Injury Assessments or Needs Confirmation Residential Report; (m) Payment for consultation with Specialists for conditions other than the Client s presenting injuries; (n) Cost of Pharmaceutical items that are not required as a consequence of personal injury.

10 In general, any Services provided by the Supplier must be necessary and appropriate for achieving satisfactory rehabilitation of the Client. 11. LEVELS OF CARE Description of Service Levels The Supplier will provide Services to Client which meet the Service Levels described below provided that the Supplier may only provide Services at the Service Level which is specified in the Referral or as agreed with ACC from time to time. Service Level RS1 RS2 Service Description Goal: To provide a home for life environment within a community setting for Client who require low intensity inputs. Client requires: Specific supports with activities of daily living e.g. medication control, initiation assistance, fatigue management. Oversight to a level identified by risk management for safety of Client Maintenance of social integration and personal care skills including daily structured routines, behaviour management Attendant Care and Coaching assistance to a minimum level Goal: To provide long term care with therapy and rehabilitation inputs within a community setting. Client requires: Specific supports for activities of daily living Frequent training and coaching interventions Social integration 24 hour trained carer Oversight Supervision Programme of activities to a schedule of needs, monitored on a weekly basis. Time Frames before Independent Assessment required As per Report from Supplier based on a support plan which requires Case Owner approval Or according to the time frames set in the Client s individual rehabilitation plan Client service level need should be reviewed continuously taking into consideration: Supplier Reports to Case Owner On-going confirmation of need for residential support (required every 2 years) Time frames set in the Client s individual rehabilitation plan

11 Service Level RS3 RR350 Service Description Goal: To provide long term care for clients with high needs involving intensive human assistance for physical or cognitive needs which cannot be managed with environmental modifications (e.g. clients who have minimal levels of consciousness, or who are in a persistent vegetative state, clients who have spastic quadriplegia, clients with high, complex behavioural needs and require 1:1support to manage anti-social behaviour) involving intensive human assistance for physical or cognitive needs which cannot be managed with environmental modifications. Client requires: 24 hour Oversight Supervision by Specified Carers working under the direction of a Supervisor 1 (clause 8) Assistance with activities of daily living which require intensive support (e.g. 2 persons for significant periods of time throughout the day). Maintenance therapy activities Social integration Temporary accommodation for spinal injured Client in accordance with Schedule 8 Time Frames before Independent Assessment required Client service level need should be reviewed continuously taking into consideration: Supplier Reports to Case Owner On-going confirmation of need for residential support (required every 2 years). Time frames set in the Client s individual rehabilitation plan According to the time frames in set in the Client s individual rehabilitation plan Service Levels Process The Case Owner will identify the Service Level and timeframe for the completion of the rehabilitation to the Supplier on the Referral. Movement from a high Service Level to a lower Service Level is seen as the natural progression of care. If the Supplier considers that a Client needs to move to a higher Service Level this must be negotiated and agreed with the Case Owner. Crisis Care is not part of this contract Disagreement on Service Level Where the Supplier disagrees with the Service Level or length of stay in the Referral the Supplier must outline the reasons for disagreement in the Report for Residential Support. Where ACC agrees that a higher Service Level was appropriate from Admission the Supplier will be retrospectively paid for the applicable service level. 1 A Supervisor must be available for immediate verbal consultation by the Specified Carer on a 24/7 basis, and physically available within 60 minutes travel time.

12 12. LINKAGES The Supplier will develop and document linkages with relevant groups and organisations in the community, where they are appropriate to the Client group, for example: (a) Drug and alcohol services; (b) Mental health services; (c) Education sector; (d) Culturally appropriate groups; (e) Work and Income New Zealand; (f) Community Groups; (g) Justice Department; (h) Police; (i) Advocacy Groups; (j) Vocational Supplier Groups; (k) Community based day Programmes, independent of those that may be operated by the Supplier. 13. REPORTS AND DOCUMENTS Client specific rehabilitation care plans are an essential component of health management, and should reflect the changing needs of the client over time. All Clients being managed under this agreement should have up to date, relevant and specific care plans that support the service purpose (clause 1) It is essential that ACC Case Owners and appropriate ACC team members are actively involved in the development of the rehabilitation programmes for Client, and are appropriately informed as to Client progress. That involvement could range from a short or phone call detailing the current status of the client, to a detailed report as the result of an incident. 14. REPORT FOR RESIDENTIAL SUPPORT It is a requirement of this service that all Clients have an individualised care plan 2 developed within 15 days of entry into the Service detailing the proposed rehabilitation pathway for the Client. This initial plan must be agreed with the Client s Case Owner. Once agreed the supplier will submit ACC1155 Report Residential support to the case owner As part of the Client s on-going rehabilitation and management individualised care plans are to be reviewed, and if necessary updated, on a monthly basis (see clause 7) Any significant changes in Client need, risks, or incidents must be reported, in the form of an exception report, to the Case Owner at the earliest possible opportunity i.e. both verbally within 1 working day, and by writing within 2 working days Changes in Client care should be reported via the ACC1156 Variance report Residential support to the Client s Case Owner For short term cases (i.e. those Client who are expected to be in residence for less than 2 years duration), an updated individualised care plan should be sent to the Case Owner on a 6-monthly basis. 2 An individualised care plan should at a minimum include: a summary of the Clients injuries and other relevant medical conditions; identify risks and mitigation strategies specific to the Client; outline the medication regime (if appropriate); outline the Clients activity/rehabilitation schedule; include any Client specific goals and outcomes

13 14.6. For long term cases (i.e. those Client who are expected to be in residence for more than 2 years duration), an annually updated individualised care plan should be sent to the Case Owner To enable ACC to meet its business processes effectively, the Case Owner may request an updated individualised care plan on an ad hoc basis. These are to be provided within 5 working days of request. Ad hoc requests are expected to be required on an exceptional basis only A Final Discharge Planning report should be sent to the Case Owner no less than 4 weeks before the planned date of discharge A Formal Discharge Notification report is to be sent to the Case Owner within 5 working days following discharge. 15. PRICES Subject to clause 2 of this Schedule, the prices payable by ACC for Services provided to Client under this Service Schedule are the prices specified in Part A clause No Additional Fees The prices shown in Part A clause 3 are a total, global price for all Services in respect of the Client, and no additional amount (e.g. co-payments or Client contribution to standard Hotel Services) may be charged to ACC, the Client or any other person for that Service or other related Services provided under this Service Schedule. The exception to this is Pharmacy items which are for medical conditions not related to the Client s traumatic brain injury or any other personal injury for which the Client has cover. The cost of these items should be met by the Client Medical Consumables The prices shown in Part A clause 3 include the provision of basic medical consumables. Appendix 4 provides detail of the types of medical consumables included in the bed day rate. 16. PRICES PAYABLE DURING CLIENT ABSENCES Client Leave It is recognised that Client may require some time on leave during their rehabilitation. This should be kept to a minimum to ensure rehabilitation gains are maintained. A maximum of 14 days in any 12 month period is acceptable to ACC, except where clause a applies During the first 2 days a Client is absent from the Supplier inpatient facility ACC will pay the Supplier at the applicable Service Level Inpatient day rate as set out in Part A clause 3. No prior approval is required for the Client to be absent for those first 2 days. The Supplier is required to arrange and pay for any required home based care for the Client during the 2 day absence If a Client is to be absent from the Supplier s inpatient facility for more than 2 consecutive days, prior Case Owner approval must be obtained. If prior Case Owner approval is obtained, ACC will pay the Supplier for a subsequent maximum of 6 days at the Bed Retention Rate. ACC will pay for any home based care required for the Client during any agreed absence up to a maximum of 6 days in addition to the first 2 days described in clause 16.2 above.

14 ACC may, at its discretion, grant prior approval for additional leave for a Client in addition to 14 days per year in the following circumstances: (a) The Supplier applies to the Client s Case Owner for prior approval for the additional leave; and (b) The additional leave is required to assist the Client s reintegration into the community, or consistent with the rehabilitation plan; and (c) The Supplier and the Case Owner for the Client defines specific expectations around the leave. Where ACC grants prior approval for such additional leave, ACC will pay the Supplier for the additional leave days at the Bed Retention Rate. ACC will pay for any home based care required for the Client during any agreed additional leave Absence without Leave (AWOL). The Supplier must have a policy for staff to follow which describes the process if a Client is AWOL including: (a) Identifying Client is AWOL (b) Initiating an initial search for the Client. (c) Notifying the Case Owner, family/whanau and Police in a timely manner. If the Client is located within 2 days the Supplier will retrieve the Client. The Supplier will meet the costs of retrieval of the Client. ACC will pay the Supplier the Service Level rate set prior to the Client going AWOL. If the Client is located more than 2 days after being AWOL and retrieval is to be undertaken then ACC will pay the Supplier for: (a) The most cost effective form of transport; and/or (b) An escort if required at the rate of $20 an hour. To return the Client to the facility ACC will pay the Bed Retention rate for a further 2 days after the initial 2 days of the Client AWOL absence Self Discharge or Death of Client If a Client self-discharges or dies, ACC will pay the Supplier the applicable Service Level rate for one additional day following the self discharge or the death of a Client Significant Complication Where a Client has a Significant Complication, as per clause 6.3, which leads to the acute admission of the Client to hospital, payment will be as outlined in clauses 16.2 and 16.3 above. However, prior approval for the Bed Retention rate will be waived, if the Case Owner has received the necessary documentation as detailed in clause 6.3. The Bed Retention rate can continue to be paid for the Client s absence if ACC Team Manager agrees. This approval will be on a weekly basis.

15 17. RESULTS BASED ACCOUNTABILITY We agree to mutually develop a set of Performance Measures that will align with a Results Based Accountability (RBA) Framework. The Performance Measures in the table below represent initial key service areas that ACC and the Supplier will monitor to help assess service delivery. It is anticipated the Performance Measures will evolve over time to reflect our collective priorities. How much How well Better off 1. # of personal plans completed within three weeks of entry into the service 2. # of personal plans reviewed every month 3 % of personal plans completed within three weeks of entry into the service % of personal plans reviewed every month # / % of goals in personal plans achieved in the last 6 months 3. # of reportable incidents # of reportable incidents in the reporting period followed up and resolved". 18. ACC CONTRACT MONITORING Client level Reporting Reports are to be provided as per clauses 13 and Contract Monitoring Unless specified to the contrary Monitoring Returns are due at ACC by: Report Type Due date Contract monitoring return 6-monthly by: 20 January 20 July Monitoring returns should be ed to SocialRehab@acc.co.nz Table of Measures to be Reported On: Theme Volumes Short Term Client (expected duration of residence <2 years) Number of individual Client resident during the reporting period. Long Term Client (expected duration of residence >2 years) Number of individual Client resident during the reporting period. Rehabilitation Planning Number of individual rehabilitation plans completed within three weeks of entry into the service. Percentage of individual rehabilitation plans completed within three weeks of entry into the service. Number of individual rehabilitation plans reviewed at least once every month. 3 See clause 7.2 (d)

16 Theme Short Term Client (expected duration of residence <2 years) Long Term Client (expected duration of residence >2 years) Percentage of individual rehabilitation plans reviewed at least once every month. Number of goals in individual rehabilitation plans achieved in the last 6 months. Percentage of goals in individual rehabilitation plans achieved in the last 6 months. Incident Management Number of reportable incidents/issues in the reporting period. Number of reportable incidents in the reporting period followed up and resolved. As the RBA model is being developed the inclusion of a commentary from the Supplier would be welcomed. 19. OBJECTIVE OF TEMPORARY ACCOMMODATION SPINAL SERVICE The aim of this component of the Service is to provide temporary accommodation for spinal injured Clients who are waiting for the completion of housing modifications or for suitable rental accommodation to be available. The temporary accommodation will be provided in addition to any community rehabilitation services agreed as part of a Client s individual rehabilitation plan, where all the criteria set out in this Schedule apply. 20. ELIGIBILITY FOR TEMPORARY ACCOMMODATION SPINAL SERVICES The Supplier may provide Temporary Accommodation Spinal Services where: (a) The Client has been discharged from acute services provided under ACC s contract for Specialist Spinal Cord Active Rehabilitation Services; and (b) The Client is waiting for the completion of housing modifications or for suitable rental accommodation to be available; and (c) The Supplier has received prior written approval from the Case Owner to provide the Temporary Accommodation Spinal Services to the Client. 21. INCLUSIONS IN TEMPORARY ACCOMMODATION SPINAL SERVICE Temporary Accommodation Spinal Services which meets all Health and Safety regulations will be provided by the Supplier for the Client subject to and in accordance with the provisions of this Service Schedule, including (without limitation): (a) (b) (c) (d) (e) (f) (g) (h) Provision of wheelchair accessible room, facilities and utilities, including; HVAC (heating, ventilating, and air conditioning) where a person has diagnosed thermoregulation issues, where there is no thermoregulation issues then heating should be a minimum requirement; Water; Linen, and laundry of room linen; Room cleaning; Local telephone calls; Power; Oversight of Client, available to Client for crisis intervention and general assistance;

17 (i) Cooking facilities (or where cooking facilities are not provided or not considered to be appropriate for the Client given their rehabilitation outcomes, the Supplier will provide meals in accordance with clause 23); and (j) Access to community activities provided by the Supplier, subject to clause COMMUNITY ACTIVITIES The Client may access community activities provided by the Supplier, at the Client s discretion. The Supplier may charge a fee, agreed with the Client, to the Client if the Client accesses these activities. 23. MEAL PROVISION If the Client is unable to provide meals for themselves, or the Client s carer is unable to supply meals for the Client in the Supplier s residential facility, the Supplier may supply meals to the Client. 24. EXCLUSIONS TO TEMPORARY ACCOMMODATION SPINAL SERVICE (a) (b) Any specialist spinal cord specific support or rehabilitation; Any other services agreed as part of the spinal service community care or discharge criteria. Where appropriate these services will be provided as rehabilitation as agreed in the Client s discharge plan and supplied and funded according to separate service contracts. 25. DEFINITIONS In this Service Schedule, unless the context otherwise requires: Admission means the documentation process by which a Client is admitted to the Supplier s facility; and Admitted and Admit have a corresponding meaning; Date of Expiry has the meaning defined in Part A, clause 1; Direct Supervision means prompting the Client to initiate and complete a specific task where the Client is physically able to undertake the task but requires a person to tell them or remind them what to do next. This is usually done on a one supervisor to one Client basis where experience or qualifications of the person supervising are appropriate to the task; Discharge means the process of documentation that changes the Admission status of a Client whereby the Client leaves the facilities of the Supplier having received Services, and Discharge Date has a corresponding meaning; Discharge Report means the report required under clause 14, to be provided to ACC upon Discharge; Exception means an incident as defined in clause 14; Failed Discharge means the re-admission of a Client to a facility within six weeks of Discharge;

18 General Practitioner means a Medical Practitioner who holds or is deemed to hold vocational registration in respect only of the general practice of medicine; Health Professional means (a) A registered medical practitioner; or (b) A person who holds a current annual practising certificate issued by the Chiropractic Board, the Dental Council of New Zealand, the Dental Technicians Board, the Nursing Council of New Zealand, the Occupational Therapy Board, the Pharmaceutical Society of New Zealand, or the Physiotherapy Board; or (c) A person registered with the Medical Laboratory Technologists Board, the Medical Radiation Technologists Board, or the Podiatrists Board; or (d) An optometrist registered with the Opticians Board: Health Professional Authority means any authority or body that is empowered by or under any Law, or the rules of any body or organisation, to exercise disciplinary powers in respect of any person who is involved in the supply of health or disability services; Hotel Services means standard meals, power, heating, accommodation, excludes individual purchases such as telephone calls, toiletries, personal items such as clothing; Independent Assessor means a Supplier who holds an ACC Contract for Serious Injury Assessment Services, named specifically for the purposes of providing Needs Confirmation - Residential Assessments; Inpatient day stay means a Client occupying a bed for the twenty-four hours from midnight to midnight. Inpatient rehabilitation means the rehabilitation provided by an interdisciplinary team of three or more professional groups who commence and manage an outcome-focused goal centred programme of care which is carried out in a public hospital setting; Key worker means a doctor or other professional member of the Supplier s interdisciplinary team who works with the Client, family and the team from the time of Admission to the Service. This role includes coordination of the team in setting goals and monitoring goal achievements. This person also acts as the primary contact for the Client, family and Case Owner; Law includes: (a) Any legislation, decree, judgment, order, regulation or by-law; and (b) Any rule protocol code of ethics or practice or conduct and other ethical or standards guidelines and requirements of any Health Professional Authority; in effect at the relevant time. Lead Supplier means the Supplier, who has the responsibility for managing all aspects of Service within the terms of this Service Schedule; Medical Practitioner means a person registered or deemed to be registered under the Medical Practitioners Act 1995; (see that Act, ss12, 144); Oversight Supervision means supervision during periods of time when the Client is not safe to be left unattended. The Client may be independent in some activities but may not be able to respond appropriately or safely to an emergency situation, or may act in an unpredictable way with the potential to cause harm to themselves or others; Supervisor means a rehabilitation health professional who meets the relevant criteria set out at clause 9;

19 Supplier means the person, business, company or organisation named as the Supplier, also referred to as you. Supplier includes your service providers, successors, and permitted assignees Serious Injury Assessment Report means a report from a interdisciplinary assessment, which enables the Case Owner to prepare an individual rehabilitation plan; Significant Complication Transfer of Care has the meaning defined in clause 6.3. Significant Complication means a medical complication which arises unexpectedly after Admission and is of such a nature that the Client s clinical priority becomes that of requiring a public health acute service within the meaning of section 7 of the AC Act. A Significant Complication is not covered in the Services specified in this Service Schedule. An example of a Significant Complication includes, but is not limited to where a significant medical complication arises unexpectedly, or because of an underlying medical condition that is not related to an ACC claim (for example, pneumonia, pulmonary embolism, myocardial infarction, further emergency surgery, acute psychiatric illness etc.); Specialist means a Medical Practitioner other than a General Practitioner who holds or is deemed to hold vocational registration relevant, or, in the reasonable opinion of a General Practitioner, likely to be relevant, to the injury suffered or apparently suffered by the Client; Specified Carer means a carer who has been trained in the specific needs of a Client receiving RS3 level services. Working day, for notice purposes, means a calendar day other than any Saturday or Sunday, any public holiday applicable in the place of the head office of ACC or the registered or principal office of the Supplier or any day falling within the period 24 December to 5 January inclusive;

20 APPENDIX 1 CLINICAL CRITERIA FOR TRANSFER FROM ACUTE CONDITIONS FOR TRANSFER: There are three conditions that must be met before a Client can transfer from acute to non-acute ACC funded services. 1. The person is clinically stable and likely to improve, as well as there being no life threatening condition that would require emergency surgery or intensive monitoring. 2. The clinical team responsible for discharge from acute services and the rehabilitation team agree to the transfer. 3. The person has been accepted, or is likely to be accepted as an ACC Client. Criteria and Injury Groups: Clients covered under this Service Schedule are those who suffer a personal injury as a result of an accident for which they have cover under the AC Act 2001; and require non-acute inpatient rehabilitation in a specialised unit. 1. GENERIC CRITERIA The person s condition is medically stable and likely to improve, and injured person is medically stable when the following conditions are met: 1.1 Absence of any life-threatening condition which would require emergency surgery, for example: (a) (b) To depressurise an intra-cranial haemorrhage, and To arrest potentially catastrophic haemorrhage from a ruptured aneurysm ruptured spleen or liver. 1.2 Absence of any life-threatening condition requiring intensive monitoring, for example: (a) (b) (c) (d) No significant infection, No raised intra-cranial pressure, No cerebrospinal fluid leak, No nasogastric drainage. 1.3 Airway secure and Client can control respiration, or can only control respiration with routine assistance from machine/people where this assistance is subordinate to rehabilitation needs. 1.4 Airway secure, excluding Clients with acute, short-term tracheostomy who have just come off a ventilator; the tracheostomy must be removed or be stable before medical stability is achieved. 1.5 Fractures firmly fixed either internally or externally. 1.6 No issues requiring daily clinical input from the (non-rehabilitation) specialist clinical team or with issues requiring daily medical input but which are subordinate to rehabilitation needs. Where the above clinical conditions are met, transfer to non-acute care may be suitable for Clients with the following conditions: (a) Clients feeding by mouth, naso-gastric tube or percutaneous gastrostomy, (b) Clients requiring IV antibiotics with or without central line, (c) Clients requiring CAPD, or haemodialysis, and who are stable with this management.

21 2. SPECIFIC CLINICAL CRITERIA In addition to the above criteria Clients in the following Client groups must also meet the following specific clinical criteria. 2.1 Clients with severe brain-injury 4 No uncontrolled or significantly unstable epilepsy, level of consciousness, psychiatric conditions, etc. Clients with stabilised epilepsy, cognitive disturbance and/or psychiatric conditions may be suitable provided other criteria are met. Medically stable for a severely brain-injured person occurs when the Client meets the following conditions: (a) No issues requiring daily input from the specialist medical team; (b) Intra-cranial pressure not raised; (c) No intra-cranial haematoma requiring intensive monitoring (d) No cerebrospinal fluid leak (e) No significant chest infection (f) Airway secure, excluding Clients with acute, short-term tracheostomy who have just come off a ventilator; the tracheostomy must be removed before medical stability is achieved, (those who have a longer-term tracheostomy, such as for a fractured larynx, are regarded as medically stable) (g) Fractures firmly fixed either internally or externally, although Clients with fractures can be non-weight bearing (h) No significant infection (i) Feeding by mouth, naso-gastric tube or percutaneous gastrostomy but not on naso-gastric drainage. 2.2 Clients with spinal cord injury No pressure areas or ulcers requiring surgical intervention. Clients with pressure areas that require significant time on bed rest may be suitable, provided other criteria are met. 2.3 Clients with severe multiple injuries/burns No actual or suspected DIC, renal failure, internal haemorrhage or viscus disruption (anatomical or physiological) requiring intensive monitoring. Clients have restored fluid balance with normal intake and output. Clients have no suspect compromised limb/extremity circulation. Clients who are receiving specialised dressings and/or bandages or are awaiting further surgery may be suitable provided other criteria are met. Clinician agreement to transfer care: The clinician responsible for acute care (who may be a discipline-specific specialist) agrees to discharge with reference to this framework and the clinician who is to continue non-acute care agrees to accept (that is, take over responsibility). 4 Severe brain injury is defined as: (a) Initial or worst Glasgow Coma Score (GCS) is less than or equal to 8 or Initial or worst GCS is between 9 and 15 and post traumatic amnesia (PTA) has lasted more than 24 hours.

22 ACC1155 Report Residential support Fill in this form to ask ACC to approve your proposed client individual support plan within 15 working days of a client being admitted to a facility. When you ve finished, please return this form to the person you ve been dealing with at ACC. 1. Client details Client name: Claim number: Address: NHI number: Date of birth: Date of admission to facility: 2. ACC details ACC contact person: ACC office: Address: Contact phone number: address: 3. Provider details Name: Address: Telephone: 4. Rehabilitation summary Specify the recommended service levels until date of discharge Service level Date Cost per day $ Service level rationale: What supports are being provided under the above service level? Other support: What supports need to be arranged externally? Latest independent assessment date: Recommended re-assessment timeframe: Discharge: Short-term anticipated discharge date: Long-term anticipated extension request: ACC1155 October 2015

23 ACC1155 Report Residential support 5. Summary Key functional rehabilitation outcome/progress: Issues or concerns: 6. Declaration and signatures I confirm that the above report has been completed with multi-disciplinary consultation and there have been opportunities provided to the family/whānau for input into this report. I have attached the most recent monthly care plan for this client. Provider name: Signature: Date: Client or representative name: Signature: Date: 7. ACC use only Approved Declined ACC contact person: Signature: Date: Delegation holder name: Signature: Date: When we collect, use and store information, we comply with the Privacy Act 1993 and the Health Information Privacy Code For further details see ACC s privacy policy, available at We use the information collected on this form to fulfil the requirements of the Accident Compensation Act ACC1155 October 2015