Accident Services - Who Pays? Edition Three

Accident Services – Who Pays?
The Impact of the Injury Prevention, Rehabilitation, and Compensation Act 2001 on District Health Boards

Date of publication: July 2002

Edition Three

Foreword
This guide has been developed by the Accident Compensation Corporation (ACC) and the Ministry of Health for health and disability providers working in the public hospital and health services sector. Its purpose is to provide information that will assist these providers to determine which agency is responsible for purchasing treatment, rehabilitation and related services required by an injured person, for personal injury for which that person has cover under the Injury Prevention, Rehabilitation, and Compensation Act 2001.

ACC administers New Zealand’s accident compensation scheme, which provides personal injury cover for all New Zealand citizens, residents and temporary visitors to New Zealand. In return people do not have the right to sue for personal injury.

The Injury Prevention, Rehabilitation, and Compensation Act 2001 is the principal Act under which ACC operates (see Appendix A for a definition of terms and key sections of this Act). While this Act came into force on 1 April 2002 the main impact on the purchasing of public health acute services occurred from 1 July 2002 when:

New purchasing arrangements for public health acute services applied (ie ACC purchases these services through the Minister of Health under a Service Agreement between the Minister for ACC and the Minister of Health).

Services included in ‘public health acute services’ are the services specified in the Injury Prevention, Rehabilitation, and Compensation (Public Health Acute Services) Regulations 2002 (see Appendix B).

ACC no longer purchases directly from Community Trust Hospitals, any services that are specified in regulations as being ‘public health acute services’. ACC and the Ministry of Health have agreed that all acute services will again be funded as part of the public health acute services payment and therefore Community Trust Hospital acute services became a Ministry of Health/DHB responsibility from 1 July 2002.

The Injury Prevention, Rehabilitation, and Compensation (Public Health Acute Services) Regulations 2002 which came into effect on 1 July 2002, include the services listed ins.14(2) of the Accident Insurance Act 1998 with the following key changes:

Includes a definition of ‘outpatient’.

Excludes nurse-led outpatient clinics.

Clarifies that referrals from community registered medical practitioners to DHB/Community Trust Hospital radiologists are excluded from public health acute services.

Clarifies that ancillary services including travel and accommodation for claimants, escorts, and support persons are part of public health acute services.

Clarifies that services related to provision of public health acute treatment (such as consumables and short-term loan equipment) are part of public health acute services.

Appendix C provides a summary of the impact of the Injury Prevention, Rehabilitation, and Compensation Act 2001 on the purchasing of public health acute services between 1 April 2002 and 1 July 2002.

Accredited employers will continue to manage their employees’ work-related personal injury claims under the terms of the ACC Partnership Programme, which is also outlined in this guide.

This guide does not attempt to provide a solution to resolving issues relating to the accident/illness boundary, as these usually relate to clinical judgements around individual cases. However, there is guidance for hospitals and ACC to resolve some boundary issues, particularly in respect of the move from acute medical treatment to rehabilitation. The guiding principle in such cases is for treatment to continue until these boundaries are defined.

Ministry of Health contact details

Ministry of Health, PO Box 5013, Wellington, phone 04 496 2000, fax 04 496 2340. Website: www.moh.govt.nz

ACC contact details

ACC Corporate office, PO Box 242, Wellington, phone 04 918 3975, fax 04 918 3975. Website: www.acc.co.nz

Northern medical fees (covers all of the North Island from Horowhenua north), PO Box 90341, Auckland Mail Centre, phone 09 915 8300, fax 09 915 8301

Southern medical fees (covers the area from Kapiti south and all of the South Island), PO Box 408, Dunedin, phone 03 417 9000, fax 03 471 9847

The ACC Provider Helpline 0800 222 070

Medical misadventure claims 0800 735 566

Sexual abuse claims (sensitive claims) 0800 735 566

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Related information

Information relating to ACC/Accident Services