SIRA has published Guidelines for the Provision of Relevant Services (Health and Related Services)

About the Guidelines 

New South Wales' State Insurance Regulatory Authority (SIRA) has published the Guidelines for the Provision of Relevant Services (Health and Related Services).

The Guidelines specify SIRA’s service and billing expectations for services delivered by health and health-related service providers in the NSW workers compensation (WC) and compulsory third party (CTP) schemes, including occupational therapy services. The guidelines can be found on this page: https://www.sira.nsw.gov.au/fraud-and-regulation/new-regulation-for-health-and-related-services-in-workers-compensation-and-ctp-schemes 

Significant new requirements for occupational therapy service providers include: 

  • a code of conduct for providers working in the schemes
  • new requirements around telehealth
  • new invoicing requirements
     

The Guidelines are part of SIRA’s approach to health and related provider regulation that commenced with the 2022 amendments to the State Insurance and Care Governance Act 2015 and the State Insurance and Care Governance Regulation 2021. The Act provides the power to issue a direction, for the Regulation to specify the circumstances in which a direction is given, and for SIRA to issue Guidelines.  

The requirements for occupational therapy services 

Different parts of the Guidelines apply to different providers and apply differently in the WC and MA schemes. These are the parts of the Guidelines that apply to occupational therapy service providers:  

Scheme 

Parts that apply to occupational therapists 

WC 

  • Part 1: Code of conduct  

  • Part 2: Requirements for telehealth services 

  • Part 5: Billing requirements      

  • Part 6: Invoicing requirements (excluding pharmaceutical services) 

CTP 

  • Part 1: Code of conduct 

  • Part 2: Requirements for telehealth services 


Part 8 of the Guidelines also sets out which parts apply by provider and by scheme.   

SIRA made a number of changes to the Guidelines in response to feedback raised during consultation. Further detail on changes in response to feedback can be found at the Outcomes tab here: https://www.sira.nsw.gov.au/consultations/draft-guidelines-for-the-provision-of-relevant-services-health-and-related-services.   

If you have any further questions about the Guidelines, please contact healthpolicyandsupervision@sira.nsw.gov.au 

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