Non-Acute Rehabilitation Pathway service

Who can deliver rehabilitation?

Several registered health professionals may be involved in a client’s rehabilitation in the community, these include: 

• allied health
• nursing
• medical
• support workers, health care assistants, allied health assistants

Support workers, health care assistants, allied health assistants can deliver rehabilitation when overseen by registered health professionals where appropriate.

Clients may access rongoā Māori and NARP services at the same time.

Working out the right amount of community care 

The clinical team will work with the patient, their family and whānau and primary carer to create the rehabilitation plan. The plan will include:

• achievable patient centred goals
• therapeutic plans to meet those goals.

The plan will describe:

• what the patient will be doing
• how providers should support the patient that meets their injury-related needs.

Can Te Whatu Ora districts provide community rehabilitation in a facility instead of a person's home?

Yes, there are several pathways, including Transitional Care Rehabilitation, which takes place in a residential care facility.

Should districts provide community services to all elderly patients admitted to ED/Acute?

No. The NARP service is available to all injured patients, without age restriction, where they meet the criteria to receive hospital-level rehabilitation.

The operational guidelines outline the eligibility criteria and include that the client:

• has sustained an injury with cover accepted by ACC
• requires rehabilitation primarily for the covered injury
• is ready for rehabilitation
• is capable and willing to actively participate in rehabilitation
• has achievable rehabilitation goals that will improve their functional independence
• has needs that best met by this service.

Is Rehabilitation Admission Avoidance for anyone who needs services after an acute hospital admission?

No. Rehabilitation Admission Avoidance is a specialised pathway. It's for patients who would otherwise have received an inpatient rehabilitation service but can be supported at home instead with an integrated package of support - Community Group 4.

NARP is not required:

• when a patient would not need inpatient rehabilitation. These patients can receive ACC supports via normal referral methods
• if a patient would normally be discharged home from ED/Acute with some supports.

Clinicians use the profiling tools to assess eligibility for NARP pathways. When a patient has not had a NARP inpatient rehabilitation episode, they can only access the NARP Group 4 community pathway. This pathway is Rehabilitation Admission Avoidance.

A client’s inpatient case mix can be worked out using the interRAI Acute Care Admission Assessment or by using the manual profiling tool. The case mix is required for billing purposes.

View our inpatient profiling tool here.

A client’s community case mix can be worked out using the interRAI Acute Care Discharge Assessment, or by using the manual profiling tool.

View our user-friendly community profiling tool here.

Clinicians will manually profile patients using the community profiling tool or use interRAI. A community pathway is generated when an interRAI Acute Care assessment is completed on admission to, and discharge from, inpatient care.

How does casemix funding allow rehabilitation tailored to individual patient need?

The casemix service design provides districts with flexibility and funding to determine how to provide the right care response, in the right location, to best meet individual patient rehabilitation needs.

The actual time spent by healthcare providers for individual patients will vary, based on their need.

Case-weight funding enables districts to deliver services via inpatient or community settings. It also enables districts to operationalise the community service delivery using their own methods that best suit the needs of the patient, including the use of satellite sites or through subcontracting.

The funding we provide covers the average service provision across the patients accessing NARP. It should be aggregated to give a population funding amount.

We will continue to work with our Te Whatu Ora partners to monitor the services. So, it is important that you send us accurate information. Over time, we can ensure that the funding continues to adapt to clinical best practice.

Why is the NARP community casemix service based on a 12-week timeframe?

The timeframe is up to 12 weeks duration. This enables district providers to provide services that meet patient needs across varying levels of complexity. If patients take less time than the 12 weeks duration, the full case-weight package is still paid.

An integrated patient journey is one of the core principles of this service. 12 weeks allows enough time for most, if not all, patients to rehabilitate from their injury. Ongoing needs after this time are more likely related to their underlying health. A shorter timeframe would likely mean some patients would need to transition back into our care. This fragments the patient journey.

What if a patient is being discharged from inpatient rehabilitation and requires a community rehabilitation service well in excess of 12 weeks?

The district can refer directly into our services. This ensures the patient experiences a seamless community programme. You will need to send us an ACC7985 form and clearly articulate the need for an extended rehabilitation timeline.

How are district providers expected to use interRAI in NARP? Is it used in both inpatient and the community?

The interRAI Acute Care assessment tool is essential for our casemix funding approach for NARP patients. The interRAI Acute Care assessment tool has inpatient and community algorithms embedded. This removes the need for manual profiling of patients.

When to complete an assessment

• On admission to inpatient rehabilitation (Acute Care Admission) which provides the inpatient casemix group.
• On discharge from inpatient rehabilitation (Acute Care Discharge) which provides the community casemix group.

We will work with Te Whatu Ora to:

• design an end-to-end suite of assessments across the patients health journey
• support the development of a clinical quality framework.

At this stage interRAI is not mandated to use in the community NARP setting. Districts may already be using interRAI tools in the community and can continue to do so. They may use other assessment and outcome tools.

How is equipment funded under the NARP contract?

Public Health Acute Services (PHAS) includes the following services for up to six weeks after discharge from acute care:

• outpatient medical practitioner appointments
• equipment
• high tech imaging and other radiology services.

The exception to this is a client receiving NARP from the hospital. For these clients, hospital clinicians can order equipment at any stage to support the transition home if the equipment is needed for longer than six weeks and is injury related.

While a client is receiving NARP services the hospital will provide any equipment required by the client to meet their needs, including pressure relief needs, and to achieve a suitable rehabilitation outcome. This is funded outside of NARP case-weights. Allied Health (Physiotherapist and Occupational Therapist) assessors can request Managed Rehabilitation Equipment Services (MRES) simple list equipment. This equipment must relate to the injury-related need.

Equipment requests must be made in accordance with our MRES operational guidelines.

Read the MRES operational guidelines

When registering as an MRES user on the Enable site, select Non-Acute Rehab Pathway as the organisation.

Allied Health (Physiotherapist and Occupational Therapist) assessors can register as an ACC Assessor. The form to register  is found under the tools and resources tab. Online app hub | Enable New Zealand

If a client requires MRES standard, complex or non-list equipment the supplier must inform us. We will arrange a specialist assessment service to undertake the needs assessment.

Can patients receive rongoā Māori health services at the same time as being in a NARP service?

We have enabled access to rongoā Māori which is traditional Māori healing. This gives whānau Māori access to services that align with tikanga Māori practices and principles. Patients can access rongoā Māori and NARP services at the same time.

Our rongoā service is a programme by Māori, with Māori, for Māori and available to people of all ethnicities. The service incorporates a holistic, kaupapa Māori approach to wellbeing that includes:

• ā tinana (physical)
• ā wairua (spiritual)
• ā hinengaro (mental and emotional)
• ā whānau (family and social).

Rongoā Māori services for patients

Working with us as a rongoā Māori practitioner

Can you use Telehealth to provide NARP rehabilitation?

Telehealth consultations can be provided to patients where the provider determines it as a clinically appropriate consultation method to meet the treatment and rehabilitation needs of their patient. Funding for these services are within the allocated NARP case-weight.

What type of travel is covered within NARP?

The NARP contract requires you to coordinate the patient care and take all reasonable steps to minimise travel required by employees for a patient’s community rehabilitation pathway.

The case-weighted community rates allocate funding to facilitate patient rehabilitation, including shopping. You need to manage this efficiently by looking at the most cost-effective options, like:

• shopping for essential items
• shopping online with delivery
• click and collect
• family, whānau or friends able to do the shopping.

How has casemix funding considered travel requirements for rural settings?

We have provided an allowance for typical travel time and distance within the community case-weight funding. The district may use satellite sites or sub-contract services to manage travel costs. There is an exceptional travel code for trips exceeding 100km. Access this via the contract.

Does ACC cover any other transport needs for patients?

A patient can request ACC funding for travel support, like a taxi, outside of NARP funding when:

• they are unable to drive themselves to the supermarket or other essential location as a result of their injury
• this support is not provided within their rehabilitation plan.

Set up Casemix data collection

We have supplied a spreadsheet for capturing billing data to be submitted for payment.. If the spreadsheet is your preferred method of data collection, contact one of the pilot NARP Districts: Auckland, Waikato or Canterbury.

The master spreadsheet and guide is locagted on this webpage. 

Generate an invoice

Once you have both the admission and discharge dates for the client's NARP pathway you can invoice us via SendInvoice. You can invoice us as soon as a discharge date has been recorded.

Get connected with SendInvoice in our Developer Resource Centre

Why can’t ACC monitor data from the NMDS instead of us having to send you data?

We do not have a data sharing agreement for access to NMDS. Legally we can only access clinical information related to the accepted injury and not health conditions.

Will there be funding to set up NARP community services?

Districts should set up the pathways like a normal service that grows and changes over time. The case-weighted rates pay for service delivery of the pathways in line with contract specifications.

When does payment to the district providers for case-weights occur?

At the end of each part of the patient's journey, invoice us and include the start and end dates of that part of the pathway. Pathway parts include Inpatient Rehabilitation, Transitional Care Rehabilitation, Rehabilitation Avoidance and Community Rehabilitation. This will provide us within enough information to monitor case-weights. We won't need additional date exchange with your district. You can find more information about this in the NARP operational guidelines.

Community pathways: why is there one price per group, rather than separate prices of each of the subgroups?

There is one case-weighted rate for each of the community groups 2, 3 and 4 to minimise the number of service item codes required. For each group there are sub-classifications based on anticipated level of input.

To enable you to provide a sufficient level of care, we have allowed for a proportionally higher amount of claims accessing the pathways that require higher level servicing. We have created monitoring codes for each sub-classification to assess this overtime. If needed, we could create separate pricing for each subgroup.

What data sources determine the NARP Casemix funding model?

The case-weights were built on data from several sources, including:

• representation from the demonstration with Auckland, Waikato and Christchurch district providers
• expert opinion from Auckland University
• external partners
• the ACC clinical team.

This was tested against national data across all Te Whatu Ora districts to ensure the case-mix will be suitable for all.

For a detailed breakdown of the NARP Casemix funding model, refer to the information packs from August 2021 and May 2023. Contact us to request a copy of this.

How were the price build ups for the case-weighted rates determined?

The inpatient case-weights are worked out by developing a daily unit price multiplied by the expected service duration. The daily unit price was built up using the average service inputs from the varied health professionals plus a markup for indirect costs like travel and overheads.

Similarly, community case-weights were developed by estimating the average amount of inputs from various health professionals plus a mark-up for indirect costs like travel and overheads.

Many sources of data were used to develop the average service duration for each casemix group.

When we established the case-weight package prices, we considered current market cost pressures. This included Multi Employer Collective Agreement (MECA) and inflation. We have included a pricing clause in the NARP service schedule that ensures we monitor change. This will ensure case-weights are reflective of market cost pressures.

What happens if we see increased patient complexity resulting in increased need and cost impacts?

A benefit of NARP is that casemix allows us to better reflect patient complexity by providing funding for patients with similar needs, rather than having one price for all.

The service schedule includes a pricing clause. This ensures we monitor the level of time and duration allowed for within the case-weights to enable a sufficient level of rehabilitation.

Sometimes a patient may have an exceptional need that cannot be reasonably met by NARP casemix services. You can notify us of the exceptional circumstance as outlined in the service schedule.

Why did ACC choose interRAI? What happens to AROC?

InterRAI is a suite of standardised assessment tools developed internationally to assess the physical, psychological, and social functioning of individuals in different healthcare settings. Settings include:

• hospitals
• nursing homes
• home care.

The assessment supports high-quality clinical decision-making.

The decision to move to interRAI was made in partnership with the then District Health Boards as an assessment platform already used existing in aged care. InterRAI Services, previously called TAS, supports and promotes interRAI in Aotearoa New Zealand on behalf of the Manatū Hauora | Ministry of Health. InterRAI assessments have been used successfully here since 2015 to support the health of older people in their homes and in aged residential care.

Te Whatu Ora districts can continue to use AROC as a clinical tool. The use of interRAI does not exclude the use of AROC.

What is considered as highly complex injury and outside of NARP case-weight packaged funding?

Exceptionally complex injury include: 

• specialized rehabilitation for complex injuries, such as Spinal Cord injury, serious burns or severe Traumatic Brain injury and;
• Kirirtaki (client) is waiting for a Rehabilitation bed in a Spinal Cord Injury Hospital or Traumatic Brain Injury unit.

Kiritaki (clients) with exceptionally complex injuries do not require an interRAI assessment, as a case-weight service item code is not required, as they are paid on per day rate.

Note: Suppliers must use the ACC7985 for Exceptional Circumstances  to request funding for exceptionally complex injuries.

What level of rehabilitation is required for NARP funding?

The client is:  

• Capable – Their overall physical and cognitive function is such that they can and do take part. 
• Willing - They want to participate. They demonstrate motivation to participate.
• Actively participates – They’re not just receiving rehabilitation therapy passively.  They’re consciously taking part in rehabilitation activities and therapies
• A lient can actively participate while non weight bearing on the affected limb such as using a walking frame and supporting their weight on the uninjured limb.
• Most Clients will not be on bedrest but there can be some situations where a Client is actively participating while on bedrest. 
• Clients who are unwell, can’t or are unwilling to take direction, aren’t in a rehabilitation programme as defined in this guide, so are not funded under this service. 

Note: Unwillingness would not be the sole reason for ACC not funding as Providers are experienced at successfully encouraging Clients to actively engage. 

Little ‘r’ versus Big ‘R’ rehabilitation 

Rehabilitation can be described as big ‘R’ rehabilitation and little ‘r’ rehabilitation.  

There must be differentiation between big ‘R’ rehabilitation and little ‘r’ rehabilitation.  

• Little ‘r’ describes rehabilitation where there is a focus on preventing complications. The client is assisted and encouraged to move, as able, to prevent the consequences of prolonged lack of movement. The need for rehabilitation intervention is usually short term and may be particularly needed after surgery. The client usually recovers function quickly and generally does not need intensive or ongoing rehabilitation and is not within NARP criteria.
• Big ‘R’ describes rehabilitation where there has been significant loss of function. There is a need for therapist guided intervention which gradually progresses the client’s functional abilities over time and may require the client to learn to complete a functional activity in a new way, either temporarily or permanently.

When a client is well enough to actively participate in Rehabilitation (big R), ACC purchases that rehabilitation directly through the NARP services. 

Find out more about Little 'r' versus big 'R' rehabilitation in the Operational Guidelines.

How do we apply for access to Momentum to run the ACC reports?

Instructions for requesting access to interRAI reports

There are several types of interRAI reporting available for non-clinicians.

To apply read only access to Momentum to run the casemix report(s).

1. User Access Form:

Complete the user access form available at Access Form Link. This will generate an email to your manager for approval. Once approved, your manager should forward the email to interrai@tas.health.nz

2. Online Course Registration:

Contact interRAI at interrai@tas.health.nz to register for a self-paced online course, which typically takes about one hour to complete. This is required to ensure users know how to navigate and use the system.

3. Course Completion Notification:

Inform interRAI at interrai@tas.health.nz once you have successfully completed the online course.

4. Account Setup:

Upon receiving confirmation of your course completion, the interRAI service will set up your account and share the access details with you.

Please note, ACC and interRAI services are currently looking at the usability of these reports in supporting billing functions and will share more information in due course.

There is also a Power BI dashboard available that compares key assessment attributes across all the districts who use the assessments. This does not require the registration or training as above.

Contact Visualise@tas.health.nz requesting access to “ACC interRAI Power BI reports” with email addresses of staff who want access.