Necessary and reasonable treatment
MAC takes several factors into consideration when assessing treatment or services as being necessary and reasonable, including but not limited to:
- the extent to which services will be of benefit, including whether the services are likely to promote or maintain recovery or independence, or improve functional autonomy
- the appropriateness of services having regard to the nature and severity of the injury, and the likely effectiveness of the services
- any alternative treatment or services that are available
- whether the service provider is appropriate to provide the services
- the cost effectiveness of providing the services
- length of time the services are to be provided for
A recommended treatment plan for a MAC Scheme participant should be submitted to TIO MAC for approval before treatment is commenced to confirm that costs will be covered and to facilitate the timely payment of services.
Clinical framework
The
Clinical-Framework-for-the-Delivery-of-Health-Services provides the principles and guidelines to help you deliver the right care at the right time.
