Artificial limbs
The artificial limb service supports clients who have lost a limb.
Clients are provided with an artificial limb (prosthetic) to meet their individual needs and
restore their independence to the maximum extent practicable.
This service also includes ongoing regular reviews or replacement of their prosthetic and
repairs when needed to maintain their independence.
The claims process
Client referrals
Clients can be referred to the artificial limb service by a medical specialist.
If the prosthetic later needs repairs, that referral can be made by the client, a treatment
provider, GP or ACC case manager.
Referrals will only be made in relation to individuals who have limb loss, limb damage, or
limb deformity, where that loss or deformity is covered by an accepted ACC claim.
ACC‘s assessment and the client’s prosthetic options
Prosthetic options are discussed after a comprehensive assessment involving the injured
person, and family/whanau where appropriate.
ACC may decline to fund a prosthetic required specifically for a sporting or recreational
purpose.
Provider’s role
The provider will use the assessment to:

create a rehabilitation plan

recommend, fit, follow up, review and repair the prosthetic for the client.
The frequency of reviews and monitoring of clients’ prosthetics will be determined by the
prosthetic team.
It will be based on the clients’ individual needs and the type of prosthetic in use.
Provider’s role in client assessment
The health provider is central to the client’s assessment and rehabilitation plan as
discussed below.
Client assessments - timeframe
When the client is first referred to a provider, that provider will produce an assessment
report in accordance with the client’s injury.
The assessment must be done within
…when
one working day of a medical specialist’s
referral

urgent repairs are required.
‘Urgent’ repairs are defined as those
which would:

render the prosthetic unsafe or
unusable

cause significant disruption to daily
life (eg unable to attend work)

cause a skin breakdown.
five working days of a medical specialist’s
referral

the client has just had an amputation

a replacement prosthetic or adjustment
is required for a prosthetic that is
uncomfortable, but there is no visible or
threatened skin breakdown.
15 working days of a medical specialist’s
referral

a replacement prosthetic is identified as
needing to be replaced in the
foreseeable future,
but there is no
visible or threatened skin breakdown.
Client assessments - content
The assessment report must include the following details:

Client details, including nature and cause of injury.

The day-to-day activities the client could do before the injury, but cannot do after
the injury.

The client’s level of impairment and functional activity, taking into account
previous lifestyle and future activities/limitations.

The non-prosthetic options available to the client and ACC that meet cost
effective social and vocational rehabilitation needs. Where a prosthetic is not an
appropriate option, include other options which will assist with day-to-day
activities.

The rationales for particular options that will meet the client’s needs.

The proposed cost of the prosthetic and/or options and expected date of any
fittings and reviews.
The assessment report needs to say how the review process works, and how ACC, the
client and their family/whanau can participate in the decisions made.
Client assessments - considerations
The provider will take into account the client’s:

lifestyle prior to their injury

working environment or potential working environment

home environment and activities of daily living

social situation and support mechanisms

safety management needs.
Client assessments - outcomes
The primary assessment ensures:

the client’s prosthetic needs and options are assessed, detailed, and fully discussed

resources go to those who need it most

the client’s prosthetic needs match their daily living, vocational, educational, and
recreational needs. In some circumstances this may include access to a second
prosthesis

ongoing rehabilitation to help maximise and maintain the client’s independence

Clients with limb loss understand all aspects of management, rehabilitation,
community and environmental supports that are available

Clients with limb loss understand the importance of timeliness in the clinical pathway

the rehabilitation plan sets goals that restore and maintain optimal independence

the client’s comfort, physical presentation, appearance, and dignity are not
compromised by any part of the assessment, provision and fitting process

the client’s cultural background is respected at all times

the client makes a speedy and lasting return to principal economic activity or
greatest independence, considering the impact on employment where relevant

the client is aware of other relevant support services and are referred on when
appropriate.
Provider’s role in creating a rehabilitation plan
The provider is central to creating a rehabilitation plan for the client.
The provider needs to be aware that the plan must be:

forwarded to the ACC case manager within 10 working days of completion

approved by the ACC case manager then form the basis for the client’s ongoing
services applicable to the specific claimant under this agreement

attached to the ACC Individual Rehabilitation Plan for the client

updated annually or as needed.
Client Rehabilitation Plan – content
The Client Rehabilitation Plan must include the following details:

Client’s name, contact address and details

Client’s ACC number

Date of birth

Ethnicity

Case manager name

Type of injury

Type of Prosthetic

Expected life of the prosthetic

Location for follow up appointments

Expected consumables and how often they will be required

Wound status (as appropriate)

Number of Client reviews for each 12 month period and the rationale for the
number of reviews

Recommended physiotherapy, counselling, occupational therapist programmes, or
other services (where applicable).
Client Rehabilitation Plan – timeframe
The provider will forward the Client Rehabilitation Plan to ACC for approval within 10
Working Days of the completion of the Primary Assessment and Assessment Report.
Once approved by ACC the Client Rehabilitation Plan will be the basis for ongoing
services applicable to the client.
If ACC has not contacted the provider with a decision within five Working Days and the
provider has made a reasonable attempt to contact ACC, the provider may proceed with
the provision of the services set out in the Client Rehabilitation Plan.
Provider’s role in prosthetic repair and replacement
There is no written warranty for specific prosthetics but all new and replacement
prosthetics will have a three month warranty period from the date of fitting, and services
must be provided within timeframes.
Prosthetic repair timelines
All prosthetic repairs must be
completed within:
….when
one working day of referral (urgent
repairs)
there are no exceptional circumstances
that make this impossible (eg, product
unavailability).
two working days of the date on which ACC
approved the assessment report (non
urgent repairs)
there are no exceptional circumstances
that make this impossible (eg, product
unavailability).
Prosthetic replacement timelines
All prosthetic replacements must be
completed within:
….when
21 working days of the date on which ACC
approved the assessment report
the fabrication (including remodelling) is
not for a recent amputee.
Where the provider cannot meet these timeframes, the provider must give advance
notice of this delay to the case manager, in order so alternative solutions can be
considered.
Replacement Limb Assessment Report
The Replacement Limb Assessment Report is produced by the provider.
It details the rationale for a replacement prosthetic and includes:

The proposed cost of the prosthetic and expected date of any fittings

Cost-effective alternatives and options available to the client and ACC that meet
social and vocational rehabilitation needs.

Where a prosthetic is not an appropriate option for the client, include other options
which will assist with activities of daily living.

The rationale for particular options that will meet the client’s needs for independence.
The Replacement Limb Assessment Report shall be sent to ACC within five working days
of the assessment, to enable a funding and purchasing decision to be made.
On receipt of the Replacement Limb Assessment Report, ACC will make a funding and
purchasing decision and advise the provider of that decision within five working days.
What is not covered

ACC will not pay for any repairs to the prosthesis due to faulty componentry within
three months of a fitting. Note that in any case ACC’s responsibility for repairs to the
prosthesis commence after the expiry date of the prosthesis warranty supplied by the
provider at the time of fitting.

ACC is not liable for any repair costs if they are due to neglect, abuse or misuse of
the prosthesis.
Approvals

Repairs to the prosthesis up to a maximum amount of $1,000.00 (GST-exclusive) do
not require ACC approval after the warranty period has expired. Note that the
provider is responsible for ensuring that the client has an accepted ACC claim before
making any such repairs.

Repairs to the prosthesis over 1,000.00 (GST-exclusive) must have prior approval
from ACC. When seeking approval for repairs over $400.00 (GST-exclusive) the
provider is required to detail the rationale for the repairs and costs.

Where approval for repairs over $1,000.00 (GST-exclusive) is sought, ACC will make
a decision on approval and advise the provider of that decision within five working
days.

Where a replacement prosthetic is required then the client will be referred for a full
assessment.
Provider service standards
The provider agrees to meet the following service standards:

Provide all necessary expertise and resources, by telephone where necessary.

Take all steps necessary to clarify ACC’s requirements for the services.

Advise ACC immediately if the provider becomes aware of any matter which may
change or delay the performance of the services. The advice must include detailed
particulars of the likely change or delay and recommendations to minimise any
adverse effect from it.

Comply with all reasonable directions and instructions of ACC.

Keep documents up to date and readily available for staff to read

Co-operate with any other service provider engaged by ACC to deliver services to any
client

Ensure that records and documentation are maintained in a manner that is current,
detailed and organised and enables effective provision of services.

Ensure that all reports and other written communications to ACC are clear, thorough,
complete and acceptable to ACC in both form and substance, and available on
request to the client.

Have in place, and follow, procedures, policies and written procedures around:

Receiving and responding to referrals

Receiving and responding to complaints

Systems to measure customer satisfaction with the services

Collection, privacy and storage of information

Roles and responsibilities of those providing the services

Culturally appropriate practices

Maximum waiting times

Rights and responsibilities of claimants

Compliance with relevant legislation, regulations, ethical standards and clinical
protocols.
For clients with...
…the provider will provide ongoing
access to the provision of
physiotherapy services
lower limb prostheses
aimed specifically at prosthetic use, gait
retraining and claimant education, as
outlined in an approved artificial limb
rehabilitation plan.
upper limb prostheses
and/or occupational therapy services aimed
specifically at prosthetic use and claimant
education, as outlined in an approved
artificial limb rehabilitation plan.
Provider staff qualifications
The provider will employ staff with the requisite skills and qualifications, provide the
necessary services, and provide staff with the resources they need.
Staff skills and qualifications

Prosthetic staff must have:

a degree in prosthetics and orthotics from a recognised university

certification from an approved training programme (eg, the Central Institute of
Technology or Christchurch Polytechnic)

demonstrated appropriate experience and a current membership or fellowship of
the NZAOP.

Prosthetic technicians must hold certificates of proficiency.

Medical practitioners must be vocationally registered as orthopaedic surgeons or
rehabilitation physicians.

Physiotherapists must have current New Zealand registration and hold a current
practising certificate.

Occupational therapists must have current New Zealand registration and hold a
current practising certificate.
Provider services must include:

Assessment teams for the initial and ongoing clinical assessment, review and
monitoring of clients in each identified centre around the country. The teams will be
comprised of a medical practitioner, a prosthetist, a physiotherapist, and an
occupational therapist (where applicable).

The physiotherapist and occupational therapist should also have demonstrated a
specific interest and/or expertise in the problems of claimants with limb loss.
The resources available to staff must include

Appropriate and ongoing staff training and development.

Appropriate professional supervision.

Administrative and organisational supervision and support.
Provider service standards
Telephone advice

The provider will ensure that the services delivered from their centres will include
skilled telephone advice in regard to prosthetic problems for clients and their support
people when sought.

Physical therapy services will be provided as follows:

for clients with lower limb prostheses, ongoing access to the provision of
physiotherapy services aimed specifically at prosthetic use, gait retraining and
claimant education, as outlined in an approved artificial limb rehabilitation plan.

for clients with upper limb prostheses, ongoing access to the provision of
physiotherapy and/or occupational therapy services aimed specifically at
prosthetic use and claimant education, as outlined in an approved artificial limb
rehabilitation plan.
NB: These are distinct therapy services relating specifically to prosthetic use and do not
include acute or ongoing rehabilitation services already purchased by ACC or any other
funders. However it is anticipated that the provider will encourage strong collegial links
with rehabilitation units and physiotherapists, occupational therapists and rehabilitation
nurses in these services and develop memoranda of understanding around referral
processes, the provision of services and limb and claimant management boundaries.
ACC’s responsibilities for physiotherapy services under this agreement will only
commence on discharge of the claimant.
Provider location standards
Services will be delivered as close to the client’s residential setting as is practical, for
reasons that include stopping excessive travel distances.
Central service locations
Where the provider is providing the services on a nationwide basis, limb-fitting centres
must be located in at least five major regional centres - Auckland, Hamilton, Wellington,
Christchurch and Dunedin.
This may be in conjunction with a specialist health and hospital service or may be a
stand-alone service.
Satellite service locations
Outside these main centres, satellite services will be provided regularly, as determined
by client numbers and needs.
Service facilities
Services will be provided at a purpose-built and convenient facility that is fully accessible
for disabled clients and family/whanau.
The provider will provide adequate reception, record keeping and administrative
facilities.
Service exclusions
The following are excluded from the artificial limb service:

immediate post amputation non-prosthetic therapy in acute hospital or rehabilitation
centre

case management

counselling services

patient advocacy.
Review process
Reviews will occur as per the Assessment Report and/or the Artificial Limb Rehabilitation
Plan or as required and approved by ACC.
A Review includes:

Review of a new prosthesis and the client’s use of it by the full assessment team at
the time of final fitting and/or delivery of the Prosthetist to the client.

Telephone review with the client with provision to have the client attend prosthetics
service if necessary one to six weeks after delivery of prosthesis.

Recall of the client to the provider for prosthesis reassessment three to six months
after delivery of prosthesis.
ACC rights to evaluate
While the provider is responsible for reporting on measures that demonstrate they are
providing a quality service, ACC may wish to evaluate the provision of the services
provided under this agreement by the provider.
Scope of evaluation
The evaluation undertaken by ACC may include (but shall not be restricted to):

an operational audit

the processes outlined in this Agreement, including the timeliness, appropriateness
and cost-effectiveness of the services provided and the ongoing management of this
Agreement

satisfaction of clients with the provider and ACC

any other matters reasonably considered to be relevant by ACC.
Appointed person
An appropriate person, appointed and retained by ACC, may conduct an evaluation of
the above areas of any service.
In conducting such evaluations he/she may (subject to the rights of clients or other
persons receiving services) attend the provision of services, talk with clients and their
representatives, where appropriate, and/or any of the provider’s personnel.
Notice
Such a person shall give the provider not less than 10 working days notice of intention to
conduct an evaluation.
Cost
The cost of this evaluation is the responsibility of ACC. If the evaluation reveals areas of
the service that are not complying with this Agreement, the provider will be advised and
requested to take appropriate action.
Access to records and premises
Subject to observance of the requirements of the law, the provider will (and will ensure
every one of its subcontractors will) allow ACC access to those records and premises of
the provider and any relevant subcontractor retained by the provider which are
necessary for the purposes of the evaluation.
The provider will (and will ensure every one of its subcontractors will) provide ACC with
every reasonable facility for and assistance in obtaining access for the purpose of such
evaluations.
Second opinions and complaints resolution
In the first instance, resolution and the opportunity to rectify the issue should first be
sought from the provider.
If the issue is not resolved the matter should be escalated to ACC.
The client can request a second opinion from an independent, appropriately qualified
Prosthetist. Please contact the Health Procurement and Contracting Team for assistance.
Updated: 25 August 2015