SERVICE SCHEDULE FOR PSYCHOLOGICAL SERVICES

CONTRACT NO: «Contract_»

A. QUICK REFERENCE INFORMATION

1. TERM FOR PROVIDING PSYCHOLOGICAL SERVICES

1.1. The Term for the provision of Psychological Services is the period from the date of signing by
both parties (“Commencement Date”) until the close of 30 April 2024 (the “Date of Expiry”)
or such earlier date upon which the period is lawfully terminated or cancelled.

1.2. Prior to the End Date, the parties may agree in writing to extend the Term of this Service
Schedule for a maximum of two further periods of one year. Any decision to extend the Term
of the Service Schedule will be based on:
1.2.1 the parties reaching agreement on the extension in writing prior to the End Date, and
1.2.2 ACC being satisfied with the performance of the Services by the Supplier, and
1.2.3 all other provisions of this Contract either continuing to apply during such extended
Term or being re-negotiated to the satisfaction of both parties.
1.3. There is no obligation on the part of ACC to extend the Term of the Service Schedule, even if
the Supplier has satisfactorily performed all the Services.

2. SPECIFIED AREA AND SERVICE LOCATION (CLAUSE 4)

TLAs.

3. NAMED SERVICE PROVIDERS

Name, ACC Provider Number

4. SERVICE ITEMS AND PRICES

Table 1 – Psychological Service Items and Prices

Service Service Item Price Pricing
Service Item Definition
Item Code Description (excl GST) Unit
PSY50 In-person assessment In accordance with Part B, clause 5. $186.48 Per hour to
(excluding PSY51 This is a treatment needs a
and PSY52) assessment only and is not used to maximum
PSY50T Assessment determine cover of a mental injury. of 4 hours
(excluding PSY51 Includes assessment and report
and PSY52) delivered writing time up to a maximum of 4
by Telehealth hours.
PSY51 In-person assessment In accordance with Part B, clause 5. $186.48 Per hour to
to determine MICPI Assessment inclusive of reading, a
cover writing and Client report review maximum
PSY51T Assessment to time. of 16 hours
determine MICPI
cover delivered via
Telehealth

ACC Psychological Services Service Schedule – 1 July 2023

 Service Service Item Price Pricing
Service Item Definition
Item Code Description (excl GST) Unit
PSY40 Pre-Cover In accordance with Part B, clause $186.48 Per hour to
WRMI 5.10. a
Early Intervention, maximum
in-person Involves early provider contact and of 4 hours
PSY40T Pre-Cover information gathering.
WRMI It has two purposes:
Early Intervention, 1) to provide early psychological
via Telehealth intervention to reduce the
psychological impact of the
traumatic event on the Client; and
2) to gather information which can
be used in a mental injury
assessment report.
PSY52 In-person assessment In accordance with Part B, clause 5. $186.48 Per hour to
to determine WRMI Assessment inclusive of reading, a
cover report writing time and Client maximum
PSY52T Assessment to report review time. of 16 hours
determine WRMI
cover via Telehealth
PSY53 Pre-Cover WRMI In accordance with Part B, clause $186.48 Per hour to
Post Assessment 5.11. a
In-person Allows the Client continuity of maximum
Therapeutic Sessions support while ACC determines of 2 hours
PSY53T Pre-Cover WRMI WRMI cover.
Post Assessment
Therapeutic Sessions
via Telehealth
PSY60 Treatment in-person In accordance with Part B, clause $186.48 Per hour
Sessions without 5.7. and / or
MICPI cover part
PSY60T Treatment Sessions thereof to a
without MICPI cover maximum
via Telehealth of 16 hours
per block
PSY61 Treatment in-person In accordance with Part B, clause $186.48 Per hour
Sessions with MICPI 5.7. and / or
cover part
PSY61T Treatment Sessions thereof to a
with MICPI cover via maximum
Telehealth of 16 hours
per block
PSY62 Treatment in-person In accordance with Part B, clause $186.48 Per hour
Sessions with WRMI 5.7. and / or
cover part
PSY62T Treatment Sessions thereof to a
with WRMI cover via maximum
Telehealth of 16 hours
per block
PSY70 Progress / In accordance with Part B, clauses $186.48 Per report
Completion Report 5.8 or 5.9.
without MICPI cover
PSY71 Progress / In accordance with Part B, clauses $186.48 Per report
Completion Report 5.8 or 5.9.
with MICPI cover

ACC Psychological Services Service Schedule – 1 July 2023

 Service Service Item Price Pricing
Service Item Definition
Item Code Description (excl GST) Unit
PSY72 Progress / In accordance with Part B, clauses $186.48 Per report
Completion Report 5.8 or 5.9.
with WRMI cover

Table 2 – Did Not Attend and Travel Codes – Service Items and Prices
Service Service Item Price Pricing
Service Item Definition
Item Code Description (excl. GST) Unit
PSYDNA Non-Attendance Fee Did Not Attend - payable for the Max 2 per
missed face to face assessment or claim
treatment if a Client does not attend (payable
a scheduled appointment without once per
giving 2 Business Days prior DNA)
notification, and the Supplier has
taken all reasonable steps to ensure $74.59 On site
they attend, including reminding the 40%
Client of the appointment 3-4 days
before the scheduled time. Not to be $111.89 Off-site
used in conjunction with any other 60%
non-travel code.
The Supplier must notify ACC.
PSYTD10 Travel Distance A contribution towards travel: $0.70 Per km
• for return travel via the most
direct, practicable route; and
• where the return travel exceeds
20km.
Note 1: where the Supplier has no
base or facility in the Service
provision area, return travel will be
calculated between the “start point”
and “end point” closest to the Client
(as agreed by ACC).
Note 2: ACC does not pay for the
first 20km of travel and this must be
deducted from the total distance
travelled. If travel includes more
than one client (ACC and/or non-
ACC) then invoicing is on a pro-rata
basis.
PSYTT5 Travel Time - less Paid for the first 60 minutes (or less) $93.24 Per hour or
than 1-hour return, or of total travel in a day where: part thereof
for first hour of travel • the travel is necessary; and
• the Service Provider travels via
the most direct, practicable route
between their base/facility and
where the services are provided;
and
• the distance the Service Provider
travels exceeds 20km return;
and/or
• the time the Service Provider
travels exceeds 30 minutes.
Note 1: where the Supplier has no
base or facility in the Service
provision area return travel will be

ACC Psychological Services Service Schedule – 1 July 2023

 Service Service Item Price Pricing
Service Item Definition
Item Code Description (excl. GST) Unit
calculated between the “start point”
and “end point” closest to the Client
(as agreed by ACC).
Note 2: If travel includes more than
one Client (ACC and/or non-ACC)
then invoicing is on a pro-rata basis.
PSYTT1 Travel Time - Paid for return travel time after the $186.48 Per hour or
subsequent hour first 60 minutes in a day paid under part thereof
PSYTT5, where:
• the travel is necessary; and
• the Service Provider travels via
the most direct, practicable route
available between their
base/facility and where the
services are provided; and
• additional travel time is required
after the first hour of travel.

Note 1: where the Supplier has no

base or facility in the Service
provision area return travel will be
calculated between the “start point”
and “end point” closest to the Client
as agreed by ACC.

Note 2: the first 60 minutes must be

deducted from the total travel time
and if travel includes more than one
client (ACC and/or non-ACC) then
invoicing is on a pro-rata basis.
PSYTA1 Air Travel Air travel when a Service Provider Actual and Per trip
is: Reasonable
• requested by ACC to travel to an
outlying area that is not the
Service Provider’s usual area of
residence or practice to deliver
Services; and
• air travel is necessary and has
been approved by ACC.

Note: ACC will only pay for actual

and reasonable costs and receipts
must be retained and produced if
requested by ACC. If more than one
client (ACC and/or non-ACC)
receives services, then invoicing is
on a pro-rata basis.
PSYT6 All other travel Costs for return travel by ferry, taxi, Actual and Per trip
rental car, public transport and Reasonable
parking when:
• return travel is via the most
direct, practicable route; and
• the return travel exceeds 20km.

ACC Psychological Services Service Schedule – 1 July 2023

 Service Service Item Price Pricing
Service Item Definition
Item Code Description (excl. GST) Unit
Note 1: where the Supplier has no
base or facility in the Service
provision area return travel will be
calculated between the “start point”
and “end point” closest to the Client
as agreed by ACC.

Note 2: ACC will only pay for

actual and reasonable costs and
receipts must be retained and
produced if requested by ACC. If
more than one client (ACC and/or
non-ACC) receives services, then
invoicing is on a pro-rata basis.
PSYAC Accommodation Payable when an Assessor has been Actual and Per Night
requested by ACC to conduct a Reasonable
clinic in an outlying area that is not (max of
the Assessor’s usual area of $258.28
residence or practice and overnight excl. GST
accommodation is necessary. ACC per day)
will pay actual and reasonable
accommodation costs of up to a
maximum of $258.28excl. GST per
day with prior ACC approval and
receipts provided.

Hotels – Maximum of $172.19 excl.

GST per night.

Meal and Incidental Allowances –

Actual and reasonable up to the
following maximum of $86.09 excl.
GST per 24-hour period where
overnight stay is required.

No reimbursement for alcohol,

including mini-bar expenses.
PSYTR1 Remote Clinic Room Paid where an Approved Service Actual and Per Day
Hire Provider is: Reasonable
• requested by ACC to deliver (max of
services in an outlying area that $226.58
is not the Service Provider’s excl. GST
usual area of residence or per day)
practice; and
• the Service Provider is required
to hire rooms for the specific
purpose of delivering Services.

Note: ACC will only pay for the

actual and reasonable costs and
receipts must be retained and
produced if requested by ACC. If
more than one client (ACC and/or
non-ACC) receives services, then
invoicing is on a pro-rata basis.

ACC Psychological Services Service Schedule – 1 July 2023

 Price Review

ACC will review the prices specified in this clause 4 when, at ACC’s sole discretion, it
considers that a review is necessary. The factors that ACC may take into account during a
review include, but are not limited to:
• general inflation
• changes in service component costs
• substantial changes in the market

If, following a pricing review, ACC determines that the factors it took into account have not
had a significant impact on price, the prices will remain unchanged.

If ACC proposes any price increase, the price increase will only take effect if the Supplier has
agreed to the increase in writing. If the Supplier agrees to the price increase, the price increase
will take effect from a date specified by ACC.

5. RELATIONSHIP MANAGEMENT

Table 3 - Relationship Management

Level ACC Supplier
Recovery Team / Recovery Individual staff or operational
Client
Team Member contact
Relationship and performance Engagement and Operational contact/ National
management Performance Manager Manager
Service management Portfolio Team or equivalent National Manager

6. ADDRESSES FOR NOTICES

NOTICES FOR ACC TO:

ACC Health Procurement (for deliveries)
Justice Centre
19 Aitken Street
Wellington 6011
P O Box 242 (for mail)
Wellington 6140
Marked: “Attention: Procurement Specialist”
Phone: 0800 400 503
Email: [email protected]

NOTICES FOR SUPPLIER TO:

«Vendor_Name_Legal»
«Physical_Address_1» (for deliveries)
«Physical_Address_2»
«Physical_City»
«Postal__Address_1» (for mail)
«Postal_Address_2»
«Postal_City» «Postal_Code»
Marked: “Attention: «Contractual_First_Name» «Contractual_Surname»”
Phone: «Contractual_Phone»
Mobile: «Alternative_Number»
Email: «Contractual_Email»

ACC Psychological Services Service Schedule – 1 July 2023

 Table of Contents

1. PURPOSE ....................................................................................................................................... 8
2. SERVICE OBJECTIVES ................................................................................................................ 8
3. SERVICE COMMENCEMENT ..................................................................................................... 8
4. SERVICE LOCATION ................................................................................................................... 9
5. SERVICE REQUIREMENTS ...................................................................................................... 10
6. SERVICE SPECIFIC QUALITY REQUIREMENTS.................................................................. 13
7. SERVICE EXIT ............................................................................................................................ 18
8. PERFORMANCE REQUIREMENTS ......................................................................................... 19
9. CONTRACT MONITORING REPORTING REQUIREMENTS ............................................... 19
10. OPERATIONAL CONTACT ....................................................................................................... 19
11. RELATIONSHIP MANAGEMENT ............................................................................................ 20
12. NOTICE PERIOD ......................................................................................................................... 20
13. PAYMENT AND INVOICING .................................................................................................... 20
14. DEFINITIONS AND INTERPRETATION ................................................................................. 20
15. PSYCHOLOGICAL SERVICES FORMS TO BE ACCESSED FROM THE ACC WEBSITE . 20

ACC Psychological Services Service Schedule – 1 July 2023

B. SERVICE SPECIFICATIONS FOR PSYCHOLOGICAL SERVICES

1. PURPOSE

ACC wishes to purchase Psychological Services from the Supplier.

The purpose of the Service is to enable Clients to achieve and maintain their maximum level of
health and independence in daily activities.

2. SERVICE OBJECTIVES

ACC will measure the success of this Service based on the following objectives:
2.1.1. Assessment of the Client’s current psychological status for the purposes of ACC’s
treatment planning to address rehabilitation needs;
2.1.2. Identification of current barriers that are preventing rehabilitation towards
independence;
2.1.3. Providing timely and appropriate, evidence-based psychological interventions to
address the identified barriers, to achieve Client independence;
2.1.4. Providing Client education for self-management;
2.1.5. Providing early education to the family/whānau of the Client about the effects of
psychological problems/mental injury to foster strong recovery/coping strategies and
Client managed recovery and rehabilitation; and
2.1.6. Achieving agreed outcome specifications.

3. SERVICE COMMENCEMENT

Client Eligibility for Service

3.1.1. A Client is eligible to receive Psychological Services if the Supplier has received a
written referral for Psychological Services from ACC for the Client and if one of the
following apply:
3.1.2. The Client: has suffered a personal injury as defined in the Accident Compensation Act
2001 (AC Act) which has been accepted as having cover under the AC Act, and may
include:
3.1.2.1. Mental injury suffered by a person because of physical injuries (MICPI)
suffered by the person; or
3.1.2.2. Work related mental injury (WRMI) suffered by a person in the
circumstances described in section 21B of the AC Act; or
3.1.2.3. Mental injury suffered by a person because of a non-covered treatment
injury (TIMI) suffered by the person; and
3.1.2.4. has suffered a personal injury that has resulted in the requirement of
Psychological Services to assist with their rehabilitation; or
3.1.3. The Client may have suffered a personal injury as defined in the AC Act and a claim
has been lodged for:
3.1.3.1. Work-related mental injury (WRMI) that is likely to have been suffered by
a person in the circumstances described in section 21B of the AC Act; and
3.1.3.2. It has resulted in the requirement of Psychological Services to assist with
their rehabilitation.

ACC Psychological Services Service Schedule – 1 July 2023

 Service Commencement
3.2.1. Clients who may require Psychological Services include Clients who have developed
psychological difficulty as a result of their personal injury or are experiencing
psychological barriers to recovery from their personal injury.
Referral Process
3.3.1. The Supplier may only receive a Referral for Psychological Services (ACC265) from
ACC following a:
3.3.1.1. Psychiatric assessment or recommendation;
3.3.1.2. Neuropsychological assessment or recommendation;
3.3.1.3. Pain assessment or recommendation;
3.3.1.4. Other specialised assessment or recommendation;
3.3.1.5. Recommendation from a Psychology Advisor (PA); or
3.3.1.6. Recovery Team Member identifying the need for Psychological Services.
3.3.2. The Supplier is deemed to have accepted a Referral unless ACC receives written, email
or verbal notice from the Supplier within 3 Business Days of receipt of the Referral.
3.3.3. ACC will not pay the Supplier for Services for a person or Client who has not been
referred to the Supplier in accordance with this Service Schedule.

4. SERVICE LOCATION

The Supplier will provide the Psychological Services at the location(s) specified in Part A,
Clause 2.

If the Client’s circumstances are exceptional or if a physical condition precludes the Client from
attending the Supplier’s service location for an Assessment/Reassessment or treatment then the
Service may be provided in a location that meets the needs of the eligible Client.

Where Assessment/Reassessment or treatment of a Client is required in a location away from

the Supplier’s facility, travel costs will be reimbursed at the rate specified in Part A, Clause 4.
Where possible Services will be carried out in one locality to minimise travel costs to ACC. If
provision of the Service is required in a location outside that specified in Part A, Clause 2 of
this Service Schedule, the Supplier must seek prior written approval from ACC and, if ACC
approves the request, travel costs will be reimbursed at the rate specified in Part A, Clause 4.
Services can be delivered by Telehealth, where clinically appropriate, and where this is
considered to best meet the Client’s needs and circumstances. Services delivered by Telehealth
must:
4.4.1. have Client or authorised representative consent (recorded in the clinical notes), and
with the option of an in-person meeting if the Client prefers;
4.4.2. Be accessible by the Client;
4.4.3. be preceded by an initial suitability assessment and safety plan performed by the
Service Provider;
4.4.4. meet the same required standards of care provided through an in-person consultation;
4.4.5. have clinical records that meet ACC and professional body requirements;
4.4.6. meet the requirements outlined within ACC’s guidance on the provision of services
through Telehealth, and the New Zealand Psychologist’s Board Telehealth guidance
and comply with the relevant New Zealand regulations, standards, and guidelines for
Telehealth.

ACC Psychological Services Service Schedule – 1 July 2023

 4.4.7. have both the Client receiving the Telehealth service, and the provider delivering the
Telehealth service, physically present in New Zealand at the time the Service is
provided.
4.4.8. in circumstances where the Client will access the services at a location outside the
Service Provider’s Territorial Authority, have prior written approval from ACC.

5. SERVICE REQUIREMENTS

All Psychological Services being assessments for Mental Injury caused by Physical Injury
(MICPI) cover, Work-Related Mental Injury (WRMI) cover or assessments without MICPI,
provided by the Service Provider for a Referred Client, will include an assessment consultation
and report which will be part of an Individual Rehabilitation Plan agreed to by ACC and the
Client.
5.1.1. The Supplier must ensure that all Client appointments under Psychological Services are
delivered:
5.1.1.1. in-person; or
5.1.1.2. via Telehealth in accordance with Part B, Clause 4 of this Service Schedule
and ACC’s Telehealth Guide.
5.1.2. The Supplier will provide all equipment and technology necessary to deliver services
by Telehealth and manage their own technical issues.
The Supplier must ensure that Psychological Services provided by the Service Provider for the
Client include:
5.2.1. Arranging any necessary appointments with the Client;
5.2.2. Providing an initial clinical evaluation to:
5.2.2.1. Assess the Client’s current psychological status;
5.2.2.2. Identify current barriers that are preventing rehabilitation towards
independence;
5.2.2.3. Identify current appropriate treatment strategies designed to meet the
rehabilitation needs of the Client;
5.2.2.4. Determine suitability of the referral;
5.2.2.5. Confirm the number of sessions recommended in the Referral.
The Supplier must ensure that each Assessment Consultation and Assessment Report covers the
following:
5.3.1. A detailed history of the Client;
5.3.2. An introduction to the Client of the purpose of the Services, confidentiality issues, and
any other concerns the Client may have at the outset;
5.3.3. The history of the presenting mental injury or psychological problem, and its causal
link to the original personal injury;
5.3.4. Functional enquiry regarding current mental status, mood and other compromising
psychological or psychiatric symptoms;
5.3.5. Personal, educational, social and occupational history;
5.3.6. Medical and psychiatric history;
5.3.7. Client’s goals and motivation;
5.3.8. A risk assessment;
5.3.9. Service Provider’s plan of action which details how functional objectives will be
achieved to meet the expected outcomes of the Referral; and

ACC Psychological Services Service Schedule – 1 July 2023

 5.3.10. Written agreement with an initial assessment where an independent assessment has
been conducted, or written explanation including an extensive rationale of any variance
to the initial assessment.
The Supplier must ensure that Assessment Reports are in the Service Provider’s own format
and are submitted to ACC with the Psychological Services Action Plan (ACC266).
For Assessment of MICPI or WRMI cover only, there is a maximum of 16 hours to complete
the Assessment. This includes preparation and reading time, face-to-face assessment time, and
report writing. It also includes time to review the Assessment Report with the Client either in-
person or via Telehealth.
The Supplier must ensure that the assessment review appointment includes the Client unless
there are concerns around Client or Service Provider safety, or if this is deemed clinically
inappropriate.
The Supplier must ensure that follow up service sessions include:
5.7.1. Conducting a clinical evaluation of the Client to determine suitability of the Referral
and confirmation of the number of sessions recommended in the Referral;
5.7.2. The provision of cognitive-behavioural or other evidence-based therapy to promote
Client adaptation to their injuries;
5.7.3. Access to information regarding mental injury and its effects;
5.7.4. Providing early education to the family/whānau of the Client about the effects of
psychological problems/mental injury to foster strong recovery/coping strategies and
Client managed recovery and rehabilitation;
5.7.5. Re-assessing goals and discussing progress made throughout the sessions;
5.7.6. Monitoring clinical outcomes for the Psychological Services provided; and
5.7.7. Ensuring the Client has sufficient supports in place on completion of Psychological
Services.
There is a maximum of 16 hours per block for follow up sessions, however, the Supplier must
ensure that Service Providers only deliver the number of follow up sessions actually required
for a Client consistent with achieving the Client’s objectives and goals.
Progress Reports
5.9.1. Following an initial Assessment Report and provision of the Psychological Services
Action Plan (ACC266) the Supplier must ensure that the Service Provider submits
Progress Reports (ACC267) to ACC and the Client’s General Practitioner in
accordance with this clause.
5.9.2. Progress Reports must be submitted on completion of 50% of the total Psychological
Services sessions being provided to each Client where the total number of follow
up/treatment sessions is 16 or greater.
5.9.3. ACC provides the template for the Progress Report Notice on the website acc.co.nz.
The Service Provider must complete all sections that are relevant for the Client.
5.9.4. While working on the Progress Report, Service Providers will work in co-ordination
with all rehabilitation services approved by ACC and provided for the Client and will
ensure the transfer of information to all relevant parties on request of ACC.
Completion Reports
5.10.1. On completion of the Psychological Services, the Supplier must ensure that a
Completion Report (ACC268), which complies with this clause, is provided to ACC
and the Client’s General Practitioner.
5.10.2. ACC provides the template for the Completion Report Notice on the website acc.co.nz.
The Service Provider must complete all sections that are relevant for the Client.

ACC Psychological Services Service Schedule – 1 July 2023

 Pre-cover Work-Related Mental Injury (WRMI) Early Intervention
5.11.1. The Supplier must provide pre-cover WRMI Early Intervention Services, which
involves early contact with the Client to help gather information for the Service
Provider and ACC to a maximum of four hours.
5.11.2. Pre-cover WRMI Early Intervention has two purposes:
5.11.2.1. To provide early psychological intervention, to reduce the psychological
impact of the traumatic event on Clients, and to assist in the prevention of
mental injury; and
5.11.2.2. To gather information which can be used in an Assessment Report should
the Client wish to progress to a cover decision for WRMI.
5.11.3. Following the Pre-cover WRMI Early Intervention Service if:
5.11.3.1. The Client wishes to progress to a WRMI cover decision, the Supplier must
provide an assessment as specified in PSY52; or;
5.11.3.2. The Client decides not to proceed to a WRMI cover decision, the Supplier
must outline in an email to ACC the number and date of sessions undertaken
by the Client, any issues covered and the outcome of the sessions.
Pre-cover Work-Related Mental Injury (WRMI) Post Assessment Therapeutic Sessions
5.12.1. The Supplier must provide pre-cover WRMI Post Assessment Therapeutic Sessions,
which allows a Client continuity of support while ACC determines whether such
Clients have cover for Work-Related Mental Injury following receipt of the Assessment
for WRMI Cover Report.
5.12.2. Pre-cover WRMI Post Assessment Therapeutic Sessions have two purposes:
5.12.2.1. To provide early psychological intervention to reduce the psychological
impact of the traumatic event on Clients, and to assist in the prevention of
mental injury; and
5.12.2.2. To allow continuity of support.
Approval Process for Further Psychological Services
5.13.1. Prior to completion of the initial Psychological Services outlined in the Client’s
Individual Rehabilitation Plan and in the Referral, the Supplier may request ACC
funding approval to provide further Psychological Services to that Client in respect of
the same claim. The Supplier must ensure that the Service Provider makes this request
at least 2 weeks before the approved initial Psychological Services are finished.
5.13.2. Any such request for funding approval for further Psychological Services must be
submitted to, and approved by, ACC prior to commencement of any further session(s),
and must include the following information:
5.13.2.1. the functional objectives and outcomes of the proposed further
Psychological Services;
5.13.2.2. what the initial Psychological Services have achieved to date in terms of
outcomes;
5.13.2.3. the reason why further Psychological Services are necessary;
5.13.2.4. the recommended number of further Psychological Services sessions;
5.13.2.5. expected timeframes for further Psychological Services.
5.13.3. ACC will provide notice in writing to the Supplier, Service Provider and the Client of
its decision (at ACC’s sole discretion) to accept or decline the Service Provider’s
request for funding approval for further Psychological Services within two weeks of
receipt of the request.

ACC Psychological Services Service Schedule – 1 July 2023

6. SERVICE SPECIFIC QUALITY REQUIREMENTS

Service Delivery Timeframes

6.1.1. The Service will usually be provided during normal working hours but may be provided
after hours or during weekends.
6.1.2. The Supplier must ensure that the Service Provider does not carry out more than one
Psychological Services session with a Client on any day without prior approval from
ACC.
6.1.3. Upon receipt of a Referral from ACC for Psychological Services, the Supplier will:
6.1.3.1. Ensure that the Client is contacted within 3 Working Days of receiving the
Referral to arrange an initial appointment, and, where applicable;
6.1.3.2. Ensure that ACC is notified within 1 Working day of receiving notice that
the Client has declined to attend the initial appointment.
6.1.4. The Supplier will contact ACC if the Client cannot be contacted within the time frame
stipulated in Part B, Clause 6.1.3.
6.1.5. The Supplier will ensure that the initial consultation is provided within 10 Working
days of contacting the Client.
6.1.6. The Supplier will contact ACC if the initial consultation cannot be completed within
the time frame stipulated in Clause 6.1.5. An Assessment Report will be submitted no
later than 10 working days following the Assessment.
6.1.7. Progress Reports must be supplied to ACC on completion of 50% of the total
Psychological Services being provided to each Client where the total number of
Psychological Services follow up/treatment sessions being provided is greater than 16.
6.1.8. Psychological Services should be completed within 24 weeks of submitting the
Assessment Report.
6.1.9. If a Client fails to attend a Psychological Services session, ACC must be notified within
1 Working day of the missed appointment.
6.1.10. If additional Psychological Service sessions are anticipated, a request must be sent to
ACC at least 2 weeks prior to the completion of the initial Psychological Services
Session, in accordance with Part B, Clause 5.13.
6.1.11. Further Psychological Services, must be commenced within 10 Working days after the
date of receipt of ACC funding approval under Part B, Clause 5.13.
6.1.12. A Completion Report must be supplied to ACC within 2 weeks of the final
Psychological Services session.
Named Service Providers
6.2.1. The Supplier will utilise the services of only the Named Service Providers included in
Part A, Clause 3 (or subsequently added as Service Providers by ACC pursuant to Part
B, Clause 6.3), in the course of providing Psychological Services for Clients.
Addition of Named Service Providers
6.3.1. The Supplier may, at any time during the Term of this Service Schedule, make a written
request to ACC that a psychologist be added as a Service Provider. The written request
must include sufficient information for ACC to determine that the Service Provider
meets the criteria listed in Part B, Clause 6.5.
6.3.2. ACC may in its sole discretion accept or decline each such request, by providing written
notification to the Supplier. Agreement to such a request may be made subject to
conditions.
6.3.3. If a request is accepted under this clause, the psychologist shall be deemed added as a
Service Provider from the date of ACC’s written notification to the Supplier.

ACC Psychological Services Service Schedule – 1 July 2023

 Removal of Named Service Providers
6.4.1. The Supplier may, at any time during the Term of this Agreement for Psychological
Services, provide written notification to ACC that a Service Provider has ceased to be
a Service Provider for Psychological Services. The Service Provider shall be deemed
to be removed from this Service Schedule, 5 Working Days after receipt of the
Supplier’s notice by ACC.
6.4.2. ACC may, at any time during the Term of this Service Schedule for Psychological
Services, provide written notification to the Supplier that a Service Provider is to be
removed from this Service Schedule for Psychological Services. The Service Provider
shall be deemed to be removed from this Service Schedule, 5 Working Days after
receipt of ACC’s notice by the Supplier. ACC shall not issue such a notice arbitrarily.
Service Provider Qualifications
6.5.1. The Supplier will ensure that each Service Provider providing Psychological Services
has the required scope of practice: Clinical Psychologist, Psychologist, Counselling
Psychologist, Neuropsychologist or Educational Psychologist, and meet the following
additional criteria:
6.5.1.1. Qualifications:
6.5.1.1.1. Is a registered Psychologist in New Zealand under the Health
Practitioners Competence Assurance Act 2003;
6.5.1.1.2. Has a qualification which meets at least level 8 (postgraduate) of
an NZQA recognised course of study, which includes in its
content: assessment, classification and formulation; abnormal
psychology; skills in two or more models of therapeutic
intervention; human development and knowledge and skills in
the use of psychometric tools (if using psychometrics);
6.5.1.1.3. Holds a current Annual Practicing Certificate with the NZ
Psychologist Board; and
6.5.1.1.4. Holds current financial membership with at least one of the
following:
(i) NZ Psychological Society;
(ii) NZ College of Clinical Psychologists; or
(iii) An international professional body acceptable to ACC; and
6.5.1.2. Experience and competencies:
6.5.1.2.1. Has a minimum of one year full-time postgraduate experience
working in mental health (not including clinical placements and
internships);
6.5.1.2.2. Can demonstrate experience in working with Clients who have
mental health difficulties associated with physical injuries or
work-related trauma with this experience having been obtained
or maintained in the last 5 years;
6.5.1.2.3. Can provide documentation of participation in relevant
workshops, seminars and conferences;

ACC Psychological Services Service Schedule – 1 July 2023

 6.5.1.2.4. Where applicable, is able to demonstrate knowledge of, and
competency in using at least one of the following classification
systems – Diagnostic and Statistical Manual of Mental Disorders
– Fourth Edition – Text Revision (DSM- IV- TR) or Diagnostic
and Statistical Manual of Mental Disorders – Fifth Edition
(DSM – 5), International Classification of Diseases – 10th
Revision (ICD- 10), Psychodynamic Diagnostic Manual (PDM),
Diagnostic Classification of Mental Health and Developmental
Disorders of Infancy and Early Childhood – Revised (DC:0-
3R); and
6.5.1.2.5. Has notified ACC of any areas of specialisation such as
specialisation in children, adolescents, specific cultural
knowledge and skills (such as a second language).
6.5.1.3. All Service Providers who work with a person under the age of 18 must
complete a Children’s Workforce Safety Check to ensure they are safety
checked to the standard required under the Children's Act 2014 and the
Children’s (Requirement for Safety Checks of Children's Workers)
Regulations 2015.
Supervision required by all Service Providers
6.6.1. The Supplier will ensure that all Service Providers will have a supervisory agreement
in place with a professional peer who is appropriate for the services being provided,
and the Supplier will supply ACC with the contact details and qualifications of all
Service Providers’ supervisors.
New Service Providers require additional supervision
6.7.1. The Supplier must ensure that Service Providers who are new to providing mental
injury assessments to ACC obtain supervision from a supervisor who is an experienced
ACC mental injury assessor. The supervisor needs to be approved by ACC and must
review and co-sign a minimum of the Service Provider’s first 10 mental injury
assessments prior to the Service Provider supplying them to ACC. The purpose is to
ensure the new Service Provider’s early reports are of the quality required.
Competency Levels
6.8.1. The Supplier will ensure that all Service Providers are clinically and culturally
competent, appropriately experienced, trained and qualified to provide Psychological
Services.
6.8.2. The Supplier will have in place a system that identifies and monitors clinical and
cultural competency levels, training needs and compliance with training requirements
by Service Providers to ensure that all requirements in this Agreement are met.
Training
6.9.1. The Supplier will ensure that all Service Providers who provide Psychological Services
will have satisfactorily completed recognised courses to further develop, refresh and
update their skills and knowledge.
Provisional Service Provider Requirements
6.10.1. If a Service Provider does not have the required full experience requirements specified
in clause 6.5, the Supplier may apply for them to be approved as a Provisional Service
Provider if they meet the following criteria:
6.10.1.1. Qualifications:
6.10.1.1.1. Must be able to demonstrate Service Provider qualification
requirements (either standard or specified equivalency); and
6.10.1.1.2. Must have experience and demonstrate competencies

ACC Psychological Services Service Schedule – 1 July 2023

 6.10.1.1.3. Must provide details of on the job training to gain or update the
Service Provider’s experience working directly with Clients who
have developed psychological problems following physical
injury and traumatic incidents; or
6.10.1.1.4. Engage in further professional development with specific
relevance to working with psychological problems following
physical injury and/or traumatic incidents where recent
professional development is not thought to be sufficient.
Supervision Requirements for Provisional Service Providers
6.11.1. All Provisional Service Providers must meet the following supervision requirements:
6.11.1.1. Have an arrangement in place for ongoing supervision with an appropriately
qualified and experienced supervisor who has experience treating and
assessing Clients with psychological problems following physical injury
and traumatic incidents, including experience in ACC mental injury
assessments;
6.11.1.2. Discussion of all cases with the supervisor prior to and following the
assessment;
6.11.1.3. Engagement in fortnightly one - on - one supervision with the supervisor;
6.11.1.4. Maintenance of a supervision log which outlines the cases discussed and
provides a summary of issues and recommendations for each case;
6.11.1.5. Have each Assessment Report and each Treatment report read and co-
signed by the supervisor;
6.11.1.6. A final supervision report from the supervisor, supervision log, and two
anonymised mental injury assessments, will be required by ACC once the
criteria to work as a Named Service Provider are considered to have been
met. This supervision report and supervision log should be received by ACC
within 36 months of approval of provisional status.
6.11.2. The Supplier must provide ACC with a summary letter or other document outlining
how the above requirements will be met over the provisional period.

Psychology Interns
6.12.1. For the purposes of this clause, the following definitions apply:
6.12.2. “Psychology Intern” means a student engaged in a Psychology Board accredited post-
graduate diploma, master or doctoral course of studies, to achieve full registration in
the Clinical Psychologist, Psychologist, Neuropsychologist or Counselling
Psychologist scopes of practice, but who does not as yet have the necessary clinical
experience.
6.12.3. “Supervisor” means a supervisor of a Psychology Intern that meets all the following
requirements:
6.12.3.1. Is registered with the New Zealand Psychologists Board as a Psychologist,
Clinical Psychologist, Neuropsychologist, or Counselling Psychologist
scope of practice.
6.12.3.2. Holds a current Annual Practicing certificate with the NZ Psychologists
Board; and
6.12.3.3. Is a current member of at least one of the following:
6.12.3.3.1. New Zealand Psychological Society, or
6.12.3.3.2. NZ College of Clinical Psychologists; or
6.12.3.3.3. An international professional body acceptable to ACC; and

ACC Psychological Services Service Schedule – 1 July 2023

 6.12.3.4. Is an approved ACC named service provider with at least 2 years of clinical
experience.
6.12.3.5. Is approved by the Psychology Intern’s university to provide supervision for
Psychology Interns.
6.12.3.6. Is allocated to no more than two Psychology Interns during each clinical
practicum.
6.12.4. Psychology Services to ACC clients may be provided by Psychology Interns if a
Supervisor is co-located on-site at the relevant service location during the ACC client’s
treatment session.
6.12.5. The Supplier may only invoice ACC in relation to these services in accordance with
clause (6.12.6).
6.12.6. The Supplier acknowledges and agrees that it may invoice ACC for the supervisor’s
time only when and to the extent the supervisor has been physically present providing
direct supervision to the Psychology intern during the ACC client’s treatment session.
In these circumstances, the Supplier may invoice ACC under the supervisor's provider
ID number utilising the psychology intern code in the applicable service schedule.
6.12.7. For all other circumstances, including where the Supervisor is co-located in the building
but not physically present providing direct supervision during the appointment, the
Supplier will not claim, and ACC will not fund Psychology Services provided by
Psychology interns.
6.12.8. The Supplier must ensure its record-keeping includes what, if any, Psychology Services
are provided to ACC clients by a Psychology Intern.
6.12.9. The Supplier must ensure that the following requirements are met in all circumstances
where a Psychology Intern is providing Psychological Services:
6.12.9.1. The Psychology Intern must adhere to the New Zealand Psychologists
Board’s standards of ethical conduct and clinical and cultural competence
as well as any best practice guidelines adopted and endorsed by the board,
(these standards are required by the Health Practitioners Competence
Assurance Act 2003) including:
6.12.9.1.1. Core competencies for the Practice of Psychology in New
Zealand;
6.12.9.1.2. Code of Ethics for Psychologists Working in Aotearoa/New
Zealand;
6.12.9.1.3. Cultural Competencies for Psychologists Registered Under the
Health Practitioners Competence Assurance Act (2003) And
Those Seeking to Become Registered.
6.12.9.2. The Psychology Intern must have a Supervisor. The Psychology Intern may
have a second nominated Supervisor to provide supervision if the primary
Supervisor is not on site. The Psychology Intern must ensure that their
named Supervisor/s is or are co-located on-site and available when
undertaking clinical work with ACC clients.
6.12.9.3. Each Supervisor meets all requirements included in the definition of that
term above.
6.12.9.4. The Supervisor/s are registered with the NZ Psychologists Board in the
same scope, in which the Psychology Intern is undertaking their internship.
6.12.9.5. The Psychology Intern may only see ACC clients under one Supplier
contract.

ACC Psychological Services Service Schedule – 1 July 2023

 6.12.10. If the Supplier is hosting a Psychology Intern that will or may provide Psychological
Services, the Supplier must provide to ACC:
6.12.10.1. An application – (ACC 8344 Psychology intern application form), the
Psychology Interns annual practicing certificate, academic transcript,
6.12.10.2. An induction plan including how the Supplier is going to introduce and
educate the Psychology Intern about the Psychological Services,
6.12.10.3. Details of the Psychology Intern’s supervision plan and arrangements
including:
6.12.10.3.1. The Supervisor/s details,
6.12.10.3.2. Frequency and model of supervision as determined by the
Psychology Intern's university, and
6.12.10.3.3. Informed consent process for clients, and
6.12.10.3.4. Acknowledgement signed by the Supervisor/s.
6.12.10.4. All clinical work undertaken by the Psychology Intern will be overseen by
the Supervisor/s, who will maintain responsibility for the client’s care at all
times,
6.12.10.5. That the Supervisor/s will be co-located on-site when the Psychology Intern
is undertaking clinical work with ACC clients, and
6.12.10.6. Note that the Supervisor of a Psychology Intern will check and co-sign each
report and clinical record completed by the Psychology Intern. The
Supervisor/s is responsible for ensuring that the standard of each assessment
and treatment provided is at least equivalent to that of a qualified
psychologist.

7. SERVICE EXIT

This Service is complete when:

7.1.1. a satisfactory Completion Report is received by ACC and the Client’s General
Practitioner on completion of the recommended and approved number of sessions; or
7.1.2. ACC advises, or the Service Provider recommends and ACC agrees, that the Client
cease receiving Psychological Services due to non-progress or non-attendance.
Any recommendation to cease due to non-progress or non-compliance from the Service
Provider must be made in consultation with ACC and must be accompanied by a report
demonstrating non-attendance including:
7.2.1. details of attempts to contact the Client;
7.2.2. letters written to the Client;
7.2.3. measures taken to address non-compliance including the presentation of alternatives
offered; and
7.2.4. the Client's response to this contact.

ACC Psychological Services Service Schedule – 1 July 2023

8. PERFORMANCE REQUIREMENTS

The Supplier’s performance will be measured as shown in Table 5 – Performance Measurement

Table 5 – Performance Measurement
Objective Performance measure Target Data Source
1. Timely Contact with the Contacts the Client within 3 80% Supplier Reports
Client working days of receipt of
referral or notifies ACC
within 1 working day of
receiving notice of Client
decline to attend.
2. Timely Initial consultation Initial Consultation provided 80% Supplier Reports
with the Client within 10 working days of
contacting the Client
3. Timely Reporting The Assessment report is 80% Supplier Reports
provided within 10 working
days following the
assessment.

9. CONTRACT MONITORING REPORTING REQUIREMENTS

ACC may request the Supplier to supply further information or reports on Psychological
Services provided. Any request will be reasonable, and the Supplier shall provide the
information within 30 days of the request.
The purpose of such a report is to monitor the progress and quality of Service delivery under
this Service Schedule against expected performance in accordance with Part B, Clauses 5,6 and
8.
The evaluation undertaken by ACC may include (but shall not be restricted to):
9.3.1. The processes outlined in this Service Schedule, including the timeliness,
appropriateness and cost effectiveness of the Services provided and the ongoing
management of this Service Schedule;
9.3.2. Satisfaction of the Referrer with the Service Provider and the quality of the Service
Provider’s Services;
9.3.3. Satisfaction of Clients with the Supplier, Service Provider and ACC; and
9.3.4. Any other matters reasonably considered to be relevant by ACC.

10. OPERATIONAL CONTACT

During the Term of this Service Schedule the Supplier will nominate a person (as specified in
Part A, Clause 5) to be the main contact for ACC who will:
Have primary responsibility for relationships and communication with ACC and the operation
of this Service on a day to day basis;
Be proactive in informing ACC of issues with provision of Services as outlined;
Raise issues and suggest solutions regarding this Service;
Ensure that the Service is operated in accordance with this Service Schedule;
Represent the Supplier in discussions on performance; and
Ensure that ACC is advised promptly when the person’s contact details change.

ACC Psychological Services Service Schedule – 1 July 2023

11. RELATIONSHIP MANAGEMENT

To ensure the continuing effective operation of the Service, formal working relationships are to
be maintained as defined in Part A, Table 3 - Relationship Management.

12. NOTICE PERIOD

The period of notice required for cancellation of this Service Schedule as set out in the Standard
Terms and Conditions, Clause 20 is hereby reduced from three months to one month.

13. PAYMENT AND INVOICING

Services prices are defined for this Service in Table 1 – Psychological Service Items and Prices.
ACC agrees to pay the prices set out in Table 1 – Psychological Service Items and Prices.
The prices set out are the entire amount chargeable to ACC in relation to the Services and no
additional amount may be charged to ACC, the Client or other person for Services under this
agreement.

14. DEFINITIONS AND INTERPRETATION

“Face-to-Face” includes in-person and Telehealth, if both the Service Provider and Client are
in New Zealand, and the Client consents.
“In-person” means the provider and Client are physically present in the same room.
“MICPI” means Mental Injury Caused by Physical Injury.
“TIMI” (Treatment Injury Mental Injury) means Mental Injury caused by a non-covered
Treatment Injury.
“Telehealth” means the use of information or communication technologies to deliver services
when Clients and Providers are not in the same physical location. For this Service Schedule,
Telehealth relates to real-time videoconferencing interactions and telephone consultations.
Telehealth excludes electronic messaging e.g. texts and emails. A telehealth consultation is to
replace an in-person visit so it does not include a quick triage or check-in phone calls (unless
specified). Telehealth may be used to deliver applicable services (as per Part A, Clause 4) only
if both the Service Provider and Client are in New Zealand, and the Client consents. Delivery
via Telehealth channels must be clinically appropriate and be in line with Part B, Clause 4 of
this Service Schedule.
“WRMI” means Work-Related Mental Injury.

15. PSYCHOLOGICAL SERVICES FORMS TO BE ACCESSED FROM THE ACC

WEBSITE

At www.acc.co.nz:
• ACC266: Psychological Services Action Plan.
• ACC267: Psychological Services Progress Report.
• ACC268: Psychological Services Completion Report.
• ACC4247: Mental Injury Assessment form which includes the Guidelines for
completing mental injury assessment reports.

ACC Psychological Services Service Schedule – 1 July 2023