Dental Benefits Rules 20091
Dental Benefits Act 2008
I, NICOLA ROXON, Minister for Health and Ageing, make the following Rules under section 60 of the Dental Benefits Act 2008.
Dated 4 December 2009
Nicola Roxon
Minister for Health and Ageing
Contents
1 Name of Rules 2
2 Commencement 2
3 Revocation 2
4 Definitions 2
5 Dental Benefits Schedule 4
6 Dental providers (Act, s 6 (1) (b)) 4
7 Persons eligible to render services on behalf of dental providers (Act, s 7 (a)) 4
8 Particulars to be recorded (Act, s 17 (2)) 4
9 Classes of persons who satisfy the means test (Act, s 24 (1) (d)) 5
10 Issuing more than 1 voucher for a person for a calendar year (Act, s 27 (5)) 6
11 When vouchers are not required to be issued (Act, s 29)
12 Period of effect of voucher (Act, s31) 6
13 Persons to whom the vouchers are to be issued (Act, s 32 (c)) 7
Schedule 1 Dental Benefits Schedule 8
Notes 8
1 Name of Rules
These Rules are the Dental Benefits Rules 2009..
2 Commencement
These Rules commence on 1 January 2010
3 Revocation
The Dental Benefits Rules 2008 are revoked.
4 Definitions
In these Rules:
Act means the Dental Benefits Act 2008.
carer payment has the meaning given by Part 2.5 of the Social Security Act 1991.
dental hygienist means a person who is registered or entitled to practice as a dental hygienist under a law of a State or Territory.
dental provider has the meaning given in rule 6.
dental provider has the meaning given in rule 6.
dental therapist means a person who is registered or entitled to practice as a dental therapist under a law of a State or Territory.
disability support pension has the meaning given by Part 2.3 of the Social Security Act 1991.
double orphan pension has the meaning given by Part 2.20 of the Social Security Act 1991.
FTB(A) teenager has the same meaning as in section 24 of the Act.
FTB recipient has the same meaning as in section 24 of the Act.
medicare number has the same meaning as in section 84 of the National Health Act 1953.
MRCAETS means the Military Rehabilitation and Compensation Act Education and Training Scheme.
Note Military Rehabilitation and Compensation Act Education and Training Scheme is a legislative instrument.
parenting payment has the meaning given by the definition of parenting payment in section 18 of the Social Security Act 1991.
partner has the same meaning as in the Social Security Act 1991.
provider number has the same meaning as in the Health Insurance Regulations 1975.
public sector dental provider means:
(a) a dental provider employed by, contracted to, or providing dental services under an arrangement with:
(i) the Commonwealth; or
(ii) a State; or
(iii) an internal Territory; or
(iv) a local governing body; or
(v) an authority established by a law of the Commonwealth, a law of a State or a law of an internal Territory; or
(b) a dental provider on whose behalf another dental provider provides dental services under an arrangement with a body mentioned in subparagraph (a) (i), (ii), (iii), (iv) or (v).
receive, for disability support pension, parenting payment, special benefit, carer payment and double orphan pension, has the meaning given by section 23 of the Social Security Act 1991.
special benefit has the meaning given by Part 2.15 of the Social Security Act 1991.
VCES means the Veterans’ Children Education Scheme.
Note 1 Veterans’ Children Education Scheme is a legislative instrument.
Note 2 For the definitions of other expressions used in these Rules, see Part 1 of the Act.
5 Dental Benefits Schedule
For subsection 61 (1) of the Act, the Dental Benefits Schedule is set out in Schedule 1.
6 Dental providers (Act, s 6 (1) (b))
For item 88000 of the Dental Benefits Schedule, the following classes of persons are dental providers:
(a) dentists who are registered or licensed to practice as dentists under a law of a state or territory and who are registered with Medicare Australia;
(b) dental specialists who are registered or licensed to practice as dental specialists under a law of a state or territory and who are registered with Medicare Australia.
7 Persons eligible to render services on behalf of dental providers (Act, s 7 (a))
For item 88000 of the Dental Benefits Schedule:
(a) a dental service may be rendered on behalf of a dental provider by the following classes of persons:
(i) dental hygienists;
(ii) dental therapists; and
(b) a dental service may be rendered on behalf of a public sector dental provider by another public sector dental provider.
8 Particulars to be recorded (Act, s 17 (2))
Patient billed services
(1) For the payment of dental benefits for item 88000 of the Dental Benefits Schedule, the following particulars must be recorded on the account or receipt:
(a) the patient’s name;
(b) the date of the service;
(c) either:
(i) the item number in the Dental Benefits Schedule that corresponds to the service; or
(ii) a description of the service;
(d) either:
(i) the dental provider’s name and provider number; or
(ii) the dental provider’s name and address;
(e) the amount charged for the service, total amount paid, and any amount outstanding for the service.
Bulk billed services
(2) If there is an assignment of dental benefits for item 88000 of the Dental Benefits Schedule, the following particulars must be recorded on the assignment of benefit form:
(a) the patient’s name;
(b) the date of the service;
(c) either:
(i) the item number in the Dental Benefits Schedule that corresponds to the service; or
(ii) a description of the service;
(d) either:
(i) the dental provider’s name and provider number; or
(ii) the dental provider’s name and address;
(e) the amount of the dental benefit being assigned to the dental provider.
9 Classes of persons who satisfy the means test (Act, s 24 (1) (d))
For paragraph 24 (1) (d) of the Act, a person satisfies the means test, in a calendar year, if in the calendar year:
(a) both:
(i) section 23 of the Act applies to the person; and
(ii) the person is receiving any of the following payments:
(A) disability support pension;
(B) parenting payment;
(C) special benefit;
(D) carer payment;
(E) payments made under VCES or MRCAETS, if the person is a person mentioned in paragraph (c), in column 3, of item 2 of the table in subsection 22A (1) of A New Tax System (Family Assistance) Act 1999; or
(b) both:
(i) section 23 of the Act applies to the person; and
(ii) the person’s parent, carer or guardian is receiving parenting payment or double orphan pension for the person; or
(c) both:
(i) section 23 of the Act applies to the person; and
(ii) the person’s partner is receiving parenting payment; or
(d) both:
(i) section 23 of the Act applies to the person; and
(ii) another person is receiving payments under VCES or MRCAETS on behalf of the person where that other person is a person referred to in paragraph (c), in column 3, of item 2 of the table in subsection 22A(1) of A New Tax System (Family Assistance) Act 1999.
10 Issuing more than 1 voucher for a person for a calendar year (Act, s 27 (5))
(1) For item 88000 of the Dental Benefits Schedule, more than 1 voucher may be issued for a person for a calendar year if:
(a) the person is an FTB(A) teenager for whom there is more than 1 FTB recipient; or
(b) the person’s voucher has been lost or destroyed, or the person has not received it.
(2) For paragraph (1) (a), the Medicare Australia CEO may issue a voucher to 2 FTB recipients for the FTB(A) teenager.
(3) For paragraph (1) (b), the Medicare Australia CEO may issue a replacement voucher if the person:
(a) asks Medicare Australia for a replacement voucher, stating whether the voucher was lost, destroyed or not received; and
(b) has not already received a dental benefit under item 88000 of the Dental Benefits Schedule in the current calendar year.
11 When vouchers are not required to be issued (Act, s 29)
The Medicare Australia CEO is not required to issue a voucher for an eligible person if:
(a) the person has not been assigned a medicare number; or
(b) both:
(i) written consent has not been provided by a person mentioned in sub-subparagraph (ii) (A) or (B) for the Department of Veterans’ Affairs to provide his or her personal information to Medicare Australia for use in the administration of the Medicare Teen Dental Plan; and
(ii) either:
(A) the person is eligible for payments under VCES or MRCAETS; or
(B) another person is receiving payments under VCES or MRCAETS on behalf of the person.
12 Period of effect of voucher (Act, s 31)
For item 88000 of the Dental Benefits Schedule:
(a) a voucher for the calendar year commencing on 1 January 2008 takes effect at the beginning of 1 July 2008 and remains in effect until the end of 31 December 2008; and
(b) a voucher for a calendar year commencing on 1 January of a subsequent year takes effect at the beginning of 1 January of that year and remains in effect until the end of 31 December of that year.
Note Paragraph (a) applies to all vouchers issued in the calendar year commencing on
1 January 2008, including vouchers issued before the commencement of these Rules.
13 Persons to whom the vouchers are to be issued (Act, s 32 (c))
For item 88000 of the Dental Benefits Schedule, a voucher is to be issued:
(a) if an eligible dental patient is receiving Youth Allowance — to the eligible dental patient; or
(b) if an eligible dental patient is receiving an ABSTUDY payment — to the eligible dental patient; or
(c) if a person is receiving an ABSTUDY payment for an eligible dental patient — to the person receiving the payment; or
(d) if an eligible dental patient is an FTB(A) teenager:
(i) if there is 1 FTB recipient for the teenager — to the FTB recipient for the teenager; or
(ii) if there is more than 1 FTB recipient for the teenager — to the FTB recipient with the highest percentage of care arrangements for the teenager; or
(iii) if there is more than 1 FTB recipient for the teenager and the FTB recipients have equal care arrangements for the teenager — to a maximum of 2 FTB recipients with the most current records of entitlement; or
(e) if an eligible dental patient is receiving a payment mentioned in subparagraph 9 (a) (ii) — to the eligible dental patient; or
(f) if an eligible dental patient is a person mentioned in paragraph 9 (b) — to the parent, carer or guardian receiving the payment; or
(g) if an eligible dental patient is a person mentioned in paragraph 9 (c) — to the partner receiving the payment; or
(h) if an eligible dental patient is a person mentioned in paragraph 9 (d) — to the person receiving the payment on behalf of the eligible dental patient.
Schedule 1 Dental Benefits Schedule
(rule 4)
Item
Service
Benefit ($)
88000
Preventative dental check, provided to an eligible dental patient by, or on behalf of, a dental provider, consisting of an oral examination and, if clinically necessary, any of the following services:
(a) radiological examination and interpretation;
(b) removal of plaque or stain;
(c) removal of calculus;
(d) topical application of re‑mineralising agent;
(e) dietary advice;
(f) oral hygiene instruction;
(g) fissure sealing;
Limit of 1 preventative dental check for an eligible dental patient each calendar year
157.00
Notes
1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See http://www.frli.gov.au
