Health Insurance (Section 3C Cleft Lip and Cleft Palate Services) Determination 2020
7. Limitation on services7. Limitation on services
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7. Limitation on services
(1) An item specified in the Schedule to this Determination only applies to a service provided to a patient diagnosed with an eligible cleft and craniofacial condition as specified in the table at section 9.
(2) Subject to subsection (5), items 75001 to 75006 or 75024 to 75051 that include the symbol (AO) apply only to a service provided:
(a) by a dental practitioner who is registered under a law of a State or Territory in the specialty of orthodontics; or
(b) by a dental practitioner:
(i) who is not registered under a law of a State or Territory in the specialty of orthodontics; and
(ii) whose qualifications or experience demonstrate to the Australian Society of Orthodontists, prior to 31 March 2013, his or her competence in the field of orthodontics that is applicable to the giving of:
(A) services mentioned in items 75001 to 75006 or 75024 to 75051; or
(B) services mentioned in at least 1 of these items; or
(c) a dental practitioner who, immediately prior to 1 November 2012, was an accredited orthodontist as defined in rule 2.59.2(3)(b) of the GMST Regulations 2011 or any equivalent provision of preceding regulations.
(3) Subject to subsection (5), items 75009 to 75023 that include the symbol (AO) and the symbol (AOS) apply only to a service provided by:
(a) a dental practitioner who is registered under a law of a State or Territory in the specialty of orthodontics; or
(b) a dental practitioner:
(i) who is not registered under a law of a State or Territory in the specialty of orthodontics; and
(ii) whose qualifications or experience demonstrate to the Australian Society of Orthodontists, prior to 31 March 2013, his or her competence in the field of orthodontics that is applicable to the giving of:
(A) services mentioned in items 75009 to 75023; or
(B) services mentioned in at least 1 of these items;
(c) a medical practitioner who is a specialist in the practice of his or her specialty of oral and maxillofacial surgery; or
(d) a dental practitioner who, immediately prior 1 November 2012, was an accredited orthodontist as defined in rule 2.59.2(3)(b) of the GMST Regulations 2011 or any equivalent provision of preceding regulations; or
(e) a dental practitioner who, immediately prior to 1 November 2012, held an approval granted by the Minister for the purposes of the definition of professional service in subsection 3(1) of the Act.
(4) In this section, an equivalent provision of preceding regulations means a provision of regulations prescribed pursuant to section 4 of the Act in force at any time prior to the commencement of the GMST Regulations 2011, being a provision concerning the accreditation of a dental practitioner who was not registered or licensed as an orthodontist under a law of a State or Territory that provided for the registration or licensing of orthodontists.