The Commission may accept financial responsibility for dental treatment provided to an entitled person by a dental prosthetist, dentist, dental specialist, dental hygienist, dental therapist or oral health therapist where the treatment is provided in accordance with:
(a) these Principles; and
(b) the Notes for Allied Health Providers (Section 1 General Information and Section 2(c) (as Section 2(c) affects dental prosthetists, dentists, dental specialists, dental hygienists, dental therapists and oral health therapists, as the case may be)).”
5.1.2 The Commission will accept financial responsibility for dental treatment provided to an entitled person in a Tier 1 Hospital or Contracted Day Procedure Centre without the need for prior approval.
Note: the Notes for Allied Health Providers, the “Fee Schedule of Dental Services for Dentists and Dental Specialists” and the “Fee Schedule of Dental Services for Dental Prosthetists”, as incorporated‑by‑reference into the Principles, could be relevant to dental treatment provided to an entitled person in a hospital.
5.1.2A Except in an emergency, the Commission’s prior approval is required before dental treatment is provided to an entitled person in a hospital other than a Tier 1 Hospital or on premises other than a Contracted Day Procedure Centre unless the “Fee Schedule of Dental Services for Dentists and Dental Specialists” or the “Fee Schedule of Dental Services for Dental Prosthetists” provides that prior approval is not required for the treatment.
5.1.3 Subject to prior approval, an entitled person may be referred to a dental specialist by a dental hygienist, dental therapist, oral health therapist, dental prosthetist, dentist or other dental specialist.
5.2 Financial responsibility
The DVA Document entitled “Fee Schedule for Dentists, Dental Specialists and other Dental Practitioners (excluding Dental Prosthetists)”, referred to in Schedule 1, and comprised of Dental Schedules A, B and C, lists the dental services provided by dentists, dental specialists, dental hygienists, dental therapists or oral health therapists, for which the Commission will accept financial responsibility, when provided to an entitled person, and sets out the limits of that financial responsibility.
5.2.2 The DVA document entitled “Fee Schedule of Dental Services for Dental Prosthetists”, referred to in Schedule 1, lists the dental services provided by dental prosthetists for which the Commission will accept financial responsibility, when provided to an entitled person, and sets out the limits of that financial responsibility.
5.2.3 Dental Schedule C in 5.2.1 imposes a monetary limit (biennial monetary limit) in respect of dental services provided to an entitled person under that Schedule in a period of two consecutive Calendar years.
5.2.4 Subject to 5.1.2 and 5.1.2A (treatment in Tier 1 Hospital/Contracted Day Procedure Centre), where a Schedule in 5.2.1 or 5.2.2 specifies a need for prior approval in respect of a service, the Commission is not to accept financial liability for the service unless it has granted prior approval or retrospective approval for the service.
5.2.5 The biennial monetary limit set under Dental Schedule C in 5.2.1 will not apply in relation to a dental service where that service is for a service injury or service disease.
5.2.6 Subject to paragraph 5.5.1, the Commission will not accept financial responsibility for dental treatment after a person is no longer entitled to the treatment.
5.2A Disqualified Dental Practitioners
5.2A.1 The Commission is not to accept financial responsibility for the cost of a dental service provided to an entitled person by, or on behalf of, a dental prosthetist, dentist or a dental specialist if, at the time the service was provided, a medicare benefit would not have been payable in respect of the service under section 19B of the Health Insurance Act 1973 (in force from time to time) if the dental prosthetist, dentist, dental specialist, dental hygienist, dental therapist or oral health therapist had provided the service as a practitioner under that Act.
5.3 Entitlement
5.3.1 Subject to these Principles, an entitled person who holds a Gold Card, White Card or written authorisation issued on behalf of the Commission, may be provided with dental services at the expense of the Commission.
5.3.2 A person who holds a Gold Card will be provided with the following dental services:
(a) for treatment of an injury or disease that is not a service injury or a service disease:
(i) the dental services listed in Schedules A, B and C of the DVA document entitled “Fee Schedule of Dental Services for Dentists, Dental Specialists and other Dental Practitioners (excluding Dental Prosthetists)”, referred to in Schedule 1 — on condition the services are provided in accordance with those Schedules;
Note: Schedule C imposes a biennial monetary limit.
(ii) the dental services listed in the DVA document entitled “Fee Schedule of Dental Services for Dental Prosthetists”, referred to in Schedule 1 — on condition the services are provided in accordance with that Schedule.
(b) for treatment of a service injury or service disease:
(i) the dental services listed in Schedules A, B and C of the DVA document entitled “Fee Schedule of Dental Services for Dentists, Dental Specialists and other Dental Practitioners (excluding Dental Prosthetists)”, referred to in Schedule 1 — on condition the services are provided in accordance with those Schedules (but without the biennial monetary limit in the Schedule C);
(ii) the dental services listed in the DVA document entitled “Fee Schedule of Dental Services for Dental Prosthetists”, referred to in Schedule 1 — on condition the services are provided in accordance with that Schedule.
5.3.3 A person who holds a White Card is entitled to dental treatment of a service injury or service disease and will be provided with:
(a) the dental services listed in the DVA document entitled “Fee Schedule of Dental Services for Dentists, Dental Specialists and other Dental Practitioners (excluding Dental Prosthetists)”, referred to in Schedule 1 — on condition the services are provided in accordance with that Schedule; and
Note: Schedule C of the Fee Schedule imposes a biennial monetary limit.
(b) the dental services listed in the DVA document entitled “Fee Schedule of Dental Services for Dental Prosthetists”, referred to in Schedule 1 — on condition the services are provided in accordance with that Schedule.
5.4 Emergency dental treatment
5.4.1 Prior Approval is not necessary for emergency dental treatment provided to an entitled person where the treatment is provided in accordance with:
(a) the Principles;
(b) the “Fee Schedule of Dental Services for Dentists, Dental Specialists and other Dental Practitioners (excluding Dental Prosthetists)”, referred to in Schedule 1;
(c) the “Fee Schedule of Dental Services for Dental Prosthetists”, referred to in Schedule 1; and
(d) the Notes for Allied Health Providers;
as those documents relate to the treatment, but if prior approval is required for the treatment then the Commission’s retrospective approval for the treatment must be sought as soon as possible after the treatment is provided and approval must be granted if the Commission is to accept financial liability for the emergency dental treatment.
Note: Schedule C of the “Fee Schedule for Dental Services for Dentists, Dental Specialists and other Dental Practitioners (excluding Dental Prosthetists)” imposes a biennial monetary limit.
5.4.2 Financial responsibility for emergency dental treatment for persons who hold a White Card will only be accepted for treatment of a service injury or service disease.
5.5 Orthodontic treatment for children
5.5.1 Orthodontic treatment will continue to be provided for an eligible young person of a deceased member if the eligible young person has ceased to be eligible for treatment because he or she has turned sixteen years of age or has ceased full‑time education if:
(a) the treatment is approved by the Commission while the eligible young person is still eligible; and
(b) the treatment is commenced while the eligible young person is still eligible; and
(c) the treatment will be completed within two years of commencement of treatment or such longer time as the Commission considers reasonable.
5.6 General anaesthesia
5.6.1 Financial responsibility for a general anaesthetic provided as part of dental treatment will be accepted only if:
(a) the anaesthetic is administered by a specialist anaesthetist or approved medical practitioner in a hospital, Day Procedure Centre or dental surgery where adequate resuscitation equipment is provided; and
(b) unless the anaesthetic is administered in a Tier 1 Hospital or Contracted Day Procedure Centre — prior approval has been obtained.
5.7 Prescribing of pharmaceutical benefits by dentists
5.7.1 Local Dental Officers or dental specialists may prescribe Pharmaceutical Benefits for entitled persons.
5.7.2 Subject to paragraph 5.7.4, prescriptions prescribed under paragraph 5.7.1 must be in accordance with the PBS.
5.7.3 The Commission will accept financial responsibility for Pharmaceutical Benefits, available under the PBS that are required as part of dental treatment:
(a) for a service injury or service disease of an entitled person who holds a White Card; or
(b) for an entitled person who holds a Gold Card;
other than the amount that would have been payable by the person if the person were a “concessional beneficiary” under the National Health Act 1953.
5.7.4 The Commission will accept financial responsibility for Pharmaceutical Benefits that are not available under the PBS and are required as part of dental treatment:
(a) for a service injury or service disease of a person who hold a White Card; or
(b) for a person who holds a Gold Card;
but such a prescription must be written on a private prescription.
5.8 Other dental services
5.8.1 The Commission will not accept financial responsibility for dental treatment that involves the use of intravenous sedation or relative analgesia technique in a Local Dental Officer’s or dental specialist’s surgery.