PART 5 — DENTAL TREATMENT

5.1 Providers of services

5.1.1 The Commission may accept financial responsibility for dental treatment provided to an entitled person by a dental prosthetist, dentist or dental specialist where the treatment is provided in accordance with these Principles and in accordance with the Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects a dental prosthetist, dentist or dental specialist, 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.

Note: paragraph 5.4.1 deals with emergency dental treatment.

5.1.3 Subject to prior approval, an entitled person may be referred to a dental specialist by a dental prosthetist, dentist or other dental specialist.

5.2 Financial responsibility

5.2.1 The DVA document entitled “Fee Schedule of Dental Services for Dentists and Dental Specialists”, in force on the date in Schedule 1, and comprised of Dental Schedules A, B and C, lists the dental services provided by dentists, or dental specialists, 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”, in force on the date 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 (annual monetary limit) in respect of dental services provided to an entitled person under that Schedule in a Calendar year.

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.