Private ruling: GST and health services
Date of advice: 13 July 2021
Published: September 2021

Ruling: Q1: Is the supply of your Speech and Language therapy home visit (which includes a travel component) to an NDIS participant GST-free? | A1: Yes. Provided that the supply of your Speech and Language therapy home visit (which includes any travel undertaken) is generally accepted as being necessary for the appropriate treatment of the NDIS participant, we consider that it will be GST-free. | Q2: Is the supply to an NDIS participant to attend meetings at the NDIS participant's home, educational setting or other venue (which includes a travel component) GST-fee? | A2: Yes. Provided that the supply to an NDIS participant to attend meetings at the NDIS participant's home, educational setting or other venue (which includes a travel component) is generally accepted as being necessary for the appropriate treatment of the NDIS participant, we consider that it will be GST-free. | Q3: Is the supply of individualised objects, pictures or text-based visual resources that you provide to the NDIS participants: a) during the Speech and Language home visit GST-free? b) following the Speech and Language home visit GST-free? | A3: Yes. On the basis that the supply individualised objects, pictures or text-based visual resources that you provide to the NDIS participants is generally accepted as being necessary for the appropriate treatment of the NDIS participant, we consider that it will be GST-free where it is provided: a) during the Speech and Language home visit, or b) following the Speech and Language home. | Q4: Is the supply of a report to the NDIS participant which: a) provides an assessment of the NDIS participant and/or identifies future goals with recommendations on how to proceed and possible intervention strategies GST-free? and, b) does the supply in (a) continue to be GST-free where the report is directed/provided to another party such as a school, or childcare facility? | A4: Yes, the supply of the report to the NDIS participant is GST-free. This applies even when the report is directed to another party such as a school or childcare facility. | Q5: Do the responses to questions 1-4 change for a child who is: a) an NDIS participant under Early Childhood Early Intervention? or b) not an NDIS participant (i.e. full fee paying and/or entitled to Medicare rebate)? | A5: No. The responses to questions 1-4 do not change where the child is: a) an NDIS participant under Early Childhood Early Intervention, or b) not an NDIS participant (i.e. full fee paying and/or entitled to Medicare rebate). Relevantly, section 38-10(1) of the A New Tax System (Goods and Service Tax Act 1999 (GST Act) provides that a supply of 'Other health services' is GST-free if: • it is a service of a kind specified in the table in this subsection, or of a kind specified in the regulations (paragraph 38-10(1)(a) of the GST Act); and • the supplier is a recognised professional in relation to the supply of services of that kind (paragraph 38-10(1)(b) of the GST Act); and • the supply would generally be accepted, in the profession associated with supplying services of that kind, as being necessary for the appropriate treatment of the recipient of the supply (paragraph 38-10(1)(c) of the GST Act). Therefore, where section 38-10 of the GST Act applies the status the recipient as an NDIS participant is not relevant to the determination of whether the supply is GST-free. Consequently, in the case where a child falls within 5(a) or 5(b) we consider that the supplies in questions 1-4 for such recipient are GST-free.

Relevant facts and circumstances: You provide speech pathology services. You are currently not registered for GST as you are below the GST turnover threshold, however, you project that your GST turnover threshold may exceed $75,000 and will therefore be required to be registered for GST. As such this ruling is made on the basis that you are registered or required to be registered for GST. You are a member of national peak body for the speech pathology profession, and within this body you are a certified practicing member. You do not fall within the meaning of a medical practitioner for the purposes of the Health Insurance Act 1973 . As part of your speech pathology services you work with children who are: • full fee paying. • on Medicare Chronic Disease Management Plans, • NDIS participants falling in the Early Childhood Early Intervention Category and • with the NDIS who are too old to qualify for Early Childhood Early Intervention. • claiming rebates from Private Health Insurance In respect of the services you provide, a Medical benefit is claimed where the client meets certain criteria set out in the Medicare Benefits Schedule. The details of the Medicare Benefits Schedule has been provided as part of this ruling request. You follow 'best practice' as a Speech Pathologist when working with children which includes (but is not limited to): • Involving the child's family in assessment, goal setting and providing them with the knowledge and skills to support their child's development outside of a clinical intervention session. • Treating a child's family as an equal partner, valuing their unique knowledge of their child's strengths and needs as well as their understanding of what and how recommendations may be able to be implemented within the context of their individual family. • Observing a child's communication skills across different settings e.g. in clinic/ childcare/ Kinder/ at home etc. • Supporting families to provide learning opportunities for their child across a child's natural environments including occurring activities of daily living and within their day to day routines and settings, ensuring that the development of a child's communication skills is not limited to the artificial and highly controlled context of a clinical setting. • Parent and caregiver capacity building and providing families with the skills, tools or resources to carry out parent-led intervention at home in natural settings. • Working with not only the child and their family, but also communicating with the child's wider support network to ensure that opportunities and supports are provided across settings across different relationships e.g. with a Speech Pathologist but also with Parents and Grandparents, in-home Carers/Support Workers, Paediatricians, Occupational Therapists, Psychologists, Behavioural Therapists, Teachers etc.) For the purposes of this private ruling request you have provided a sample copy of a written services agreement (Services Agreement) that you propose to enter for an NDIS Participant. Under the terms of the Services Agreement there is an NDIS plan in effect for a given length of time, which sets out the reasonable and necessary supports that are specified in the statement of supports in the participant's NDIS plan. For the purposes of this private ruling request a copy of an NDIS plan has not been provided. The Services Agreement explains you agree to provide the NDIS participant with Speech Pathology Support Services for the duration of this Service Agreement. Relevantly it explains that the type of service may differ over the course of the NDIS participant's treatment. Further your service may be delivered at a venue other than your clinic (for example a NDIS participants home, school, local community). If this occurs your service includes a fee to account for travel. As part of treating the NDIS participant you may provide non-face-to-face supports which are explained under the Services Agreement as additional things for a child when they are not in a session to provide a comprehensive service. These non-face-to-face supports are done in the best interest of the child when working towards their communication goals. Non-face-to-face supports which are part of the necessary treatment of a client include: • Creating or adding to a visual resource to support a child's communication such as providing individualised objects, pictures or text-based visual resources • Making or responding to phone calls or emails from other professionals involved in the child's care • Attending and participating in allied health and educational support meetings to collaborate in shared problem solving and strategy development • Preparing a report, such as a progress report for the annual NDIS plan review meeting • Analysing, scoring and writing communication assessment reports • Other (as described by your speech pathologist if they arise) In respect of the individualised objects, pictures or text-based visual resources these items may be used and provided during a Speech and Language therapy home visit or alternatively may be provided to the NDIS participant outside of the relevant visit (for example it will be sent by post or email). Fees for non-face-to-face supports are based on the time taken by you to efficiently and effectively perform the task, for example creating the object, picture or text-based resource, at the agreed hourly rate. Reports provided to NDIS participants for which you charge a fee include assessments (Speech Pathology Assessment Report or Speech Pathology Progress Report) and/or written documents identifying a participant's goals and /or intervention strategies. These reports are a necessary part of the performance of the Speech and Language therapy intervention of the NDIS participant and in some case may be directed/provided to another party such as a school, childcare facility, medical practitioner or another allied health practitioner.

Relevant legislative provisions: A New Tax System (Goods and Services Tax) Act 1999 section 38-10