Private ruling: Goods and services tax (GST) and Musculoskeletal Therapy
Published: December 2014

Ruling: Q1: Is GST payable on your supply of Musculoskeletal Therapy (MST) services? | A1: Yes.

Relevant facts and circumstances: You are registered for GST. You supply MST. MST is a branch of manual medicine which focuses on the treatment and management of musculoskeletal pain and dysfunction. MST involves an extensive physical evaluation and an integrated therapeutic approach in the treatment of affected muscles, joints and nerves. MST treats symptoms, relieves pain, and identifies and addresses contributing factors and underlying causes of musculoskeletal conditions. It differs from remedial massage in that the inclusion of critical evaluation throughout the curriculum contributes to an ability to effectively assess a presenting musculoskeletal condition, identify its causes/contributing factors and to develop a holistic plan of management that will provide an effective result. Exercise prescription, diet/nutritional measures, postural awareness as well as hands-on techniques may be employed. The MST profession is a stand alone allied health profession. MST does not involve techniques that naturopaths, acupuncturists, physiotherapists, chiropractors, chiropodists, osteopaths, podiatrists, herbal medicine practitioners or dieticians use. MST treats the same conditions that an acupuncturist, physiotherapist or chiropractor would. The MST services are generally accepted in the acupuncturist, physiotherapist and chiropractor professions as being necessary for the appropriate treatment of the patient. Australian Natural Therapists Association (ANTA) has uniform national registration requirements relating to the supply of MST services and various other services. The services you supply will be performed by a member of ANTA. The MST practitioner is accredited with ANTA to supply MST services specifically. The practitioner has a qualification in MST that is accepted for admission as a member in ANTA, that is, the Bachelor of Health Science (MST), which is a three year degree that provides a comprehensive theoretical foundation in biomedical and clinical sciences as is standard in most health science degrees. The musculoskeletal therapist is trained in the development of communication management skills including an appreciation of legal and ethical issues that may arise in a clinical setting. Manual skills are core to MST training and are used in the exploration and evaluation of joint restriction and the contractile state of specific muscles. Medicare benefit is not payable in respect of the MST services. The practitioner is not a medical practitioner, that is, the practitioner is not a person registered or licensed as a medical practitioner under a law of a State or Territory that provides for the registration or licensing of medical practitioners. The services provided to patients are covered under private health insurance policies under Myotherapy services. Patients will be sourced through word-of-mouth and from referrals from doctors and other allied health practitioners. The patient is the party who normally engages the service provider and is responsible for payment for the services. The services will be performed in a particular State or Territory of Australia. You expect to earn over $75,000 a year from providing MST services.

Relevant legislative provisions: A New Tax System (Goods and Services Tax) Act 1999 subsection 7-1(1) | A New Tax System (Goods and Services Tax) Act 1999 section 9-5 | A New Tax System (Goods and Services Tax) Act 1999 section 9-40 | A New Tax System (Goods and Services Tax) Act 1999 section 38-7 | A New Tax System (Goods and Services Tax) Act 1999 section 38-10 | A New Tax System (Goods and Services Tax) Act 1999 section 195-1

Reasons for decision: Summary: You do not make GST-free supplies of medical services under subsection 38-7(1) of the A New Tax System (Goods and Services Tax) Act 1999 (GST Act) because medicare benefit is not payable in respect of the MST services and your health practitioner is not a medical practitioner. You do not make GST-free supplies of allied health services under subsection 38-10(1) of the GST Act because the services performed in your case are not any of the kinds of allied health services listed in the table in subsection 38-10(1) of the GST Act. | Detailed Reasoning - Detailed reasoning: GST is payable on taxable supplies. You make a taxable supply if you meet the requirements of section 9-5 of the GST Act, which states: You make a taxable supply if: (a) you make the supply for *consideration; and (b) the supply is made in the course or furtherance of an enterprise that you carry on; and (c) the supply is *connected with Australia; and (d) You are registered or required to be registered. However, the supply is not a *taxable supply to the extent that it is *GST-free or *input taxed. (*Denotes a term defined in section 195-1 of the GST Act) You meet the requirements of paragraphs 9-5(a) to 9-5(d) of the GST Act. This is because: • you will make supplies of health services for consideration; and • you will supply these services in the course or furtherance of an enterprise that you carry on; and • the services will be performed in Australia; and • you are registered for GST. There are no provisions of the GST Act under which your supplies are input taxed. Therefore, what remains to be determined is whether your supplies are GST-free. Medical services are GST-free under subsection 38-7(1) of the GST Act. 'Medical service' is defined in section 195-1 of the GST Act as: • a service for which medicare benefit is payable, or • any other service supplied by or on behalf of a medical practitioner or approved pathology practitioner that is generally accepted in the medical profession as being necessary for the appropriate treatment of the recipient of the supply. Medical practitioner means a person who is a medical practitioner for the purposes of the Health Insurance Act 1973 (HIA). Section 3 of the HIA defines medical practitioner as a person registered or licensed as a medical practitioner under a law of a State or Territory that provides for the registration or licensing of medical practitioners. Medicare benefit is not payable on the services in your case. The practitioner in your case is not a medical practitioner. Therefore, your supplies of MST are not medical services. Hence, you will not make a GST-free supply under subsection 38-7(1) of the GST Act. Supplies of certain allied health services are GST-free under subsection 38-10(1) of the GST Act. Subsection 38-10(1) of the GST Act states: A supply is GST-free if: (a) it is a service of a kind specified in the table in this subsection, or of a kind specified in the regulations; and (b) the supplier is a *recognised professional in relation to the supply of services of that kind; and (c) 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. The table lists the following types of services: • Aboriginal or Torres Strait Islander health • Acupuncture • Audiology, audiometry • Chiropody • Chiropractic • Dental • Dietary • Herbal medicine • Naturopathy • Nursing • Occupational therapy • Optometry • Osteopathy • Paramedical • Pharmacy • Psychology • Physiotherapy • Podiatry • Speech pathology • Speech therapy • Social work Recognised professional is defined in section 195-1 of the GST Act. It states: a person is a recognised professional, in relation to the supply of a service of a kind specified in the table in subsection 38-10(1), if: (a) the service is supplied in a State or Territory in which the person has a permission or approval, or is registered, under a *State law or a *Territory law prohibiting the supply of services of that kind without such permission approval or registration; or (b) the service is supplied in a State or Territory in which there is no State or Territory law requiring such permission, approval or registration, and the person is a member of a professional association that has uniform national registration requirements relating to the supply of services of that kind; or (c) in the case of services covered by item 3 in the table - the service is supplied by an accredited service provider within the meaning of section 4 of the Hearing Services Administration Act 1997 . MST is not listed in the table referred to above and does not involve the techniques associated with the kinds of services listed in the table. Therefore, you are not supplying services of a kind specified in the table. Additionally, the GST Regulations do not specify additional kinds of services to those listed in the table referred to above. Hence, you do not meet the requirement of paragraph 38-10(1)(a) of the GST Act. As you do not meet the requirements of subsection 38-10(1) of the GST Act, you do not make a GST-free supply of an allied health service under that provision. There are no provisions in the GST Act under which your supplies of MST services are GST-free. As all of the requirements of section 9-5 of the GST Act are met, GST is payable on your supplies of MST services.