Document ID: chunk:federal_register_of_legislation:F2024C00800:front:0:p42
Version: federal_register_of_legislation:F2024C00800
Segment Type: other
Provision Reference: 
Character Range: 112265–115118

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 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", referred to 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", 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 (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.

5.2.5 The annual 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 or dental specialist had provided the service as a practitioner under that Act.

5.3 Entitlement
5.3.1 Subject to these Principles, an entitled person