Introduction of child dental benefits

With effect from 1 January 2014, the federal government has introduced a new Medicare scheme called the Child Dental Benefits Scheme. This is regulated by the Dental Benefits Act 2008.

This replaces the Medicare Teen Dental Plan and has been established to allow benefits to be paid to eligible providers for services provided to eligible children and teenagers.

The new schedule (Items 88011 – 88943) is available for out of hospital basic dental treatment such as consultations, diagnostics, restorations and extractions but does not apply to orthodontic or cosmetic dental work.

Medicare have provided a set of steps which will ensure compliance. These are easy to follow and logical. This is a summary of Medicare’s “information for dental providers” document excluding reference on how to actually make claims for benefits provided:

1. Ensure you are eligible to provide the services

All services must only be provided by a dental practitioner who has a Medicare Provider Number. Note there are different arrangements for dentists providing public treatment, and those proposing to do so, should contact your state/territory government for further information.

Services (or part of the service) may be provided by various therapists or a prosthetist on behalf of the dentist but must meet accepted dental practice and appropriate supervision requirements. As a claim can only be made on a dentist or specialists provider number, you remain liable to Medicare in the event of any query, investigation and/or demand for reimbursement, so you should ensure all therapist/prosthetist services meet the strict requirements.

2. Confirm the patient’s eligibility

The scheme relates to children 2 – 17 years of age who satisfy a means test. The DHS will write to eligible children each year and patients may give dental providers a copy of the letter as evidence of eligibility. It is also recommended that contact be made with Human Services on 132 150.

3. Entitlements

Eligible patient benefits are capped over a two calendar year period, and for those patients who receive their first service in 2014, the cap is $1,000 per person.

Eligibility will be assessed annually and if required, a patient may fully extinguish their benefit in the first calendar year. If not fully utilised in the first year, the remaining balance may only be used in the 2nd year if the patient remains eligible.

4. Informed Consent

Prior to performing services, a dental provider must obtain consent from the patient or their parent/guardian as to the proposed treatment and any associated costs for which they may be liable. This must be recorded on a (signed) patient consent form at the time treatment first commences and again on the first day the patient receives services in a subsequent year.

5. Record Keeping

Adequate and appropriate records of all services provided under this Scheme must be retained for 4 years (although we recommend until the child turns 21) from the date of service, including all patient consent forms and detailed clinical notes (which must include reference to the specific tooth or teeth under treatment within the Scheme, who performed the treatment, the findings, assessment, diagnosis and plan as well as the Item Number charged etc)