Changes to the Dental Benefits Rules

From the 1st January 2015 changes to The Rules (Dental Benefits Rules 2014) will take effect. The Child Dental Benefits Schedule (CDBS) operates under two pieces of legislation, the Dental Benefits Act 2008 (the Act), and the subordinate legislation to the Act, the Rules.

Members and their practice staff should make themselves aware of these changes before providing any services under the CDBS.

The changes to the rules are:

• Sets the patient cap for the 2015-2016 period to $1,000, the same as the 2014-2015 period.
• It is no longer an option for dentists to provide their name and address on CDBS invoices and claiming forms. This option has been removed as these details can be accessed by the Department of Human Services through a dentist’s Medicare provider number.
• Extension of the date to which a State or Territory public dental clinic is eligible for dental benefits under the CDBS to 30 June 2015.
• Removal of reference to ‘treatment’ from Rule 15(1)(a) to further clarify the requirement that consent must be obtained before providing any item in the Dental Benefits Schedule.
• No longer requiring DHS to notify a child or parent of CDBS eligibility where the child has zero remaining cap balance as this may be confusing to the recipient.
• Changes to the Dental Benefits Schedule which consist of:
  • Addition of item 88412, incomplete endodontic therapy (tooth not suitable for further treatment), to provide for situations when root canal therapy cannot be completed. This item has a limitation of one per tooth.
  • Given the addition of item 88412, a benefit will not be payable for any other endodontic service (items 88411, 88414, 88415, 88416, 88417, 88418, 88419, 88421, 88455 and 88458) if item 88412 has been claimed for the same tooth.
  • The limitation on item 88768 has changed to eight (8) per 24 month period.
  • The limitation on item 88455 has been amended so that a benefit does not apply if a benefit has been paid for item 88414, 88415, 88416, 88417, 88418 or 88421 on the same tooth on the same day. The requirement that 88455 may only be provided within three months of 88415 or 88416 remains unchanged.
• Changes to who notifications of CDBS eligibility are sent to in particular cases.
• To align with other Commonwealth health benefit programmes, it is now a requirement that the patient is eligible for Medicare at the time the dental service is provided.
• A number of machinery amendments including amendments for clarification and improved interaction of the Schedule with DHS systems.

Educational materials on the CDBS will be updated in December, including an updated ‘Guide to the Child Dental Benefits Schedule’ which will contain the latest Dental Benefits Schedule. These updated materials will be available in later December at humanservices.gov.au/healthprofessionals then Other health care providers > Dentists.