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Edited version of your written advice

Authorisation Number: 1012788357304

Ruling

Subject: GST and health services

Question 1

Are you making a GST-free supply under subsection 38-7(1) of the A New Tax System (Goods and Services Tax) Act 1999 (GST Act), when you provide diabetes education to patients referred to you by a General Practitioner (GP) under an allied health form?

Answer

Yes.

The diabetes education health service will be a GST-free supply of a medical service if there is a medicare benefit payable for the supply.

Question 2

Are you making a GST-free supply under subsection 38-10(1) of the GST Act, when you provide diabetes education directly to patients?

Answer

Yes.

The diabetes education health service provided by a registered nurse will be a GST free supply of other health services under section 38-10 if it is generally accepted in the nursing profession as being necessary for the appropriate treatment of the recipient of the supply.

This would be the case where the services are provided by other recognised professionals in your practice, such as a Dietician, and all the requirements of section 38-10 are satisfied.

Where the services are provided by an employee that is not a recognised professional, but that person is directly supervised by a recognised professional the supply would also be GST free where all the requirements of section 38-10 are satisfied.

Relevant facts and circumstances

You are registered for GST.

You are a Credentialled Diabetes Educator registered with the Australian Diabetes Educators Association (ADEA).

The ADEA website, viewed 1 April 2015, www.adea.com.au, provides information about their credentialling program including that an applicant for initial credentialling or recredentialling must include their current primary discipline registration or practicing certificate as a:

You provide diabetes education health services which involves providing holistic diabetes education to patients either referred to you by a General Practitioner or sourced directly.

Patients are referred to you by a General Practitioner (GP) using the form Referral Form for Individual Allied Health Services under Medicare for patients with chronic medical conditions and complex care needs.

You are registered with Medicare Australia to provide diabetes education health services under Medicare Australia.

Medicare Benefits Schedule items, 10951, 81100 through to 81125 and 81305 relate to the provision of an allied health service in relation to diabetes education.

The publication, Australian Government Department of Health, Medicare Benefits Schedule Allied Health Services 1 November 2014, provides information on the provision of diabetes education by allied health professionals.

To be eligible to provide services under Medicare, allied health professionals must meet specific eligibility requirements, be in private practice and be registered with Medicare Australia. There are specific requirements for each Medicare item. In summary these include, amongst other requirements:

You are a registered nurse registered with Australian Health Practitioner Regulation Agency (APHRA).

You have various employees who will be providing diabetes education health services. These include a Dietician and an Exercise Physiologist. The professions of other employees are not known at this stage.

Relevant legislative provisions

A New Tax System (Goods and Services Tax) Act 1999 Subsection 38-7(1), and

A New Tax System (Goods and Services Tax) Act 1999 Subsection 38-10(1) .

Reasons for decision

In this ruling, please note:

Question 1

Subsection 38-7(1) states that a supply of a 'medical service' is GST-free. 'Medical service' is defined in section 195-1, in part, as:

The provision of diabetes education health services by you to patients referred to you by a GP via Referral Form for Individual Allied Health Services under Medicare for patients with chronic medical conditions and complex care needs will be the provision of a service where a medicare benefit is payable under various items listed in the Medicare Benefits Schedule. This is subject to conditions outlined by Medicare Australia.

When you provide a diabetes education health service and there is a medicare benefit payable for the supply, the service will be a GST-free supply of a medical service.

Question 2

You make a GST-free supply of other health services if all the requirements of subsection 38-10(1) are met.

Subsection 38-10(1) states:

Health services

Item

Service

1

Aboriginal or Torres Strait Islander health

2

Acupuncture

3

Audiology, audiometry

4

Chiropody

5

Chiropractic

6

Dental

7

Dietary

8

Herbal medicine (including traditional Chinese herbal medicine)

9

Naturopathy

10

Nursing

11

Occupational therapy

12

Optometry

13

Osteopathy

14

Paramedical

15

Pharmacy

16

Psychology

17

Physiotherapy

18

Podiatry

19

Speech pathology

20

Speech therapy

21

Social work

Service of a kind specified in the Table

Diabetes education health service is not a service specified in the table in subsection 38-10(1) (Table).

Issue 2.a.1 of the Health Industry Partnership - issues register (Issues Register) considers the requirement of 'services of a kind' in relation to psychotherapists and psychoanalysts. Issue 2.a.1 of the Issues Register in part states:

Applying this principle to your situation, while diabetes education is not specified in the Table it may be a technique of one of the services listed in the Table.

Whether or not, diabetes education is a technique of one of the services in the Table is a question of fact.

Recognised professional

Recognised professional is defined in subsection 195-1, in part, as:

A registered nurse satisfies paragraph (a) of the definition of a recognised professional as nursing is regulated by law and a nurse must be registered under the relevant law in each state and territory.

Issue 2.a.6 of the Issues Register considers the type of recognised professional that provides a service of 'Dietary' listed at Item 7 of the Table. Issue 2.a.6 of the Issues Register states:

A Dietician registered with the Dieticians Association of Australia satisfies paragraph (b) of the definition of a recognised professional.

An Exercise Physiologist registered with a professional association with uniform national registration would also satisfy paragraph (b) of the definition of a recognised professional.

You will need to assess whether your supply of diabetes education health service is provided by a recognised professional in relation to a health service listed in the Table.

Issue 2.a.7 of the Issues Register provides guidance on what is considered to be 'a professional association that has uniform national registration requirements' under paragraph b of the definition, and in part, states:

Issue 2.a.8 of the Issues Register considers the situation where allied health practitioners employ assistants that are not 'recognised professionals' to provide certain services to patients. Issue 2.a.8 of the Issues Register, in part, states:

Where the diabetes education health service is not provided by a recognised professional in relation to a health service listed in the Table, the person providing the service will need to be directly supervised in order to satisfy the requirement of being a recognised professional under paragraph 38-10(1)(b).

Appropriate treatment

For the purposes of paragraph 38-10(1)(c), the recognised professional must provide the service listed in the Table, and the relevant profession would need to consider the service as being necessary for the appropriate treatment of the recipient of the supply.

Whether or not, diabetes education health service is generally accepted in the relevant profession as being necessary for the appropriate treatment of the recipient of the supply is a question of fact.

You will need to assess whether diabetes education health service is generally accepted as appropriate treatment by the relevant profession in the Table in relation to the recognised professional providing the service.

Summary

In this case, the diabetes education health service provided by a registered nurse will be a GST free supply of other health services under section 38-10 if it is generally accepted in the nursing profession as being necessary for the appropriate treatment of the recipient of the supply.

This would be the case where the services are provided by other recognised professionals in your practice, such as a Dietician, and all the requirements of section 38-10 are satisfied.

Where the services are provided by an employee that is not a recognised professional, but that person is directly supervised by a recognised professional the supply would also be GST free where all the requirements of section 38-10 are satisfied.

Therefore, you will be making GST-free supplies under subsection 38-10(1) of the GST Act when you supply diabetes education health services.


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