Chapter 1

Dental Benefits Amendment Bill 2012

1.1        On 20 September 2012 the Senate referred the provisions of the Dental Benefits Amendment Bill 2012 (Bill) to the Senate Community Affairs Legislation Committee (Committee) for inquiry and report by 29 October 2012. The Bill was introduced in to the House of Representatives on 12 September 2012.[1]

Purpose of the Bill

1.2        The Bill seeks to amend the Dental Benefits Act 2008 (the Act) in order to establish the framework for the Child Dental Benefits Schedule (CDBS), a newly announced policy initiative which will provide funding for the provision of dental services to eligible children between the ages of two and 18 years.[2] Under the proposed CDBS, more than three million children would become eligible for government-subsidised dental care.

1.3        The Minister for Health, the Hon Tanya Plibersek MP (Minister), stated in her Second Reading Speech to the Bill:

Since the late 1990s, the prevalence of child caries and the mean number of teeth affected by dental disease in children has increased. A recent Australian Institute of Health and Welfare report showed that 45 per cent of 12-year-olds had decay in their permanent teeth and almost 25 per cent of 12-year-olds had untreated decay. If a decline in oral health of children becomes established, we are going to see a need for increased services in the future.

Investment in our children's teeth is an investment in the future. We know that poor childhood oral health leads to poor adult oral health, and has wide‑ranging impacts on general health and wellbeing, including increasing the demand on our health and hospital system.[3]

Background

1.4        On 29 August 2012 the Minister announced a new dental reform package, with over $4 billion in Commonwealth funding allocated to the package over six years, commencing in 2014.[4] The major components of the reform package are:

• $2.7 billion to provide subsidised basic dental services to around 3.4 million eligible Australia children from January 2014 through the proposed CDBS;
• $1.3 billion to provide around 1.4 million additional services for adults on low incomes from July 2014; and
• $225 million in funding for dental capital and workforce, to support expanded services for outer metropolitan, regional, rural and remote areas.[5]

1.5        The additional $1.3 billion for additional dental services to adults on low incomes will be provided to the states and territories through a National Partnership Agreement, although the government has stated that this funding will be conditional on the states and territories at least maintaining their current level of funding for dental care services.[6] The $225 million in funding for non-metropolitan areas will be provided through a Flexible Grants Program, with applications for grants scheduled to open in 2014.[7]

1.6        The reform packaged was jointly announced by Greens Health Spokesperson, Senator Richard Di Natale, who described the package as 'the most significant reform of dental care in our nation's history'.[8]

Closure of the Chronic Disease Dental Scheme

1.7        Under the proposed dental reform package, the existing Chronic Disease Dental Scheme (CDDS) will be abolished. The CDDS, introduced in late 2007, provided up to $4250 in Medicare benefits for dental services for individuals with chronic conditions and complex dental care needs.[9]

1.8        The CDDS was closed to new patients from 8 September 2012, and any services for existing CDDS patients must now be completed by 30 November 2012 in order to qualify for benefits under the CDDS.

Replacement of the Medicare Teen Dental Plan

1.9        The Child Dental Benefit Schedule would replace the current Medicare Teen Dental Plan (MTDP). The MTDP was introduced in 2008, and provides dental benefits of up to $163.05 each year for a preventative dental check for eligible teenagers between the ages of 12 and 18 years old.

Proposed scope of the Child Dental Benefit Schedule

1.10      The proposed CDBS would subsidise dental care services for eligible children between the ages of 2 and 18 years old, and will cover a broader range of services than the current MTDP. The Minister has stated that the CDBS will provide a benefit for basic dental services including prevention and treatment; for example, check-ups, fillings and extractions.[10]

1.11      The benefit would be capped at an entitlement of $1000 per child over two years, and would be available to children who receive (or in households that receive) payments under several existing Commonwealth benefits.[11] On this basis, the government estimates that around 3.4 million children will be eligible for the scheme[12] (out of a total population of around 4.6 million children).[13]

Legislative framework for the provision of dental benefits

1.12      The Dental Benefits Act 2008 (the Act) was created to establish a legislative framework for the payment of dental benefits under the Government's Medicare Teen Dental Plan.[14] Division 2 of Part 4 of the Act specifies that teenagers between the ages of 12 and 18 who satisfy a specified means test may receive dental benefits.

1.13      The Act does not detail the types of dental services for which benefits can be claimed; rather, the Act provides for many of the details regarding the scope of dental benefits payable to be provided for in a legislative instrument, the Dental Benefit Rules 2009 (Dental Benefit Rules).

1.14      Section 26 of the Act also provides flexibility for groups of people other than eligible teenagers to receive dental benefits, by providing that the Dental Benefit Rules may include a class of persons as qualifying to receive benefits in relation to a specified dental service.

1.15      Division 3 of Part 4 of the Act provides that benefits are to be paid in the form of vouchers issued by the Medicare CEO.

Provisions of the Bill

1.16      The Bill contains amendments to the Act to create a framework for the CDBS.

1.17      Section 2 of the Bill states that the commencement date of the amendments is 1 January 2014, consistent with the Minister's announcement regarding the dental care reform package.

Extending the age range of eligible dental care benefits recipients

1.18      Schedule 1 of the Bill contains amendments to the Act which have the effect of extending the age range of persons eligible for dental benefits under the Act. The EM to the Bill explains:

The Act currently provides at section 5 that an “eligible dental patient” includes a person in respect of whom a voucher issued under Part 4 is in effect. Part 4 presently supports the Medicare Teen Dental Plan by requiring vouchers to be issued to children aged at least 12 but under 18 years. The amendments have the effect of extending the age range of children eligible to receive vouchers to those aged at least 2 but under 18 years – the range of children to be eligible for the CDBS.[15]

1.19      Item 2 of Schedule 1 of the Bill seeks to amend section 22 of the Act, by providing that a person qualifies for a voucher in a calendar year if he or she is aged 'between 2 and 18 years' during the calendar year. Item 5 of Schedule 1 of the Bill seeks to amend paragraphs 23(1)(a) and 23(1)(b) of the Act, to replace current references to '12 years' of age to read '2 years'.

1.20      In order to reflect the expanded age range required for the CBDS, several amendments are made to replace references to qualifying 'teenagers'. Items 3 and 7-16 of Schedule 1 of the Bill replace the word 'teenager' with 'person' throughout sections 23-25 of the Act.

Enabling different monetary caps for different groups or dental services

1.21      Subsection 62(2) of the Act currently provides that the Dental Benefit Rules may place limitations on the amount of benefit payable to an eligible patient for a specified dental service. Item 17 of Schedule 1 of the Bill seeks to amend this subsection to allow different limitations for different classes of patients, or for different dental services. The EM explains:

Item 17 makes an amendment to subsection 62(2) to introduce flexibility in the application of the monetary cap proposed for the CDBS to allow, for example, different caps to apply to different groups of persons or different groups of services. This will allow the government flexibility to implement the outcomes of consultation with dental professions in developing the schedule of services, which will occur after the passage of the Bill.[16]

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