Made | 19th December 2005 | ||
Coming into force | 1st April 2006 |
by one or more providers of relevant primary dental services;
and "urgent course of treatment" shall be construed accordingly;
(2) A reference to the Secretary of State includes a reference to a Special Health Authority or Primary Care Trust exercising functions on her behalf.
Charges for the provision of dental services
3.
—(1) Subject to paragraph (2) below, a charge of the amount provided for in, and calculated in accordance with, regulation 4 may be made and recovered in respect of—
(2) No charge shall be made and recovered under paragraph (1) in respect of—
the charge which may be made and recovered for that course of treatment is the charge which is payable under paragraphs (1) to (3) and (5) of this regulation for the components of the course of treatment which have been completed but not for any components which are incomplete.
(8) Where a dental appliance, an orthodontic appliance or a type of dental treatment is not listed in one of Schedules 1 to 4, the Secretary of State shall determine into which of the Schedules that appliance or treatment should fall so that the charge for a course of treatment or urgent course of treatment, or the supply of a dental appliance under the Act otherwise than as part of relevant primary dental services, can be determined in accordance with paragraphs (1) to (5) above.
Effect of referral to another provider of dental services on the calculation of charges
5.
Where a patient has commenced a course of treatment or urgent course of treatment with one provider of relevant primary dental services but is referred to—
only one charge for the course of treatment or urgent course of treatment calculated in accordance with regulation 4 may be made and recovered from the patient.
Circumstances in which charges cannot be made for treatment that occurs after a course of treatment is completed
6.
—(1) Subject to paragraphs (2) and (3), where a provider of relevant primary dental services has provided a restoration to a patient as part of a course of treatment or an urgent course of treatment for which the relevant charge calculated in accordance with regulation 4 has been made, or would have been made if the patient was not exempt from being charged, and within the relevant period that restoration has to be repaired or replaced to secure oral health, no charge may be made or recovered for the repair or replacement of the restoration.
(2) Paragraph (1) shall not apply where—
(c) the repair or replacement is required as a result of trauma.
(3) In this regulation, "the relevant period" means the 12 month period beginning on the date on which the restoration was provided and ceasing 12 months after that date.
(4) Where a provider of relevant primary dental services has completed a course of treatment other than an urgent course of treatment but, within 2 months of that course of treatment being completed, the same provider determines that the patient requires further treatment which falls within the same or a lower charging band, calculated in accordance with paragraphs (1) to (4) of regulation 4, as the previous treatment and that further treatment is provided (whether or not within 2 months of that course of treatment being completed) by the same provider, no charge may be made or recovered in respect of that further treatment.
(5) In paragraph (4), "completed" means the patient has been provided with each and every component of the course of treatment.
Conditions for exemption under the Act
7.
—(1) It is a condition of the exemption under paragraph 1(1) of Schedule 12ZA to the Act in respect of the provision of relevant primary dental services or a supply of a dental appliance under the Act otherwise than as part of relevant primary dental services—
(2) In this regulation "the relevant date" means—
(3) The declaration referred to in paragraph (1) shall be made by the person to whom the services are to be provided, except that where the request for services is made by another person on his behalf it shall be made instead by the person who requests the services.
(4) Nothing in paragraph (1)(b) prevents the Secretary of State, an NHS trust, an NHS foundation trust or a Primary Care Trust from accepting evidence other than the specified evidence as establishing that a person is within one of the specified categories.
(5) In this regulation "the specified categories" means the categories of person specified in column 1 of Schedule 5 and "the specified evidence", in relation to any of those categories, means the evidence specified in relation to it in column (2) of that Schedule.
Making and recovery of charges
8.
—(1) Where any charge is payable under regulation 4(4) in respect of the supply of a dental appliance under the Act otherwise than as part of relevant primary dental services, a Primary Care Trust, NHS trust or NHS foundation trust —
(2) A provider of relevant primary dental services, in providing relevant primary dental services for which a charge may be made under regulations 4(1) to (3) or (5)—
(3) Where a provider of relevant primary dental services has commenced a course of treatment or urgent course of treatment with regard to a patient and refers the patient to—
only the original provider of the relevant primary dental services may make and recover the charge set out in regulation 4 and shall comply with sub-paragraphs (b) and (d) of paragraph (2) above.
(4) Where a declaration has been made under regulation 7(1)(a), but the person about whom the declaration has been made is not at the relevant date within one of the specified categories, and in consequence of the declaration, a charge has not been recovered—
the Secretary of State may recover the charge from the person who made the declaration (whether or not the obligation to pay has been acknowledged).
(5) In this regulation, "relevant date" and "the specified categories" have the same meaning as in regulation 7.
Remission and repayment of charges under other regulations
9.
The charges which may be made and recovered by virtue of the preceding provisions of these Regulations are subject to the provisions of regulations made under section 83A of the Act providing for remission and repayment.
Repayment of charges
10.
—(1) This regulation applies to any person who—
(2) Subject to the following provisions of this regulation, any person to whom this regulation applies is entitled to have such a charge repaid.
(3) Subject to paragraph (4), it is a condition of the entitlement to a repayment under this regulation that the person makes a claim to the Secretary of State for the repayment—
(b) in a manner approved by the Secretary of State for that purpose; and
(c) supported by such evidence as the Secretary of State may reasonably require.
(4) Subject to paragraph (5), where the person is unable for the time being to act, another person may make a claim on that person's behalf.
(5) The Secretary of State may refuse to accept a claim made by one person on behalf of another where, in the Secretary of State's opinion—
(6) If satisfied that a person is entitled to repayment under this regulation, the Secretary of State shall cause a repayment to be made to that person in such manner as appears to the Secretary of State to be appropriate in the circumstances of the particular case.
Charges for replacement in the course of the provision of relevant primary dental services
11.
—(1) Where a provider of relevant primary dental services replaces a dental appliance or orthodontic appliance supplied as part of those services and it is determined in accordance with Schedule 6 that the replacement is necessitated by—
the provider of relevant primary dental services may make and recover a charge from the relevant person.
(2) The amount of the charge to be made and recovered under paragraph (1) is, subject to paragraph (3), 30% of the Band 3 charge (rounded down, where necessary, to the nearest whole ten pence) as set out in regulation 4(3).
(3) If the Secretary of State considers—
she may determine that the charge shall not be payable, or that its amount shall be reduced.
(4) In this regulation, "relevant person" means—
Reduction of remuneration and accounting for charges in relation to providers of relevant primary dental services
12.
—(1) Subject to paragraphs (2) and (3), where a provider of relevant primary dental services has provided relevant primary dental services for which a charge is payable under these Regulations, the remuneration which would otherwise be payable by the relevant Primary Care Trust to that provider shall be reduced by the amount of that charge, irrespective of whether or not that charge has been recovered by the provider.
(2) A dental practitioner remunerated by a Primary Care Trust providing relevant primary dental services under section 16CA (2) of the Act (dental services provided by a Primary Care Trust or Local Health Board) shall comply with the requirements in paragraphs (b) and (d) of regulation 8(2) and shall account for and pay to that Primary Care Trust, in such manner as it may require, the amount of any charges recovered from a patient under these Regulations.
(3) A dental practitioner remunerated by a Primary Care Trust, NHS trust or NHS foundation trust providing relevant primary dental services pursuant to an agreement for relevant primary dental services made under section 28C of the Act (personal medical or dental services) shall comply with the requirements in paragraphs (b) and (d) of regulation 8(2) and shall account and pay to the body by which he is remunerated, in such manner as it may require, the amount of any charges recovered from a patient under these Regulations.
Transitional provisions
13.
—(1) Subject to paragraphs (2) to (8) of this regulation, any charge which is payable under the Dental Charges Regulations 1989 prior to 1 April 2006 but which has not been made and recovered before that date, may be made and recovered in accordance with the provisions of those Regulations as though they remained in force.
(2) Where a person, who is not otherwise exempt from paying a charge under these Regulations, as part of the provision of general dental services or services under a pilot scheme—
(c) has not been provided with all the treatment listed on that form prior to 1 April 2006; and
(d) receives part of the treatment listed on that form on or after 1 April 2006,
a charge in accordance with paragraph (3) may be made and recovered for that treatment.
(3) The charge which may be made and recovered from a person falling within paragraph (2) is the lower of the charges set out in sub-paragraphs (a) and (b)—
(4) The calculation by the provider as to which of the charges referred to in paragraph (3) is the lower shall take place on—
(5) Regulation 6(4) applies to a person falling within paragraph (2) and the 2 month period referred to in regulation 6(4) shall be deemed to run from—
(6) Where—
the charge that may be made and recovered for the supply of that appliance is the lower of—
(7) Where a person, who is not otherwise exempt from paying a charge under these Regulations, as part of the provision of general dental services is provided with at least part of a course of occasional treatment within the meaning of paragraph 17 of Schedule 1 to the General Dental Services Regulations 1992 on or after 1 January 2006 but prior to 1 April 2006 where—
the charge that may be made and recovered for that treatment is the lower of—
(8) The calculation by the provider as to which of the charges referred to in paragraph (7) is lower shall take place on—
(9) Where a person who falls within paragraph (2), (6) or (7) has paid part or all of a charge prior to 1 April 2006 for treatment provided or appliances supplied and that charge is higher than the charge he is required to pay under paragraph (3), (6) or (7) respectively, he is entitled to have repaid to him the amount of the charge he has paid in excess of the charge he is required to pay.
(10) The repayment to a person in accordance with paragraph (9) shall be made by the provider who has provided treatment or supplied dental appliances to that person under this regulation.
(11) For the purposes of this regulation—
Revocations
14.
The Regulations listed in Schedule 7 are hereby revoked.
Signed by authority of the Secretary of State for Health
Rosie Winterton
Minister of State, Department of Health
19th December 2005
Crowns including any pin or post aids to retention
Bridges including any pin or post aids to retention
(1) | (2) |
Category | Evidence |
1.
Under 18 years of age. |
1.
The person's birth certificate |
2.
18 years of age and receiving qualifying full-time education (within the meaning set out in paragraph 1(2) of Schedule 12ZA to the Act) |
2.
The person's birth certificate and a document signed by the principal or another officer of the recognised educational establishment (within the meaning of paragraph 1(3)(a) of Schedule 12ZA to the Act), or by or on behalf of the person providing instruction by other comparable means, to the effect that the person is receiving full-time instruction at the establishment or by other comparable means. |
3.
Expectant mother |
3.
A certificate, signed by a registered medical practitioner or a registered midwife, as to the pregnancy |
4.
Having borne a child in the previous 12 months |
4.
The child's birth certificate |
she may investigate the matter.
2.
The Secretary of State may make such inquiry into any matter falling within paragraph 1 as she thinks fit and if either—
the inquiry shall take the form of an oral hearing by a committee appointed by the Secretary of State for the purpose.
3.
The Secretary of State, having considered any report made by the committee under paragraph 2—
4.
The Secretary of State shall communicate her determination to—
Regulation 3(2) sets out a number of circumstances in which no charge may be made and recovered for the provision of dental treatment or the supply of dental appliances under the Act. Other circumstances in which no charge may be made for dental services under the Act are set out in Schedule 12ZA of the Act.
Regulation 4 sets out the applicable charges and the system for calculating those charges. Where a patient receives a course of treatment (which may include the supply of dental or orthodontic appliances) from a provider of relevant primary dental services, the charge that will be payable for that course of treatment, if none of the exemptions from charging apply, will be determined by examining in which of the Schedules to the Regulations each of the components of the course of treatment is listed. If any of the components of the course of treatment are listed in Schedule 3, a Band 3 charge of £189 will be payable. If any of the components of the course of treatment are listed in Schedule 2 and none of the components are listed in Schedule 3, a Band 2 charge of £42.40 will be payable. If all of the components of the course of treatment are listed in Schedule 1, a Band 1 charge of £15.50 will be payable.
Where a dental appliance is supplied under the Act otherwise than by a provider of relevant primary dental services and none of the exemptions from charging apply, a Band 3 charge will be payable. Where a patient receives an urgent course of treatment and each component of that course of treatment is listed in Schedule 4, a Band 1 charge will be payable.
Regulation 11 provides that where a patient receives a replacement dental or orthodontic appliance, the need for which it is determined in accordance with the procedure set out in Schedule 6 was brought about by an act or omission of the patient, the charge that will be payable for the replacement will be 30% of the Band 3 charge of £189 rounded down to the nearest 10 pence. The regulation does give the Secretary of State the power to reduce the charge or to determine that it shall not be payable in certain circumstances.
The Regulations provide that only one charge for a course of treatment may be made and recovered even if provided by more than one provider (regulation 5); for circumstances in which charges cannot be made and recovered for both treatment provided after a course of treatment is complete and for the repair or replacement of a restoration (regulation 6); for conditions for statutory exemptions from charges (regulation 7 and Schedule 5); for the procedure for making and recovering charges due under the Regulations (regulation 8); for the repayment of charges which have been paid where a person has the benefit of a statutory exemption but has not complied with the conditions in regulation 7 (regulation 10); for a reduction in the remuneration of a provider of relevant primary dental services by the amount of the charges payable under the Regulations and for a dental practitioner remunerated by either a Primary Care Trust, NHS trust or NHS foundation trust, which is providing relevant primary dental services itself, to account for, and pay to, the body by which he is remunerated the amount of the charges he has recovered from patients under these Regulations (regulation 12); and for the revocation of superseded Regulations on dental charges (Regulation 14 and Schedule 7).
Regulation 13 makes transitional provision for persons who, on or after 1 January 2006, are provided with a plan for treatment as part of the provision of general dental services or services under a pilot scheme and who receive part of that treatment prior to 1 April 2006 and part of that treatment after 1 April 2006. The provider calculates whether the overall charge for the treatment listed on the plan is lower if calculated in accordance with the 1989 Regulations or in accordance with these Regulations and the lower charge is payable. A similar calculation as to which of the charges is lower and, therefore, payable will also occur where an arrangement has been made for a dental appliance to be supplied on or after 1 January 2006 but that appliance is not supplied prior to 1 April 2006. Transitional provision is also made for a person who is provided with at least part of a course of occasional treatment, as part of the provision of general dental services, between 1 January 2006 and 1 April 2006, where a further part of the course of occasional treatment is provided on or after 1 April 2006, in circumstances where each and every treatment included in that course of occasional treatment is listed in Schedule 4 to these Regulations (Urgent Treatment under Band 1 Charge). In these circumstances, the provider will calculate whether the overall charge for the treatment received is lower if calculated as a course of occasional treatment in accordance with the 1989 Regulations or if calculated as an urgent course of treatment in accordance with these Regulations, and the lower charge is payable. The Directions referred to in paragraph (2)(b)(ii) of Regulation 13 which set out the requirements for a plan for treatment in relation to services under a pilot scheme are available from www.dh.gov.uk.
If a person has paid some or all of the charges due for treatment under the 1989 Regulations prior to 1 April 2006 and, using the above mentioned calculations, it is determined that the amount paid is in excess of the amount due under the transitional provisions, the provider must repay the excess amount paid to that person.
[2] Section 126(1A) was inserted by section 183(3)(b) of the Health and Social Care Act 2003 (c.43).back
[3] S.I. 1989/394. This has been amended by S.I. 1990/1638, S.I. 1991/581, S.I. 1992/369, S.I. 1993/419, S.I. 1994/530, S.I. 1995/444, S.I. 1996/389, S.I. 1997/558, S.I. 1998/490, S.I. 1998/2221, S.I. 1999/544, S.I. 2000/596, S.I. 2001/707, S.I. 2001/2807, S.I. 2002/544, S.I. 2002/2353, S.I. 2003/586, S.I. 2003/2382, S.I. 2004/696, S.I. 2004/1091 and S.I. 2005/576back
[4] S.I. 1992/661. Relevant amendments are to paragraph 4 of Schedule 1 to S.I. 1992/661. Paragraph 4 of Schedule 1 was amended by S.I. 1996/2051, S.I. 2001/2421, S.I. 2001/3963 and S.I. 2002/2469,back
[6] These Directions were made in August 1998 and are available at www.dh.gov.uk.back