Chapter 4: Health

Date

The Government’s policy

In its policy document Tax Reform: not a new tax, a new tax system and associated Fact Sheets the Government said the following health goods and services will be GST-free:

  • Medical services that attract a Medicare benefit or are commonly used health services listed by the Government.
  • Health care provided at hospitals, nursing homes, hostels and similar establishments.
  • The concession will extend to accommodation, drugs, dressings and meals supplied to patients or nursing home residents in the course of their treatment or care.
  • Nursing home services provided to the elderly in their own home, including Home and Community Care services, will be treated in the same manner as if the person had been resident in a nursing home.
  • Supplies not related to health care, such as food served in hospital cafeterias, or televisions rented to patients will be taxable in the normal manner.
  • The supply of medical aids and appliances for use by people with severe medical conditions or disabilities (examples include wheel chairs, crutches, artificial limbs and modifications to motor vehicles for the disabled).
  • Drugs and medicines that can only be provided on prescription and PBS and RPBS medicines provided on prescription.

The Committee’s framework for assessing the scope of GST-free health

As a basis for its consideration of the health sector, the Committee noted the Government’s rationale for making most medical and hospital services GST-free.

Applying taxes to health care would place the private health sector, with its heavier reliance on direct fees, at a competitive disadvantage with the public health system.

This policy has been uppermost in the Committee’s mind in considering the precise range of health goods and services that will be GST-free. This is also consistent with the Committee’s Terms of Reference, requiring it to frame its recommendations in light of the need to

‘…ensure the tax system minimises any discrimination between private and public provision of goods and services in the GST-free areas.’

Many submissions argued that health was a ‘public good’ and therefore deserving of even more concessionary treatment than that proposed by the Government. While acknowledging the intrinsic merit of health (and education, religious services and charities), the Committee has confined its considerations to the guidelines established by the Government. For the Committee to frame its recommendations on the basis of the ‘merit’ argument would be to go beyond the its Terms of Reference.

The Committee considered that it was important to differentiate between the institution delivering a service and the service itself. If blanket concessional treatment were to be given to the institution that usually delivers such services, these institutions may expand the scope of the services they provide into areas that should not be given GST-free treatment.

In determining the scope of GST-free health goods and services, the Committee thought it desirable, to use existing definitions to the extent that is possible. Such an approach is more likely to result in the Government receiving recommendations which are in a form that is readily transferable into legislation. It will also assist stakeholders to more readily understand the recommended scope of GST-free health.

However, the Committee, in the course of its deliberations also became aware of certain areas of health where it would be desirable to make allowance for the changing nature of the delivery of health services.

In examining the health sector, the Committee drew on the knowledge and individual experience of its members, consultation with relevant government officials, and on information provided by various industry representatives and practitioners. In the end the Committee decided that its consideration of the scope of the GST-free health sector, could best be facilitated by separating the sector into seven fairly distinct subsets:

  • medical (health) services;
  • hospital services;
  • residential care;
  • community care;
  • disability services;
  • medical appliances and aids; and
  • drugs and medicines.

Residential and community care, and disability services are not terms used in the Government’s policy documents. These documents call for the Committee to make recommendations on the precise scope of health services for the aged that will be GST-free. However, in the course of its deliberations, the Committee felt that it was not possible to consider aged services without also considering services to the disabled.

Key issues for consideration

Medical (health) services

Tax Reform: not a new tax, a new tax system stated that:

‘Medical services will be GST-free if they attract a Medicare benefit or are commonly used health services, listed by the Government. Examples of GST-free health services are:

Health services covered by Medicare:

general practitioner and specialist consultations; and

diagnostic, surgical and therapeutic procedures (for example, opthalmology, neurology, optometry, radiation oncology, anaesthetics, radiology, ultrasound etc) and pathology.

Other medical services that will be GST-free include:

hospital charges (accommodation etc);

dental services;

optical;

physiotherapy, chiropractic;

speech therapy;

occupational therapy;

counselling services;

home nursing;

dietary services; and podiatry.

The precise scope of qualifying medical services is a matter on which the Government will take a final decision following advice from the Tax Consultative Committee.’

The Committee looked first at those services attracting a Medicare benefit. To attract a Medicare benefit, three criteria need to be met: provider eligibility; patient eligibility and whether the service is listed on the Medicare Benefits Schedule.

While the Committee recognised that Government policy stated that the service must attract a Medicare benefit, it was concerned that:

  • the medical practitioner should not have to identify patient eligibility; and
  • medical practitioners should be placed on the same footing as practitioners of common health services who do not have a detailed register of services.

Accordingly, the Committee recommends that clinically relevant services provided by medical practitioners, or on their behalf, for example radiographers or nurses, be GST-free.

  • The only exception to this would be certain medical procedures (primarily non-essential cosmetic surgery) which are not provided through the public health system.

For commonly used health services, the Committee considered whether any other services should be added to the list in Tax Reform: not a new tax, a new tax system. The Committee noted that the Government had listed health services that would generally be considered by the community to be mainstream rather than complementary or alternative, and have been available as a specialist service, with specific qualifications for some time. The Committee also noted that a large number of submissions argued persuasively that some services should be added to the list because they were strikingly similar in nature to services already included, such as podiatry and chiropody. The Committee therefore restricted its consideration of GST-free health services to those which were either very similar in nature to those already nominated, or which the Committee considered fitted the general characteristics of the list proposed by the Government.

It was also recognised by the Committee that many recreational pursuits may have health benefits (eg g
ym memberships), but decided that it was necessary to ‘draw the line’ at a reasonable point. The Committee also kept in mind that such an extension could have had significant revenue implications for the Government.

The Committee agreed that the following services should be added to the list:

  • osteopathy;
  • chiropody;
  • speech pathology;
  • audiology, audiometry;
  • ambulance;
  • paramedical;
  • nursing;
  • aboriginal health services;
  • social work services;
  • pharmacy; and
  • psychology.

In addition to providing a listed service, the practitioner must also be a member of a relevant professional body subject to State government professional registration or uniform national professional self-regulation. The Committee considered that this was an important safeguard to ensure that only suitably qualified persons within the community would have GST-free status for the services that may be provided.

The Committee also thought that only those services that are clinically relevant and of a type normally provided by that profession should be GST-free.

The Committee noted that Tax Reform: not a new tax, a new tax system indicated that ‘counselling services’ should be GST-free. The Committee noted that counselling services are generally provided by three professional groups within the community: social workers, psychologists, and the relatively new profession of counsellors. The Committee noted that social workers and psychologists either have a State/Territory registration requirement or a self-regulation national professional association. There are few equivalent systems for counsellors at this time, and the Committee notes that there are also no minimum qualification requirements before an individual can describe themselves as a counsellor. The Committee considered therefore, that counsellors should not be considered a registered practitioner for the purposes of providing counselling services. The Committee noted the majority of counsellors providing drug and alcohol abuse, HIV aids, depression and grief management counselling are operating in hospitals, charities and other similar institutions rather than in private practice. The Committee considers that, following State Government professional registration or development of a national self-regulating body, the Government should include counsellors as a registered practitioner for the purpose of providing GST-free status.

There are a number of programs for delivery of health services funded from Commonwealth and State or Territory Governments that the Committee thought should be included as GST-free health services, such as community health services. Most of these services will be GST-free as qualifying health services, but in some cases patients will be charged a fee for other services provided as part of their health care which do not come under the definition of commonly used health services. An example is the fee charged in some coordinated care trials currently in place. The Committee considered that coordination of services was integral to the delivery of health services and should not be treated as a separate charge.

The Committee considered that goods used as part of the health service and administered on the premises where the service is performed should also be included in the GST-free treatment of the health service.

As noted earlier, a number of submissions were received from groups seeking to have their services included in the list of commonly used health services. The Committee recognised that many of these services may have benefits to the community. However, it decided that it should give effect to the Government’s policy intent by limiting additions to cases where the service had the same characteristics as those services listed in ‘Tax Reform: not a new tax, a new tax system’.

The Committee also noted that ambulance subscription fees are a limited form of private health insurance. In line with the Government’s position that private health insurance premiums should be GST-free, the Committee recommends that ambulance subscription fees should be treated in a similar manner.

Hospital services

Tax Reform: not a new tax, a new tax system stated that:

‘Health care provided at hospitals…will be GST-free. The concession will extend to accommodation, drugs, dressings and meals supplied to patients…in the course of their treatment.

Supplies of items not related to health care such as food served in hospital cafeterias, or televisions rented to patients, will be taxable in the normal manner.’

In determining its position on hospital services, the committee considered it useful to make use of existing legislative and regulatory systems such as the Australian Health Care Agreements (AHCA) between the Commonwealth and the States, the Medicare Benefits Schedule and the National Health Act 1953 (section 67). This approach allowed the Committee to define the appropriate hospital services as being those consistent with the treatment of health care, while excluding certain medical procedures (primarily cosmetic surgery such as tattoo removal), telephone and television rentals, as well as cafeteria meals.

GST-free treatment should extend to the related provision of accommodation, dressings, drugs and patient meals, but there is a need to restrict the scope of these related goods. The Committee has chosen to limit this scope to goods that are part of the health service and which are administered on the premises where the service is performed.

This helps to ensure that consumers cannot have a range of other goods provided to them GST-free, if they would ordinarily be taxable if purchased privately in the community. An extreme example would be provision of a hundred tubs of topical heat cream to an outpatient with a knee injury. These do not qualify as a GST-free aid or appliance and would ordinarily be taxable if purchased in any retail store. They should not become GST-free just because they are delivered by the hospital.

The use of the AHCAs, the MBS and the National Health Act 1953 (s67) also allows the Committee to identify the scope of GST-free hospital health services as those including:

  • hospital in the home services;
  • hospital outreach services; and
  • contracted out health services.

This ensures that new, innovative and more efficient delivery mechanisms for hospital health services are not hampered by a strictly institutional definition of hospital services.

In formulating its final position, the Committee also considered various submissions from industry groups. Many of the issues raised in these submissions have been accommodated in the recommendations of the Committee. However, other issues were raised seeking concessional treatment contrary to the general operation of a GST (such as purchasing all inputs tax free, instead of paying tax and subsequently receiving an input credit), and the overall policy decisions of the Government. These issues have been addressed earlier in the report and the committee reiterates that GST operation and policy issues were outside the scope of its Terms of Reference.

Residential care

Tax Reform: not a new tax, a new tax system stated that:

‘Health care provided at…nursing homes, hostels and similar establishments will be GST-free. The concession will extend to accommodation, drugs, dressings and meals supplied to …nursing home residents in the course of their…care.

Supplies of items not related to health care…will be taxable in the normal manner.

The precise scope of health services for the aged that will be GST-free will be the subject of consultation following the election.

The construction and sale of new homes will be subject to the G
ST in the normal manner even where the home is part of a retirement complex. The sale of an existing home will not be taxed. However, separate charges for health services received within a retirement village will be GST-free consistent with the overall treatment of health services.’

Residential care involves the provision of personal and/or nursing care and related services in a setting owned or managed by the organisation providing that care.

While Government policy has noted that consultation would be with regard to health services for the aged, the Committee notes that a number of facilities provide care to younger disabled persons as well as aged residents.

  • Even in facilities funded under the Aged Care Act 1997 (nursing homes and hostels) a small percentage (around 10 per cent) of residents are younger persons with a disability.

In line with its Terms of Reference to ensure the resulting compliance and administration costs of its recommendations are kept to a minimum, the Committee considered that facilities should not have to bear additional administrative burdens to distinguish between aged and other residents.

The Committee thought that, given the broad nature of residential care, it would be appropriate to link GST-free treatment of goods and services to existing definitions in the Quality of Care Principles (subordinate legislation to the Aged Care Act 1997). It would also be useful if GST-free status was linked to goods and services provided at an institution or project funded under the Aged Care Act 1997, or the Disability Services Act 1986 or complementary State or Territory legislation.

The Committee also considered that private sector facilities not receiving funding through the Commonwealth, State or Territory governments, should, to the extent possible, be provided the same treatment as equivalent public funded services. To ensure that the service provided is equivalent to that provided by publicly funded institutions, the Committee recommends an assessment process be implemented. The assessment arrangements can be finalised by the Minister for Health and Aged Care.

Finally, the Committee recommends that some flexibility be provided, in particular circumstances, for new residential care programs funded under the Commonwealth, State or Territory budgets. These arrangements should also be subject to the approval of the Minister for Health and Aged Care.

The treatment of retirement villages and independent living dwellings was the subject of written submissions to the Committee. It was argued that recognition should be given, through GST-free status, to a wide range of arrangements linking housing and care to older people. The Committee noted that the Government has already determined that retirement villages will be subject to the GST in the same manner as other forms of long term accommodation.

Community care

Tax Reform: not a new tax, a new tax system stated that:

‘Nursing home services provided to the elderly in their own home, including Home and Community Care (HACC) services, will be treated in the same manner as if the person had been resident in a nursing home.’

Community care involves the provision of personal and/or nursing care and related services to an aged and/or disabled person, residing at home. Services can be funded under a number of government programs, of which programs funded under the Home and Community Care Act 1985 are the most well known, or purchased directly through the private market.

As in residential care, the Government stated that consultation would determine the precise scope of services for the aged that will be GST-free. This has proved difficult for the Committee, as a number of younger persons with disabilities receive the same community care service from the same provider as aged persons. For example, in the HACC program around 25 per cent of the estimated 220,000 clients are aged under 70.

To limit GST-free treatment to community care services provided to the aged would be difficult for the service provider to administer and would run counter to other policy benefits achieved from meeting the service needs of all clients in their own home rather than an institutional setting.

The Committee considered that, to give effect to the Government’s policy intent, HACC services and similar services funded under the Aged Care Act 1997 should be GST-free. To provide consistency of treatment, it further considered that HACC type services funded from either Commonwealth, or State or Territory budgets should be GST-free if approved by the Minister for Health and Aged Care.

The Committee also considered that privately provided community care services should, to the extent possible, be provided the same treatment as equivalent public funded services. This would be consistent with minimising any discrimination between private and public provision of goods and services in the GST-free areas.

However, it was not possible to provide full equivalent treatment between community care services delivered through government programs and those purchased privately. The difficulty arises because privately provided services are used by the general public as well as the aged and people with disabilities. These include household help services such as cleaning and ironing that should not be GST-free when provided to the general public.

To provide equivalent treatment would have required the establishment of an assessment mechanism to ensure that only those people needing household help because of age or disability could purchase them GST-free. This was considered to be difficult to administer and adding significantly to the cost of providing community care.

In light of this, the Committee considered that it would be appropriate to limit GST-free treatment for community care purchased in the private market to daily living activities assistance services as defined under the Quality of Care Principles. The Principles are determined by the Minister for Health and Aged Care under the Aged Care Act 1997, and define the responsibilities of providers for the quality of care provided. Daily living assistance services include assistance with bathing, showering, personal hygiene and grooming.

  • These services are used by those requiring a reasonably high level of care and would not normally be purchased by the wider community.

A number of submissions have noted the importance of community (home) care services for the aged and people with disabilities. In particular, it was recognised that these services are important to allowing people to remain in the community as long as possible. The Committee accepts this and has supported GST-free treatment for a broad range of community care services in its recommendations.

Disability Services

In addition to residential and community care services dealt with above, there are a number of other services provided to people with disabilities that the Committee looked at. These services include:

  • advocacy services;
  • information services;
  • print disability services;
  • competitive employment training and placement services; and
  • supported employment services.

These services are a special case as Tax Reform: not a new tax, a new tax system does not specifically mention them, but they were brought to the attention of the Committee and raised in submissions. Goods for people with disabilities are considered below as part of medical aids and appliances.

The Committee thought that the practical difficulties in separating the aged and people with disabilities in the delivery of residential care and community care require that these services be GST-free to the disabled. However, the Committee thought that providing GST-free treatment to these additional services, went beyond the Government’s policy intent.

I
n particular, having regard to the design principles of the GST, the Committee considered that sales from supported employment services such as sheltered workshops should be subject to GST. However the Committee did want to emphasise:

  • that sales provided on a non-commercial basis by income tax deductible charities would, of course be GST-free. The discussion of the non-commercial activities of charities is at Chapter 7; and
  • that it was particularly concerned about the impact of tax reform on sheltered workshop services, and noted that the impact should be monitored and that Governments should give careful consideration to providing additional assistance if necessary.

The issue of supported employment services was raised in submissions in the context of what constituted non-commercial activities by charities.

The Committee also noted that the definition of medical aids and appliances did not allow for the service fees which many people with a disability accrue as a result of using medical aids and appliances such as electronic wheelchairs. The Committee noted the difficulty in distinguishing these services from similar services provided to the wider community. For this reason the Committee decided against providing GST-free treatment to these services. However, the Committee was concerned about the impact of tax reform on these services, and noted that the Government may wish to give consideration to providing additional assistance to individuals who incur these costs.

Medical appliances and aids

Tax Reform: not a new tax, a new tax system stated that:

‘The supply of medical appliances for use by people with severe medical conditions or disabilities (examples include: wheelchairs, crutches, artificial limbs and modifications to motor vehicles for the disabled) will be GST-free.

The precise scope of items to be made GST-free, is a matter on which the Government will take a final decision following advice from the Tax Consultative Committee.’

There are many medical appliances and aids that are used by people with disabilities in the community. Generally, most of these items are only of benefit to people with specific disabilities and needs. However, there are many products that may be of benefit to both people with disabilities, as well as having uses in the wider community.

In considering the precise scope of qualifying medical appliances the Committee was mindful of its Terms of Reference requiring it to:

  • ensure the resulting compliance and administration costs of its recommendations are kept to a minimum; and
  • ensure its recommendations do not have significant adverse revenue impacts.

As noted above, the Government stated in Tax Reform: not a new tax, a new tax system that qualifying medical appliances and aids would only be made GST-free where they are for use by people suffering from severe medical conditions or disabilities. The Committee felt that it was too difficult in practice to define the terms ‘severe medical condition or disability’. As an alternative, the Committee felt that the list of qualifying goods should be confined to those goods designed specifically for use by people with an illness or disability which are of a kind not ordinarily used in the wider community.

In considering its position, the Committee thought that there were two options for effectively delivering a GST-free approach:

  • defining a list of appliances that would be GST-free; or
  • defining a list of appliances, but making them taxable in the usual manner, and providing a rebate or credit to people with disabilities.

The rebate approach

The rebate approach has significant benefits in terms of simplicity, clarity and limiting adverse revenue impacts. The rebate approach has compliance benefits for business. The business does not have to distinguish special concessional goods from other goods sold by the business. The benefits of the rebate approach increases as the list of qualifying goods increases.

However, the Committee was not attracted to the targeting of effective GST-free status to particular consumers (as under the rebate scheme), because it would require a mechanism for identifying eligible purchasers and paying rebates. It would also add to the burden on people with disabilities who would be required to keep receipts.

The GST-free list approach

The other option that the Committee considered was to allow consumers to purchase qualifying appliances GST-free.

The Committee favoured this approach as it would remove administrative problems in providing the rebate and would be significantly less burdensome on the disabled.

In specifying the list of aids and appliances to be given GST-free treatment, the committee has considered various submissions from industry and members of the public. The Committee agreed with the suggestions of some submissions to include corrective lenses (including contact lenses), and sleep apnoea machines on the list of GST-free appliances.

The Committee notes that some items that should be included on the list, as they fit the principle outlined above, may have been unintentionally excluded due to time restrictions. The Committee suggests that further refinement of the list may be necessary prior to the development of legislation.

Drugs and medicines

Tax Reform: not a new tax, a new tax system stated that:

‘Drugs and medicines that can only be provided on prescription and PBS and RPBS medicines provided on prescription will be GST-free. The Government will take a final decision on the precise scope of qualifying drugs and medicines following advice from the Tax Consultative Committee.’

Within the boundary of what is ordinarily regarded as drugs and medicines, there are often competing objectives to be traded off to achieve a satisfactory outcome. However, the issue of whether certain drugs and medicines possess meritorious qualities, was not one that was used as the basis for the Committee’s decision. This would have required a consideration of the overall policy objective of making drugs and medicines GST-free.

Instead, the Committee has considered the following competing objectives as the basis for this boundary drawing exercise:

  • simplicity in administration and compliance;
  • clear and definitive boundaries; and
  • limits to concessional treatment for revenue protection.

Over the counter (OTC) non-prescription drugs

The most crucial issue for the Committee was to determine the treatment of over the counter (OTC) non-prescription drugs and medicines.

As laws currently stand, prescription drugs can only be sold through pharmacies. Most drugs that are scheduled on the PBS and RPBS are prescription only drugs. However, there are some OTC drugs that appear on the PBS and RPBS schedules. (for example, a commonly used pain reliever is an OTC product that also appears on the PBS and RPBS schedules). For the reasons outlined below, the Committee is of the view that if GST-free treatment were to be extended generally to OTC drugs, this would add complexity by imposing a burden on general retailers, requiring them to separately account for sales of these products.

These same issues were considered by the Committee in determining GST-free treatment for medical appliances and aids. On that occasion, the Committee considered that the small number of retailers and small number of qualifying goods, would make the compliance burden for business manageable. However, in the case of OTC drugs, the large number of potential retailers and goods would make the compliance burdens much more significant.

However, the Committee was attracted to proposals provided in submissions to extend GST-free treatment to products on Schedule 3 (S3) of Standard for the uniform scheduling of drug
s and poisons. S3 products must be sold within a pharmacy and sold under the supervision of a pharmacist. This would reduce the need for a prescription for certain over the counter products, such as metered aerosols used by asthmatics, but would not complicate the running of business for general retailers. Pharmacists will already be selling a mixture of taxable and GST-free products. The Committee also received advice from Commonwealth Government officers that the revenue impact of this extension would not be significant.

Therefore, the Committee believes that GST-free treatment should be limited to:

  • products that can only be supplied on prescription (S4 and S8 of the Standard for the uniform scheduling of drugs and poisons);
  • products that can only be sold within a pharmacy and under the advice of a pharmacist (S3 of the Standard for the uniform scheduling of drugs and poisons); or
  • PBS or RPBS products supplied on prescription.

The Committee received a number of submissions seeking GST-free treatment for other over the counter drugs and natural remedies. Submissions also suggested the use of the Australian Regulatory and Therapeutic Goods (ARTG) schedule as the basis for regulating the types of drugs that would qualify for GST-free treatment. However, the Committee felt that such proposals had significant adverse revenue implications and would not be simple to administer and could significantly add to compliance burdens on business.

Recommendations

Medical (health) services

The Committee recommends that the following medical (health) services be GST-free:

  • Clinically relevant health services provided by a registered medical practitioner (as defined in section 3 of the Health Insurance Act 1973).
  • Including those services provided on behalf of a medical practitioner such as nurses, audiologists, radiographers as outlined in paragraph 12.2 of the Medicare Benefits Schedule and section 3AA of the Health Insurance Act 1973).
  • Excluding certain medical procedures (primarily cosmetic surgery such as tattoo removal) specified in paragraphs 13.2.4 and 13.1.2 of the Medicare Benefits Schedule.
  • Commonly used health services as listed in Tax Reform: not a new tax, a new tax system together with the additional services below:
  • osteopathy;
  • chiropody;
  • speech pathology;
  • audiology, audiometry;
  • ambulance;
  • paramedical;
  • nursing;
  • aboriginal health services;
  • social work services;
  • pharmacy; and
  • psychology.
  • Listed services must be clinically relevant and be of the type normally supplied in that profession. The practitioner must also be a member of a relevant professional body subject to State government professional registration or uniform national professional self-regulation.
  • Services, such as coordination services, funded through Commonwealth and State Government programs that are integral to the delivery of qualifying health services for patients.
  • Such services should be GST-free where they are approved by the Minister for Health and Aged Care as essential for patient welfare.
  • Ambulance subscription fees should also be GST-free.
  • GST-free treatment should also extend to goods provided as part of the service and administered on the premises where the service is performed.

Hospital services

The Committee recommends that the following hospital services provided for the purpose of providing health services to a patient should be GST-free:

  • Public hospital services as defined in the Australian Health Care Agreements 1998-2003 (and subsequent agreements) between the Commonwealth and States; or replacement agreements, except for those services defined under paragraphs 13.2.4 and 13.1.2 of the Medicare Benefits Schedule;
  • Hospital treatment as defined in section 67 of the National Health Act 1953 delivered to private patients (whether covered by private health insurance or self-insured) by a private hospital (as defined in subsection 3(1) of the Health Insurance Act 1973) or by day hospital facility (as defined in subsection 4(1) of the National Health Act 1953) except for those services defined under paragraphs 13.2.4 and 13.1.2 of the Medicare Benefits Schedule; and
  • GST-free treatment should also extend to goods provided as part of the service and administered on the premises where the service is performed.

Residential care

The Committee recommends that the following be GST-free:

  • The supply of goods and services listed in the Quality of Care Principles (subordinate legislation to the Aged Care Act 1997) and provided by ‘qualifying institutions and projects’.
  • Goods and services listed under the Quality of Care Principles are broad ranging and include accommodation and maintenance of buildings and grounds, personal care services, treatments and procedures, recreational therapy, a limited range of furnishings, and bedding. These services do not include additional items such as television hire and hair dressing.

Qualifying institutions and projects are those:

  • Funded under the Aged Care Act 1997.
  • Funded under the Disabilities Services Act 1986 or complementary State or Territory legislation.
  • Funded privately, but assessed by the Commonwealth as providing services similar in nature and objective to Aged Care Act 1997.
  • Decisions on assessment arrangements, and whether cost recovery should be part of any Commonwealth assessment, is to be decided by the Minister for Health and Aged Care.
  • Funded under annual appropriations through the Health and Aged Care and Family and Community Services portfolios or equivalents in the States and Territories, and approved by the Minister for Health and Aged Care, as providing services similar in nature and objectives to facilities funded under the Aged Care Act 1997.

Community care

The Committee recommends that the following community care services be provided GST-free:

  • services funded under the Home and Community Care (HACC) program;
  • services provided to a person residing at home under the Aged Care Act 1997;
  • services provided to a person residing at home and funded under the Health and Aged Care or Family and Community Services portfolio and approved by the Minister for Health and Aged Care as being similar in nature and objectives to HACC services;
  • services provided to a person residing at home and funded through State and Territory budgets and approved by the Minister for Health and Aged Care as being similar in nature and objectives to HACC services; and
  • daily living activities assistance services purchased from the private market, as set out at item 2.1 of Schedule 1 of the Quality of Care Principles and provided in the person’s own accommodation.

Disability services

The Committee recommends that:

  • the Government not extend GST-free treatment for disabled services beyond its recommendations regarding residential care and community care.

Medical appliances and aids

The committee recommends that the following appliances and aids should be given GST-free treatment where:

  • they are specifically designed for people with an illness or disability; and
  • are not of a kind ordinarily used in the wider community.

Cardiovascular

heart monitors

pacemakers

surgical stockings

Communication aid & for persons with disabilities

communication boards and voice output devices

communication cards

page turners

eye pointing frames

software programs specially designed for persons with disabilit
ies

printers and scanners specially designed for software and hardware used by persons with disabilities

switches and switch interfaces

mouth/head sticks/pointers

alternative keyboards

electrolarynx replacements

speech amplification/clarification aids

Continence

Urine/faecal drainage/collection devices

waterproof covers or mattress protectors

absorbent pads for beds and chairs

disposable/reusable continence pads pants and nappies required for continence use (excluding nappies for babies, sanitary pads or tampons)

enuresis alarms

incontinence appliances

hospital/medical/continence deodorising products

waterproof protection for bed and chairs

sterile plastic bags

electric bag emptier

enemas, suppositories and applicators

urinals and bedpans

penile clamps

Daily living for persons with disabilities

customised eating equipment for persons with disabilities

customised toothbrushes for persons with disabilities

dentures and artificial teeth

environmental control units designed for the consumer’s disability

computer modifications required for people with physical disabilities

‘medical alert’ devices

Diabetes

finger prickers

test strips

syringes and needles

glucose monitors

Dialysis

home dialysis machines

Enteral nutrition

enteral nutrition and associated delivery equipment

Footwear for persons with disabilities

surgical shoes, boots, braces and irons

orthotics

Hearing/speech

hearing aids

visual display units designed for persons with hearing and/or speech impairment to communicate with others

telephone communication devices designed to allow hearing impaired persons to send and receive messages by telephone

batteries designed specifically for use with hearing aids

visual/tactile alerting devices

interactive and broadcast videotext systems

closed caption decoding devices

external processors for cochlear implants

Home modifications for persons with disabilities

bidet/bidet toilet attachment

special door fittings relating to the consumer's disability

Mobility of persons with disabilities

Motor vehicle

special purpose car seat

car seat harness specifically designed for persons with disabilities

wheelchair and occupant restraint

wheelchair ramp

electric/hydraulic wheelchair lifting device

motor vehicles for TPI pensioners

motor vehicle modifications

Physical

Bedding for persons with disabilities

manually operated adjusted beds

electronically operated adjusted beds

hospital-type beds

customised bed rails

bed cradle

bed restraints

bed poles and sticks

pressure management mattress and overlays

backrests, leg rest and footboards for bed use

Orthoses

spinal orthosis

lower limb orthosis

upper limb orthosis

pressure management garment

callipers

corsets (surgical)

handsplints and cervical collars

mandibular advancement splints

Positioning aids

alternative positional seating corner chairs

alternative positional seating abduction cushion or long leg wedges

alternative positional seating modifications

standing frames

standing frames or tilt table modifications

side lying boards

night-time positioning equipment modifications

Prostheses

artificial limbs

mammary

Seating aids

postural support seating tray

electrically operated therapeutic lounge/recliner chairs specifically designed for disabled persons

cushions specially designed for the benefit of disabled persons

Transfer aids

manual, electric, ceiling track or pool hoist specifically designed for

persons with disabilities

hoist sling

gooseneck

transfer board

transfer sheet, mat or belt

stairlifts

portable stair climbers

monkey ring for people with disabilities

Walking aids

crutches

specialised walking stick

standard adult walking frame

standard child walking frame

specialised walking frame

walking frame modifications

specialised ambulatory orthosis

specialised ambulatory orthosis modifications

quadrupod and tripod walking aids

Wheelchairs and accessories

wheelchairs, motorised wheelchairs, scooters, tricycles, spinal carriages and other goods for the carriage of disabled persons

accessories associated with wheelchairs, motorised wheelchairs, scooters, tricycles, spinal carriages and other goods for the carriage of disabled persons

battery chargers for wheelchairs

stair-aid apparatus designed for carrying disabled people in wheelchairs up or down stairs

Pain management systems

syringe driver

patient control analgesia

Personal hygiene for persons with disabilities

bathboard or toilet seats

bath supports

shower chair or stools

shower supports

shower trollies

commodes

shower chairs

commode cushions

commode pans

toilet frames

toilet supports

self-help poles

mobile shower chairs

Respiratory appliances

continuous positive airway pressure (CPAP) appliances

respiratory appliance mask assembly complete

respiratory appliance mask assembly components

respiratory appliance accessories

products for those with breathing difficulties including:

peak flow meters

nebulisers

spacers

vaporisers

respirators

air pumps

bottled oxygen and associated hardware

oxygen concentrators

breathing monitors

continuous Positive Airways Pressure devices

ventilators

sleep apnoea machines

Safety helmet specially designed for persons with disabilities

Skin

jobst suits

transcutaneous nerve stimulator machines

Stoma

stoma products including all bags and related equipment for patients with colostomies and ileostomies

Vision

tactile/Braille books/magazines/newspapers

electronic readings aids

talking book machines (and parts) specially designed for the vision impaired

enlarged text computer monitors for vision impaired persons

Braille note takers

Braille printers and paper

Braille translators (hardware and software)

money identification equipment

auditory/tactile alerting devices

sonar canes

reading magnification devices (excluding magnifying glasses)

lenses for prescription spectacles

prescription contact lenses

artificial eyes

ultrasonic sensing devices designed for use by vision impaired persons

viewscan apparatus designed for use by vision impaired persons

Drugs and Medicines

The committee recommends that the following drugs and medicines should be GST-free:

  • drugs and medicines that can only be provided on prescription (S4 and
    S8 items on the Standard for the uniform scheduling of drugs and poisons);
  • drugs and medicines that can only be sold within a pharmacy under the advice of a pharmacist (S3 on the Standard for the uniform scheduling of drugs and poisons); and
  • PBS and RPBS products provided on prescription.