Download regulation 9 applications

REGULATION 9 APPLICATIONS
FOR
REPLACEMENT OF DENTAL APPLIANCES
TERMS OF REFERENCE
Regulation 9 applications are submitted on the patient’s behalf by their dentist. The
purpose is to seek a decision from the Health Board’s Primary Care Division (PCD) on
whether the patient is eligible for free replacement of appliances which are required
as a result of an act or omission on the part of the patient. The reasons for the
replacement should be because the appliance has broken beyond repair, lost or illfitting due to neglect on behalf of the patient, eg not worn or lost and found but no
longer fits.
The appliances covered by Regulation 9 are Dentures, Bridges, Splints and
Orthodontic.
REGULATION 9 APPLICATION FORM
Regulation 9 application forms are available from the Stationery Department,
Primary Care, Law House, Airdrie Road, Carluke, ML8 5ER (copy attached).
Please note that, when completing the forms in respect of orthodontic appliances,
the Practitioner should only claim the replacement fee under item 32(e) in the
Statement of Dental Remuneration, and not the full appliance fee. Failure to furnish
the correct fee could result in payment of the GP17/GP17(O) being rejected by
Practitioner Services – Dental, Edinburgh.
Duly completed forms should be returned to Primary Care Services, Kirklands
Hospital, for the attention of the Administration Team Leader. The practice should
retain the form GP17/GP17(O) pending receipt of the PCD’s decision and should not
submit it along with the Regulation 9 application.
Attached is a copy of an information sheet compiled by Practitioner Services –
Dental, Edinburgh, which provides further guidance on their requirements for prior
approval and contains a check list for completing a GP17/GP17(O) under Regulation
9.
ACTION BY HEALTH BOARD
On receipt of the Regulation 9 application, the first procedure for the Administration
Team Leader is to check that the form has been correctly completed and signed by
both the dentist and patient (parent/guardian in respect of children aged 16 and
under).
REGULATION 9 APPLICATIONS
FOR
REPLACEMENT OF DENTAL APPLIANCES
The next step is to ensure the reason why a replacement is necessary has been
completed, otherwise the form will be returned to the patient or parent/guardian.
For appliances lost whilst in care, eg hospital, it would greatly facilitate the decision
of the dates of admission and the ward, if known, could be supplied, as the PCD will
write to the relevant Hospital to obtain their views and ask if they will assume
responsibility.
The Administration Team Leader then reviews all the information available
concerning each application and a decision is made on how much the patient is
required to pay, taking factors into account such as receipt of benefit(s), following a
protocol developed in consultation with the Area Dental Committee GP SubCommittee. The application is then authorised and a letter sent to both the patient
and the dentist to inform them of the Board’s decision. The patient’s letter informs
them that if they feel that the amount they should pay would result in financial
hardship, they may appeal against the Board’s decision and in doing so submit a
note of their weekly income and major items of expenditure.
All Regulation 9 applications and any appeals received are reported to the Area
Dental Committee GP Sub-Committee as an Appendix to the Dental GPA Report
issued at the end of every quarterly period.
REGULATION 9 APPLICATIONS
FOR
REPLACEMENT OF DENTAL APPLIANCES
REGULATIONS
The Regulations covering applications for replacement of dental appliances are
contained within the National Health Services (Dental Charges) (Scotland)
Regulations 2003, as amended, which state inter alia:
9.—(1) Where a dental practitioner providing general dental services or providing
services under a pilot scheme replaces a dental appliance supplied as part of those
services and it is determined in accordance with Schedule 3 that the replacement is
necessitated by –
(a) an act or omission on the part of the person supplied; or
(b) if the act or omission occurred when the person supplied was under 16
years of age, an act or omission of the person supplied or of the person
having charge of the person supplied when the act or omission occurred,
the dental practitioner 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), the Statement remuneration for the supply of
the dental appliance.
(3) If the Health Board considers–
(a) that payment of the full amount of the charge under paragraph (1)
would involve undue hardship to the relevant person; or
(b) that the replacement, though necessitated by the relevant person’s act
or omission, was not wholly necessitated by lack of reasonable care on
the part of the relevant person,
it may determine that the charge shall not be payable, or that its amount
shall be reduced.
(4) In this regulation, “relevant person” means–
(a)
where paragraph (1)(b) applies, the person having charge of the
person supplied when the act or omission occurred;
(b)
in any other case, the person supplied.