10 March 2026
Alisha Riley
[FYI request #33762 email]
Tēnā koe Alisha
Your request for official information, reference: HNZ00200952
Thank you for your email on 18/02/2026, asking Health New Zealand | Te Whatu Ora (Health NZ)
for the following under the Official Information Act 1982 (the OIA):
This request seeks information currently held by Health New Zealand, including information
inherited from the former District Health Boards (DHBs) and the former Ministry of Health
operational units.
Where the specific data requested resides in legacy systems (such as regional instances of
Titanium software previously managed by individual DHBs), please consider this a request
for data from those source systems
1. Historical Coding Capabilities:
Prior to 2022, what specific clinical code (if any) was mandatory for Community Oral Health
Service (COHS) therapists and private dentists to record a diagnosis of 'Dental Fluorosis' in
patient records that would be centrally reported to the Ministry of Health?
2. SNOMED CT Implementation:
On what date was SNOMED CT (specifically code 51225000) fully integrated into the
'Titanium' software used by the Community Oral Health Service as a mandatory field for
recording enamel defects?
3. Dataset Existence:
Does Health NZ hold any centralised dataset containing diagnostic rates of dental fluorosis
(by severity) derived from routine clinical encounters (not ad-hoc surveys) for the years
2010–2024? If yes, please provide the total count of fluorosis diagnoses recorded per
year."
4. Private Dentist Reporting:
Is there currently any requirement for private dentists to report diagnostic codes (such as
SNOMED CT 51225000) to Health NZ, or is reporting limited to claiming subsidies for
treatment provided?
Response
1. Historical Coding Capabilities:
Prior to 2022, what specific clinical code (if any) was mandatory for Community Oral Health
Service (COHS) therapists and private dentists to record a diagnosis of 'Dental Fluorosis' in
patient records that would be centrally reported to the Ministry of Health?
2. SNOMED CT Implementation:
On what date was SNOMED CT (specifically code 51225000) fully integrated into the
'Titanium' software used by the Community Oral Health Service as a mandatory field for
recording enamel defects?
A response is provided in
Appendix one attached below
.
Dataset Existence:
Does Health NZ hold any centralised dataset containing diagnostic rates of dental fluorosis
(by severity) derived from routine clinical encounters (not ad-hoc surveys) for the years
2010–2024? If yes, please provide the total count of fluorosis diagnoses recorded per
year."
Health NZ does not hold any centralised dataset containing diagnostic rates of dental fluorosis. We
are therefore refusing a response to this item under section 18(e) of the OIA as the information
does not exist.
3. Private Dentist Reporting:
Is there currently any requirement for private dentists to report diagnostic codes (such as
SNOMED CT 51225000) to Health NZ, or is reporting limited to claiming subsidies for
treatment provided?
There is no requirement for private dentists to report diagnostic codes to Health NZ. Sections D1
and E10 of the Combined Dental Agreement outline the required reporting to be submit ed to
Health NZ through the enrolment and claim forms.
The agreement is provided as
Appendix two for your information.
How to get in touch
If you have any questions, you can contact us at
[email address].
If you are not happy with this response, you have the right to make a complaint to the
Ombudsman. Information about how to do this is available at
www.ombudsman.parliament.nz or
by phoning 0800 802 602.
As this information may be of interest to other members of the public, Health NZ may proactively
release a copy of this response on our website. Al requester data, including your name and
contact details, wil be removed prior to release.
Nāku iti noa, nā
Daniel e Coe
Manager (OIAs) – Government Services
Health New Zealand | Te Whatu Ora
Appendix One: Response to items 1 and 2.2
Item 1 - Historical Coding Capabilities: Prior to 2022, what specific clinical code (if any) was mandatory for
Community Oral Health Service (COHS) therapists and private dentists to record a diagnosis of 'Dental
Fluorosis' in patient records that would be centrally reported to the Ministry of Health?
Item 2 - 2. SNOMED CT Implementation: On what date was SNOMED CT (specifically code 51225000) fully
integrated into the 'Titanium' software used by the Community Oral Health Service as a mandatory field for
recording enamel defects?
Region
Item 1 Response
Item 2 - 2 Response
Central
Capital Coast and Hutt Val ey: No specific
Over Central Region’s five districts,
code was mandatory prior to 2022.
SNOMED CT (specifical y code 51225000)
Hawkes Bay: No clinical code was mandatory
has not been integrated into the 'Titanium'
for Community Oral Health Service (COHS)
software used by the Community Oral Health
therapists in Hawke’s Bay DHB prior to 2022,
Service as a mandatory field for recording
Mid Central: There has never been a
enam
el defects.
requirement for recording “Dental Fluorosis” for
CAOHS or private dentists under the CDA
(Current Dental Agreement)
Wairarapa: The Community Oral Health
Service is not required to report on or code
dental fluorosis, either currently or prior to 2022
.
Whanganui: No specific code is used to record
a diagnosis of Dental Fluorosis. However, the
district uses a dif erent set of codes to classify
various conditions that affect enamel structure,
examples of which follow:
Northern:
Auckland Regional Dental Service (ARDS),
ARDS does not use SNOMED CT for
the Auckland metro region children’s COHS
recording enamel defects in children, and it
(Community Oral Health Service, does not
has not been mandatory
record “dental fluorosis" on a patient's record to
report "dental fluorosis" to the Ministry of
Health. This has not been mandatory. There is
no ARDS Titanium odontogram charting code to
represent 'dental fluorosis'
Te Tai Tokerau (Northland): No such code
SNOMED CT has not been integrated into
existed in Titanium. No mandatory fluorosis
Titanium for mandatory enamel defect coding;
code was required or reported
.
therefore, no data exists.
Te Manawa Taki
Over the five districts there was no specific
Over the five districts SNOMED CT codes are
coding for Dental Fluorosis prior to 2022, nor is
not used by Community Oral Health Services.
any code being used now.
There is no requirement for code reporting for
outpatient services. We do not follow a
standardised coding system.
Te Waipounamu
Over the five districts there was no specific
Over the five districts SNOMED CT codes are
coding for Dental Fluorosis prior to 2022, nor is
not used by Community Oral Health Services.
any code being used now.
There is no requirement for code reporting for
outpatient services. We do not follow a
standardised coding system.
TeWhatuOra.govt.nz
Health NZ, PO Box 793,
Wellington 6140, New Zealand
«PROVIDER_NUMBER» / «CONTRACT_CONTRACTID»/«CONTRACT_VERSION»
Provider No. / Agreement No.
HNZ00200952 APPENDIX TWO
Agreement
between
District Address 1
District Address 2
District Address 3
Contact:
«CONTRACTDEPUTY_NAME»
and
«PROVIDER_NAME»
NZBN:
Combined Dental Agreement
1 November 2025
«PROVIDER_ADDRESS»
«PROVIDER_ADDRESS2»
«PROVIDER_CITY»
Contact:
«PRVDRCONTACT_NAME»
«PROVIDER_NAME»
«PROVIDER_NUMBER» / «CONTRACT_CONTRACTID»/«CONTRACT_VERSION»
CONTENTS OF THIS AGREEMENT
PART A: STANDARD TERMS AND CONDITIONS ............................................................................... 3 A1
Term of the Agreement ............................................................................................................. 3
A2
Agreement to Fund and Provide Services ................................................................................ 3
A3
Order of Priority ......................................................................................................................... 3
A4
Enforceability ............................................................................................................................. 3
A5
Treaty of Waitangi ..................................................................................................................... 3
A6
Relationship Principles .............................................................................................................. 4
A7
Māori Health Priority .................................................................................................................. 4
A8
Health Education ....................................................................................................................... 4
A9
Provision of Services ................................................................................................................. 4
A10
Payments .................................................................................................................................. 4
A11
Other Arrangements .................................................................................................................. 5
A12
Transferring Your Rights and Obligations ................................................................................. 5
A13
Transferring Our Rights............................................................................................................. 5
A14
Subcontracting .......................................................................................................................... 5
A15
Records ..................................................................................................................................... 6
A16
Financial Management .............................................................................................................. 6
A17
Audit .......................................................................................................................................... 6
A18
Quality of Services .................................................................................................................... 7
A19
Insurance .................................................................................................................................. 7
A20
Indemnity ................................................................................................................................... 7
A21
Notification of Problems ............................................................................................................ 7
A22
Public Statements and Advertising ........................................................................................... 7
A23
Dispute Resolution .................................................................................................................... 7
A24
Consumer Complaints ............................................................................................................... 8
A25
Our Liability ............................................................................................................................... 8
A26
Uncontrol able Events ............................................................................................................... 8
A27
Health Emergency Planning ..................................................................................................... 9
A28
Confidentiality ............................................................................................................................ 9
A29
No Action by Third Parties ........................................................................................................ 9
A30
Waiver and Rights ..................................................................................................................... 9
A31
Entire Agreement ....................................................................................................................10
A32
Notices ....................................................................................................................................10
A33
Relationship ............................................................................................................................10
A34
Ending the Agreement ............................................................................................................10
A35
Variations to this Agreement ...................................................................................................11
A36
Changes Fol owing a Ministerial Direction or Change in Law.................................................11
A37
Review of this Agreement .......................................................................................................12
A38
Annual Review ........................................................................................................................12
A39
Price Review ...........................................................................................................................12
A40
Execution ................................................................................................................................13
Part B: INTERPRETATION AND DEFINITIONS ..................................................................................14
Health New Zealand | Te Whatu Ora
CDA 1 November 2025
Page 1
«PROVIDER_NAME»
«PROVIDER_NUMBER» / «CONTRACT_CONTRACTID»/«CONTRACT_VERSION»
B1
Interpretation ...........................................................................................................................14
B2
Definitions ...............................................................................................................................14
PART C: PROVIDER QUALITY SPECIFICATIONS (PQS) ..................................................................18 C1
Provider Quality Specifications Apply to al Services. .............................................................18
C2
Quality Improvement and Requirements for Māori .................................................................18
C3
Risk Management ...................................................................................................................18
C4
Consumer Rights ....................................................................................................................18
C5
Entry to Service .......................................................................................................................18
C6
Service Provision ....................................................................................................................19
C7
Staff Management ...................................................................................................................19
C8
Facilities ..................................................................................................................................19
PART D: BUSINESS RULES ................................................................................................................20 D1
Reporting Information ..............................................................................................................20
D2
Payment ..................................................................................................................................20
D3
Referral to the Health and Disability Commissioner ...............................................................21
D4
Referral to an Appropriate Complaints Body ..........................................................................21
D5
Status of This Agreement during a Disciplinary or Competency Review ...............................22
D6
Termination of this Agreement as a result of Disciplinary Process ........................................22
D7
Pharmaceuticals ......................................................................................................................22
D8
Enrolment Registers ................................................................................................................23
D9
Adolescent Oral Health Coordination Services .......................................................................23
PART E: NATIONAL SERVICE SPECIFICATION FOR ORAL HEALTH SERVICES FOR
ADOLESCENTS AND SPECIAL DENTAL SERVICES FOR CHILDREN AND ADOLESCENTS ......24 E1
Introduction .............................................................................................................................24
E2
Māori Health ............................................................................................................................24
E3
Pacific Health ..........................................................................................................................24
E4
Eligibility ..................................................................................................................................24
E5
Service Components ...............................................................................................................25
E6
Access .....................................................................................................................................28
E7
Exclusions ...............................................................................................................................28
E8
Linkages ..................................................................................................................................28
E9.
Quality Requirements ..............................................................................................................29
E10
Information and Reporting Requirements ...............................................................................30
PART F: SERVICE PRICING FOR ORAL HEALTH SERVICES FOR ADOLESCENTS AND
SPECIAL DENTAL SERVICES FOR CHILDREN AND ADOLESCENTS ...........................................31 F1
Eligibility for and Pricing of Services .......................................................................................31
F2
Pricing for Standard Oral Health Services for Adolescents ....................................................31
F3
Schedule of prices for Oral Health Services for Adolescents Requiring High Caries
Treatment Planning .................................................................................................................34
F4
Pricing for Special Dental Services .........................................................................................35
PART G: SERVICE area covered under this agreement ...................................................................38 G1
Service Area ............................................................................................................................38
Health New Zealand | Te Whatu Ora
CDA 1 November 2025
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PART A: STANDARD TERMS AND CONDITIONS
A1
Term of the Agreement
A1.1
This Agreement wil commence on 1 November 2025 and end on 30 June 2026, unless ended
earlier by either of us in accordance with clause A34 of this Agreement.
A2
Agreement to Fund and Provide Services
A2.1
We agree to fund, and you agree to provide the Services, at no financial cost to the patient or
any other person, in accordance with the terms and conditions set out in this Agreement.
A2.2
Providers may choose to provide either:
a.
both Oral Health Services for Adolescents and Special Dental Services for Children and
Adolescents; or
b.
only Oral Health Services for Adolescents; or
c.
only Special Dental Services for Children and Adolescents.
A2.3
You may claim for the Services that you have performed, at the prices specified in Part F of
the Agreement, in accordance with the payment terms and the service specifications set out in
this Agreement.
A2.4
You wil meet the provider quality specifications set out in Part C and comply with the further
quality requirements in Part E and elsewhere in this Agreement when providing the Services
under this Agreement.
A2.5
You wil comply with the business rules set out in Part D when providing Services under this
Agreement.
A2.6
This Agreement excludes the provision of sedation services and other services that are not
within the scope of practice of a general Dentist, Dental Therapist, Dental Hygienist or Oral
Health Therapist.
A3
Order of Priority
A3.1
Where there is any conflict, the terms of Parts E and F of this Agreement shall take
precedence over the terms of Parts A to D inclusive of this Agreement.
A4
Enforceability
A4.1
If any provision in any part of this Agreement is lawful y held to be illegal, unenforceable or
invalid, the determination will not affect the remainder of this Agreement, which wil remain in
force. We agree to take such reasonable steps or make such reasonable modifications to the
provision as is necessary to ensure that it is legal, enforceable and valid.
A4.2
This clause A4 wil not affect any rights validly to terminate any parts of this Agreement as a
whole or in accordance with the terms of this Agreement or otherwise.
A5
Treaty of Waitangi
A5.1
The Treaty of Waitangi establishes the unique and special relationship between Iwi, Māori and
the Crown. As a Crown agent, Health New Zealand considers the Treaty of Waitangi
principles of partnership, proactive protection of Māori health interests, co-operation and
utmost good faith, to be implicit conditions of the nature in which the internal organisation of
Health New Zealand responds to Māori health issues.
A6
Relationship Principles
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A6.1
The fol owing values will guide us in all our dealings with each other under this Agreement:
a.
Integrity – we will act towards each other honestly and in good faith.
b.
Good communication – we will listen, talk and engage with each other openly and
promptly including clear and timely written communication.
c.
Enablement – we will seek to enable each other to meet our respective objectives and
commitments to achieve positive outcomes for communities and consumers of health
and disability services.
d.
Trust and co-operation – we wil work in a co-operative and constructive manner
recognising each other’s viewpoints and respecting each other’s differences.
e.
Accountability – we wil each recognise the accountabilities that each of us have to our
respective and mutual clients and stakeholders.
f.
Innovation – we will encourage new approaches and creative solutions to achieve
positive outcomes for communities and consumers of health and disability services.
g.
Quality Improvement – we will work co-operatively with each other to achieve quality
health and disability services with positive outcomes for consumers.
A6.2 Both of us agree to foster a long-term co-operative and collaborative relationship to enable
both of us to achieve our respective objectives efficiently and effectively.
A7
Māori Health Priority
A7.1 Both parties recognise and accept that the principles of the Treaty of Waitangi wil apply to this
Agreement in relation to Māori Health, as stated in clause A5 of these Standard Terms and
Conditions.
A7.2
You agree that Māori health is a specifically identified health gain priority area. You must take
into account our strategic direction for Māori health in terms of minimum requirements for
Māori health as communicated to you by us from time to time. These minimum requirements
are based on the Treaty of Waitangi, crown objectives for Māori health and specific
requirements negotiated with us from time to time.
A8
Health Education
A8.1
You wil incorporate within your Services, where appropriate, an emphasis on health education
and advice to al adolescents and children on the benefits of being smoke-free/auahi kore.
You wil provide any available resources that you have received from us, Manatū Hauora or
other organisations to adolescents and children at the time of consultation.
A9
Provision of Services
A9.1
You agree to provide the Services as set out in this Agreement and conduct your practice or
business in a prompt, efficient, professional and ethical manner.
A10
Payments
A10.1 We agree to pay you for providing Services at the prices specified in Part F of this Agreement
in accordance with clause D2 of this Agreement.
A10.2 If we overpay you for providing the Services, as soon as you become aware of such
overpayment you agree to immediately notify us in writing of that overpayment. You agree to
repay any overpayment to our Payment Agent within ten Working Days of:
a.
you notifying our Payment Agent under this clause A10.2; or
b.
our Payment Agent notifying you of any overpayment that we become aware of, unless
you can clearly demonstrate that it was not an overpayment.
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A10.3 If you do not repay the overpayment in accordance with this clause we may set off that
amount against any amount that we owe you, provided that we give you 20 Working Days
written notice of this.
A10.4 Where you owe us any amount under this Agreement, including where you are obliged to
indemnify us under clause A20, we may set-off that amount against any amount that we owe
you, provided that we give you 20 Working Days written notice of this.
A10.5 We will pay you default interest on any amount due to you under this Agreement and in
arrears for more than 3 days at the base interest rate of our bankers plus 2% per year
calculated from the due date for payment to the date of actual payment. You must first have
given us an invoice completed in the format required and we must have received it by the date
specified in clause D2.8.
A10.6 We may withhold any payment for Services while you are in breach of this Agreement.
A11
Other Arrangements
A11.1 You agree not to enter into any contract or arrangement that will prejudice your ability to meet
your obligations under this Agreement, but subject to this, you may provide services to others.
A12
Transferring Your Rights and Obligations
A12.1 You may not transfer any of your rights or obligations under this Agreement without our prior
written approval. We will not unreasonably withhold our approval where you demonstrate to
our satisfaction that the proposed transferee is financial y solvent, experienced, competent
and able to perform al your obligations under this Agreement.
A12.2 You must give us as much notice as possible if you wish to transfer your rights and/or
obligations under this Agreement to another party and provide any information that we request
relating to the proposed transfer.
A13
Transferring Our Rights
A13.1 We may transfer our rights under this Agreement by giving you notice of this.
A14
Subcontracting
A14.1 Subject to clauses A14.2, A14.3 and A14.4, you may, with our written consent, (not to be
unreasonably withheld), subcontract any of the Services covered by the Agreement, provided
that the subcontractor is able to perform the obligations under the subcontract, which shal be
not less than your obligations in respect of the relevant Services under this Agreement. “You
can only subcontract with a provider who has a current CDA contract.”
A14.2 Where you subcontract any Services under clause A14.1 above, you wil remain principally
liable in al respects for the subcontractor’s performance of the services, and compliance with,
your other obligations under the Agreement.
A14.3 Where you enter into a subcontract in terms on clause A14.1 above, you will ensure that the
subcontract:
a.
gives you the authority to provide us with any information or reports we may require you
to provide under the Agreement;
b.
gives us authority to have direct access to the premises and records of the
subcontractor for the purposes of auditing the subcontractor in accordance with this
Agreement.
c.
provides that the subcontractor must not further subcontract any subcontract it has
entered into with you pursuant to clause A14.1 above without our prior written consent;
and
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d.
provides for the exercise of our rights as set out in this Agreement and expressly
provides that those rights may be enforced by us pursuant to the Contracts (Privity) Act
1982.
A14.4 In addition we may specify at any time:
a.
service categories in respect of which we may require you to provide us with further
information, except for prices, about any subcontracts you have entered into in order to
provide those service categories; and
b.
the nature of the information we reasonably require about those subcontracts.
If we do this, you must provide us with that information about those subcontracts as soon as is
practicable and, in any event, not later than one month after we notify you that we require it.
A15
Records
A15.1 You agree to keep secure, legible, complete and accurate records of the Services you provide
under this Agreement for which you claim payment and make them available to us or our
auditors in accordance with our reasonable instructions. You agree that any information you
submit to us, or to be retained by you, pertaining to this Agreement will be able to be verified
by Audit.
A15.2 You agree to take al care to ensure that in the event of ceasing to provide the Services, your
records are properly preserved in accordance with the provisions of the Health (Retention of
Health Information) Regulations 1996, and that they are also accessible to us.
A15.3 You agree to immediately notify Health New Zealand if:
a.
you know of or suspect any unauthorised use, copying or disclosure of any Personal
Information.
b.
you receive any Personal Information from Health New Zealand that is not intended for
you and is not directly relevant to your claims or services delivered.
c.
to immediately destroy al copies of any Personal Information and provide evidence
satisfactory to Health New Zealand that it has done so, if you receive any Personal
Information from Health New Zealand that is not intended for you and directly relevant
to your claim or services delivered.
A16
Financial Management
A16.1 You agree to operate sound financial management systems and procedures.
A17
Audit
A17.1 You and your permitted sub-contractors must allow us and our authorised agents, access on
24 hours' notice to:
a.
your premises;
b.
your records;
c.
all premises where the records are kept; and
d.
staff, sub-contractors or other people used by you in providing the Services, and allow
us to interview any staff, sub-contractors and the people you supply Services to (and
their families) for the purposes of carrying out an audit of your performance and
compliance with this Agreement.
A17.2 Clauses D1.9 and D2.7 sets out further provisions relating to the Audit processes, and clauses
D4.1 and D7.3 set out further provisions relating to steps that may be taken as a result of an
Audit.
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A17.3 Where we reasonably suspect that fraudulent claiming has occurred, we may enter your
premises and conduct an Audit at any time without prior notice.
A17.4 Our right to Audit under this clause continues after this Agreement ends but only to the extent
that it is relevant to the period during which this Agreement exists.
A18
Quality of Services
A18.1 You must comply with the quality requirements set out in Part C of this Agreement when
providing the Services.
A19
Insurance
A19.1 You must affect and maintain such insurance as we reasonably require from time to time in
relation to your performance of this Agreement.
A20
Indemnity
A20.1 You must indemnify us against al claims, damages, penalties, losses and costs (whether
direct or indirect) which we incur as the result of your performance of the Services or your
failure to comply with your obligations in this Agreement.
A21
Notification of Problems
A21.1 You agree to advise us promptly, in writing, of anything which may, or is likely to, substantially
reduce or affect your ability to provide the Services, including anything relating to any
premises or equipment used by you or your key personnel, and anything which may have high
media or public interest.
A21.2 You agree to have in place realistic and reasonable risk management processes and
contingency plans to enable you to continue to provide the Services on the occurrence of any
of the matters or things covered by this clause A21 and you agree to provide us with full
details of those plans if we request them.
A22
Public Statements and Advertising
A22.1 Neither of us may, during or after this Agreement, either directly or indirectly criticise the other
publicly, without first ful y discussing the matters of concern with the other in good faith and in
a co-operative and constructive manner.
A22.2 You agree not to use our name or logo without our prior written consent and then only in
accordance with our instructions.
A23
Dispute Resolution
A23.1 Subject to clause A23.2 and A23.3 below, if either of us has any dispute with the other in
connection with this Agreement, then:
a.
both of us agree to use our best endeavours and act in good faith to settle the dispute
between us;
b.
if the dispute is not settled by agreement within 20 Working Days, then, unless both of
us agree otherwise, either of us may (by written notice to the other) require that the
dispute be submitted to mediation by a single mediator agreed by both of us, or if both
of us cannot agree on a mediator, a mediator nominated by LEADR, or if LEADR no
longer exists or is unable to nominate a mediator, the President for the time being of the
New Zealand Law Society. In the event of any such submission to mediation:
i.
full written particulars of the dispute must be promptly given to the other;
ii.
the mediation wil be conducted in accordance with the LEADR New Zealand
Incorporated Standard Mediation Agreement;
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i i.
the mediator wil not be deemed to be acting as an expert or an arbitrator;
iv.
the mediator wil determine the procedure and timetable for the mediation; and
v.
the cost of the mediation wil be shared equal y between both of us (unless
agreed otherwise);
c.
neither of us will initiate any court proceedings during the dispute resolution process
unless proceedings are necessary to preserve that party’s rights; and
d.
subject to clause A34.5, both of us agree to continue to comply with al our obligations
under this Agreement until the dispute is resolved, but payments may be withheld to the
extent that they are disputed.
A23.2 Clause A23.1 wil not apply to any dispute:
a.
as to whether or not any person is an Eligible Person;
b.
concerning any renegotiation or review of any part of this Agreement; or
c.
directly or indirectly arising from any matter which has been referred to a Complaints
Body unless the Complaints Body directs otherwise.
A23.3 If we determine that a dispute under clause A23.1 is of general or national application, then we
may choose to address that dispute with a Representative Body, in accordance with the same
procedure as is set out in clause A23.1.
A24
Consumer Complaints
A24.1 You must comply with any standards for the health sector relating to consumer complaints.
A24.2 In particular, you must implement a complaints procedure in accordance with the Code of
Consumers' Rights and comply with the requirements of the Code relating to complaints.
A25
Our Liability
A25.1 We are not liable to you for any claims, damages, penalties, losses or any other costs you
may incur in providing the Services.
A26
Uncontrollable Events
A26.1
The party affected by an Uncontrollable Event will not be in default under the terms of this
Agreement if the default is caused by that Uncontrol able Event. The party affected must:
a.
promptly give written notice to the other specifying:
i.
the cause and extent of that party’s inability to perform any of the person’s
obligations; and
ii.
the likely duration of the non-performance;
b.
in the meantime take al reasonable steps to remedy or reduce the impact of the
Uncontrol able Event.
A26.2 Neither of us is obliged to settle any strike, lock-out or other industrial disturbance.
A26.3 Performance of any obligation affected by an Uncontrollable Event must be resumed as soon
as is reasonably possible after the Uncontrollable Event ends or its impact is reduced.
A26.4 If you are unable to provide any Services as a result of an Uncontrol able Event we may make
alternative arrangements suitable to us for the supply of those Services during the period that
you are unable to supply them.
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A27
Health Emergency Planning
A27.1 You must develop a Health Emergency Plan that sets out how your clients/patients and staff
will be provided for during a Health Emergency and review the Health Emergency Plan
periodical y to maintain currency.
A27.2 The plan must identify your response to a worst case scenario pandemic event (40% of the
population affected with 2% death rate).
A27.3 A copy of the plan must be made available to Health New Zealand on request and must be
consistent with Health New Zealand’s pandemic and emergency plans (available from Health
New Zealand).
A27.4 When requested by Health New Zealand you wil be involved in processes to ensure that
emergency responses are integrated, coordinated and exercised. The level of participation
required will be reflective of the nature of the services you provide and the expected roles and
services in an emergency situation.
A28
Confidentiality
A28.1 Except to the extent that this Agreement otherwise provides, or we are required to disclose
information by Law including where we consider it necessary to disclose information under
the Official Information Act 1982 or otherwise under our public law obligations, neither of us
may disclose to any other person any information provided to the other which we agree is
confidential or which is either commercially sensitive or not intended for disclosure to third
parties (confidential information), unless and until the confidential information becomes public
knowledge other than through a breach of any obligation of confidence.
A28.2 When this Agreement ends you must return to us all of our confidential information in your
possession or control.
A28.3 Both of us acknowledge that this Agreement, but not any confidential information exchanged
pursuant to this Agreement, may be published by us through any media including
electronical y via the Internet.
A29
No Action by Third Parties
A29.1 This Agreement is not intended to confer legal y enforceable benefits on any person who is not
a party to it and no third party may enforce any of the provisions in this Agreement.
A30
Waiver and Rights
A30.1 Your Services must always be performed within the time frame specified in this Agreement.
Any waiver by us of this requirement or of any other right or remedy we may have under this
Agreement must be in writing and duly signed by us. Each waiver may only be relied on for
the specific purpose for which it is given. A failure or delay by either one of us to exercise any
right given to it under this Agreement does not mean that the right has been waived.
A30.2 The exercise by us of any express right set out in this Agreement does not limit any other
rights, powers or remedies available to us under this Agreement, at Law or in equity, including
any rights, powers or remedies which would be available to us if the express rights were not
set out in this Agreement.
A31
Entire Agreement
A31.1 This Agreement sets out the entire agreement and understanding between both of us and
replaces all prior oral or written statements, representations and agreements or arrangements
relating to its subject matter.
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A32
Notices
A32.1 Any notice given pursuant to this Agreement must be in writing and may be served personally
or sent by registered mail or electronic mail. All notices must state the contract reference
number given to this Agreement.
A32.2 Notices given:
a.
personal y are served upon delivery;
b.
by post (other than airmail) are served three days after posting;
c.
by airmail are served two days after posting; and
d.
by email are served upon receipt of the correct answer back.
A32.3 The address and contact number for each of us are as specified in this Agreement or as from
time to time notified in writing to the other party.
A33
Relationship
A33.1 Nothing in this Agreement should be interpreted as constituting either of us as an agent,
partner or employee of the other and neither we nor you may represent to anyone that:
a.
it is the other party or is an agent, partner, trustee, joint venture partner or employee of
the other party; or
b.
it has any power or authority to incur any obligation of any nature on behalf of the other
party.
A34
Ending the Agreement
A34.1 This Agreement may be ended at any time by either of us:
a.
upon three (3) months' notice in writing; unless both of us agree otherwise in writing or
b.
in the case of a provider of Services to one thousand (1,000) or more enrolled patients,
upon six (6) months' notice in writing, unless both of us agree otherwise in writing.
A34.2 Without limiting any other rights we may have, we may end this Agreement immediately by
written notice to you:
a.
if we have good reason to believe you are or wil be unable to carry out al your material
obligations under this Agreement. Before ending this Agreement for this reason we
must Consult with you and if we believe the health or safety of any person is at risk we
may suspend your provision of the Services while we Consult with you;
b.
if you have failed to carry out any of your obligations in this Agreement and the failure is
material and cannot be remedied;
c.
if you (or, if applicable, any one of you) are adjudged bankrupt;
d.
if you are a company and you are placed in receivership or liquidation;
e.
if you have failed to carry out any of your obligations in this Agreement and the failure
can be remedied by you but you fail to do so within 30 days of receiving written notice of
the default from us;
f.
if you have been convicted of any dishonesty offence relating to any claim for payment
from any party (not limited to Health New Zealand) for provision of any type of health
services whether claim pursuant to this Agreement or otherwise; or
g.
in accordance with clause D6.2
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A34.3 If after 30 days from your receiving our notice referred to in clause A34.2 the obligation still
has not been met, we may by written notice, instead of ending this Agreement:
a.
at any time vary or withdraw from the coverage of this Agreement any of the Services in
respect of which you have not met your obligation, either straight away or at any later
date; and
b.
cease payment for any of the Services from the date of their withdrawal.
A34.4 You have the same rights and must fol ow the same procedures if we have not met a material
obligation under this Agreement and as a consequence you wish to withdraw the relevant
Service.
A34.5 Either of us may terminate this Agreement where it is entitled to do so and in accordance with
the terms of this clause A34 despite the existence of a dispute under clause A23 above.
A35
Variations to this Agreement
A35.1 This Agreement may be varied at any time:
a.
by written agreement signed by both of us, whether as a result of a review process
conducted in accordance with the terms of this Agreement or otherwise; or
b.
pursuant to clause A36 below.
A35.2 Despite anything in clause A35.1, amounts payable to you under clause A10 may be
increased from time to time by written notice from us to you, fol owing a pricing review
conducted by us under clauses A38 and A39.1.
A35.3 Where prices have been varied in accordance with clause A35.2, we wil add a new pricing
schedule to Part F of this Agreement, following notification to you of the new prices.
A36
Changes Following a Ministerial Direction or Change in Law
A36.1 We may vary the terms of this Agreement to give effect, where applicable, to:
a.
any Ministerial direction or requirement given under section 32, section 33 or section
33B, respectively, of the Act, or under the Crown Entities Act 2004;
b.
to give effect to the requirements of section 10 of the Public Finance Act 1989; or
c.
any change in Law,
by giving you written notice as soon as practicable. Such written notice must also provide
details of the proposed amendments to the terms of this Agreement and the date that these
amendments (in the absence of any agreement on alternative amendments under clause
A36.3 below) are due to take effect.
A36.2 Where we intend to vary the terms of this Agreement under clause A36.1 above, we agree to
propose amendments that will have the least adverse impact, financial or otherwise, on you
while also giving effect to the relevant direction, obligation or change under clause A36.1
above.
A36.3 Following written notice of a variation to the terms of this Agreement under clause A36.1
above both of us wil then, in good faith, and subject to clause A36.1 above, seek to agree on
the proposed amendments.
A37
Review of this Agreement
A37.1 You may raise issues with us at any time to be considered both throughout the year and as
part of the annual review.
A38
Annual Review
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A38.1 We and your Representative Body shall have the right each year of the term of this Agreement
and prior to the 31 December each year to raise issues, relating to this Agreement that either
of us wish to address in accordance with the following review process:
A38.2 The party initiating the annual review may propose, in writing to the other, amendments to this
Agreement and the reasons for such amendments. The other must respond within 20
Working Days of receipt, to the proposed amendments or make an alternative proposal.
A38.3 We and your Representative Body must undertake the review in good faith to seek prompt
agreement on any proposed amendments or any alternative proposals. Once agreement is
reached on any proposed amendments or any alternative proposal, then this Agreement will
be varied to take account of any such agreed amendments in accordance with clause A35 of
this Agreement.
A38.4 If neither we nor the Representative Body are able to agree on any proposed amendments or
any alternative proposal, within one month of the party who initiated the review receiving the
other party’s response in terms of clause A38.2 above, then the matter will be referred to
mediation.
A38.5 If any disagreement regarding any proposed amendment or any alternative proposal is not
settled by mediation, within one month of the disagreement being referred to mediation in
terms of clause A34.4 above, then this Agreement wil continue in force un-amended.
A39
Price Review
A39.1 We agree to review, no later than 31 December each year, the prices contained in this
Agreement in accordance with the review process described in clause A38 above.
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A40
Execution
Executed as an Agreement:
Health New Zealand | Te Whatu Ora:
Authorised Signatory
(signature)
Name ..........................................................
Position .......................................................
Date ............................................................
«PROVIDER_NAME»:
Authorised Signatory
(signature)
Name ..........................................................
Position .......................................................
Date ............................................................
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PART B: INTERPRETATION AND DEFINITIONS
B1
Interpretation
B1.1
In this Agreement:
a.
“we”, “us” and “our” means Health New Zealand | Te Whatu Ora or any organisation or
organisations to which this Agreement is transferred from Health New Zealand and its
permitted consultants, subcontractors, agents, employees and assignees;
b.
“you” and “your” means the provider named in this Agreement including its permitted
subcontractors, agents, employees and assignees;
c.
“both of us”, “each of us”, “either of us” and “neither of us” refers to the parties;
d.
terms given a defined meaning in this Agreement have that meaning;
e.
where the context permits, words referring to the singular are to include the plural and
the reverse;
f.
any reference to any of the parties includes that party's executors, administrators or
permitted assigns, or if a company, its successors or permitted assigns or both;
g.
everything expressed or implied in this Agreement which involves more than one person
binds and benefits those people jointly and several y;
h.
clause headings are for reference purposes only;
i.
a reference to a statute includes:
i.
all regulations under that statute;
i .
all amendments to that statute; and
i i.
any statute substituting for it which incorporates any of its provisions;
j.
all periods of time or notice exclude the days on which they are given and include the
days on which they expire; and
k.
all references to “including” are to be read as “including without limitation”.
B2
Definitions
B2.1
In this Agreement the following terms have the stated meaning:
Term
Meaning
Act
Pae Ora (Healthy Futures) Act 2022.
Agreement
This agreement between both of us for the funding and provision
of the Services.
Approving Dental Officer (ADO)
A Dentist appointed to act on behalf of Health New Zealand to
approve treatments that are provided under this Agreement that
require Health New Zealand’s pre-approval.
Audit
Includes inspection, monitoring, audit, investigation, review and
evaluation of your performance and compliance with the terms of
this Agreement carried out in accordance with clause A17.
Calendar Year
The period from 1 January to 31 December of a particular year.
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Term
Meaning
Complaints Body
Any person or organisation appointed:
a.
by a Health Professional Authority; or
b.
by Law; or
c.
by us,
to deal with complaints or other issues relating to the funding or
provision of the Services and includes any advisory committee.
Completion
The completion, in respect of each patient, of the action plan of
Services required to be carried out for that patient following that
patient’s annual check-up.
Code of Consumers’ Rights
The Health and Disability Commissioner Code of Health and
Disability Services Consumers' Rights Regulations 1996, as
amended from time to time.
Consult
Each of us must:
a.
fully state our proposals and views to the other and
carefully consider each response to them;
b.
act in good faith and not predetermine any matter; and
c.
give the other adequate opportunity to consult any other
interested party.
The obligation of either of us to Consult will be discharged if the
other refuses or fails to Consult.
Dentist
A dentist registered with the Dental Council under the Health
Practitioners Competence Assurance Act 2003.
Dental Therapist
A dental therapist registered with the Dental Council under the
Health Practitioners Competence Assurance Act 2003.
Dental Hygienist
A dental hygienist registered with the Dental Council under the
Health Practitioners Competence Assurance Act 2003.
Director-General of Health
The chief executive of
Manatū Hauora
appointed under the State
Sector Act 1988 or the person acting as chief executive of
Manatū Hauora under that Act.
Eligible Person
A person who is eligible to receive services funded under the
Act, as specified by the Minister of Health in a direction issued
under section 32 of the Act (or in any equivalent direction issued
previously under the New Zealand Public Health and Disability
Act 2000 and continued by section 112(1) of the Act, so long as
such direction remains in effect).
Equity Index
The EQI is a statistical model that estimates the extent to which
students face socio-economic barriers to achievement at school.
The information that this model provides al ows the Ministry of
Education to better target equity funding.
Guidelines
The Quality Guidelines and the Operational Guidelines.
Link
Oral Health – Health New Zealand | Te Whatu Ora (search
Operational Guideline).
High Caries Treatment Planning The high caries treatment planning services as defined in clause
E5.2.
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Term
Meaning
Health Professional Authority
Any authority or body that is empowered by any statute or the
rules of anybody or organisation, to exercise disciplinary powers
in respect of any person who is involved in the supply of health
and disability services and includes the Health and Disability
Commissioner.
Health New Zealand
Health New Zealand, a Crown agent established under section 11
of the Pae Ora (Healthy Futures) Act 2022.
Te Whatu Ora
Law
Includes:
a.
any legislation, decree, judgement, order or by-law;
b.
any rule, protocol, code of ethics, practice or conduct and
other ethical or other standards, guidelines, requirements,
of any Health Professional Authority;
c.
any relevant standards of the New Zealand Standards
Association; and
d.
any future Law.
Manatū Hauora
Manatū Hauora
(by whatever name known) and any successor
department of state and includes the Minister of Health and
Ministry of Health
Director-General of Health and any of his, her or their delegates.
Non-Completion
The patient has failed to present, despite your best endeavours
in terms of clause F2 of this Agreement, for further treatment
scheduled in accordance with the action plan of Services
required to be carried out for that patient fol owing that patient’s
annual check-up.
Operational Guidelines
The guidelines, as amended from time to time, entitled:
“Operational Guidelines for the Provision of Oral Health Services
for Adolescents and Special Dental Services for Children and
Adolescents”
Link
Oral Health – Health New Zealand | Te Whatu Ora (search
Operational Guideline).
Oral Health Services – Tier One The Oral Health Services – Tier One Service Specification
Services Specification
published by the Health New Zealand website as part of the
nationwide service framework library, which is available at
Oral
Health – Health New Zealand | Te Whatu Ora as updated from time
to time.
Oral Health Services for
The oral health services described in clause E1.2(a).
Adolescents
Oral Health Therapist
An oral health therapist registered with the Dental Council under
the Health Practitioners Competence Assurance Act 2003.
Payment Agent
The payment and reporting agency, as designated by us from
time to time.
Pharmaceutical Schedule
The current Pharmaceutical Schedule as published by
PHARMAC from time to time, being a list of pharmaceuticals that
are subsidised by the Government and stating the amount of the
subsidy paid.
Quality Guidelines
The guidelines, as amended from time to time, entitled: “Oral
Health Services Agreement: Provider Quality Specification
Guidelines for Implementation”, which relate to the provision of
your development and/or formalisation of quality systems for the
purposes of this Agreement.
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Term
Meaning
Records
All records and information relevant to the performance of your
obligations under this Agreement. The records include those that
are held by you, your staff, your subcontractors or otherwise held
on your behalf, and includes records in al forms including written
and electronic forms. For the avoidance of doubt “records”
includes patient records.
Representative Body
A body or bodies that either we, or you, consider to be
representative of the interest of oral health providers collectively,
or of particular groups of oral health providers.
Special Dental Services for
The special dental services as described in clause E1.2(b).
Children and Adolescents
Services
The services that you are to provide in accordance with this
Agreement, as amended from time to time, including as
applicable, Oral Health Services for Adolescents and/or Special
Dental Services for Children and Adolescents.
Services Area
As outlined in Part G
Uncontrol able Event
An event which is beyond the reasonable control of one of us but
does not include:
a.
any risk or event which the person claiming could have
prevented or overcome by taking reasonable care
including having in place a reasonable risk management
process; or
b.
a lack of funds for any reason (other than where we have
failed to make do payment).
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PART C: PROVIDER QUALITY SPECIFICATIONS (PQS)
C1
Provider Quality Specifications Apply to all Services.
C1.1
You agree that your Services will comply with the provider quality specifications outlined in this
Part C, insofar as these are reasonably achievable within the amount of funding provided.
C1.2
If you are unable to meet any of these provider quality specifications you agree to notify us in
writing and identify the reasons for your inability to comply.
C2
Quality Improvement and Requirements for Māori
C2.1
You agree to have systems and processes for the ongoing development of service quality.
C2.2
You agree to have processes to bring the perspectives of Māori to the planning and
development of your Services. These processes will be suited to the scope and location of
the Services provided and their impact on Māori.
C3
Risk Management
C3.1
You wil establish a formal written process for the identification, evaluation and management
of key risks to consumers, visitors and staff.
C3.2
You wil meet al requirements of the Health and Safety at Work Act 2015 and any regulations
made under that Act (as amended or replaced from time to time).
C3.3
You wil have documented policies and procedures to guide staff in meeting health and safety
requirements. Policies and procedures will cover key areas of relevance to the service. This
will include but is not limited to:
a.
compliance with al New Zealand Dental Association and Dental Council Codes of
Practice, Codes of Ethics, and Standards;
b.
security: systems to manage security appropriate to the degree and range of risk(s)
relevant to the Services provided.
C3.4
You wil develop systems for the recording and resolution of incidents and adverse events.
This system wil include an internal documented reporting process that al ows identification of
trends and links to quality development processes, including corrective and preventive
strategies.
C4
Consumer Rights
C4.1
You agree that Services provided by you wil meet al requirements of the Code of Consumers’
Rights. This includes ensuring that the Code of Consumers’ Rights is prominently displayed,
and copies are readily available to patients using the Services.
C5
Entry to Service
C5.1
You wil ensure that eligibility and access criteria for the Services, in particular as stipulated in
clauses E4 and E6 of this Agreement, are met.
C5.2
You wil ensure that:
a.
adequate and accurate information about the Services is available to referrers or
clients or potential clients to facilitate consumer access to Services, including after-
hours Services as applicable; and
b.
Service information is communicated in ways that are effective, acceptable to and
readily understood by the consumers.
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C5.3
Where consumers are not eligible for a Service or are declined, you will ensure that processes
are in place to ensure the immediate safety of the consumer and others including:
a.
sufficient preliminary assessment to ensure that the consumer does not require the
Service;
b.
advising the consumer and/or their family and/or whanau of alternative services and if
necessary, formal y referring the consumer to an alternative service;
c.
documenting the reasons for declination and informing us if required; and
d.
having a process for documenting the management of declinations.
C6
Service Provision
C6.1
Services wil be provided in a timely, equitable and efficient manner to meet consumers’
assessed needs.
C6.2
Service delivery wil reflect current best practice and be provided by sufficient numbers of
suitably skilled and qualified personnel. Current best practice includes the requirement for a
planned approach to al stages of service delivery for every consumer.
C6.3
Consumer records and related administrative processes will meet legislative and accepted
professional and/or sector standards.
C6.4
Formal documented processes will be maintained to plan and implement safe and timely
referral, discharge or transfer.
C6.5 You wil maintain a range of linkages and co-operate with other providers and community
agencies to promote effective service delivery.
C6.6
As you are providing children’s services as defined in section 15 of the Children’s Act 2014,
then in accordance with section 16 of the Act you will:
a.
adopt, as soon as practicable, a child protection policy (in respect of the provision of
children’s services) that complies with section 19 of that Act;
b.
review that policy thereafter a minimum of every 3 years; and
c.
in accordance with best practice, post a copy of the child protection policy on your
internet site, or if you do not have a website ensure a hard copy of your policy is
available in your Practice.
C7
Staff Management
C7.1
You agree to have staff management processes consistent with good human resource
practice, including access to adequate supervision and training to ensure that personnel are
and remain competent to meet the requirements of their positions and the appropriate
supervision of trainees, volunteers and other such staff.
C7.2
You agree to ensure that all registered health practitioners who provide Services under this
Agreement hold a current annual practising certificate and practice within their scope of
practice and area of competence.
C7.3
You agree to ensure that staff providing the Services are clearly identified to patients.
C8
Facilities
C8.1
You agree to ensure that at all times al buildings, plant and equipment are adequately
maintained, fit for their purpose, maintained in safe working order and al legislative, regulatory
and other relevant standards are met.
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PART D: BUSINESS RULES
D1
Reporting Information
D1.1
You wil report the information requirements outlined in Part E10 of the service specifications
contained in this Agreement.
D1.2
All reporting of information by you for Services provided through this Agreement shall:
a.
be submitted on the appropriate forms provided by us or the Payment Agent for the
purpose of submitting information or on any forms approved by us, including computer
forms;
b.
be sent to the Payment Agent, at the location set out in the Operational Guidelines,
within the timeframe outlined in the service specifications contained in Part E of this
Agreement; and
c.
if you use computer forms, a duplicate copy should be sent to Payment Agent.
D1.3
You wil receive a list of the Equity Index for the high schools in your District. This list will be
updated from time to time by the Ministry of Education and published on their website. This
list will be the relevant list of Equity Index bands for payment purposes as set out in clause F2.
D1.4
We will give you notice of any review of, or proposal relating to, information requirements set
out in the service specifications, in accordance with the review provisions in this Agreement.
D1.5
We, or the Ministry, may, from time to time, require additional information. We will agree with
you a mutually acceptable timetable for delivery of this additional information. Once
agreement is reached you will deliver against the timetable agreed.
D1.6
We may request additional information from you in relation to the Services specified in this
Agreement. In the request, we will detail the reasons for the request and the intended usage
of the required information.
D1.7
You wil endeavour to provide us with every reasonable assistance in obtaining the required
information. Both of us will agree to any conditions and specifications of ad-hoc information
requirements in writing, including the cost and resource implications.
D1.8
The information you provide should, in all cases, be an accurate, consistent and complete
representation of the facts to the best of your knowledge and belief.
D1.9
To enable us to Audit your data col ection and reporting processes, you agree to provide us
with access to the fol owing on request:
a.
the person(s) responsible for the capture of this data;
b.
a description of the manual and automated procedures and processes used to
transform this data into the information you provide; and
c.
the procedures that describe how you ensure the security of information according to
the Privacy Act 2020 and the Health Information Privacy Code 2020.
D1.10 The costs associated with the provision of information specified under this Agreement at the
date of execution are to be paid for by you. These costs are deemed to be included in the
prices for the Services agreed under this Agreement.
D2
Payment
D2.1
Payment for Services specified in this Agreement will be made, within 20 Working Days from
the receipt of valid information described in clause E10.2 by the Payment Agent, by direct
credit to your nominated bank account.
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D2.2
Any information submitted in respect of any patient by you for payment for providing Services
specified in this Agreement may not be approved for payment if:
a.
we believe that the information you have submitted is erroneous;
b.
we believe that the Services you have provided are not in accordance with the service
specifications contained in this Agreement; or
c.
you have not obtained approval to provide the Services, if you are required to obtain
such approval in the service specifications contained in this Agreement.
In al these cases we will discuss with you the reasons for our non-approval of payment.
D2.3
If you fail to comply with the reporting requirements set out in Part E and elsewhere in this
Agreement, we may withhold 10% of any current or future payment owing to you until such
requirements are met.
D2.4
If you receive any payments for Services under this Agreement, you may not receive further
payment from us for those same Services under this Agreement, any other agreement, any
notice issued under section 88 of the Act or any other arrangement.
D2.5
You may claim payment under this Agreement for Services for Special Dental Services
provided under clauses E5.6 of this Agreement in compliance with the requirements set out in
Part F (Service Pricing) of this Agreement.
D2.6
The prices set out in Part F represent the full payment to be received by you for providing the
relevant Services and you are not entitled to:
a.
charge the patient any additional fee for any of the Services provided under this
Agreement;
b.
require the patient to accept and pay for any additional Services from you as a
condition of you providing services to that patient funded under this Agreement.
D2.7
If we have reason to believe you have obtained or attempted to obtain any payment from us
for any Services that have not been provided or that have been provided otherwise than in
accordance with this Agreement, we may Audit your practice in regard to this.
D2.8
You must lodge an invoice and valid information with the Payment Agent no later than twelve
(12) months after the date on which the entitlement to payment arises.
D3
Referral to the Health and Disability Commissioner
D3.1
Where there is a consumer complaint and/or a concern that there is a breach of consumer
rights by you, your staff or your service, a complaint may be referred to the Health and
Disability Commissioner for investigation under the provisions of the Health and Disability
Commissioner Act 1994.
D4
Referral to an Appropriate Complaints Body
D4.1
If as a result of an Audit of your practice and/or a complaint we have reason to believe there
are concerns requiring further investigation, undertaken under clause A17, including concerns
that you may be in breach of any of your obligations under this Agreement, we may, without
prejudice to our other rights under this Agreement, refer the issue to a Complaints Body that
we consider to be an appropriate body to address and/or determine the issue.
D4.2
You are required to assist any Complaints Body with its investigation, including providing any
information, documentation or other material required by the Complaints Body for its
deliberations.
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D5
Status of This Agreement during a Disciplinary or Competency Review
D5.1
During the time a disciplinary or competency review is under way, restrictions may be placed
on your practice.
D5.2
If we have serious concerns that the safety of patients may be compromised by you or
members of your staff continuing to provide the Services while a disciplinary or competency
review is resolved, we may either suspend your right to provide Services under this
Agreement, or require that your staff cease being involved in the provision of Services,
pending the outcome of the review.
D6
Termination of this Agreement as a result of Disciplinary Process
D6.1
If, as a result of a disciplinary or competency review, you are found to be in breach of the
terms and conditions of this Agreement we may terminate this Agreement in accordance with
clause A34 of this Agreement.
D6.2
Where a serious complaint against you or your staff has been proven we may immediately
terminate this Agreement.
D7
Pharmaceuticals
D7.1
We will, through PHARMAC, make available to you the Pharmaceutical Schedule. The
Pharmaceutical Schedule sets out the terms and conditions under which pharmaceuticals are
supplied to patients and practitioners. You agree to comply with the terms and conditions of
the Pharmaceutical Schedule.
D7.2
You agree that al prescriptions issued by you, whether electronic or hard copy, will include
the following details:
a.
referrer’s type;
b.
referrer’s Dental Council NZ number or person ID
c.
referrer’s name;
d.
the date prescribed;
e.
the patient’s name and address;
f.
the patient’s National Health Index number (NHI) (where available);
g.
the patient’s date of birth (where no NHI number) and where the patient is under 13
years of age;
h.
the patient’s gender (where no NHI number);
i.
the patient’s category;
j.
the patient’s community services card status;
k.
the patient’s high user health card status;
l.
the name of the pharmaceutical.
m.
the dose;
n.
the frequency of dose;
o.
the quantity or total days supply;
p.
any special instructions (if applicable);
q.
the referrer’s signature.
r.
the appropriate funder should include J14 in the prescription script for al 14-17 years.
s.
patient’s ethnicity
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D7.3
If we believe that you or your staff, as identified in an Audit, have unnecessarily,
inappropriately or excessively prescribed any pharmaceutical for any person we may, without
prejudice to our other rights under this Agreement, refer the matter to a Complaints Body to
address and/or determine the matter. If the Complaints Body so recommends, we may
require that you pay to us the amount of the cost or loss suffered by reason of the practice or
matter investigated by the Complaints Body. We may deduct any such amounts against
amounts that are currently or may become payable to you.
D8
Enrolment Registers
D8.1
In order to become a patient an Eligible Person must meet the criteria in clause E4 and must
complete, accurately and in full, the enrolment form supplied by
Health New Zealand. You
must countersign this form and return the relevant section to our Payment Agent.
D8.2
You agree to enter each enrolled patient on a register retained for this purpose by you.
D8.3
If you decide to remove a patient from your register you agree to use reasonable endeavours
to inform the patient in writing. You agree to copy this written notice to our Payment Agent.
This notice must include the patient’s name, last known address and date of birth.
D8.4
A patient may at any time, in writing, request us to remove his or her name from your register.
On receipt of such a request we wil advise you that the patient’s name has been removed
from your register.
D9
Adolescent Oral Health Coordination Services
D9.1 We will nominate a regional dental health co-ordinator for our district for Oral Health Services
for Adolescents. You wil be required to work with the regional dental health coordinator,
whose role will include carrying out the following functions:
a.
facilitating improved uptake for Oral Health Services for Adolescents in your district;
b.
creating effective links between providers of Oral Health Services for Adolescents and
your local community oral health service;
c.
liaising with, and forging links between, providers of Oral Health Services for
Adolescents and local Māori;
d.
creating effective links between providers of Oral Health Services for Adolescents and
providers of other primary care services;
e.
representing oral health service providers in public health initiatives, in particular in
any issues relating to fluoridation; and
f.
providing an effective link between providers of Oral Health Services for Adolescents
and Health New Zealand.
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PART E: NATIONAL SERVICE SPECIFICATION FOR ORAL HEALTH SERVICES FOR
ADOLESCENTS AND SPECIAL DENTAL SERVICES FOR CHILDREN AND ADOLESCENTS
E1
Introduction
E1.1 This service specification is to be read in conjunction with the Oral Health Services – Tier One
Service Specification.
E1.2
Oral Health Services for Adolescents and Special Dental Services for Children and Adolescents
encompass a range of dental services to assist the maintenance of a functional natural dentition.
a.
Oral Health Services for Adolescents are those Services described in clauses E5.1, E5.2,
E5.3, E5.4, and E5.5, and include preventive care, chair-side education and some
treatments for oral disease and the restoration of tooth tissue.
b.
Special Dental Services for Children and Adolescents are those Services described in
clause E5.3, E5.6, and E5.7 are those which support school dental services and include
some treatments for oral disease, the restoration of tooth tissue, extractions and other
treatments that are beyond the scope of a dental therapist or oral health therapist and
some treatment for children and adolescents who cannot access their regular oral health
provider.
E2
Māori Health
E2.1 Providers are expected to improve the oral health outcomes and reduce oral health inequalities
for Māori children and adolescents as outlined in He Korowai Oranga – the Māori Health
Strategy and Whakamaua the Maori Health Action Plan when providing the Services.
E3
Pacific Health
E3.1 Providers are expected to improve the oral health outcomes and reduce oral health inequalities
for Pacific children and adolescents, as outlined in Oral Health Services – Tier One Service
Specification.
E4
Eligibility
E4.1 An Eligible Person for Oral Health Services for Adolescents is:
a.
adolescents from the start of school year 9 up to the day before their 18th birthday; and
b.
children, year 8 at school and under, who have been referred or released early from the
school dental service as not being able to be treated by them due to medical or
management reasons, and whose transfer has been approved by an Approving Dental
Officer.
E4.2 Providers will not exclude from enrolment Eligible Persons based on their presentation at
enrolment with a high level of treatment need or their likelihood to have a high prevalence of
oral disease.
E4.3 An Eligible Person for Special Dental Services for Children and Adolescents comprises:
a.
all children from birth until the end of school Year 8 enrolled with the school dental service;
and who otherwise would not have reasonable access to their regular oral health services
provider; and
b.
adolescents, from and including school year 9 up to their 18th birthday, who otherwise
would not have access to their regular oral health services provider.
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E5
Service Components
E5.1
Standard Oral Health Services for Adolescents
Standard Oral Health Services for Adolescents consist of a range of dental services that will be
purchased as a package. The package of Services wil cover the following areas:
1.
consultation, including examination and diagnosis, prophylaxis, advice on dental care and
any special tests and bitewing radiographs considered necessary. This includes both
regular consultations as necessary and any necessary emergency consultations in
normal hours;
2.
all necessary one surface restorations in posterior teeth (molars and premolars);
3.
periapical X-rays where required;
4.
fissure sealants where required;
5.
removal of supragingival calculus;
6.
other preventive treatments (e.g. topical fluoride applications) where required; and
7.
chair-side education on oral health care.
All patients will receive at least one annual consultation per calendar year. Additional
consultations will be scheduled as the patient’s needs dictate. All treatments should be
scheduled within two months of the initial consultation date. All patients should have their
treatment plans designed to meet their level of need and caries risk.
All patients must receive the services to which the patients are reasonably entitled under this
service specification. Services provided should be based on patient need and aligned to
recognised good practice within dentistry. A consultation may be claimed once each Calendar
Year for each patient.
Chair-side education should, at the first consultation, include advice on brushing, flossing and
the use of mouth guards, with any necessary follow-up at subsequent visits. Patients with a
high caries risk should be provided with advice about appropriate oral hygiene aids and
encouraged to seek continuing oral health services.
E5.2
High Caries Treatment Planning
Additional services for adolescents who have a high level of dental caries may, with the
Approving Dental Officer's approval, be funded on a fee-for-service basis rather than on a
standard package of services basis for the services described in clause E5.1.
A treatment plan including all of the proposed treatments must be submitted to the Approving
Dental Officer for prior approval.
Further details in relation to oral health services where High Caries Treatment Planning is
required are outlined in the Operational Guidelines.
E5.3
Additional Oral Health Services for Adolescents Not Requiring Prior Approval
Additional Oral Health Services for Adolescents not requiring prior approval consist of a range
of dental services that will be provided where required. These services may be provided without
prior approval from an Approving Dental Officer.
The fol owing services will be purchased on a fee-for-service basis.
1.
two surface (approximo-occusal) restorations in posterior teeth;
2.
three surface (mesio-occusal-distal) restorations in posterior teeth;
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3.
complex coronal restorations (including restoration of one or more cusps);
4.
single surface restorations in anterior teeth and buccal surfaces of premolars;
5.
more than one surface restorations in anterior teeth;
6.
preformed metal crowns;
7.
extractions (excluding extractions for orthodontic purposes) with local anaesthetic;
8.
re-cement inlay or crown;
9.
emergency dressings;
10.
emergency consultations outside the normal practice hours of that surgery.
11.
panoramic radiographs;
12.
occlusal radiographs;
13.
pulp removal and root restorations in deciduous teeth;
14. pulpotomy in deciduous teeth;
15.
pulpotomy in permanent teeth (ful or partial);
16. pulp cap (direct or indirect); and
17.
root canal treatment and root fil ings in permanent anterior or premolar teeth.
E5.4
Additional Oral Health Services for Adolescents Requiring Prior Approval
Additional Oral Health Services for Adolescents requiring prior approval consist of a range of
dental Services that will be provided where required and with the prior approval of an Approving
Dental Officer.
The fol owing services will be purchased on a fee-for-service basis:
1.
minor surgical operations;
2.
treatment of periodontal disease;
3.
precision-cast metal partial dentures;
4.
acrylic partial dentures;
5.
ceramic to metal crowns;
6.
all ceramic crowns (partial or full coverage, bonded or cemented);
7.
gold crowns (partial or full coverage);
8.
full coverage composite crowns;
9.
cast posts and cores;
10.
preformed posts (para, flexi, etc) and cores;
11.
porcelain jacket veneers;
12.
labial composite veneers;
13.
single ful dentures;
14.
pair of ful dentures;
15.
bite splints;
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16.
apexification/root fillings teeth with an open apex;
17.
adhesive bridges (Maryland type);
18.
root canal treatment and root fil ings in permanent posterior teeth; and
19. silver diamine fluoride application.
E5.5
Special Dental Services for Children and Adolescents Not Requiring Prior Approval
These services may be provided without prior approval from an Approving Dental Officer.
The fol owing Services will be purchased on a fee-for-service basis:
1.
initial oral consultation for children referred for special dental services or for children or
adolescents who are not able to access their regular oral health provider in an
emergency during normal practice hours;
2.
emergency consultations outside normal practice hours;
3.
periapical or bitewing radiographs where required (each film);
4.
panoramic radiographs;
5.
occlusal radiographs;
6.
one surface restorations in posterior teeth (including the anterior and posterior pit and all
buccal, palatal and lingual fissure extensions of molars);
7.
two surface (mesio-occlusal or distal-occlusal) restorations in posterior teeth;
8.
three surface (mesio-occlusal-distal) restorations in posterior teeth;
9.
complex coronal reconstructions (including restoration of one or more cusps);
10.
single surface restorations in anterior teeth and buccal surfaces of premolars;
11.
more than one surface restorations in anterior teeth;
12.
preformed metal crowns;
13.
extractions (excluding extractions for orthodontic purposes) with local anaesthetic;
14.
extractions (excluding extractions for orthodontic purposes) with general anaesthetic;
15. root canal treatment and root fillings in permanent anterior and premolar teeth
16.
pulp removal and root restorations in deciduous teeth;
17.
pulpotomy in deciduous teeth;
18.
pulpotomy in permanent teeth (ful or partial);
19.
pulp cap (direct or indirect);
19.
emergency dressings; and
20.
re-cement inlay or crown.
E5.6
Special Dental Services Requiring Prior Approval
These Services may be provided with prior approval from an Approving Dental Officer.
The fol owing Services will be purchased on a fee-for-service basis:
1.
minor surgical operations;
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2.
acrylic partial dentures;
3.
gold crown (partial or full coverage)
4.
complex reconstructions in composite resin;
5.
cast post and core;
6.
preformed post and core;
7.
preparation and obturation of root canals in permanent posterior teeth
8.
labial composite veneer;
9.
dentures full upper or lower;
10.
dentures upper and lower;
11.
bite splints;
12.
apexification;
13.
root canal treatment and root fil ings in permanent posterior teeth; and
14.
silver diamine fluoride application.
Further definitions of particular treatments are outlined in the Operational Guidelines.
E6
Access
a.
Access for Oral Health Services for Adolescents is through enrolment with a contracted
provider of Oral Health Services for Adolescents.
b.
Access for Special Dental Services for Children and Adolescents is through referral from
a child oral health provider or a contracted provider of Oral Health Services for
Adolescents or self-referral for urgent treatment at times when the patient is unable to
have reasonable access to their regular oral health services provider or when the patient
is not enrol ed with an oral health services provider.
c.
Oral Health Services for Adolescents are to be provided so as to increase access and
improve adolescent oral health, particularly amongst high risk adolescents.
d.
Special Dental Services are to be provided within the Services Area so as to ensure timely
access for eligible children and adolescents requiring urgent dental care and care outside
the scope of dental therapy practice.
E7
Exclusions
a.
Eligibility for Oral Health Services for Adolescents and Special Dental Services for
Children and Adolescents ceases on an Eligible Person’s 18th Birthday;
b.
orthodontic treatment;
c.
patients who are eligible for treatment through ACC;
d.
diagnostic and treatment services outside those described in the treatment schedules;
e.
fee paying overseas students.
E8
Linkages
Providers are required to demonstrate appropriate and effective links with the following services:
a.
providers of child community oral health services;
b.
hospital dental services;
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c.
oral health regional coordination services;
d.
dental professional associations, regulatory agencies or other agencies where
appropriate;
e.
consumer advocacy services, including Māori advocacy services;
f.
new migrant and refugee health services;
g.
Health New Zealand-based and community-based adolescent and well child/tamariki ora
services and health promotion services; and
h.
PHO-based primary care services.
E9.
Quality Requirements
E9.1
Generic Quality Requirements
As outlined in Oral Health Services – Tier One Service Specification.
E9.2
Service Development
The objective of Oral Health Services for Adolescents and Special Dental Services Children and
Adolescents is to achieve a standard of oral health that leads to adults maintaining good oral
health.
Providers will:
a.
ensure that each patient has access to a basic level of oral health care;
b.
ensure accurate monitoring of oral health status of the enrolled adolescent population
(see reporting requirements in clause E10); and
c.
encourage patients, especially Māori and Pacific people and other at risk children and
adolescents, to seek oral health services on a regular basis.
E9.3
Effectiveness
We will assess the effectiveness of services based on:
a.
collaboration with providers of adolescent oral health coordination services;
b.
improvement in the oral health status of adolescents;
c.
enrolment and utilisation of services by adolescents;
d.
giving priority to the provision of care in areas or to groups with issues of access or
higher levels of oral disease; and
e.
providers making best endeavours to Complete each course of treatment for enrolled
patients.
E9.4
Acceptability
a.
Children and adolescents are to be treated with respect, dignity and in ways that are
cultural y sensitive.
b.
Services should take into account the needs of children, adolescents, their families and
whanau, and consumer groups.
E9.5
Safety and Efficiency
You wil adhere to the provisions under the Provider Quality Specifications.
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Monitoring and Supervision wil be in compliance with the Health Practitioners Competence
Assurance Act 2003.
You wil ensure:
a.
Oral health Services are to be provided by suitably qualified and competent health
practitioners who hold an Annual Practising Certificate from the Dental Council.
b.
Dental Therapists, Dental Hygienists, Oral Health Therapists and Dentists are the lead
practitioners providing the Services and work together to provide a seamless service and
develop appropriate links with private providers, hospital and community dental services
and other health care services and consumer advisory services to maintain a high
standard of care for each child.
c.
Oral health treatment and outcome data are to be col ected at the unit (individual child or
adolescent) level, and reported as directed.
d.
Dental Therapists, Dental Hygienists and Oral Health Therapists have access to timely
and appropriate advice from a Dentist during delivery of clinical care.
Service providers delivering care from mobile clinics will limit the maximum population treated
by any one mobile facility to that agreed with the District.
E9.6
Guidelines
Oral health service providers must comply with the Quality Guidelines and the Operational
Guidelines issued by Health New Zealand.
Health New Zealand reserves the right to update and/or amend the Quality Guidelines and the
Operational Guidelines from time to time, provided that there is consultation with a
Representative Body (e.g. NZDA, NZOHA, Te Ao Marama) regarding any such amendment. A
copy of any updated Guidelines wil be forwarded to Providers when the changes are
implemented.
E9.7
Facilities
As outlined in the Oral Health Services – Tier One Service Specification.
E10
Information and Reporting Requirements
E10.1
Enrolment Reporting Requirements
Providers must ensure that each patient's NHI number is used as a unique identifier when
complying with al enrolment and reporting requirements in this Agreement. If a patient enrols
with another oral health provider, the original oral health provider should be informed of this by
the Payment Agent.
Oral health providers will confirm the patients’ details at their annual examination and inform the
Payment Agent if there are any changes to the above details.
E10.2
Service Delivery Information
The Provider will report al treatments provided to patients to the Payment Agent. This data,
along with the treatment claims, will be submitted after the patient’s treatment has been
Completed. Al reporting wil be as per the Operational Guidelines.
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PART F: SERVICE PRICING FOR ORAL HEALTH SERVICES FOR ADOLESCENTS AND
SPECIAL DENTAL SERVICES FOR CHILDREN AND ADOLESCENTS
F1
Eligibility for and Pricing of Services
The eligibility criteria that patients must meet before they can receive the Services listed below
are specified in the service specifications contained in Part E of this Agreement. The pricing
terms applicable to the Services are set out in this Part F.
F2
Pricing for Standard Oral Health Services for Adolescents
The standard services described in clause E5.1 of this Agreement will be purchased as a
package. You will receive one payment per patient per year for these standard Services after
the date you have either:
a.
achieved Completion for that patient; or
b.
you have reported to us non-Completion relating to that patient, provided that:
i. the patient attended their annual check-up.
ii. the patient failed to present for further treatment, scheduled in accordance with
the action plan of services to be carried out for that patient fol owing that
patient’s annual check-up.
i i. you have used your best endeavours to get the patient to present for their
further scheduled treatment, including at least two documented recal s for
treatment; and
iv. you have reported such non-Completion to us.
v. You agree to only claim payment from us for services provided within your local
Health New Zealand district for the Service Area outlined in Part G.
The price paid to you for each patient wil be according to the school EQI applicable. The
relevant price is set out in the table below (as amended from time to time under clause A39).
Price (GST excl.)
New EQI Score
Equity Index
Code
2025/26
569 to 491
Band 1
COM1
$246.37
490 to 448
Band 2
COM2
$189.80
447 to 365
Band 3
COM3
$155.37
If a patient is attending a high school that is not assigned an EQI number by the Ministry of
Education, the price paid to you for the patient wil be the price we pay for patients attending
high schools in Band 3.
If a patient is not enrol ed at a high school, the price paid to you for the patient will be the price
we pay for patients attending high schools in Band 2.
You agree to only claim payment from us for Services provided within the geographical areas
for which we are responsible as specified in Part G whether or not a patient is resident within
our geographical area.
If you provide Services from a facility located outside the agreed geographical areas, then you
agree not to claim for payment under this Agreement. You must have in place a separate
contract for the additional facility with Health New Zealand Area. If you do not have a contract
for the additional facility, you will be responsible for arranging such contract and payment with
Health New Zealand.
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F2.1
Schedule of prices for Additional Oral Health Services for Adolescents not Requiring
Prior Approval
The additional Services not requiring prior approval, described in clause E5.4 of this Agreement,
will be purchased on a fee-for-service basis. You will receive payment for these additional
Services for each patient after the date you have achieved Completion for that patient, or, if
further treatments are required after the date, you have achieved Completion for that patient,
after those further treatments are Completed.
Payment for these additional services wil be based on the information reported by you in
accordance with clause E10. The payment you wil receive, per Service provided, wil be in
accordance with the table below.
Price (GST excl.)
Items
Code
2025/26
Two surface (approximo-occlusal) restorations in posterior
FIL2
$106.86
teeth
Three surface (mesio-occlusal-distal) restorations in
FIL3
$131.52
posterior teeth
Complex coronal reconstructions in amalgam (including
FIL4
$147.62
restoration of one or more cusps)
Simple restorations in anterior teeth
FIL5
$96.86
More than one surface restoration in anterior teeth
FIL6
$130.25
Performed metal crowns
CRN1
$83.75
Extractions (excluding extractions for orthodontic purposes)
EXT1
$158.38
with LA
Re-cement inlay or crown
RCM1
$29.99
Panoramic radiographs
RAD2
$49.59
Occlusal radiographs
RAD3
$33.38
Root canal treatment and root filling in permanent anterior
or premolar teeth (per canal) including all necessary
RCT1
$330.85
radiographs performed during treatment and mandatory
post-operative radiology for patient's record
Pulp removal and root fil ing in deciduous tooth (maximum
RCT2
$181.51
fees per deciduous tooth treated)
Pulpotomy in deciduous teeth
RCT3
$116.41
Pulpotomy in permanent teeth (ful or partial)
PUL1
$350.00
Pulp cap (direct or indirect)
PC1
$150.00
Emergency dressings
EMD1
$34.30
Initial oral consultation for school dental clinic patients
referred for Special Dental Services or for school dental
clinic patients or adolescents who are not able to access
CON3
$88.82
their regular health provider in an emergency during normal
practice hours
Emergency consultations outside normal hours
CON4
$131.16
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F2.2
Schedule of Prices for Additional Oral Health Services for Adolescents Requiring Prior
Approval
The additional Services requiring prior approval, as described in clause E5.5 of this Agreement,
will be purchased on a fee-for-service basis. You will receive payment for these additional
Services for each patient after the date you have achieved Completion for that patient. If further
treatments are required after the date you have achieved Completion for that patient, then
payment will be made after those further treatments are Completed.
Payment for these Services will be based on the information reported by you in accordance with
clause E10 of this Agreement. These additional Services may only be provided with the prior
approval of Approving Dental Officer. Where the prior approval of an Approving Dental Officer
is not sought but an application is made subsequently and not approved, then neither we nor
the patient wil be liable to pay for those Services.
The payment you will receive, per Service provided, will be in accordance with the table below:
Price (GST excl.)
Item
Code
2025/26
Minor surgical operation or other time-based procedures (first MSO1
$102.97
half hour)
Minor surgical operation or other time-based procedures
MSO2
$51.46
(each additional quarter hour)
Treatment of periodontal disease
PDT1
$80.89
Precision-cast metal partial denture
DENT1
$1,858.29
Precision-cast metal partial denture - each extra tooth
DENT2
$62.57
Acrylic partial dentures
DENT3
$807.82
Acrylic partial dentures - each extra tooth
DENT4
$62.64
Acrylic partial dentures - each clasp
DENT5
$32.54
Adhesive Bridges (Maryland Type)
ABMT
$1,247.02
Ceramic to metal crowns
CRN2
$1,080.83
All ceramic crowns (partial or full coverage, bonded or
CRN3
$1,078.05
cemented)
Gold Crown (Partial or ful coverage)
CRN4
$1,024.76
Full coverage composite crowns
CRN5
$213.30
Bite Splints
SPLT
$542.09
Cast posts and cores
PST1
$289.08
Preformed posts (para, flexi, etc)
PST2
$120.02
Porcelain veneer
VEN1
$929.09
Labial composite veneer
VEN2
$143.45
Denture ful upper or lower
DEN6
$1,145.07
Denture upper and lower
DEN7
$2,531.23
Apexification/root fil ing with an open apex
APX1
$181.51
Health New Zealand | Te Whatu Ora
CDA 1 November 2025
Page 33
«PROVIDER_NAME»
«PROVIDER_NUMBER» / «CONTRACT_CONTRACTID»/«CONTRACT_VERSION»
Root Canal treatment and root fillings in permanent molar
teeth (per canal treated) including all necessary radiographs
RCT5
$330.85
performed during treatment and a mandatory post-operative
radiograph for the patient's record.
Silver diamine fluoride first application to 1 to 3 teeth
SDF1
$99.97
Silver diamine fluoride second application to 1 to 3 teeth
SDF2
$49.96
Silver diamine fluoride first application to 4 or more teeth
SDF3
$149.93
Silver diamine fluoride second application to 4 or more teeth
SDF4
$99.97
F3
Schedule of prices for Oral Health Services for Adolescents Requiring High Caries
Treatment Planning
Additional services for adolescents require High Caries Treatment Planning, as described in
clause E5.2 of this Agreement, will be purchased on a fee-for-service basis. You will receive
payment for these Services once the patient has Completed the course of treatment agreed
between you and the Approving Dental Officer. Any further non-schedule treatments, necessary
within the same Calendar Year, wil also require the prior approval of the Approving Dental
Officer.
It is expected that High Caries Treatment Planning will arise in one of three ways:
a.
the enrolling adolescent is in Year 9 and has left the school dental service with extensive
unmet treatment need. The Principal Dental Officer of the relevant school dental service
should be made aware, if not already so, of such individuals leaving the service; or
b.
the adolescent has not attended the school dental service or any other health provider
for an extended period of time, resulting in a large amount of unmet treatment need; OR
c.
the adolescent has recently entered New Zealand from overseas and, being an Eligible
Person, presents to the oral health service provider with a large amount of unmet
treatment need; or
d.
the adolescent’s caries risk has changed dramatically.
The criteria for access to High Caries Treatment Planning funding is - where the adolescent can
be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre-
molars) in addition to any other treatment needed. Once High Caries Treatment Planning has
been approved the fees for the capitated items within the consultation package are able to be
separately charged for as a fee for service as in clause F3.2 below.
F3.1
Approving Process for applications for Services requiring prior approval
The provider will submit a Form 497 (application for approval to provide treatment not covered
by the fee schedule) outlining the treatment required and including bitewing and any other
appropriate radiographs. This may be accompanied by a letter or computer-generated treatment
plan. The radiographs will be returned to the Dentist.
Having approved the request and assigned an ‘approval number’, the Approving Dental Officer
will return the signed original and duplicate copy of the form to the provider and retain one copy
for Health New Zealand’s records.
The provider must note the approval number on the appropriate claim form: Oral Health
Services in High Caries Treatment Planning (Adolescents) Treatment Report/Claim Summary
and attach the original application for approval to provide treatment not covered by the fee
schedule.
F3.2
Payment for Higher Caries Treatment planning
Health New Zealand | Te Whatu Ora
CDA 1 November 2025
Page 34
«PROVIDER_NAME»
«PROVIDER_NUMBER» / «CONTRACT_CONTRACTID»/«CONTRACT_VERSION»
Payment for these Services will be based on the information reported by you as outlined in the
service specification for High Caries Treatment Planning in clause E5.2 of this Agreement.
If you make a claim under approved High Caries Treatment Planning, you may Examine the
patient again in 6 months and provide care under CON1 package of care
The payment you will receive, per Service provided, will be in accordance with the table below.
Price (GST excl.)
Item
Code
2025/26
Consultation, including examination and diagnosis,
prophylaxis, advice on dental care and any special tests
CON5
$80.81
and bitewing radiographs considered necessary
One surface posterior fil ings (molar and pre-molar)
FIL1
$81.50
Periapical X-ray
RAD1
$12.75
Fissure sealant
FIS1
$28.23
Any other Services provided to an adolescent requiring High Caries Treatment Planning will be
priced in accordance with the tables in clause F2.
F4
Pricing for Special Dental Services
The standard services for Special Dental Services for Children and Adolescents are described
in clause E5.6 of this Agreement.
You agree to only claim payment from us for Services provided within the geographical areas
for which we are responsible as specified in Part G, whether or not a patient is resident within
our geographical area.
If you provide Services from a facility located outside the agreed geographical areas, then you
agree not to claim for payment for those Services under this Agreement. You must have in place
a separate contract for the additional facility with Health New Zealand. If you do not have a
contract for the additional facility, you wil be responsible for arranging such contract with Health
New Zealand.
F4.1
Schedule of Prices for Special Dental Services Not Requiring Prior Approval
The payments you will receive, per service provided, for the Services described in clause E5.6
are as fol ows.
Price (GST excl.)
Item
Code
2025/26
Initial oral consultation for school dental clinic patients
referred for Special Dental Services or for school dental
clinic patients or adolescents who are not able to access
CON3
$88.82
their regular health provider in an emergency during normal
practice hours.
Emergency consultation outside normal practice hours
CON4
$131.16
Bitewing radiograph
PBW1
$12.75
Periapical radiograph
RAD1
$12.75
Health New Zealand | Te Whatu Ora
CDA 1 November 2025
Page 35
«PROVIDER_NAME»
«PROVIDER_NUMBER» / «CONTRACT_CONTRACTID»/«CONTRACT_VERSION»
Panoramic radiograph
RAD2
$49.59
Occlusal radiograph
RAD3
$ 33.38
One surface restoration in posterior teeth (including the
anterior and posterior pit and all buccal, palatal and lingual
FIL1
$81.50
fissure extensions of molars)
Two surface (approximo-occlusal) restorations in posterior
FIL2
$106.86
teeth
Three surface (mesio-occlusal) restorations in posterior
FIL3
$131.52
teeth
Complex coronal reconstructions (including restoration of
FIL4
$147.62
one or more cusps)
Simple restoration in anterior teeth
FIL5
$96.86
More than one surface restoration in anterior teeth
FIL6
$130.25
Preformed metal crowns
CRN1
$83.75
Extraction of a single permanent tooth or deciduous
quadrant (excluding extractions for orthodontic purposes)
EXT1
$158.38
with local anaesthetics
Extraction of a single permanent tooth or deciduous
quadrant Excluding extraction or orthodontic purposes with
EXT3
$108.41
general anaesthetic
Root canal treatment and root filling in permanent anterior
or premolar teeth (per canal) including all necessary
RCT1
$330.85
radiographs performed during treatment and mandatory
post-operative radiology for patient's record
Pulp removal and root fil ing in a deciduous tooth (maximum RCT2
$181.51
fee per deciduous tooth treated)
Pulpotomy in deciduous tooth
RCT3
$116.41
Pulpotomy in permanent tooth (ful or partial)
PUL1
$350.00
Pulp cap (direct or indirect)
PC1
$150.00
Emergency dressing
EMD1
$34.30
Re-cement inlay crown
RCM1
$29.99
Payment for these Services wil be based on the information reported by you as required by
clause E10.
F4.2
Schedule of Prices for Special Dental Services Requiring Prior Approval
The payments you will receive, per Service provided, for the Services described in clause E5.7
are as fol ows:
Price (GST excl.)
Item
Code
2025/26
Minor surgical operation or other time-based procedures
MSO1
$102.97
(first half hour)
Minor surgical operation to other time-based procedures
MSO2
$51.46
(each additional quarter hour)
Treatment of periodontal disease
PDT1
$80.89
Health New Zealand | Te Whatu Ora
CDA 1 November 2025
Page 36
«PROVIDER_NAME»
«PROVIDER_NUMBER» / «CONTRACT_CONTRACTID»/«CONTRACT_VERSION»
Acrylic partial denture
DEN3
$807.82
Acrylic partial denture -each extra tooth
DEN4
$62.64
Acrylic partial denture -each clasp
DEN5
$32.54
Gold Crown (partial or full coverage)
CRN4
$1,024.76
Complex reconstruction in composite resin
CRN5
$213.30
Cast post and core
PST1
$289.08
Preformed post and core
PST2
$120.02
Labial composite veneer
VEN2
$143.45
Bite splints
SPLT
$542.09
Denture ful upper or lower
DEN6
$1,145.07
Denture upper and lower
DEN7
$2,531.23
Apexification
APX1
$181.51
Root Canal treatment and root fillings in permanent molar
teeth (per canal treated) including all necessary
RCT5
$330.85
radiographs performed during treatment and a mandatory
post-operative radiograph for the patient's record.
Silver diamine fluoride first application to 1 to 3 teeth
SDF1
$99.97
Silver diamine fluoride second application to 1 to 3 teeth
SDF2
$49.96
Silver diamine fluoride first application to 4 or more teeth
SDF3
$149.93
Silver diamine fluoride second application to 4 or more
SDF4
$99.97
teeth
Payment for these Services will be based on the information reported by you as required by
clause E10. These additional Services may only be provided with the prior approval of an
Approving Dental Officer. Where the prior approval of an Approving Dental Officer is not
sought but an application is made subsequently and not approved, then neither the patient nor
we wil be liable to pay for those Services.
Health New Zealand | Te Whatu Ora
CDA 1 November 2025
Page 37
«PROVIDER_NAME»
«PROVIDER_NUMBER» / «CONTRACT_CONTRACTID»/«CONTRACT_VERSION»
PART G: SERVICE AREA COVERED UNDER THIS AGREEMENT
G1
Service Area
The Services are to be provided in the geographical area of the former «DHB_NAME» District Health
Board as described in Schedule 1 of the New Zealand Public Health and Disability Act 2000.
The Parties agree that the Provider’s appointment under this Agreement is non-exclusive, and Health
New Zealand may appoint third parties to provide services or deliverables similar to or the same as the
Services or Deliverables at any time or may provide them itself.
If you are a mobile provider, the Parties agree that the Service Area covered under this Agreement
excludes schools that are already serviced by another CDA Provider, unless both of us agree
otherwise in writing. A list of schools with current mobile dental providers in the Service Area wil be
provided by us.
Health New Zealand | Te Whatu Ora
CDA 1 November 2025
Page 38
