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1 Is the supply of colon hydrotherapy services by you, where the service is performed by a qualified colon hydrotherapist, considered a GST-free supply of Other health services under section 38-10 of the A New Tax System (Goods and Services Tax) Act 1999 (GST Act)?

1 No. Your supply of colon hydrotherapy services by a qualified colon hydrotherapist is not GST-free under section 38-10 of the GST Act. Question 2 Is the supply of colon hydrotherapy services by you, performed by a registered nurse considered a GST-free supply of nursing services under section 38-10 of the GST Act? Answer 2 No. The supply of colon hydrotherapy services by a registered nurse is not a supply of nursing services under section 38-10 of the GST Act. Question 3 Are colon hydrotherapy services provided by you GST-free under section 38-7 of the GST Act where medical service providers from the list below have referred a client to you for treatment? •                     General Practitioners, and •                     Oncologists. Answer 3 No. Colon hydrotherapy services provided by you are not GST-free under section 38-7 of the GST Act as a service performed on referral by another person is not a component of the supply being provided by the first practitioner. The scheme commenced on: DD January 20XX

Background You are a holistic health centre that focuses on natural, drug-free therapies to support overall well-being. You specialise in treatments such as colon hydrotherapy and several other holistic health services. Your approach emphasises gut health as the foundation for preventing and managing illness, aiming to help clients cleanse, rejuvenate, and maintain a balanced lifestyle in a calm, professional environment. You are registered for GST. Colon hydrotherapy overview Colon hydrotherapy involves the safe and controlled introduction of warm, filtered water into the colon to promote the evacuation of waste material. It is used to: •                     prepare patients for medical procedures, •                     manage chronic constipation, bloating, and functional digestive disorders, •                     support bowel cleansing in patients with cancer, autoimmune, and other chronic conditions, and •                     provide non-pharmacological alternatives to hospital enemas and invasive interventions. Colon hydrotherapy services are not regulated by State or Federal legislation. Qualified providers

The word 'qualified' is used in the context of having the necessary skills, knowledge, and credentials to carry out the procedure for colon hydrotherapy. You employ the following qualified providers: • Qualified colon hydrotherapists These individuals have completed the required recognised training (e.g., through Australian Colon Health) to register with the Australian Colon Hydrotherapy Association Inc (ACHA). • Registered nurses Nurses who hold a Bachelor of Nursing and are registered with the Australian Health Practitioner Regulation Agency (AHPRA) and also hold ACHA-recognised qualifications. These registered nurses provide colon hydrotherapy services in their capacity as registered nurses, however, may also hold both ACHA membership and AHPRA registration. For the purposes of this ruling, a ' qualified colon hydrotherapist ' refers exclusively to an individual whose only qualification is the training required for ACHA registration and who is not a registered nurse. Legislative and professional compliance

Colon hydrotherapy can be performed by either a qualified colon hydrotherapist or a registered nurse without a written referral or authorisation from a medical practitioner. This procedure, when performed by a registered nurse, does not breach legislative requirements or professional standards, including the code of professional conduct applicable to the South Australian nursing profession. Referrals Referrals are regularly received from general practitioners, integrative medicine doctors and oncologists. Colon hydrotherapy is incorporated into care plans for patients managing cancer, autoimmune conditions, and neurodegenerative diseases.

A New Tax System (Goods and Services Tax) Act 1999 section 9-5 A New Tax System (Goods and Services Tax) Act 1999 Division 38 A New Tax System (Goods and Services Tax) Act 1999 section 38-7 A New Tax System (Goods and Services Tax) Act 1999 section 38-10 A New Tax System (Goods and Services Tax) Act 1999 section 195-1

Question 1 Is the supply of colon hydrotherapy services by you, where the service is performed by a qualified colon hydrotherapist, considered a GST-free supply of health services under section 38-10 of the GST Act? Summary No. Your supply of colon hydrotherapy services by a qualified colon hydrotherapist is not GST-free under section 38-10 of the GST Act. Detailed reasoning Section 9-5 of the GST provides that you make a taxable supply if: (a)          you make the supply for consideration (b)          the supply is made in the course or furtherance of an enterprise that you carry on (c)          the supply is connected with the indirect tax zone (Australia), and (d)          you are registered or required to be registered for GST. However, the supply is not a taxable supply to the extent that it is GST-free or input taxed. Based on the information you provided, your supply of colon hydrotherapy services by a qualified colon hydrotherapist satisfies paragraphs 9-5(a) to 9-5(d) of the GST Act as you supply these services for consideration, in the course of your enterprise, these supplies are connected with Australia, and you are registered for GST.

However, your supplies will not be a taxable supply to the extent that they are GST-free or input taxed. Your supply of colon hydrotherapy services by a qualified colon hydrotherapist is not input taxed under any provisions of the GST Act. Therefore, we need to consider whether the supply of the services is GST-free. Division 38 of the GST Act provides that certain supplies relating to health are GST-free. In your case, the only relevant provision to examine is section 38-10 of the GST Act. Other health services Subsection 38-10(1) of the GST Act provides that a supply of health services is GST-free if: (a)          it is a service of a kind specified in the table in this subsection or of a kind specified in the regulations (b)          the supplier is a recognised professional in relation to the supply of services of that kind, and (c)          the supply would generally be accepted, in the profession associated with supplying services of that kind, as being necessary for the appropriate treatment of the recipient of the supply. All three limbs in subsection 38-10(1) of the GST Act must be satisfied for a supply of health services to be GST-free under this subsection.

The first limb in paragraph 38-10(1)(a) of the GST Act is that you must supply one of the services listed in the table referred to in this subsection. You are supplying colon hydrotherapy services. Colon hydrotherapy services are not of a kind of services listed in the table in subsection 38-10(1) of the GST Act: Other health services [...] Table 1: Health services Item Service 1 Aboriginal or Torres Strait Islander health 2 Acupuncture 3 Audiology, audiometry 4 Chiropody 5 Chiropractic 6 Dental 7 Dietary 8 Herbal medicine (including traditional Chinese herbal medicine) 9 Naturopathy 10 Nursing 11 Occupational therapy 12 Optometry 13 Osteopathy 14 Paramedical 15 Pharmacy 16 Psychology 17 Physiotherapy 18 Podiatry 19 Speech pathology 20 Speech therapy 21 Social work [...] Goods and Services Tax Industry Issues Health Industry Partnership Issue 2 Section 38-10 Other health services (Issue 2) explains that to satisfy paragraph 38-10(1)(a) of the GST Act the service must be the provision of one of the actual services listed and not just be similar to one of those services.

Where a service is not a supply of a kind specified in the table in subsection 38-10(1) of the GST Act, the requirement in paragraph 38-10(1)(a) of the GST Act will be satisfied if the service is a standard technique or a component of the supply of one or more of the services listed in the table and is supplied by a 'recognised professional' as defined section 195-1 of the GST Act. "recognised professional" : a person is a recognised professional, in relation to the supply of a service of a kind specified in the table in subsection 38 - 10(1), if: (a)          the service is supplied in a State or Territory in which the person has a permission or approval, or is registered, under a * State law or a * Territory law prohibiting the supply of services of that kind without such permission, approval or registration; or (b)          the service is supplied in a State or Territory in which there is no State law or Territory law requiring such permission, approval or registration, and the person is a member of a professional association that has uniform national registration requirements relating to the supply of services of that kind; or [...]

To satisfy point (a) above would require that colon hydrotherapy would be an appropriate treatment generally accepted by a recognised professional of a kind of service listed in the table of subsection 38-10(1)(a) of the GST Act. As this question applies solely to the qualified colon hydrotherapist as the recognised professional, point (a) fails in that a qualified colon hydrotherapist is not a recognised professional to any of the services of a kind listed in the table. To illustrate this point, Issue 2 provides an example where the service is not listed in the table, however the treatment is recognised by two professions as an appropriate treatment that is generally accepted in those professions:

2.a.4. Naturopathy and Herbal Medicine are services listed in the Table in section 38-10(1) items 8 and 9. The practice of naturopathy and herbal medicine includes iridology as a diagnostic technique, which is generally accepted in naturopathy and herbal medicine as being for appropriate treatment. A naturopath and herbalist for the purpose of preserving, restoring or improving the physiological wellbeing of a patient would use iridology. Does the ATO agree that iridology performed by a naturopath or herbalist would be GST-free? Non-interpretative - straight application of the law. Based on the above facts if iridology is a diagnostic technique of 'Naturopathy' and 'Herbal medicine', it will be of a service of a kind within section 38-10(1)(a). The service will be GST-free if: a.            it is generally accepted by *recognised professionals in 'Naturopathy' and 'Herbal medicine' that iridology is necessary for the appropriate treatment of the recipient of the supply, and b.            b. the *recognised professional supplies either Naturopathy or Herbal Medicine services and is skilled in its application.

As you do not satisfy all the requirements under subsection 38-10(1) of the GST Act, the services is not one listed, it is not provided by a recognised professional of a service of a kind listed in the table under subsection 38-10(1) of the GST Act, therefore there is no requirement to look at whether the treatment is appropriate (being the third requirement to satisfy), as the first two requirements have failed, and all three must pass in order to be GST-free services of a kind. The supply of colon hydrotherapy services by a qualified colon hydrotherapist to your patients is not GST-free under section 38-10 of the GST Act, therefore your supply is a taxable supply because all the requirements under section 9-5 of the GST Act are satisfied. Question 2 Is the supply of colon hydrotherapy services by you, performed by a registered nurse considered a GST-free supply of nursing services under section 38-10 of the GST Act? Summary No. The supply of colon hydrotherapy services by a registered nurse is not a supply of nursing services under section 38-10 of the GST Act. Detailed reasoning

A colon hydrotherapy procedure is not specified in the table in subsection 38-10(1) of the GST Act or the GST Regulations. Therefore, the colon hydrotherapy procedure 'in itself' does not satisfy the first limb in paragraph 38-10(1)(a) of the GST Act. However, the first limb in paragraph 38-10(1)(a) of the GST Act can still be satisfied where the supplier is supplying one of the services listed in the table in subsection 38-10(1) of the GST Act and the colon hydrotherapy procedure is a standard technique or a component of the supply of that listed service. Nursing is a service listed in the table in subsection 38-10(1) of the GST Act. Supplies that a registered nurse can make are constrained by the legal and professional standards applicable to the nursing profession. Therefore, services that fall within these standards of nursing practice would be nursing services for the purpose of subsection 38-10(1) of the GST Act.

As detailed in the relevant facts above you provide that the registered nurses are not employed or engaged by you in the capacity of a nurse, nor are they providing "nursing services" as defined by NMBA clinical roles. They are engaged specifically as colon hydrotherapists, and the service is provided as a complementary therapy rather than as a nursing intervention or clinical nursing service. As a result of these facts, the services are not of a kind specified under section 38-10(1)(a) of the GST Act, and therefore are not GST-free supplies of a nursing service. In conclusion, as the supply of colon hydrotherapy services by a registered nurse is not a supply of nursing services under section 38-10 of the GST Act, the supply meets the requirements of section 9-5 of the GST Act and result in a taxable supply being made by the registered nurse. Question 3 Are colon hydrotherapy services provided by youwhere the service is performed by a qualified colon hydrotherapist GST-free under section 38-7 of the GST Act where medical practitioners from the list below have referred a client to you for treatment? •                     General Practitioners, and •                     Oncologists.

Summary No. Colon hydrotherapy services provided by a qualified colon hydrotherapist are not GST-free under section 38-7 of the GST Act as a service performed on referral by another person, is not a component of the supply being provided by the first practitioner. Detailed reasoning Section 38-7 of the GST Act details that medical services are GST free under the following circumstances: Medical services (1)          A supply of a * medical service is GST - free. (2)          However, a supply of a * medical service is not GST - free under subsection (1) if: (a)          it is a supply of a * professional service rendered in circumstances covered by a prescribed provision of regulations made under the Health Insurance Act 1973 ; or (b)          it is rendered for cosmetic reasons and is not a * professional service for which medicare benefit is payable under Part II of the Health Insurance Act 1973 (or for which medicare benefit would be payable under that Part if section 19AD of that Act were disregarded). [...] Section 195-1 of the GST Act provides the definition of medical service: "medical service" means:

(a)          a service for which medicare benefit is payable under Part II of the Health Insurance Act 1973 ; or (aa)       a service for which medicare benefit would be payable under that Part if section 19AD of that Act were disregarded; or (b)          any other service supplied by or on behalf of a * medical practitioner or * approved pathology practitioner that is generally accepted in the medical profession as being necessary for the appropriate treatment of the * recipient of the supply. Section 195-1 of the GST Act provides the definition of a medical practitioner as: " medical practitioner " means a person who is a medical practitioner for the purposes of the Health Insurance Act 1973. A medical service provided by or on behalf of a medical practitioner that is generally accepted in the medical profession as being necessary for the appropriate treatment of the recipient of the supply will be GST-free under section 38-7 of the GST Act. The question raised is, will colon hydrotherapy services be supplied on behalf of the medical practitioner under a referral process?

Guidance on the treatment of referrals can be found in the Goods and Services Tax Industry Issues Health Industry Partnership Issue 1.a.11 Are massage services GST-free where a medical practitioner has referred the client? (Issues 1.a.11) provides: This question raises the application of the second limb of the definition of a '*medical service' in section 38-7. The phrase 'on behalf of' in the second limb of the definition of '*medical service' means the performance of a component of the service provided by a practitioner that is not necessarily supervised by that practitioner. An example is where a laboratory technician assists in undertaking pathology testing of specimens. However, 'on behalf of' does not include a service performed on referral by another person. A service performed on referral by another person, is not a component of the supply being provided by the first practitioner. The service being provided by the second person will be a separate supply, the GST-free status of which must be examined by reference to the supply by that second person.

A referral, in itself, will not render the subsequent supply GST-free. A massage service will be a GST-free *medical service if either: a Medicare benefit is payable; or it is undertaken by a *medical practitioner (as defined in the GST Act) and the practitioner is skilled in the provision of this supply and such treatment is generally accepted by the profession as being appropriate treatment. Additionally, under 'Issue 2' of this Log, a supply of a massage service is not a listed service for section 38-10 and will not be GST-free under that section unless it is: a.            supplied by a '*recognised professional' as defined in section 195-1 b.            is in relation to one of the table listed services such as 'Physiotherapy' c.            is 'generally accepted in that profession as being necessary for the appropriate treatment of the *recipient of the supply'.

While the question addressed in Issue 1.a.11 deals with 'massage services', the principles embed in the answer are relevant to Question 3. Where medical practitioners under section 38-7 of the GST Act such as general practitioners and oncologists refer patients to you for colon hydrotherapy services, that service is not considered a component of the supply provided by the first practitioner. Colon hydrotherapy services provided by a qualified colon hydrotherapist under referral from medical service provider is not GST-free. This is because the service is not considered a component of the referring provider's services; rather, the GST-free status depends on who is providing the service. Accordingly, colon hydrotherapy services provided by a qualified colon hydrotherapist under referral will be taxable supplies under section 9-5 of the GST Act. For removal of doubt, the same reasoning applies to registered nurses who provide colon hydrotherapy services under referral from medical service provider. These services will not be GST-free under section 38-7 of the GST Act. Instead, they will be taxable supplies under section 9-5 of the GST Act.