GST and antenatal exercise classes run by a physiotherapy assistant who is supervised by a physiotherapist

Is the entity, a physiotherapist, making a GST-free supply under subsection 38-10(1) of the A New Tax System (Goods and Services Tax) Act 1999 (GST Act), when it supplies an antenatal exercise class that is run by a physiotherapy assistant, but is directly supervised by the entity?

Yes, the entity is making a GST-free supply under subsection 38-10(1) of the GST Act when it supplies an antenatal exercise class that is run by a physiotherapy assistant, but is directly supervised by the entity, provided that the class is generally accepted in the physiotherapy profession as being necessary for the appropriate treatment of the recipient of the supply.

The entity is a physiotherapist that is registered under the relevant State or Territory Act that regulates physiotherapy services. The entity supplies physiotherapy services to antenatal women in the form of an antenatal exercise class that is run by a physiotherapy assistant.

The entity conducts an initial interview to determine whether the class is appropriate for that particular patient. The entity is always present during the class to modify the exercises for patients with special needs and to help the physiotherapy assistant in the case of an emergency.

The antenatal exercise classes assist the patient to alleviate pain, treat other pregnancy-related problems of the patient, and prepare the patient for childbirth by strengthening particular muscle groups (especially those in the pelvic region).

The general structure of the class is designed by the entity; however, the physiotherapy assistant may modify the class to cater for the special needs of particular patients.

The entity is registered for goods and services tax (GST).

Under subsection 38-10(1) of the GST Act, an entity makes a GST-free supply of health services if: • it provides a service of a kind specified in the table in subsection 38-10(1) of the GST Act (the table) or of a kind specified in the A New Tax System (Goods and Services Tax) Regulations 1999 (GST Regulations); • the entity is a recognised professional in relation to the supply of services of that kind; and • 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.

'Physiotherapy' is listed at item 17 in the table (Item 17). The entity is a registered physiotherapist that is providing physiotherapy services to a patient in the form of an antenatal exercise class. Therefore, the first requirement in subsection 38-10(1) of the GST Act is satisfied.

The second requirement is that the person providing the service must be a recognised professional in relation to the supply of physiotherapy services. Section 195-1 of the GST Act provides that a person is a recognised professional in relation to a supply of a service of a kind specified in the table 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...'

The entity (the physiotherapist that supervises the class) is registered under the relevant State or Territory Act that regulates physiotherapy services. Therefore, the entity is a 'recognised professional' as per the definition in section 195-1 of the GST Act. However, the class is actually conducted by a physiotherapy assistant. The entity (the physiotherapist) only supervises the class. Therefore, it is necessary to determine whether a class that is conducted by an assistant but is supervised by a recognised professional is still considered to be provided by a 'recognised professional', as per the second requirement in subsection 38-10(1) of the GST Act.

In the case of physiotherapy, where a person other than the physiotherapist provides a component of a physiotherapy supply, that component is not provided by a 'recognised professional' unless it is directly supervised by a recognised professional in physiotherapy. It is considered that a person is directly supervised where the physiotherapist: (a) attends the patient at the commencement of the treatment and at the subsequent commencement of each new treatment; (b) is readily available for the whole of the time that the assistant is working with the patient; (c) is available to take appropriate action in the case of an emergency; (d) determines all of the appropriate treatment to be provided by the assisting person; and (e) can satisfactorily prove that they monitor the services of the unqualified staff.

Prior to commencing classes, prospective patients are interviewed by the entity (a registered physiotherapist) to determine whether the classes are appropriate for that individual. The entity is always present during the class to modify the exercises for patients with special needs and to help the physiotherapy assistant in the case of an emergency. The general structure of the class is designed by the entity, and although the physiotherapy assistant may modify the class to cater for the special needs of the patients, the entity is always on hand to assist with this. From these factors, it is considered that the entity can satisfactorily prove that it monitors the services of the physiotherapy assistant. Therefore, requirements (a) to (e) above are satisfied.

As such, the antenatal exercise classes conducted by the physiotherapy assistant are directly supervised by the entity, a registered physiotherapist and recognised professional. Therefore, the class is provided by a recognised professional as per the second requirement in subsection 38-10(1) of the GST Act.

The third requirement is that the supply be generally accepted in the physiotherapy profession as being necessary for the appropriate treatment of the recipient of the supply.

'Appropriate treatment' is established where an entity assesses the recipient's state of health and determines a process to pursue, in an attempt to preserve, restore, or improve the physical or psychological wellbeing of that recipient to the extent that their training allows. Appropriate treatment includes the principles of preventative medicine.

Classes for antenatal women are considered to be 'appropriate treatment' where they are designed to prepare a woman for childbirth. To satisfy this requirement, the classes must be more than just aerobic type exercise classes. The classes must also focus on problems associated with being pregnant, and must help prepare the muscles required during childbirth.

The entity supplies a physiotherapy service in the form of an antenatal exercise class. The entity conducts a preliminary interview with the patient to assess the patient's needs and to determine whether the class is suitable for that individual. Furthermore, the entity's class assists the patient to alleviate pain, treats other pregnancy related problems, and prepares the patient for childbirth by strengthening particular muscle groups (especially those in the pelvic region). The class therefore provides more than an aerobic workout to the patient. As such, the entity is supplying 'appropriate treatment' to the patient. Therefore, provided that this appropriate treatment is generally accepted in the physiotherapy profession as being necessary for the recipient of the supply, the third requirement in subsection 38-10(1) of the GST Act is satisfied.

The first 2 requirements in subsection 38-10(1) of the GST Act are satisfied, and the postnatal exercise class is considered to be 'appropriate treatment' as per the third requirement. Where the supply is generally accepted in the physiotherapy profession as being necessary for the appropriate treatment of the recipient of the supply, the third requirement in subsection 38-10(1) of the GST Act is also satisfied.

As such, the entity is making a GST-free supply under subsection 38-10 of the GST Act when it supplies an antenatal exercise class that is run by a physiotherapy assistant, but is directly supervised by the entity; provided that the class is generally accepted in the physiotherapy profession as being necessary for the appropriate treatment of the recipient of the supply. History note: The last paragraph of this ATO ID was replaced on 2 October 2002. The original paragraph follows. "Act when it supplies an antenatal exercise class that is run by a physiotherapy assistant, but is directly supervised by the entity, provided that the class is generally accepted in the physiotherapy profession as being Accordingly, the entity is making a GST-free supply under subsection 38-10(1) of the GST necessary for the appropriate treatment of the recipient of the supply."