Time Limit for Retrospective NHS CHC Funding Claims

Author:
Hannah Morris
Care Home Chartered Legal Executive
Date:
03/06/2019

The period of time for which retrospective NHS CHC Funding review requests can be made is limited. In England, due to Department of Health deadlines, a request to review NHS CHC Funding can only currently be asked to consider back to 1st April 2012. The situation is different in Wales, where the NHS can only be asked to consider the 12 months prior to the request for review.

Given the cost of care and care home fees, reimbursement of care fees in either location can be significant. It is possible for the NHS to consider reviewing periods outside these time limits, but only where ‘exceptional circumstances’ are identified.  What would constitute this is unclear, with the majority of cases outside these claim periods simply rejected by the NHS.

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Previous CHC Funding Assessments

In addition to these limited claim periods, in most circumstances the NHS will only consider retrospective CHC Funding requests for periods of care where an individual’s eligibility for the funding hasn’t already been considered; or ‘previously unassessed’ periods of care (PUPoC).

Whilst historically the NHS would need to evidence that the previous assessments were robust, more recently they will reject a claim if there is any evidence of assessment for CHC Funding within the period requested. 

However, the exact circumstances of the case need to be considered, as procedural flaws may require the NHS to reconsider the period. These can include an incorrect CHC Funding assessment process, failure to involve representatives of the individual assessed, failure to provide the outcome of assessment and/or outline rights of appeal.

Persuading the NHS to re-open a CHC Funding claim for a past period, where it has been rejected due to previous assessment, can be a complicated process. It involves making a complaint to the NHS department responsible for the review and often escalation of that complaint to the relevant Ombudsman.

CHC Funding Appeal Deadlines

If someone is turned down for NHS CHC Funding, an appeal can be lodged against that decision. In 2012, the Department of Health announced some changes to timescales for appealing NHS CHC Funding decisions made in England. 

From 1st April 2012, people were given 6 months from the date of a decision to begin an appeal with the local Clinical Commissioning Group (CCG); which is the NHS department in England concerned with funding decisions.

In Wales the system is again slightly different. Local Health Boards are the departments responsible for NHS CHC Funding decisions. Each Local Health Board should agree a local review process, including timeframes. This should be made publicly available, as well as communicated to anyone who requests review of a decision. 

Obtaining CHC Funding on either a current or retrospective basis can be a complicated process. However, our Care Home Fees Solicitors can provide expert advice and help you navigate the procedure.

If you’d like to discuss how we may be able to help you to claim back care home fees already paid, or ongoing liability for residents still in care, please get in touch for a no obligation discussion.

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