Repeat Continuing Healthcare assessment: What happens when a CCG says it’s going to replace one assessment with another?
Let’s look at the following two scenarios – one of which involves a repeat Continuing Healthcare assessment:
Your relative has had a Checklist assessment for NHS Continuing Healthcare and is waiting for a full Multidisciplinary Team (MDT) assessment.
The MDT assessment takes place, a Decision Support Tool document is completed and the CCG decides that your relative is eligible for NHS Continuing Healthcare funding. This funding is then backdated to day 29 after the original Checklist document was received by the CCG.
This backdating point is vital to note, especially if the CCG has taken months and months to complete the assessment process.
Let’s now look at scenario 2:
Your relative has had a Checklist assessment for NHS Continuing Healthcare and is waiting for a full Multidisciplinary Team (MDT) assessment – just like in scenario 1.
The MDT assessment takes place, a Decision Support Tool document is completed – but then the CCG decides that your relative is not eligible for NHS Continuing Healthcare funding. You decide to appeal.
At some point after this, and during the appeal process, the CCG might say that it needs to do a repeat Checklist, i.e. a repeat Continuing Healthcare assessment.
This is when alarm bells should start ringing. Why? Because if a new Checklist is carried out, the CCG might try to backdate any subsequent funding only as far back as this new Checklist – instead of back to the original one.
In such a scenario, make sure the CCG knows you expect any subsequent Continuing Healthcare funding to be backdated correctly. i.e. to day 29 after the original Checklist was received by the CCG.
So there are 2 vital points here about repeat Continuing Healthcare assessments:
1. Where repeat assessments are carried out as part of an ongoing process prior to the final funding decision, the backdating of any subsequent Continuing Healthcare funding must be based on the original Checklist.
2. A similar principle applies if the CCG suggests repeating the DST/MDT during an ongoing process. If the original DST was flawed and incorrectly completed or ignored evidence, you may wat the CCG to repeat it. However, if the original DST showed you had a strong case for funding, it could be that the CCG, in suggesting a new one, is trying to reach a point where they can deny you funding by creating a weaker DST.
Note: If your relative’s needs actually decrease at some point during the appeal process, this does not make the original Checklist and Decision Support Tool invalid. They are still absolutely valid for the appeal process, as they reflect your relative’s needs and risks at the time they were drawn up.
Equally, just because your relative’ needs may have lessened some way into the appeal process, doesn’t mean they may not have been eligible for Continuing Healthcare when the original assessment(s)s were carried out.
While you are going through an appeal, you can also request a brand new Checklist – as part of a brand new process – if your relative has deteriorated in the meantime.
If you’ve come up against any of these issues, feel free to share your experience in the comments below.