Every week we hear from families who have succeeded in securing a positive Continuing Healthcare funding recommendation
The process for funding assessments and appeals can be lengthy and tortuous, but once you have got a positive recommendation, what happens next?
10 things to check after a positive Continuing Healthcare funding recommendation:
1. Make sure you get the decision in writing from the Clinical Commissioning Group (CCG), together with a copy of the full Decision Support Tool (DST). Remember that the CCG should only overturn the recommendation in exceptional circumstances.
2. Make sure there is no request for top up fees. These apply to local authority funding only. NHS Continuing Healthcare is NHS funding; local authority and NHS funding are two separate things.
3. Check that the care home or care provider is aware of the positive funding decision.
4. Make sure payment dates back to day 29 after the original Checklist was received. (See National Framework page 133, paragraph 9.) This may be quite some time ago if the assessment and/or appeal process has dragged on.
5. If yours is a retrospective claim, make sure you have agreement for care fees to be refunded for the whole period of your agreed claim.
6. Contact the CCG in writing to confirm that you expect care fees to be repaid immediately (with interest) and, if relevant, ongoing fees to be paid to the care provider or care home with immediate effect.
7. If your case is for ongoing funding, do not pay a penny more in care fees after you receive the funding decision.
8. Refuse any requests by the care provider or care home for additional payments; NHS Continuing Healthcare should cover ALL assessed care needs, and the NHS is legally responsible for that.
9. Communication between people within the care system itself is often less than ideal, so it’s a good idea to also let the local authority know you have secured NHS Continuing Healthcare funding.
10. Even though you have a positive outcome, if there are details in the DST notes that you disagree with, it’s a good idea to pull together a summary of everything you disagree with and/or anything that is missing or misleading, because that DST may be referred to again in future reviews.
What’s your family’s experience after securing an NHS Continuing Healthcare funding recommendation?