New review timescales for Continuing Care reviews after 1st April 2012
NHS Continuing Care is NHS funding and it covers 100% of the costs of full-time care in a care home or at home.
It’s available to people who need full-time care primarily for health reasons. Sadly, many elderly people are wrongly charged care fees when they should have been receiving this NHS funding all along.
You can reclaim care fees that have been wrongly charged. HOWEVER… the Department of Health has imposed new deadlines for retrospective care fees claims in England – and it has also introduced new timescales for reviews of current Continuing Care eligibility decisions.
Current Continuing Care reviews
If you’re applying for NHS Continuing Care funding for a period of care from 1st April 2012 onwards, and you’re found to be ineligible for funding, you can ask for a review.
Follow the steps below…
If you disagree with a decision made by the local Clinical Commissioning Group (CCG) to deny Continuing Care funding:
- You have 6 months* to notify the local CCG that you disagree with their decision and that you’re requesting a review
- The CCG has 5 days to acknowledge in writing that it has received your request – and it must also provide you with information on the Continuing Care appeal process
- The local CCG must deal with your request, complete a review and make a further eligibility decision within 3 months of receiving your initial request for review. If there’s a delay, the CCG must inform you in writing explaining why. It could be because they can’t access the relevant care records in time or they can’t pull together an appropriate multi-disciplinary team to carry out the review.
If you miss the initial 6 month deadline, but you have a good reason, you may still be able to get your case reviewed, as long as it’s still possible for the CCG to access all the relevant care records, etc.
If the CCG still denies funding and you still disagree:
- You can contact NHS England and request an Independent Review Panel (IRP) hearing; you should do this within 6 months* of the CCG’s earlier decision
- The Independent Review should be conducted within 3 months – unless it’s found that the CCG’s previous assessment for Continuing Care was not done properly OR the members of the Review Panel are not available OR the Review Panel can’t get hold of the care records in time OR you request a delay yourself due to unforeseen circumstances
- You should receive the Independent Review Panel’s funding decision within 6 weeks – and the letter you receive must give you information on how to contact the Parliamentary Health Service Ombudsman if you’re still not happy
If you are still denied funding after the IRP hearing:
- You have 12 months* to contact the Parliamentary Health Service Ombudsman to take your case further.
* from the date you were notified of the decision
The CCG is responsible for informing you about the review/appeal process for Continuing Care – and it must do this at the same time as it informs you of its Continuing Care eligibility decision.
Retrospective Continuing Care reviews
The Dept of Health has also issued deadlines for retrospective Continuing Care claims in England – for periods of care from 1st April 2004 to 31st March 2012. Find out more.
Read more about NHS Continuing Care funding – it can save you losing your home to pay for care.