You may be looking to find information on appealing a CHC funding decision. This article looks into this subject and explores the various options available to you and continues our 27 top tips on NHS Continuing Healthcare. Here’s Tip no. 21…
Following an MDT, a recommendation will be made to the Clinical Commissioning Group with regard to eligibility for funding and the panel will decide whether to adopt that recommendation.
Once a decision has been reached this should be communicated in writing to the patient or to the family member with Lasting Power of Attorney and you should be given 6 months in which to appeal that decision.
We are coming across an increasing number of cases where letters are sent out from the CCG advising that any comments should be submitted within 28 days. This is wrong and unenforceable. It serves no purpose other than to pressurise family members to rush to reply without having an opportunity to consider the evidence and will possibly lead to the wrong decisions being made. Do not make this mistake.
The best thing to do is to seek independent advice about the likelihood of successfully overturning the decision and advise the CCG that you are doing so and that you will revert to them within 6 months.
This will then allow you the time to consider your options and if necessary instruct some professional support. Alternatively, obtain the records from the care home and GP yourself and carry out a thorough review with the assistance of someone with clinical expertise and make sure that your appeal submissions cover every detail and address every issue raised in the Decision Support Tool which you believe are capable of being challenged – it is important to make sure that all of your arguments are supported by evidence from the care records!
Remember that there are two possible stages for the appeal so if you fail at local level there is still the option to appeal to Independent Review Panel with NHS England. Again you are allowed 6 months from the communication of a negative decision to lodge your appeal with them. This is effectively your last chance so make sure that all evidence is included in your arguments and if you have not already done so consider seeking professional advice at this stage.
- Time for lodging appeals is 6 months and not 28 days or any other period
- Make sure that you gather all necessary evidence including a copy of the DST which is not always sent out – if not request it from the CCG.
- Back up your arguments with evidence from the records and ensure that your written appeal submission covers everything you want to say.
- Don’t forget that there are 2 stages of appeal
- Consider using professional help with all stages of appeal.
Tip no. 22: Are You Paying Top-Up Fees Unnecessarily?