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LONG STAY CHARGES Mr. Seamus Mc. Nulty Assistant National Director, Primary Community & Continuing Care Services, West Health Service Executive
Long Stay Charges • • • Background Illegal charges by former Health Boards Suspended December 2004 New legislation unconstitutional Health Amendment Act 2005 Regulation (Statutory Instrument) Guidelines
PURPOSE OF GUIDELINES CLARITY CONSISTENCY EQUITY TRAINING
Long Stay Charges Legal Provisions – Section 53(2)(a) of the Health Act 1970 as amended by the Health (Amendment) Act 2005 – Health (Charges for In-Patient Services) Regulations 2005 S. I. No 276 of 2005 These regulations provided that charges may be levied with effect from 14 th July 2005, on persons who are in receipt of in-patient services in premises where nursing care is provided on a 24 hours basis, and in premises where nursing care is not provided on a 24 hour basis.
Long Stay Charges Background Class 1; refers to people in receipt of in-patient services on premises where nursing care is provided on a 24 hour basis on those premises. In this case, a weekly charge of € 120 can be levied or the total weekly income of that person less € 35, whichever is the lesser. Class 2; refers to people in receipt of in-patient services on premises where nursing care is not provided on a 24 hours basis on those premises. In this situation, a weekly charge of € 90 can be levied, the total weekly income of that person less € 55 or 60% of the weekly income of that person, whichever is the lesser
Long Stay Charges Background Long Stay Charges National Guidelines Expert Group • Established by Health Service Executive on 13 th July 2005 to develop National Guidelines to deal with the provision of this Act and the Regulations Terms of Reference • Phase 1: to develop guidelines within a two week period, sufficient to meet the immediate requirements of the delivery system in implementing the regulations from the 14 th of July 2005. These initial guidelines will support the establishment of a standardised approach across the delivery system in the assessment of charges to apply in each individual case. • Phase 2: to develop a more comprehensive set of guidelines in line with best practice, having considered legal opinion and its implications in relation to complex cases. Provision will also need to be made for appeals.
CHARGES CLASS 1 24 HOUR NURSING CARE. € 120. 00 (maximum) CLASS 2 LESS THAN 24 HOUR NURSING CARE. € 90. 00 (maximum)
Nursing Care • Nursing care means, care provided by a fully qualified and state registered nurse. It does not mean care provided by a nurse’s aide, care assistant or house parent. • Class 1: - Nursing care on those premises means that there is a nurse physically present on a permanent basis, i. e. 24 hours basis, all day, every day. • Class 2: - Nursing care on these premises means that there is a nurse rostered for duty for less than 24 hours a day. • If a nurse is not rostered for duty, the regulations do not apply.
Complexity • While legal opinion was sought, there was often no simple yes/no answer • Other legislation needed to be reviewed in light of practical implementation issues • Areas identified where further legislation and/or HSE policy decisions have been identified as being required • Implementation Group Informed
Legal Opinion • Is nursing care a pre-condition to the right to charge under the regulations? Ø “On balance, the regulations did not envisage the imposition of charges where no nursing care was provided”
Legal Opinion • Sections 38 & 39 of the Health Act, 2004 Ø Section 38 (formerly section 26 of the 1970 Health Act) – services provided on behalf of the HSE – charges should be imposed Ø Section 39 (formerly Section 65 of the 1970 Health Act)– services assisted by the HSE – not covered by a legislative basis for the imposition of charges
Legal Opinion • “The Health Acts have consistently recognised that services to be provided by health boards/HSE may be provided by other bodies” • “If such bodies are providing services on behalf of HSE, they cannot impose charges for that service if the HSE could not impose charges (Section 38)” • “If they are not providing services on behalf of HSE, they are entitled to impose such charges as they see fit (Section 39)” • “Voluntary Agencies are free to impose whatever charges they wish unless they are carrying out functions for and on behalf of HSE”
The Regulations • The regulations provide the statutory basis for the imposition of charges for persons in receipt of inpatient services whether or not such persons have full or limited eligibility. The regulations provide for two different classes of person on whom charges can be levied and the maximum charge which can be imposed in respect of each class
Class 1 • Class 1 refers to people in receipt of inpatient services on premises where nursing care is provided on a 24 hour basis on those premises. In this case, a weekly charge of € 120 can be levied or the total weekly income of that person less € 35, whichever is the lesser
Class 2 • Class 2 refers to people in receipt of inpatient services on premises where nursing care is not provided on a 24 hour basis on those premises. In this situation, a weekly charge of € 90 can be levied, the total weekly income of that person less € 55 or 60% of the weekly income of that person, whichever is the lesser.
CHARGES CHARGE AFTER 30 DAYS CANNOT EXCEED 80% OF NCOAP
EXEMPTIONS UNDER 18 YEARS MOTHERHOOD INVOLUNTARY DETENTION ACUTE CARE HEPATITIS C
REDUCTION / WAIVERING OF CHARGES • IMPORTANT NOTES: Ø Each case is unique and the following list is a guide for operational use Ø Each set of individual circumstances must be reviewed to determine what reductions/waiver are appropriate Ø Documentary evidence should be sought Ø Importance of Discretionary power – there may not be “one right answer” for all circumstances
Community Type Residences (All Care Groups) • Individuals living in community type residences where there is nursing care provided are liable for in-patient charges • Community Type Residences include mental health/disability hostels • Residents of these hostels live largely independent lifestyles • Objective of realising their maximum potential to integrate with the local community
Community Type Residences (All Care Groups) • Additional expenses incurred as a result of this independent lifestyle • Socialisation/Care Plan Expenses allowable up to € 90 per week • Socialisation/Care Plan Expenses relates to additional expenses incurred as a result of greater independence and integration into the community. • Contribution to Weekly Running Costs (max. € 60 p. w. ) includes outgoings such as food, heat, light, refuse charges etc. In some cases, this contribution may be paid through a kitty system or directly to service provider
Total Weekly Income • Includes income such as Social Welfare Payments, Occupational Pension, Overseas Pension, Salary, Income from Property and Rent and Income from Savings and Investments • Earnings from employment of a rehabilitative nature, up to a maximum of € 120. 00 per week, should be disregarded for the purpose of assessment • Any monies received by way of Training Allowance from an Organisation while undergoing a course of rehabilitation training should be disregarded for the purpose of assessment
APPEALS • In cases where the patient/client or their next of kin as appropriate, are dissatisfied with the decision regarding the amount of the charge, they may appeal the decision to the relevant HSE Appeals Officer. The patient/client or the next of kin where appropriate, should be advised of the appeals process on being notified of the charge.
Questions & Answers