The guidance applies to time limits starting from 1 April 2012 for individuals or their families and representatives to request a review of an eligibility decision for NHS continuing healthcare funding by the local Clinical Commissioning Group (CCG) or responsible NHS body at a local level. The Regulations the Act set out the Standing Rules to be followed when determining eligibility for NHS Continuing Healthcare and NHS Funded Nursing care (FNC), and this process is designed to set out a clear pathway as to how individuals, or their representative, may challenge eligibility for CHC. This procedure refers to a challenge made by an individual or representative following an assessment of eligibility for NHS CHC as an appeal, whereas the Standing Rules use the term for the same ‘review’ situation. Therefore when this document refers to an this equates to ‘appeal’ a of a decision’ regarding CHC eligibility made by a CCG. ‘review 1.2 This procedure is not for use where disputes arise between public bodies as to funding responsibilities or disagreement regarding a recommendation for funding made by the multi-disciplinary team (MDT). The procedure applies exclusively to patients registered with a Sheffield GP or any other patient for whom Sheffield CCG is the Responsible Commissioner, as defined by the Department of Health. 1.3 This procedure only applies to periods of care where eligibility for funding has been assessed. It does not apply to periods of unassessed care. 1.4 The Department of Health has set a time limit of 3 months for responsible CCGs to conduct an investigation and bring an appeal to its conclusion. 2.0 The Role of the Appeals Nurse’s 2.1 This Procedure sets out the procedure to be followed by the appeals to determine whether an individual’s case is appropriate for consideration under the appeal procedures, in order to assess whether that individual has been wrongly denied NHS funding. 2.2 This procedure aims to: Adhere to the Standing Rules for Continuing Healthcare Provide transparency throughout the appeal process
The guidance applies to time limits starting from 1 April 2012 for individuals or their families and representatives to request a review of an eligibility decision for NHS continuing healthcare funding by the local Clinical Commissioning Group (CCG) or responsible NHS body at a local level. The Regulations the Act set out the Standing Rules to be followed when determining eligibility for NHS Continuing Healthcare and NHS Funded Nursing care (FNC), and this process is designed to set out a clear pathway as to how individuals, or their representative, may challenge eligibility for CHC. This procedure refers to a challenge made by an individual or representative following an assessment of eligibility for NHS CHC as an appeal, whereas the Standing Rules use the term ‘review’ for the same situation. Therefore when this document refers to an ‘appeal’ this equates to a ‘review of a decision’ regarding CHC eligibility made by a CCG. 1.2 This procedure is not for use where disputes arise between public bodies as to funding responsibilities or disagreement regarding a recommendation for funding made by the multi-disciplinary team (MDT). The procedure applies exclusively to patients registered with a Sheffield GP or any other patient for whom Sheffield CCG is the Responsible Commissioner, as defined by the Department of Health. 1.3 This procedure only applies to periods of care where eligibility for funding has been assessed. It does not apply to periods of unassessed care. 1.4 The Department of Health has set a time limit of 3 months for responsible CCGs to conduct an investigation and bring an appeal to its conclusion. 2.0 The Role of the Appeals Nurse’s 2.1 This Procedure sets out the procedure to be followed by the appeals to determine whether an individual’s case is appropriate for consideration under the appeal procedures, in order to assess whether that individual has been wrongly denied NHS funding. 2.2 This procedure aims to: Adhere to the Standing Rules for Continuing Healthcare Provide transparency throughout the appeal process