The retrospective process initially involves the collecting of information by completion of a questionnaire and consent; this will include obtaining confirmation of authority to act on behalf of the individual evidenced by production of a Power of Attorney or Grant of Probate or will detailing the executors of an estate if the individual is deceased. The CCG also required certified copies of ID to support the consent.
Once all of this information is received, the paperwork which has been submitted will be reviewed by an experienced Nurse Assessor who will complete a screening process. This will look at the initial evidence to consider whether a full assessment for NHS CHC is necessary. We will normally write to the applicant following this initial screening to advise of the next stage in the claim process.
If an individual is still alive, the initial screening may highlight that a current assessment of needs is required, this will be arranged, and the individual’s representative will be invited to attend. Once the outcome of any assessment is known the effect of the outcome on the retrospective request will be reviewed and the team will contact the applicant to advise the next stage.
If on completion of the initial review, it is determined that a full assessment for NHS Continuing Healthcare is necessary, then the CCG will need to collect the relevant evidence relating to the claim period from a number of different sources. It is difficult for us to determine at this stage how long the review will take to complete as it will depend on the availability of this evidence, the length of the claim and the availability of Nurse Assessors at any given time to undertake the review itself.
All claims that have been acknowledged will be progressed and there is no need for you to chase to ensure it is progressed. All claims are being handled in chronological order of receipt of completed paperwork as this is the only fair and equitable way to proceed. The team is happy to discuss your claim with you; we must advise that we will not be able to provide timescales for progression and completion, other than to confirm that at any specific time we have received all necessary information from you for the stage at which your claim is.
Once all of the required evidence is held the case will be allocated to a Nurse Assessor who has the appropriate skills and is trained in continuing healthcare. Due to the number of claims received there may be a considerable delay between receipt of all required evidence and allocation to a Nurse Assessor. The assessor will scrutinise the evidence and compile a Needs Portrayal Document, pulling together all the relevant information from the different sources of evidence to build up a comprehensive picture of the individual’s needs across the whole time period. Once completed the assessor will share the Needs Portrayal Document with the applicant and request confirmation of the content and invite any comments the applicant wishes to add.
Once completed and returned, the information will be used to apply the eligibility criteria. If a claim period spans a number of years, then the eligibility criteria may need to be applied several times. A recommendation will be made by a multi-disciplinary team (MDT) to the CCG, as to whether the patient has a primary health need during the period under review.
If the CCG decide that the individual was eligible for all, or part of the period under consideration, the CCG will make arrangements to make a restitution payment inline with the Department of Health Redress Guidance. Cambridgeshire and Peterborough CCG calculates Redress by use of Retail Price Index.
If the CCG decide that the individual was not eligible for CHC funding for all or part of the period being considered, the decision will be sent to the applicant with details of who to contact should the applicant disagree with the decision.