New guidance on previously unassessed periods of care for NHS continuing healthcare claims

Just before Christmas the Department of Health and Social Care published new guidance for both NHS Integrated Care Boards (ICBs) and individuals on the process for managing previously unassessed periods of care (PUPoC ) for NHS continuing healthcare (CHC) claims.

As readers will know, ICBs are responsible for the operational delivery of NHS CHC and must have regard to the National Framework for NHS continuing healthcare and NHS funded nursing care, with NHS England having oversight of its delivery.

A CHC PUPoC refers to a specific request to consider eligibility for a past period of CHC where:

  • there was no consideration of NHS CHC eligibility by the ICB for that individual
  • the individual had funded that past period of care in full or part
  • there is appropriate, objective evidence that the individual should have been considered for eligibility for NHS CHC

Further guidance on identifying appropriate PUPoC requests, including details on complex scenarios, is set out in the section headed: ‘Identifying an appropriate request’.

It is important to note that this guidance generally only relates to requests for assessment of PUPoC for care provided after 1 April 2012.  However, ICBs should consider whether there are exceptional circumstances that mean consideration should be given to requests covering periods prior to this – it is expected that these will be rare.

In this context, care can be provided in a variety of settings outside of hospital including an individual’s home or a care home.

ICBs are required to consider all ‘appropriate’ requests for PUPoCs and deal with them in a timely manner (within six months where the period of care was less than one year but with a 12 month long stop date if the period of care exceeds one year ) subject to first establishing whether they are the responsible commissioner.

ICBs will need to ensure that they are person-focused and seek to ensure people get certainty around assessment and eligibility for previously unassessed periods of care. The latest guidance has been developed using feedback from organisations with expertise of NHS CHC policy and implementation and individuals who have experience of applying for NHS CHC. The previous guidance issued in 2012 on PUPoC resulted in 63,000 requests to review unassessed periods of care. ICBs will need to assure themselves that they have sufficient capability to successfully meet their obligations set out in the guidance.

Do get in touch if your ICB would like support with managing your CHC PUPoC processes and or your CHC care packages – you can read our earlier blog on five top tips for managing your CHC spend here.

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