Retrospective Funding
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Your relative may be entitled to a reimbursement of care fees—whether paid in full or as a partial contribution—for any Previously Unassessed Period of Care (PUPoC).
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Eligibility Criteria
Retrospective CHC funding applies when there is evidence that an individual should have been assessed for CHC during a past care period but was not. Key criteria include: • No CHC eligibility assessment was carried out during the relevant period. • The individual personally funded care either fully or partially during that time. • Evidence suggests the individual should have been considered for CHC funding. Under Department of Health and Social Care (DHSC) guidelines, retrospective applications for PUPoC assessments can be made for care periods dating back to 1 April 2012. Application Process A PUPoC request is initiated by submitting an Appendix 1 form to the relevant Integrated Care Board (ICB). The Appendix 1 form is a standardised document used to provide key details about the care period in question, including the individual’s medical history, care needs, and financial contributions. This form is essential for requesting a retrospective review and should be completed as thoroughly as possible to strengthen the case. Once submitted, the ICB will: 1. Conduct preliminary checks to confirm eligibility for a retrospective review, ensuring that the claim does not cover periods previously assessed or where CHC was appropriately declined. 2. Confirm the applicant’s authority (e.g., Lasting Power of Attorney or executor status) and require proof of care fees paid. Key Considerations • PUPoC assessments are paper-based, meaning applicants or representatives do not attend meetings. • An NHS nurse assessor will compile a Needs Portrayal Document (NPD), summarising the individual’s care needs over the review period based on medical and care records. • Applicants have the right to review and comment on the draft NPD, as well as submit additional evidence to strengthen their case. Assessment Stages 1. Checklist Assessment – Determines whether a full CHC assessment is necessary. If the claim spans several years, periodic Checklist assessments will account for changes in care needs over time. 2. Needs Portrayal Document (NPD) – Collates medical and care evidence chronologically, aligning it with CHC eligibility domains. Applicants can provide feedback on the NPD. 3. Decision Support Tool (DST) – A closed multidisciplinary team assesses the NPD and supporting evidence to determine retrospective CHC eligibility. Timeframes ICBs are expected to complete PUPoC reviews within the following timeframes: • Up to 1 year of care to review – 6 months from receiving a complete application and consent forms. • Over 1 year of care to review – 12 months, except in exceptional circumstances. Throughout the process, ICBs should provide clear communication and regular updates to applicants. ARROW Continuing Healthcare Consultants ensure that individuals and families have the best possible chance of securing rightful reimbursement for past care periods where CHC funding should have applied. Contact us for more information: |
