Retrospective Funding
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).
Eligibility Criteria
Eligibility for retrospective NHS Continuing Healthcare (CHC) funding applies where there is evidence that an individual should have been assessed for CHC during a past care period but was not. The key criteria include:
The Department of Health and Social Care (DHSC) guidelines allow retrospective applications for PUPoC assessments dating back to 1 April 2012.
Application Process
When a PUPoC request is submitted, the relevant Integrated Care Board (ICB) will:
Key Considerations
Assessment Stages
1. Checklist Assessment: Determines if 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 and aligns it with CHC eligibility domains. The applicant is invited to 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 reasonable 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.
Clear communication and regular updates from the ICB will keep applicants informed throughout the process.
By navigating these detailed steps, ARROW ensures that individuals have the best chance of securing reimbursement for past care periods where CHC funding should have applied.
Click on the button below to find out more about how ARROW can help with retrospective funding:
Eligibility for retrospective NHS Continuing Healthcare (CHC) funding applies where there is evidence that an individual should have been assessed for CHC during a past care period but was not. The 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 period.
- Evidence exists suggesting the individual should have been considered for CHC funding.
The Department of Health and Social Care (DHSC) guidelines allow retrospective applications for PUPoC assessments dating back to 1 April 2012.
Application Process
When a PUPoC request is submitted, the relevant Integrated Care Board (ICB) will:
- Conduct preliminary checks to confirm eligibility for a retrospective review. This includes ensuring the claim does not cover previously assessed periods of care or situations where CHC was declined based on a sound assessment.
- 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, and applicants or representatives do not attend meetings.
- An NHS nurse assessor will compile a Needs Portrayal Document (NPD) based on health and care records, summarising the patient’s needs during the review period. Applicants can review and comment on the draft NPD and provide additional evidence or written submissions to strengthen their case.
Assessment Stages
1. Checklist Assessment: Determines if 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 and aligns it with CHC eligibility domains. The applicant is invited to 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 reasonable 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.
Clear communication and regular updates from the ICB will keep applicants informed throughout the process.
By navigating these detailed steps, ARROW ensures that individuals have the best chance of securing reimbursement for past care periods where CHC funding should have applied.
Click on the button below to find out more about how ARROW can help with retrospective funding:
