NEW edition of Who Pays? published: clarity on commissioning and payment for out of area placements - or not?

So, as promised in our article, this blog sets out our thoughts on section 14 of Who Pays? This covers the exception to the general commissioning responsibility rules relating to out of area placements of adults for continuing care. 

As readers will know this is an area that, historically, has caused much head scratching when the history and factual details of who placed where have become a little sketchy..

Summary 

• From 1 September 2020, new packages of care will be funded by the NHS for up to six weeks following discharge from hospital. From 1 September 2020 responsibility for funding this will operate on a ‘placing CCG pays’ approach.
• The exceptions set out in section 14 of the guidance relate to ‘continuing care’. This includes NHS Continuing Healthcare and packages of care arranged jointly by a CCG and a local authority.
• The usual way to establish the responsible commissioner is set out at paragraph 10.2 of the guidance (starting with GP registration).
• Paragraph 14 relates to the exception where a responsible CCG arranges (by itself or jointly with a LA) a residential continuing care placement outside the CCG’s geographical area for individuals who have been assessed as needing continuing care. This CCG becomes the ‘placing CCG’. If the placing CCG arranges accommodation in a care home or independent hospital outside their geographical area and at least one planned healthcare service (other than Funded Nursing Care) connected with the provision of that accommodation is arranged, then the placing CCG retains commissioning responsibility for that person. Nothing new here.
• This responsibility remains as long as the person remains resident and requires services in the same physical location or another physical location. The responsibility relates to the accommodation and planned services and not other NHS services, where the usual rules apply and the CCG where the person is registered with a GP will be responsible for those costs.
• The exception does not apply to an individual in their own home or in supported living settings. If such an individual moves house, then commissioning responsibility transfers to the new CCG from the date of re-registration with the new GP. This is in contrast to the scenario provided in the guidance where a patient/family ask for a transfer to be closer to where the family lives. In this scenario, the CCG who arranges the new care home remains the responsible CCG (See 14.14 Scenario 3)
• In most situations, the CCG who has responsibility for commissioning services will also have a responsibility to pay for those services. So a CCG placing an individual for continuing care will be financially liable even if that person registers with a GP in another CCGs area. However, you can’t have a rule without an exception! Where a patient is discharged from hospital, the CCG who will pay for the six week initial short term placement will be the CCG responsible for the hospital stay, even where an individual is discharged to an out of area placement and registers with a GP belonging to a different CCG. The same principle applies where the hospital spell has been commissioned and paid for by NHS England. The reason for this is to avoid a ‘perverse incentive’ for CCGs to arrange an out of area placement to transfer liability for funding for the short and long term residential placement.
• A point of clarification, rather than exception relating to funding, is where patients in the community are referred for a CHC assessment but change GP or their address while the assessment is ongoing. In these cases, the responsibility for paying for continuing care will be based on GP registration at the point at which the referral was received by any CCG and then determined in accordance with the rules in 10.2 (GP registration, then residence and so on).
• Finally, there are transitional arrangements outlined at 14.33- 14.40. For existing patients who were in receipt of CHC prior to 19 March 2020 and for new patients from 1 September 2020, the arrangements are as above. For the great number of individuals that fit between these two dates CCGs must work with their partner LAs and identify which individuals need a review, which CCG is responsible for the assessment and then make arrangements for that assessment. It is therefore vital for CCGs to be able to identify their “own” patients. The backlog must be cleared by 31 December 2020. A lot of work for already pushed CCGs in the next 3 months…

I think we are all glad that this updated Guidance is now here; the scenarios are helpful and provide much needed clarity. However, as with all guidance of this nature, the proof of success will come with practical application over the next few months…years!

In the meantime, do let us know how you get on applying the revised guidance.

Katrina McCrory and Jill Weston