Draft guidance on implementing the overseas visitor charging regulations Not in force until 21 August 2017 August 2017 DH ID box Title: Draft Guidance on implementing the overseas visitor charging regulations Not in force until 21 August 2017 Author: Directorate/Division/Branch acronym/cost centre NB: Acute Care & Workforce/Provider Efficiency & Productivity/Cost Recovery Programme/13790 Document Purpose: Draft Guidance Publication date: August 2017 (draft version July 2017) Target audience: Frontline staff providing NHS-funded services Providers and commissioners of NHS-funded services Contact details: Visitor & Migrant NHS Cost Recovery Programme Richmond House 79 Whitehall London SW1A 2NS [email protected] You may re-use the text of this document (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence/ © Crown copyright 2017 Published to gov.uk, in PDF format only. www.gov.uk/dh 2 Contents Contents .................................................................................................................................... 3 Introduction ............................................................................................................................... 4 Executive summary .................................................................................................................... 7 1. Exempt services and individuals ...................................................................................... 12 2. The law in England ........................................................................................................... 16 3. Ordinary residence ........................................................................................................... 26 4. Detailed list of services which are exempt from charges ............................................... 30 5. The health surcharge: how to deal with and recognise someone who has paid or is exempt from paying ................................................................................................................ 34 6. Former UK residents, armed forces members and war pensioners ................................ 49 7. Vulnerable patients and those detained ......................................................................... 52 8. When to provide NHS treatment to those not entitled to it free of charge ................. 63 9. How to deal with those with EU rights and exemptions ................................................ 68 10. How to deal with those under reciprocal healthcare agreements and other international obligations ......................................................................................................... 80 11. Collaborative working and separation of duties: the role of staff in Cost Recovery .. 85 12. Working with the Home Office .................................................................................... 97 13. Financial and miscellaneous matters ............................................................................ 99 3 Introduction This manual of guidance supersedes and replaces all previous guidance on the implementation of the Charging Regulations. This guidance seeks to provide help and advice on the implementation of the National Health Service (Charges to Overseas Visitors) Regulations 2015, which has been amended most recently by the National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017. However, it cannot cover all circumstances and is not intended to be a substitute for the Regulations themselves, which contain the legal provisions. Relevant NHS bodies are advised to seek their own legal advice on the extent of their obligations when necessary. Not everyone is entitled to free NHS hospital treatment in England. This guidance explains what should happen when an overseas visitor needs NHS treatment provided by an NHS hospital in England. The guidance is intended for staff at relevant NHS bodies, including clinicians, senior managers and clerks, and in particular staff with a responsibility to identify and charge overseas visitors. The Department of Health strongly recommends that relevant NHS bodies have a designated person/s – hereafter referred to as an Overseas Visitor Manager (OVM) – to oversee the implementation of the Charging Regulations. All staff, including clinicians and managers, have a responsibility to ensure that the charging rules work effectively. The success of the charging rules also depends on NHS staff being aware and supportive of the role of the OVM. The OVM should be given the authority to ensure that the charging rules can be properly implemented in all departments. Main amendments made to Guidance since Charging Regulations came into force in 2015: Date updated Summary of Change Reference (para) From 23 October A requirement on all providers of NHS- 8.13 2017 funded secondary care to, where no 11.3 exemption applies, recover an estimate of the charges in advance unless doing so 11.4 would prevent or delay the provision of immediately necessary or urgent services From 23 October A requirement on all providers of NHS- Exec summary 14, 2017 funded secondary care, including non-NHS 2.17 organisations to make and recover charges from overseas visitors where relevant services have been provided to them and no exemption applies From 23 October Introducing an exemption from charges for 4.3 2017 palliative care services that are provided by a registered charity or community interest company 4 21 August 2017 Amendment to the following exemption from 5.44 charge categories: immigration health surcharge and transitional arrangements in respect of the surcharge so that the exemption from charge does not apply in respect of assisted conception services 21 August 2017 A requirement on NHS trusts and foundation 11.43 trusts to record when a person is an overseas visitor on that persons ‘consistent identifier’ (i.e. against their NHS number) 21 August 2017 Addition of reciprocal healthcare agreements 2.22 to the list of those exemption categories that, should they cease to apply to a person, they will also cease to apply in respect of any on- going course of treatment the person is having 21 August 2017 Clarification of the exemption in relation to 1.2, 2.26, 2.29 the dependents of refugees, asylum seekers and some supported failed asylum seekers 21 August 2017 Removal of the exemption for relevant 11.56 services provided outside a hospital or by its staff 21 August 2017 Addition of services that are provided as part 4.3 of the NHS111 telephone advice line to the list of services for which no charge is to be made 21 August 2017 Removal of the exemption for workers on n/a UK-registered ships (although the shipowner is liable) 1 October 2016 Removal of the reciprocal healthcare 10.7 agreement with Barbados February 2016 Changes in relation to victims of female 2.29, 7.10-7.16 genital mutilation (FGM) February 2016 Modification of the exemption for victims and 7.50- 7.59 suspected victims of human trafficking to include victims and suspected victims of modern slavery February 2016 Changes to the exemption for failed asylum 7.37-7.45 seekers supported by Local Authorities 5 February 2016 Addition of Middle East Respiratory 4.3 Syndrome (MERS) to list of exempt diseases January 2016 Removal of certain reciprocal healthcare no reference? agreements (some former U.S.S.R countries) Frequently used abbreviations A1 – the portable form issued to a posted worker confirming cover by the issuing state. The A1 accompanies a valid European Health Insurance Card for qualifying posted workers. Charging Regulations – means the National Health Service (Charges to Overseas Visitors) Regulations 2015, the National Health Services (Charges to Overseas Visitors) (Amendment) Regulations 2015 and the National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017. EEA resident – refers to visitors and migrants who reside in any countries which are in the European Economic Area. A summary of these countries can be found in Chapter 9. Throughout this guidance, reference to EEA states or EEA nationals or residents should be understood to include a reference to Switzerland or Swiss residents as appropriate, except in relation to the operation of the Cross-border Healthcare Directive (discussed in Chapter 9) which does not apply to Switzerland. EHIC – the European Health Insurance Card (previously E111). Non-EEA resident – refers to visitors and migrants who reside in any countries which are outside the European Economic Area. PRC – Provisional Replacement Certificate, issued to eligible EEA residents in cases where an EHIC cannot be produced. S1 – issued to pensioners, posted or frontier workers, and their family members, (previously E121, E109, E106). The term ‘pensioner’ includes those in receipt of a qualifying long-term benefit. If an original form is presented to an OVM, this should be sent to the Overseas Healthcare Team in Newcastle for registration (the holder may also have a copy for personal use). S2 – payment guarantee from the issuing country for planned treatment (previously E112). 6 Executive summary 1. The National Health Service (Charges to Overseas Visitors) Regulations 2015 (the Charging Regulations) came into force on 6 April 2015 and apply to all courses of treatment commenced on or after that date. The Regulations have subsequently been amended, most recently on 21 August