Policy for Identification and Charging of Overseas Visitors Policy No. MR12 Sharepoint Location Non-clinical Policies and Guidelines Sharepoint Index Directory 4.0 Information Management Sub Area Key words (for search purposes) 4.1 Health Records health, records, identification, overseas, visitor Central Index No 5060 Endorsing Body Clinical Governance Committee Endorsement Date September 2009 Review Date September 2011 Lead author and designation Diane English, Health Records & Patient Services Manager KEY POINTS: This policy Applies to the whole Trust. Sets out agreed best practice and guidelines set out by the DoH. Outlines the process that all procedures must go through for the identification and charging of overseas visitors. Confirms the DoH process for all overseas visitors. Has implications for the Trust, clinical and administrative staff responsible for the capturing and charging of overseas visitors.
Document Review History Review Date Action Taken 27/03/2009 Inclusion on new DoH guidance (Ref 11542) Changes to the Policy regarding termination of Bilateral Healthcare Agreement with the Channel Islands 02/04/2009 Inclusion on new DoH guidance (Ref 11628) Changes to the Policy regarding Failed Asylum Seekers and Ordinary / Lawful Residents. When to provide treatment for those who are chargeable. 11/06/2009 Inclusion on new DoH guidance Changes to the Policy regarding Pandemic Status all diagnosis free of charge which came into effect on 11 th June 2009. 12/06/2009 Inclusion on new DoH guidance Changes to the Policy regarding the reinstatement of Reciprocal Agreement with Belarus. 27/08/2009 Inclusion on new DoH guidance (Ref 12322) Changes to recording and reporting data about necessary planned treatment of Overseas Visitors which comes into effect from the 12 th October 2009 Reviewed and Approved By Diane English (Author) and Overseas Visitors Committee and Trust OSV Lead. Diane English (Author) and Overseas Visitors Committee and Trust OSV Lead. Diane English (Author) and Overseas Visitors Committee and Trust OSV Lead. Diane English (Author) and Overseas Visitors Committee and Trust OSV Lead. Diane English (Author) and Overseas Visitors Committee and Trust OSV Lead. Clinical Governance Committee Signature Endorsed by Endorsed by Endorsement Procedure Trust Executive (TX) Clinical Management Board (CMB) Trust OSV Lead (Medical Director) Overseas Visitors Committee Date: November 2007 Date: November 2007 Date: 11/09/2009 Endorsed by Clinical Governance Committee Date: October 2009 K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 2
Health Records & Patient Services Identification of Overseas Visitors Policy INDEX SECTION Introduction 5 Law 5 Trust Responsibilities 6 Identification of Patients - questions by the Frontline Staff 6 Stage 1 and Stage 2 Overseas Visitors Officers 6 7 The Two Stage 1 Questions 7 Acceptable Evidence 7 Charges Deposits and Undertaking to Pay 7 8 Immediate Necessary Treatment / Urgent Treatment Definitions 8 Countries which have Reciprocal Agreements 8-10 British Nationals who have paid Taxes in the past 10 Accident & Emergency Department 10 Road Traffic Accidents / Criminal Injuries 10 Ward Attenders & Direct Access 10 Prisoners 10 Repatriation to the Overseas Visitors Home Country 11 Asylum Seekers and Refugees 11 Maternity Patients 11 Newborns 11 Children 11 Members of Her Majesty s Service 11 Sexual Health Patients 12 Pandemic Status 12 Interpreting and Translation Services 12 Patient Administration System (PAS) 12 Identification Labels for Casenotes 13 Confidentiality 13 Reporting 13 Auditing 13 Further Information 14 Appendices Appendix 1 - Stage 1 Overseas Visitors Form Appendix 2 - Guidance Leaflet for Patients Appendix 3 - Guidance Poster for Patients Appendix 4 - Information Sheet A&E Patients Appendix 5 - Procedure for Wards / Nursing / Clerical Staff Appendix 6 - Procedure for OPD Clinic Staff Appendix 7 - Guidance for Financial Recovery Appendix 8 - Guidance for Clinicians K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 3
Health Records & Patient Services Identification of Overseas Visitors Policy 1. Introduction 1.1 An Overseas visitor is someone who is not ordinarily a resident in the UK. Ordinarily resident is a common law concept interpreted by the House of Lords as someone who is living lawfully in the United Kingdom voluntarily and for settled purposes. Under regulations which first came into effect on 1 st October 1982, visitors to the United Kingdom (UK) are liable to be charged for NHS Hospital treatment. Since 1 st April 1989 the amount to be charged has been determined by Health Authorities and from the 1 st April 1991 also by NHS Trusts. The regulations require that overseas visitors pay for treatment unless they fall within certain exemption categories. Changes to recording and reporting data regarding necessary and planned treatment of Overseas Visitors came into effect on the 12 th October 2009. 1.2 With the ending of extra-contractual referrals and the reallocation of the central budget for overseas visitors to Health Authorities, arrangements were made from April 1999 for Trusts to recover costs either through normal service provision agreements with main commissioners, out of area treatment provisions or direct recovery of costs from foreign governments with which the United Kingdom (UK) has a reciprocal agreement and support reconciliation of numbers. Trusts were asked to continue sending form IGA to Leeds North East Primary Care Trust in respect of every non-uk resident from a reciprocal agreement country treated by them. 1.3 National Health Service (NHS) Hospital treatment is free for people who are normally resident in the United Kingdom (UK) and is not based on British Nationality or the past or present payment of National Insurance contributions or UK taxes. 2. The Law 2.1 Section 121 of the National Health Service Act 1977 (as amended by Sections 7 (12) and (14) of the Health and Medicines Act 1988) gives authority to the Secretary of State for Health to make regulations concerning charging anyone who is not ordinarily resident in the United Kingdom for NHS services provided. These powers have been devolved to health authorities and all types of NHS Trusts. 2.2 Using powers in Section 121 Parliament has approved regulations exempting some people and some services from charges. These exemptions are listed in The NHS Charges to Overseas Visitors Regulations. 2.3 The Regulations make NHS Trusts responsible for identifying those patients who are not normally resident in the United Kingdom; establishing if they are exempt from charges by virtue of the Regulations; and if they are not exempt, making and recovering a charge from them to cover the cost of their treatment. 2.4 Within this Trust there is a multi-disciplinary team who are responsible for improving the identification of overseas visitors, streamlining the process, reviewing the documentation, and collecting payment. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 4
3. Trust Responsibilities 3.1 All Trusts have a legal obligation to: Ensure that patients who are not ordinarily resident in the United Kingdom are identified. Assess liability for charges in accordance with the regulations. If the patient is found liable, charge them to pay in accordance with the regulations. Notify the Department of Health when treatment is given to patients from Countries with which we hold a reciprocal healthcare agreement or from one of our European Economic Area partners. 3.2 See Appendix 8 for Trust Overseas Visitors Policy Guidance for Clinicians 4. Identification - Patients that should be asked the questions by the Frontline Staff 4.1 The two OSV Questions must be asked by the frontline staff, to every new patient attending a clinic appointment or beginning a new episode of treatment. Also all direct referrals to AHP (Allied to Health Professional) and any patient being admitted to a Ward including the Observation Unit A&E (Appendix 5). 4.2 All of these patients listed above (with the exception of Emergency Admissions) will also have been advised in their correspondence to bring in proof to support their right of residency or their right to reside in the UK. 4.3 Every patient admitted must be asked the same question at the first opportunity. Urgent medical attention required must take priority over enquiries regarding eligibility. 4.4 The race, color or name of a patient is irrelevant in determining overseas visitor s status and may be interpreted as discrimination. 4.5 All Wards and OPD areas are issued with the Trust OSV Policy, Stage 1 Guidance Handbook, and laminated instructions which should be displayed on all Wards and in each OPD area (Appendices 5 + 6). 4.6 Patient Information Leaflets and Posters are also available in all OPD and Ward areas (Appendices 2 + 3). 5. Stage 1 and 2 Overseas Visitors Officers 5.1 In order to ascertain the patient s liability for NHS treatment a two-stage procedure must be followed: Stage 1 Officers The Stage 1 Officers are the frontline staff e.g. wards clerks, clinic receptionists, and admitting / clinic nurses or AHP's. Stage 2 Officers Some areas have their own Stage 2 Officers within their departments. Therapy Services Ext: 4682 Endoscopy Unit Ext: 4348 Maternity Unit Ext: 5033 Stamford Hospital Ext: 8304 DSU Ext: 5016 Pathology Ext: 4175 Radiology Ext: 5418 K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 5
5.2 For all other areas to contact a Stage 2 Officer within normal working hours: Ext: 5033 (OSV Helpline) Ext: 8304 (Stamford) The Stage 2 Officer out of hours: Monday Thursday 5.00 pm to 8.00 am Friday Monday 4.30 pm to 8.30 am Bank Holidays Duty Manager, PDH Bleep 1194 Senior Nurse, ECH Bleep 1520 6. The Two Stage 1 Questions 6.1 The two Stage 1 questions are: Where have you been living for the past 12 months? Can you show evidence that you have the right to live here? 6.2 If the patient has resided in the UK for the past 12 months and they have provided the evidence, then the patient is deemed as not liable and should be treated as an NHS patient. The OSV Form (Appendix 1) must be completed, ticking the not liable box, record what evidence was provided by the patient, signed and dated by the Stage 1 Officer, and filed within the Administration section of the patient s casenotes. 6.3 If the patient has resided in the UK for the past 12 months but they have failed to provide the evidence, then a Stage 2 Officer must be contacted immediately to continue the interview and ascertain whether the patient is liable for payment of their treatment. 6.4 If the patient has not resided in the UK for the past 12 months then a Stage 2 Officer must be contacted immediately to continue the interview and ascertain whether the patient is liable for payment of their treatment. 7. Acceptable Evidence 7.1 Those patients who have lived in the UK for the past 12 months will be advised to bring 2 examples of evidence (Appendix 1). 7.2 Those patients who have not lived in the UK for the past 12 months will be advised to bring their Passport or ID Card and 1 example of evidence (Appendix1) those who are from European Economic Areas (EEA) must provide a European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) see point 10.2 7.3 Being registered with an NHS GP and having an NHS Number does not mean that the patient is entitled to acute hospital care. 8. Charges, Deposits and Undertaking to Pay 8.1 The Finance Directorate provides up to date monthly tariffs for the treatment of overseas visitors to ensure compliance with current guidelines: the Finance Officer (Ext. 4861 / 4140) deals with any queries relating to charges. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 6
8.2 All patients identified as liable will be asked to sign an Undertaking to Pay Form by the Stage 2 Officer. The private patient officers (Finance Department on Ext 4861 / 4140) must be contacted immediately in order to obtain deposits prior to treatment. A voicemail message must be left out of hours. 8.3 In the event of a patient requiring information on costs prior to signing an Undertaking to Pay, the tariff of per night charges will be the only costs given by the Finance Officer. 8.4 If a patient refuses to sign the undertaking, a copy of all information and documentation must be sent immediately to the Finance department. 8.4 As within the Trust Policy any patient who will not or cannot pay, must have this refusal recorded within the current episode of care section of their casenotes by the Stage 2 Officer. The Consultant or Clinical Staff in charge of the patient s care and the Finance Department must be informed of this refusal to pay immediately, and reference made to Section 9 of this Policy. 8.5 Please see Appendix 7 for Trust approved Guidance for Financial Recovery 9. Immediate Necessary Treatment / Urgent Treatment - Definitions 9.1 Immediate necessary treatment (including all maternity treatment) must never be withheld for any reason. If a patient can not or will not pay for their treatment then the Clinician must decide on the limited treatment required to enable the patient to return to their own country. In order to establish when treatment is to be limited the Clinician will need to consider the patients plans and intentions of returning home and their ability to do so. 9.2 Urgent treatment is that which clinicians do not consider immediately necessary, but which nevertheless cannot wait until the patient can be reasonably expected to return home. This may be for conditions such as cancer. It will be necessary for an assessment to be made as to when the patient is likely to return home in order for the clinician to establish if the need is therefore urgent. 10. Countries which have Reciprocal Agreements European Economic Area (EEA) 10.1 Patient s may be either personally liable for the cost of their treatment (see 8.2) or may be from a Country with which the United Kingdom has a Reciprocal Agreement, and in that instance, the Reciprocal Country will be charged for the treatment (including planned treatments). Data Quality department must be informed immediately of any Reciprocal patients and the relevant documentation forwarded to them. 10.2 EHIC and PRC There is a requirement to collect European Health Insurance Card (EHIC) or Provisional Replacement Certificate (PRC) data from EEA Visitors. It is essential that the Trust supply EHIC / PRC as details, without this information, the UK Government can not claim reimbursement from EEA Members States so will not be reimbursed to the Trust i.e. treatment will be effectively been provided for free. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 7
If EEA visitors do not have a valid EHIC or PRC, they must be charged accordingly to the Department of Health s Overseas Visitors Hospital Charging Regulations taking note of the various exemptions for particular types of treatment and categories of patients. Trusts will need to record planned and unplanned treatments of EEA visitors who hold a valid EHIC or PRC. The following details must be captured in order to make a claim to the Member State. Patient name, address and date of birth Treatment start and end date Total cost Entitlement type (EHIC, PRC) Country issuing entitlement Card issue number, PIN, institution code and end date (EHIC and PRC) Start date (PRC only) There is no requirement to provide any clinical information, or information regarding any EEA visitors who did not present a valid EHIC or PRC. There is also no requirement to provide any information for non-eea visitors, nor EEA citizens who are resident in the UK. 10.3 Planned Treatment E112 If the Trust accepts referrals from other EEA Member States, and visitors come specifically for treatment, a copy of a valid E112 form to certify that they are entitled to treatment is required, or a quota number from the Maltese High Commission (MHC - in the case of Malta residents only). The Trust will need to capture the following details: Patient name, address and date of birth Treatment start and end date Total cost Entitlement type (E112 or quota number from MHC) Start and end date of entitlement (from E112 form) NCG (National Commissioning Group) code, if an NCG treatment. Some E112 forms are sent from the Member State directly to Department of Works & Pensions (DWP) Overseas Visitors Health Team (OHT) in Newcastle, and a list of these will be available on the OVT Portal. Where the E112 form is not listed, the Trust will need to request a copy of a valid E112 from the patient to fax to the OHT. An E112 form which does not cover the dates of treatment is not valid the visitor is responsible for obtaining a new E112, without a valid E112 or quota number from the MHC the visitor is not entitled to free treatment, unless they are covered by another exemption in the Department of Health regulations. Note that Trusts must record details of all EEA planned treatment which was given without charge, whether from Malta via a quota number, or from any other EEA Member State with an E112 form. The DWP team do not require any additional clinical information, or any information about non-eea visitors, nor EEA citizens resident in the UK. The Trust should report details of treatment via the OVT Portal. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 8
Reporting treatments from non-eea countries For visitors from non-eea countries with whom the UK has a bilateral arrangement, the Trust does not need to report these treatments to DWP OHT. 10.4 European Economic Countries: Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Republic of Ireland, Romania, Slovakia, Slovenia, Spain, Sweden, United Kingdom, plus Iceland, Liechtenstein and Norway, (Switzerland hereafter referred as jointly as EEA). 10.5 Nationals of (including UK Nationals) in the following Countries: Armenia, Azerbaijan, Belarus, Bosnia, Croatia, Georgia, Gibraltar, Yugoslavia i.e. Serbia & Montenegro, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, New Zealand, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. 10.6 Residents irrespective of nationality in the following Countries: Anguilla, Australia, Barbados, British Virgin Islands, Falkland Islands, Isle of Man, Montserrat, St Helena, Turks and Caicos Islands. 11. British Nationals who have paid taxes in the past 11.1 Nationality or past or present payment of taxes and National Insurance contributions are not taken into consideration when establishing residence. The only thing relevant is whether the patient ordinarily lives in the UK. 12. Accident & Emergency Department 12.1 All emergency treatment is free to both NHS patients and Overseas Visitors, so the two questions should not be asked to patients attending the A&E department. 12.2 The exceptions are if an A&E patient is subsequently admitted to a Ward (including the A&E Observation Unit) then the two Stage 1 questions must be asked by the admitting nurse on the Ward. Another exception is if an A&E patient is given a follow up outpatient appointment then the patient must also be issued with an OSV Information Form for A&E patients (Appendix 4) advising them that they will need to provide proof of residency when they attend outpatients. The Stage 1 questions will then be asked by the OPD staff. 13. Road Traffic Accident / Criminal Injuries 13.1 In these cases the patient may claim personal injury compensation but this does not affect the patient s personal liability to pay for treatment as an overseas visitor. 13.2 The Trust will seek and recover costs of treatment directly from the patient. 14. Ward Attenders and Patients who are admitted direct to a Ward 14.1 It is the responsibility of the frontline staff who books the patient in to ascertain whether or not they are a new referral and not a follow up patient. Once it has been established that the patient is a new referral then the OSV process must be followed. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 9
15. Prisoners 15.1 Prisoners and anyone who has been detained under provision of the Immigration Act are entitled to free treatment. 16. Repatriation to the Overseas Visitors Home Country 16.1 Where a person has already received NHS treatment and has not been able to pay and still requires further treatment (see they may express a wish to return home. NHS Trusts can then consider funding the cost of their repatriation, if the cost of repatriation is less than the continued treatment of the patient. This will therefore produce a cost saving for the Trust for those patients who consent to return home, but Trusts can not force patients to accept repatriation. Reminder check section 9 on definition of immediate / necessary treatment. 17. Asylum Seekers and Refugees 17.1 When Asylum Seekers and Refugees first come into the Country they will make a formal application to the Home Office who will determine if their application is approved. Whilst these patients are awaiting approval they are not liable for payment of any treatment. The patient will be in possession of a valid application document / card and this must be checked for validity on a regular basis throughout the treatment. 17.2 Failed Asylum Seekers and Refugees whose applications have been finally rejected (including appeals) are liable for payment of their treatment. 17.3 Where patients have spent one year prior to treatment residing lawfully in the UK and their treatment has already commenced, they must not have their treatment interrupted and should remain free of charge until complete or they leave the country. It is for the clinician to decide what constitutes a particular course of treatment (see section 9) any subsequent courses of treatment will be chargeable. 18. Maternity Patients 18.1 Maternity Services are not exempt from charges. However, because of the severe health risks associated with conditions such as eclampsia and preeclampsia, maternity services should not be withheld if the patient is unable to pay in advance. The patient remains liable for charges and the debt should be documented, acknowledged and pursued in the normal way. 19. Newborns 19.1 Where a baby is born in hospital the mother and child are charged as one single patient, if the mother or baby is transferred to another department e.g. SCBU or Children s ward the baby will be charged separately. All other procedures apply see point 15). 20. Children 20.1 For a child under the age of 16 years and those in full time education at school or college (not university) between the ages of 16 19 years the evidence provided can be from either parent. 21. Members of Her Majesty s Service 21.1 Members of Her Majesty s Forces must provide a valid HM Forces ID Card. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 10
22. Sexual Health Patients 22.1 Sexual Health Services are not exempt from charges. 22.2 For HIV/AIDS exemption only applies to the initial diagnostic test and any associated counselling. The NHS (Venereal Diseases) Regulations 1974 and the NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000 prevent the disclosure of any identifying disease other than to the medical practitioner (or to a person employed under the direction of a medical practitioner) in connection with, and for the purpose of, either the treatment of the patient and/or the prevention of the spread of the disease. 22.3 This does not mean, however, that sexually transmitted diseases clinics do not have to apply the hospital charging Regulations. The Regulations place a legal obligation on all secondary care providers, to establish whether a person is entitled to NHS hospital treatment free of charge and if not apply a charge. Therefore, where a patient is found to be HIV positive and treatment, including drugs, is needed, the hospital or sexually transmitted diseases clinic need to have systems in place to establish if that patient is ordinarily resident or, if not, exempt from charges otherwise the charging system need to apply. 22.4 Where, in a clinical opinion, the treatment is immediately necessary then it should not be withheld or delayed while a patient s status is being established. However, at some point eligibility should be pursued. Where the treatment required is not urgent and the patient is chargeable, payment should be handled in the same way as for anyone else seeking non-urgent treatment i.e. payment obtained before treatment begins (DoH, Implementing the Overseas Visitors Hospital Charging Regulations, p18-19). 23. Pandemic Status 23.1 Pandemic Influenza is now included in the list of exempt from charge diseases. It is defined in the regulations as influenza caused by a new virus subtype that has an increased and sustained transmission during a global outbreak of influenza.the diagnosis and treatment of Swine Flu in hospitals is free of charge to all overseas visitors only in the event that it becomes pandemic following categorization of the outbreak as Phase 6 24. Interpreting and Translations Services 24.1 Should a Translator be required (exceptions Polish, Urdu and Punjabi speaking patients see below) contact Language Line. Dial Ext: 6354, quoting the hospital ID code L42242. Relatives or friends of the patient must NOT be used as Interpreters. 24.2 Trust Interpreters Polish, Urdu and Punjabi Interpreters can be contacted on Extension 4728 or Bleep 1461 (Urdu / Punjabi) and Bleep 1463 (Polish). If they are unable to attend they will contact Language Line directly. 25. Patient Administration System (PAS) 25.1 Once a patient s overseas visitor s status has been established, PAS must be updated immediately by the Stage 2 Officer. The patient s UK address should be recorded as the postal address, and the permanent overseas address should be recorded on the front screen of PAS. For all Reciprocal Patients the category must be recorded as OSV, and for PP s (personally liable) the category is OPV. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 11
26. Identification Labels for Casenotes 26.1 Once a patient has been identified as liable, the Stage 2 Officer will place an OSV identification label on the outside front cover of the casenotes (at the top left hand corner). This will highlight and assist trust staff at any future attendances by the patient. 27. Confidentiality 27.1 It is mandatory that information regarding patients is collected and recorded in a secure, safe and confidential manner. Staff who breach these rules can face Disciplinary action (Chapter 9 - DoH Guidance). For the protection of staff and patients, staff are reminded that access to Trust patient records either manual and computerised should be solely for the purpose of undertaking their individual role. For example staff should only access and use patient information when they are directly responsible for an episode of care. It does not mean obtaining information about staff or for a third party. Members of staff do not automatically have the right to access patient or staff information. Anything over and above the role must be done with the express permission of the patient or a more senior member of staff. Staff are required to maintain confidentiality at all times and under no circumstances to divulge or pass on to any un-authorised person(s) information relating to patient or staff records. A breach of confidentiality, including accessing staffs own records will result in disciplinary action. Staff are reminded also of their responsibility to take all reasonable care and safeguards to protect both the physical securities of information technology and the data contained within it. 28. Reporting 28.1 The Data Quality Department is responsible for the following: Submitting all claims relating to Reciprocal overseas visitors to the Department of Work and Pensions (DWP) Overseas Healthcare Team (OHT) in a timely manner via the Overseas Visitors Treatment (OVT) portal, in respect of all necessary and planned treatments of EEA visitors. Finance Department is responsible for: Revision of charges to include full cost recovery plus a return of capital as indicated by the DOH. Obtaining up to date schedules from Information Services in respect of overseas visitors to ensure that all outstanding payments are collected. Ensuring that complete and accurate overseas visitor s lists are regularly obtained. Attending and collecting payment from appropriate patients once advised by interviewing Stage 2 Officer. 29. Auditing 29.1 The OSV team will carry out audits to ascertain compliance in the completion of the Stage 1 Form and with the OSV processes. An OSV report will be compiled by the OSV Co-ordinator on a monthly basis and will be forwarded to the AGM s for information and any relevant actions. A six monthly report will also be compiled and sent to the GM s and Clinical Governance Committee. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 12
30. Further Information Training / Awareness sessions are available for Stage 1 staff. Information leaflets are issued to all staff at Induction (Appendix 3). Posters and leaflets are displayed and available to all patients in OPD and ward areas. Laminates are displayed in all departments and wards; further supplies are also available from Health Records Secretary Ext 5819. Stage 2 Officers are available to offer further advice and assistance if required You can find out more about entitlement to free NHS treatment at www.dh.gov.uk/overseasvisitors or telephone 0113 2545819. Please Note: Failure to comply with these procedures has the potential to lose the Trust thousands of pounds in paying patients revenue. The revenue generated from either the individual overseas visitor or from the Department of Health for Reciprocal Agreement is fed back to your department or ward for the good of all NHS patients. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 13
Appendix 1 Peterborough & Stamford Hospitals NHS Foundation Trust Overseas Visitors Form - Stage I Patient Details: Surname:.. Forename: Hospital No P The Stage 1 Officers must ask: Every newly referred patient attending an Outpatient appointment or beginning a new episode of treatment. Every patient being admitted to a Ward. Every direct referral to AHP s (Allied Health Professionals) The following Two Questions: Question 1 - Where have you been living for the past 12 months? If the patient answers the UK then Question 2 must be asked. If the patients answers anywhere other than the UK, contact the Stage 2 Officer immediately. Question 2 - Can you show evidence that you have the right to live here? If the patient provides 2 examples of evidence from Section A, they must be recorded as not liable. If the patient fails to provide the relevant evidence, contact the Stage 2 Officer immediately. Overseas Visitors from European Economics Areas EEA (Reciprocal Countries) must provide the following documents If you have lived in the UK for the past 12 months Provide 2 examples (originals only) from Section A. Section A Utility Bills / Pay Slip Housing contract / Bank Statement Pension Documents/ Bus Pass Benefit Documents If you have not lived in the UK for the past 12 months you must provide the documents listed below in section B. (originals only). Section B Passport or ID European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) Overseas Visitors from Non EEA countries must provide the following Documents Members of HM Forces must provide a valid HM Forces ID Card If you have lived in the UK for the past 12 months Provide 2 examples (originals only) from Section A. Section A Utility Bills /Pay Slip Housing contract/ Bank Statement Pension Documents / Bus Pass If you have not lived in the UK for the past 12 months Provide your Passport or ID Card and also 1 document from the list below (originals only) from Section B. Section B Current Home Office Document Workers Registration (which gives entitlement to work in the UK) Letter from Employer / College stating K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 14
reason for visit and course being attended Benefit Documents Dated Travel/ Shipping Documents For children under 16 years of age, or between16 and 19 and in full-time education at school or college (not University) the evidence provided can be from either parent. Which 2 pieces of evidence were presented? Evidence 1 - Ref No: Evidence 2 - Ref No: No evidence presented - Information Leaflet handed to patient. Yes / No Patient Not Liable or Patient bringing in evidence The Stage 1 Officer must tick the not liable or awaiting evidence box at the bottom of the form and complete the signature, date, and designation section. On completion of this form, the Stage 1 Officer will file it within the Administration section of the patient s casenotes. Stage 2 Officers Some areas have their own Stage 2 Officers within their departments. Therapy Services Ext: 4682 Endoscopy Unit Ext: 4348 Maternity Unit Ext: 5033 Stamford Hospital Ext: 8304 For all other areas to contact a Stage 2 Officer within normal working hours: Ext: 5033 Ext: 8304 The Stage 2 Officer out of hours: Monday Thursday 5.00 pm to 8.00 am Friday Monday 4.30 pm to 8.30 am Bank Holidays Duty Manager, PDH Bleep 1194 Senior Nurse, ECH Bleep1520 Stage 1 or Stage 2 Officers Personally Liable Tick the liable box, obtain a signed undertaking from the patient, advise the Finance Department immediately by telephone and forward them a copy of this form, sending the original to the OSV Helpline, ECH. DoH Liable Reciprocal Agreement in place with their Country. Tick the liable box, advise the Data Quality Lead immediately by telephone (Extension 4113 or 4983) and forward them a copy of this form, sending the original to the OSV Helpline, ECH. Not Liable - Tick the not liable box, sign and date the form, file in Administration Section of patient s Casenotes. Awaiting evidence Tick the awaiting evidence box, sign and date the form, file in Administration Section of patients casenotes Stage 1 Officer Signature Stage 2 Officer Signature Print Name Signature Designation Date K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 15
Appendix 2 Identification of Overseas Visitors (OSV) Guidance for Patients Are you visiting the United Kingdom? Did you know that you may have to pay for your treatment? Who is an Overseas Visitor? An overseas visitor is someone who is not ordinarily resident in the United Kingdom, or someone who has been living outside the UK for more than 3 months. If you do not live permanently in the UK you may be charged for your treatment Why is it important to identify Overseas Visitors? The non-identification of Overseas Visitors is a recognised National problem, and costs the NHS huge amounts of potential income each year. It is a Department of Health requirement that all Overseas Visitors are correctly identified and that liability for the cost of their treatment or consultation be ascertained. How will Overseas Visitors be identified? Every new patient (NP) attending outpatient clinics and every new admission to a Ward will be asked the two OSV questions and will also have been advised in their correspondence to bring in evidence to support their right of residency or their right to reside in the UK. Who will be responsible for asking the Questions? The two OSV questions will be asked by the admitting clerk / nurse. What are the two OSV Questions? Where have you been living for the past 12 months? Can you show evidence that you have the right to live here? How will I know what is acceptable evidence to bring in? Those patients who have lived in the UK for the past 12 months will be advised in their correspondence, to bring 2 examples of evidence from Section A listed below. Those patients who have not lived in the UK for the past 12 months will be advised to provide their Passport or ID Card and further evidence (see section B). Being registered with an NHS GP and having an NHS Number does not mean that the patient is entitled to acute hospital care. Overseas Visitors from European Economic Areas EEA (Reciprocal Countries) must provide the following documents Section A (originals only) Section B (originals only) Utility Bills/ Pay slips European Health Insurance Card (EHIC) or Housing Contracts Provisional Replacement Certificate (PRC) Bank Statements Pension Documents / Bus Pass Benefit Documents K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 16
Overseas Visitors from Non EEA countries must provide the following documents Members of HM Forces must provide a valid HM Forces ID Card Section A (originals only) Utility Bills/ Pay slip s Housing Contract Bank Statement Bank Statement Pension Documents/ Bus Pass Benefit Documents Section B (originals only) Current Home Office Document Workers registration (which gives entitlement to work in the UK). Letter from Employer/College stating reason for visit and course being attended Dated Travel / Shipping Document How is it established that a patient is not an Overseas Visitor? If the patient has lived in the UK for the past 12 months and they have provided the appropriate evidence, then they are deemed as not liable to be charged and will be treated as an NHS patient. What if the patient fails to provide the Evidence? If the patient has resided in the UK for the past 12 months, but fails to produce the required evidence, then an OSV Officer will be contacted immediately to take over the interview. The OSV Officer will: Inpatients initially ask if the patient has a relative who can bring in the evidence as soon as possible, and will also issue the patient with an OSV Information Form for In-patients. The officer will also advise them that if they do not provide this evidence within 5 working days of discharge, they will be recorded as liable for payment, and may be charged for their treatment. Outpatients they will issue the patient with an OSV Information Form for Outpatients and advise them that if they do not provide this evidence within 5 working days they will be recorded as liable for payment, and may be charged for their treatment. What if the Patient has not resided in the UK for the past 12 months? If the patient has not resided in the UK for the past 12 months, then the OSV Officer will be contacted immediately to take over the interview to determine if they are liable for the cost of their treatment. What does it mean if I am liable for the cost of my treatment? You may be either personally liable for the cost, or you may be from a Country with which the United Kingdom has a Reciprocal Agreement, and in that instance, the Reciprocal Country will be charged for your treatment. All patients identified as personally liable, will be asked to sign an Undertaking to Pay Form by the OSV Officer. The private patient officer will be informed immediately in order to obtain a deposit prior to treatment. Which Countries have Reciprocal Agreements? European Economic Countries: Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Republic of Ireland, Romania, Slovakia, Slovenia, Spain, Sweden, United Kingdom, plus Iceland, Liechtenstein and Norway, (Switzerland hereafter referred jointly as EEA). K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 17
Nationals of (including UK Nationals) in the following Countries: Armenia, Azerbaijan, Belarus, Bosnia, Croatia, Georgia, Gibraltar, Yugoslavia i.e. Serbia & Montenegro, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, New Zealand, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Residents irrespective of nationality in the following Countries: Anguilla, Australia, Barbados, British Virgin Islands, Falkland Islands, Isle of Man, Montserrat, St Helena, Turks and Caicos Islands. What about British Nationals? I have paid taxes in the past? Nationality or past or present payment of taxes and National Insurance contributions are not taken into consideration when establishing residence. The only thing relevant is whether you ordinarily live in the UK. What are the Treatment Costs for OSV? The Finance Department provides up to date monthly tariffs for the treatment of overseas visitors to ensure compliance with current DoH guidelines. The Finance Officer will deal with any further queries relating to charges. What about Patients who attend the Accident & Emergency department (A&E)? All emergency treatment is free to both NHS patients and Overseas Visitors, so the two questions will not be asked to patients attending the A&E department. The exceptions are if an A&E patient is subsequently admitted to a Ward or is given a follow up outpatient appointment. They will then be issued with an OSV Information Form advising them that they will need to provide proof of residency when they are either admitted to the ward or attend outpatients. The two OSV questions will then be asked by the OPD or ward staff. What about Ward Attenders and Patients who are admitted direct to a Ward? It is the responsibility of the clerk / nurse who books the patient in to ask the OSV questions. What if interpreting and translation services are required? Should an Interpreter be required this will be arranged on request through the Trust. Relatives or friends of the patient should NOT be used as Interpreters. What are the Repercussions of Identifying or not Identifying OSV Patients? Pro s The additional income generated from the identifying and charging of the Overseas Visitors goes to individual Departments and Wards budgets which benefits NHS patients. Con s Seeing these patients may reduce clinic appointment and in-patient bed availability, which could result in longer waits for NHS patients together with a slight additional workload for the staff involved. Loss of income, if the patient is not identified the Trust effectively carry out the treatment for free. What if I need to know more regarding OSV? You can find out more about entitlement to free NHS treatment at www.dh.gov.uk/overseasvisitors or telephone 0113 2545819. Alternatively you can contact the Patient Advice & Liaison Service (PALS) by telephoning 01733 875847 Please note the above information gives general guidance only and should not be treated as a complete and authoritative statement of law. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 18
Appendix 3 Identification of Overseas Visitors (OSV) Guidance for Patients Did you know that if you are a visitor to the United Kingdom you may have to pay for your treatment? Peterborough & Stamford Hospitals NHS Foundation Trust (PSHFT) has a legal obligation to check that you are entitled to free National Health Service (NHS) treatment. Therefore we need to ask every patient to provide us with evidence that they are entitled to free NHS treatment. If you do not normally live in the United Kingdom (UK) or have not lived in the UK for the past 12 months you may have to pay for your treatment. Sometimes your country of origin or the country where you have recently been living may have an agreement with the UK (Reciprocal Agreement) which means that the hospital can claim the costs of your treatment back from that country. The following documents listed below will help us to determine whether or not you are entitled to free NHS treatment. A member of our staff will ask you to provide these documents before you see the doctor / health professional. If you have lived in the UK for the past 12 months please provide 2 different examples from the following list (originals only) Utility Bill Pay Slip Housing contract Bank Statement Pension documents / Bus Pass Benefit documents If you have not been living in the UK for the past 12 months we will need to see your Passport or Identity Card and your European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) European Economic Areas (EEA) only For Non EEA countries you will be required to provide in addition to your Passport or ID card - 1 of the following listed below Current Home Office Document Workers Registration (this gives entitlement to work in the UK) Letter from your employer/college explaining circumstances of your stay or details of the course you are attending Dated travel documents e.g. an airline ticket Shipping Documents Members of HM Forces must provide a valid HM Forces ID Card You can find out more about entitlement to free NHS treatment at www.dh.gov.uk/overseasvisitors or telephone 0113 2545819 or alternatively contacting the Patient Advice & Liaison Service (PALS) by telephoning: 01733 875847 K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 19
Appendix 4 Peterborough & Stamford Hospitals NHS Foundation Trust Health Records Services Overseas Visitors (OSV) Information Sheet for A&E Patients Attending OPD. Following your attendance in the Accident and Emergency department an appointment has now been made for you to attend the Outpatient Department. It is a Department of Health requirement that all Overseas Visitors are correctly identified and that liability for the cost of their treatment or consultation be ascertained, you are therefore required to provide proof of the right to Residency in the United Kingdom. Please bring the following documentation with you to the appointment. Overseas Visitors from European Economics Areas EEA (Reciprocal Countries) must provide the following documents If you have lived in the UK for the past 12 If you have not lived in the UK for the past 12 months Provide 2 examples (originals only) months you must provide the documents from Section A. listed below in section B. (originals only). Section A Section B Utility Bills / Pay Slip Passport or ID Housing contract / Bank Statement Pension Documents/ Bus Pass Benefit Documents European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) Overseas Visitors from Non EEA countries must provide the following documents Members of HM Forces must provide a valid HM Forces ID Card If you have lived in the UK for the past 12 months Provide 2 examples (originals only) from Section A. Section A Utility Bills / Pay Slip Housing Contract /Bank Statement Pension Documents / Bus Pass Benefit Documents If you have not lived in the UK for the past 12 months Provide your Passport or ID Card and also 1 example (originals only) from Section B. Section B Current Home Office Document Workers Registration (which gives entitlement to work in the UK) Letter from Employer/College stating reason for visit and course being attended Dated Travel / Shipping Documents For children under 16 years of age, or between16 and 19 and in full-time education at school or college (not University) the evidence provided can be from either parent. Failure to provide the documentation listed above may result in you being identified as liable and invoiced for the cost of your treatment. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 20
Appendix 5 Peterborough & Stamford Hospitals NSH Foundation Trust Procedures for Overseas Visitors for Ward, Nursing and Clerical Staff The Stage 1 Officers must ask Every newly referred patient attending an Outpatient appointment or beginning a new episode of treatment. Every patient being admitted to a Ward Every direct referral to AHP s (Allied Health Professionals) The following two questions: Question 1 - Where have you been living for the past 12 months? If the patient answers the UK then Question 2 must be asked. If the patient anywhere other than the UK, contact the Stage 2 Officer immediately Question 2 - Can you show evidence that you have the right to live here? If the patient provides 2 examples of evidence from Section A, they must be recorded as not liable If the patient fails to provide the relevant evidence, contact the Stage 2 Officer immediately. Overseas Visitors from European Economics Areas EEA (Reciprocal Countries) must provide the following documents If you have lived in the UK for the past 12 If you have not lived in the UK for the past 12 months Provide 2 examples (originals only) months you must provide the documents from Section A. listed below in section B. (originals only). Section A Section B Utility Bills / Pay Slip Passport or ID Housing contract / Bank Statement Pension Documents/ Bus Pass Benefit Documents European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) Overseas Visitors from Non EEA countries must provide the following documents Members of HM Forces must provide a valid HM Forces ID Card If you have lived in the UK for the past 12 months Provide 2 examples (originals only) from Section A. Section A Utility Bills / Pay Slip If you have not lived in the UK for the past 12 months Provide your Passport or ID Card and 1 example (originals only) from Section B. Section B Current Home Office Document Housing contract / Bank Statement Pension Documents / Bus Pass Benefit Documents Workers Registration (which gives entitlement to work in the UK) Letter from Employer / College stating reason for visit and course being attended Dated Travel / Shipping Documents K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 21
Stage 1 Officers should not give advice or interrogate an OSV on the above questions as the regulations on NHS eligibility in this area are complex. The race, colour or name of a patient is irrelevant in determining OSV status and may be interpreted as discrimination. Should a translator be required, please contact the Trust Interpreters or Language Line. Relatives and friends of the patient must not be used as Interpreters. Nursing and clerical staff entering OSV details on PAS must ensure that the correct status and type of accommodation is entered for each Overseas Visitor (e.g. Single Room / Other / Shared Accommodation). Once the discharge date has been determined for an overseas patient then the Finance Officer Ext. 4861 or 4140 must be informed immediately. If you have any queries with regard to the above procedures or have any questions regarding Overseas Visitors please do not hesitate to contact the Stage 2 Officer: Stage 2 Officers The Stage 2 Officer with reference to current regulations will decide if the patient is eligible to free NHS treatment or not. Some areas have their own Stage 2 Officers within their departments. Therapy Services Ext: 4682 Endoscopy Unit Ext: 4348 Maternity Unit Ext: 5033 Stamford Hospital Ext: 8304 DSU Ext: 5016 Pathology Ext: 4175 For all other areas to contact a Stage 2 Officer within normal working hours: Ext: 5033 Ext: 8304 The Stage 2 Officer out of hours: Monday Thursday 5.00 pm to 8.00 am Friday Monday 4.30 pm to 8.30 am Bank Holidays Duty Manager, PDH Bleep 1194 Senior Nurse, ECH Bleep 1520 Failure to comply with these procedures has the potential to lose the Trust thousands of pounds in paying patients revenue. The revenue generated is fed directly back into Departments and Wards for the good of all NHS patients K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 22
Peterborough & Stamford Hospitals NHS Foundation Trust Overseas Visitors (OSV) - Procedure for Outpatient Clinic Staff The Stage 1 Officers must ask: Every newly referred patient attending an Outpatient appointment or beginning a new episode of treatment. Every patient being admitted to a Ward. Every direct referral to AHP s (Allied Health Professionals) The following Two Questions: Appendix 6 Question 1 - Where have you been living for the past 12 months? If the patient answers the UK then Question 2 must be asked. If the patients answers anywhere other than the UK, contact the Stage 2 Officer immediately. Question 2 - Can you show evidence that you have the right to live here? If the patient provides 2 examples of evidence from Section A, they must be recorded as not liable. If the patient fails to provide the relevant evidence, contact the Stage 2 officer immediately. Stage 1 Officers should not give advice or interrogate an OSV on the above questions as the regulations on NHS eligibility in this area are complex. The race, colour or name of a patient is irrelevant in determining OSV status and may be interpreted as discrimination. Should a translator be required, please contact the Trust Interpreters or the Language Line. Relatives and friends of the patient must not be used as Interpreters. Overseas Visitors from European Economics Areas EEA (Reciprocal Countries) must provide the following documents If you have lived in the UK for the past 12 If you have not lived in the UK for the past 12 months Provide 2 examples (originals only) months you must provide the documents from Section A. listed below in section B. (originals only). Section A Section B Utility Bills / Pay Slip Passport or ID Housing contract / Bank Statement Pension Documents/ Bus Pass Benefit Documents European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) Overseas Visitors from Non EEA countries must provide the Following documents Members of HM Forces must provide a valid HM Forces ID Card If you have lived in the UK for the past 12 months Provide 2 examples (originals only) from Section A. Section A Utility Bills / Pay Slip If you have not lived in the UK for the past 12 months Provide your Passport or ID Card and 1 example (originals only) from Section B. Section B Current Home Office Document K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 23
Housing contract/ Bank Statement Pension Documents / Bus Pass Benefit Documents Workers Registration (which gives entitlement to work in the UK) Letter from Employer/College stating reason for visit and course being attended Dated Travel / Shipping Document Which 2 pieces of evidence was presented? Evidence 1 - Ref No: Evidence 2 - Ref No: Patient Not Liable The Stage 1 Officer must tick the not liable box at the bottom of the Form and complete the signature, date, and designation section. On completion of this form, the Stage 1 Officer will file it within the Administration section of patient s casenotes. Stage 2 Officers The Stage 2 Officer with reference to current regulations will decide if the patient is eligible to free NHS treatment or not. Some areas have their own Stage 2 Officers within their departments. Therapy Services Ext: 4682 Endoscopy Unit Ext: 4348 Maternity Unit Ext: 5033 Stamford Hospital Ext: 8304 DSU Ext: 5016 Pathology Ext: 4175 For all other areas to contact a Stage 2 Officer within normal working hours: Ext: 5033 Ext: 8304 The Stage 2 Officer out of hours: Monday Thursday 5.00 pm to 8.00 am Friday Monday 4.30 pm to 8.30 am Bank Holidays Duty Manager, PDH Bleep 1194 Senior Nurse, ECH Bleep 1520 K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 24
Appendix 7 Identification of Overseas Visitors (OSV) - Guidance for Financial Recovery Introduction By following the Trust approved Identification of OSV Policy (MR12) the following staff are responsible for identifying Overseas Visitors who may be either personally liable for their treatment or from a Country with which we have a Reciprocal Agreement. Stage 1 Officers Stage 1 Officers are frontline staff across the Trust who meet, greet and admit the patients (both inpatients and outpatients) and ask the Stage 1 Questions as per Trust Policy. Unless this part of the process is carried out, the Trust will lose valuable income which it is entitled to. Under the Service Line Reporting process this means areas/departments will not show the OSV income they have earned or be given the credit for the OSV activity they have undertaken. Stage 2 Officers Stage 2 Officers will carry out more in-depth interviews with patients (as per policy) to ascertain whether the patient is personally liable for their treatment or from a Country with whom we have a Reciprocal Agreement. The Stage 2 Officer must inform Finance immediately of any identified personally liable OSV during the interview if appropriate so they can attend the patient and secure a deposit equal to the estimated cost of treatment (or at least equal to the cost of treatment received so far) can be taken. This procedure will be completed out of hours by the Duty Manager or Senior Nurse in charge. Undertaking An Undertaking to Pay form must be completed and signed by all patient s who are identified as being personally liable. There is no legal liability if a family member signs this form a guarantee facility does not exist we can only pursue non-payment through the courts if the patient signs as they are the person receiving treatment. Please note, this does not preclude a family member making the payment, anyone can settle the debt. Identification Once an OSV has been identified, a pink OSV sticker will be placed on the outside front cover of their casenote folder to identify them on each visit. The PAS (Patient Administration System) will also be revised to OSV status and must not be over-ridden or changed back to NHS status. Reciprocal Once the patient has been identified as being from a Reciprocal Country, the Stage 2 Officer will contact the Data Quality Manager, who in turn will invoice the DoH for full payment (which is income for the Trust). Finance The Finance Officer will calculate approximate costs for the treatment. Initially this is done by contacting the Consultant / Lead Clinician to find out relevant treatment, then contacting Pharmacy for drug costs, Pathology for types of blood taken and how many, Histology for types of biopsy and Radiology for types of X-Ray taken. The Finance Officer will then check all costs against the updated yearly tariff. Personally liable patients will be issued with a standard letter with individual costings together with the up to date tariffs and they will discuss methods of payment which must be made up front and prior to treatment (only Finance Officers can take payment). If full payment is received for the treatment, the Finance Officer will confirm this fact to the Consultant in Charge, Lead Clinician and General Manager by email informing them that Treatment can proceed. If the patient cannot or will not pay, the Finance Officer will e-mail (as above) advising of this fact. As per the OSV policy, the patient should then be patched and dispatched at the earliest K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 25
opportunity (the same day if possible) unless extenuating circumstances exists (which must be documented in the patient s notes as explanations will be required). If the Consultant chooses to proceed with full treatment with no payment the Finance Officer will contact the Medical Director (Trust OSV Lead) to inform him of this decision. The MD will discuss this with Director of Operations and the Chief Executive. Immediate Necessary Treatment / Urgent Treatment Definitions Immediate necessary treatment (including all maternity treatment) must never be withheld for any reason. If a patient can not or will not pay for their treatment then the Clinician must decide on the limited treatment required to enable the patient to return to their own country. In order to establish when treatment is to be limited the Clinician will need to consider the patients plans and intentions of returning home and their ability to do so. Urgent treatment is that which clinicians do not consider immediately necessary, but which nevertheless cannot wait until the patient can be reasonably expected to return home. This may be for conditions such as cancer. It will be necessary for an assessment to be made as to when the patient is likely to return home in order for the clinician to establish if the need is therefore urgent. Repatriation to the Overseas Visitors Home Country Where a person has received NHS treatment and has not been able to pay for that treatment and expresses a wish to return home, NHS Trusts can consider funding the cost of their repatriation. If the cost of repatriation outweighs the cost of treating the patient and will therefore produce a cost saving for the Trust and if the patient consents to return home, but Trusts can not force patients to accept repatriation. Asylum Seekers and Refugees When Asylum Seekers and Refugees first come into the Country they will make a formal application to the Home Office who will determine if their application is approved. Whilst these patients are awaiting approval they are not liable for payment of any treatment. The patient will be in possession of a valid application document / card and this must be checked for validity on a regular basis throughout the treatment. Failed Asylum Seekers and Refugees whose applications have been finally rejected (including appeals) are liable for payment of their treatment. Where patients have spent one year prior to treatment residing lawfully in the UK and their treatment has already commenced, they must not have their treatment interrupted and should remain free of charge until complete or they leave the country. It is for the clinician to decide what constitutes a particular course of treatment (see section 9) any subsequent courses of treatment will be chargeable. Follow-up Treatment Any patient that has previously been identified as an OSV must have a pink OSV Identification sticker placed on the casenotes. The Stage 2 Officer must be informed of every follow-up episode of care by the ward/clinic staff, and will in turn instigate the OSV processes (as above). Identification of Overseas Visitors Guidance for Financial Recovery, Endorsed Trust Executive, November 2007 and Clinical Management Board November 2007. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 26
Appendix 8 Identification of Overseas Visitors (OSV) Guidance for Clinicians Introduction Hospital treatment is free to people who live lawfully in the United Kingdom (UK). If they do not normally live here and do not meet one of the exemptions from charges then they will have to pay for treatment they might need. This is regardless of whether they are a British citizen or have lived or worked here in the past or have been issued with an HC2 certificate. Who is an Overseas Visitor? An overseas visitor is someone who is not ordinarily resident in the United Kingdom, or someone who has been living outside the UK for more than 3 months. If they do not live permanently in the UK they may be charged for their treatment. Being registered with an NHS GP and having an NHS Number does not mean that the patient is entitled to acute hospital care. Why is it important to identify Overseas Visitors? The non-identification of Overseas Visitors is a recognised National problem, and costs the NHS huge amounts of potential income each year. It is a Department of Health requirement that all Overseas Visitors are correctly identified and that liability for the cost of their treatment or consultation be ascertained. How will Overseas Visitors be identified? Every new patient (NP) attending outpatient clinics and every new admission to a Ward will be asked the two OSV questions and will also have been advised in their correspondence to bring in evidence to support their right of residency or their right to reside in the UK. Who will be responsible for asking the Questions? The two OSV questions, listed below, will be asked by the Stage 1 Officer (frontline staff) e.g. admitting clerk/nurse. Where have you been living for the past 12 months? Can you show evidence that you have the right to live here? If the patient can provide the relevant proof, their documentation will be completed by the Stage 1 Officer and filed in the patient casenotes. If the patient has not lived in the UK for the past 12 months or has failed to provide their proof, a Stage 2 Officer will be contacted to carry on with the interview to ascertain liability to pay. What does it mean if patients are liable for the cost of their treatment? They may be either personally liable for the cost, or they may be from a Country with which the United Kingdom has a Reciprocal Agreement, and in that instance, the Reciprocal Country will be charged for their treatment. All patients identified as personally liable, will be asked to sign an Undertaking to Pay Form by the OSV Officer. The private patient officer will be informed immediately in order to obtain a deposit prior to treatment. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 27
What about Patients who attend the Accident & Emergency department (A&E)? All emergency treatment is free to both NHS patients and Overseas Visitors, so the two questions will not be asked to patients attending the A&E department. The exceptions are if an A&E patient is subsequently admitted to a Ward or is given a follow up outpatient appointment. The two OSV questions will then be asked by the OPD or ward staff. What is the Clinicians role if a Patient will not or can not pay? The Stage 2 Officer must immediately inform the Consultant in charge of the patient s care if their patient will not or can not pay. It is at the discretion of the Clinician to carry out only the necessary treatment required and not to initiate any non-urgent treatment unless payment is made. Treating patients for non life threatening episodes is contrary to the DoH guidance. Details relating to these patients will also be emailed to the relevant Lead Clinicians and to the respective General Managers to ensure that Trust Policy is adhered to. The patient s failure to pay will also be recorded in their casenotes, and this information will also be communicated to the Finance Department as a matter of urgency. Immediate Necessary Treatment / Urgent Treatment - Definitions Immediate necessary treatment (including all maternity treatment) must never be withheld for any reason. If a patient can not or will not pay for their treatment then the Clinician must decide on the limited treatment required to enable the patient to return to their own country. In order to establish when treatment is to be limited the Clinician will need to consider the patients plans and intentions of returning home and their ability to do so. Urgent treatment is that which clinicians do not consider immediately necessary, but which nevertheless cannot wait until the patient can be reasonably expected to return home. This may be for conditions such as cancer. It will be necessary for an assessment to be made as to when the patient is likely to return home in order for the clinician to establish if the need is therefore urgent. Repatriation to the Overseas Visitors Home Country Where a person has received NHS treatment and has not been able to pay for that treatment and expresses a wish to return home, NHS Trusts can consider funding the cost of their repatriation. If the cost of repatriation outweighs the cost of treating the patient and will therefore produce a cost saving for the Trust and if the patient consents to return home, but Trusts can not force patients to accept repatriation. Asylum Seekers and Refugees When Asylum Seekers and Refugees first come into the Country they will make a formal application to the Home Office who will determine if their application is approved. Whilst these patients are awaiting approval they are not liable for payment of any treatment. The patient will be in possession of a valid application document / card and this must be checked for validity on a regular basis throughout the treatment. Where patients have spent one year prior to treatment residing lawfully in the UK and their treatment has already commenced, they must not have their treatment interrupted and should remain free of charge until complete or they leave the country. It is for the clinician to decide what constitutes a particular course of treatment (see section 9) any subsequent courses of treatment will be chargeable. Failed Asylum Seekers and Refugees whose applications have been finally rejected (including appeals) are liable for payment of their treatment. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 28
What are the Repercussions of Identifying or not Identifying these Patients? Pro s The additional income generated from the identifying and charging of the Overseas Visitors is fed back within the Trust, to your own Departments and Wards for the benefit of NHS patients. Con s Loss of Income (Trust) Departmental budget shortfalls Cancellations of operations Bed shortages Reduction in NHS clinic slot availability Impact on Waiting Lists Additional workloads for involved staff What if I need to know more regarding OSV? In the first instance contact a Stage 2 OSV Officer or the OSV Helpline on Ext 5033, or alternatively you can find out more about entitlement to free NHS treatment at www.dh.gov.uk/overseasvisitors or telephone 0113 2545819. K\Trust Policies Health Records \MR12 OSV Policy revised September 2009 Version 1 29