Request

1. A person must make a claim for the NHS Low Income Scheme in order to be entitled to the remission of an NHS charge (NHS (TERC) Regs, Reg. 5(2)). However, the Regulations would appear to allow a claim to be made even after the treatment has been received, but was not paid for at the time. (The 'notice of entitlement' will be valid only from the date of claim (as per Reg. 8(5)), however, that does not seem to restrict entitlement to the remission of charges for earlier treatment, as long as the conditions of entitlement were met at that earlier date.) Please can you confirm if NHSBSA will allow a claim to be made for treatment already received, but which was not paid for at the time. If you will not allow such a claim, please explain why this is not allowed, by reference to the regulations.
2. CAM para. 2.057 states that a refund cannot be claimed for charges recovered by the NHS from someone who was liable to pay. Please explain why this charge cannot be refunded on the making of a claim.
3. Please can you provide a copy of Draft Letter DL17 referred to in CAM para. 2.057.

The NHS Business Services Authority (NHSBSA) received your request on 10 July 2024.

We have handled your request under the Freedom of Information Act (FOIA) 2000.

Our response

Questions 1 and 2

I am writing to advise you that the information you requested is not held by the NHS Business Services Authority. These questions seek explanations, i.e. requesting new information to be generated in order to provide an answer, and to notionally review a hypothetical claim based on the circumstances described in your request. The premise of FOIA is to request information which is held by public authorities and not for information to be generated.

However the Loss Recovery team have provided the following answers:

Question 1

The National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 (TERC Regs) can be found at the below web link:

https://www.legislation.gov.uk/uksi/2003/2382/contents

Regulation 5 means that at the time of declaring exemption, the only way to determine if a patient meets the criteria is that they must have already made an application and that determination has already been made. They can make such a declaration during the period that the notice of entitlement is valid. If they do not have the exemption in place at the time they would have to sign the declaration, they must pay the charge and claim a refund.

When the refund claim is made under Regulation 11 a determination of their entitlement to a refund is made under Regulation 7, which is the same criteria used to determine their eligibility for a notice of entitlement by using their circumstances at the relevant date for the paid charge.

From regulation 7, the certificate will start from the date the application is made so it cannot cover a charge where an incorrect declaration has already been made. From regulation 11, an individual must have paid the charge without exercising their right to remission.

Question 2

If the relevant charge was not paid at the time and it was subsequently found that they did not have any exemption at that time, the charge then becomes recoverable as a civil debt. This means that the amount paid no longer meets the criteria for a remissible NHS charge as described in Regulation 4 of the TERC Regs.

Question 3

I can confirm that the NHSBSA holds the information you have requested and a copy of the information is attached.

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