Hospital treatment and care to residents, non-residents, overseas visitors, and foreign nationals

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demonstrating that good governance, and clear lines of accountability and authority, are in place around decisions-making – including the reasons and basis on which a decision is made, and the action required to implement a decision
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A decision made 21 December 2010 regarding: Hospital treatment and care to residents, non-residents, overseas visitors, and foreign nationals.

Decision Reference: MD-HSS-2010-0063
Decision Summary Title :	Provision of hospital treatment and care to residents, non-residents, overseas visitors and foreign nationals.		Date of Decision Summary:	14 December 2010
Decision Summary Author:	Assistant Director, Performance & Operations		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:
Written Report Title :	Provision of hospital treatment and care to residents, non-residents, overseas visitors and foreign nationals.		Date of Written Report:	14 December 2010
Written Report Author:	Assistant Director, Performance & Operations		Written Report : Public or Exempt?	Public
Subject: Interim policy relating to the provision of hospital treatment to residents, non-residents, overseas visitors and foreign nationals.
Decision(s): The Minister decided to introduce an updated interim policy relating to the Provision of hospital treatment and care to residents, non-residents, overseas visitors and foreign nationals. This updated interim policy will replace existing 2004 policy. It will come into effect on 4th January 2011 and be reviewed pending States decisions with regard to long-term care funding.
Reason(s) for decision: The revised policy has updated criteria including: free non-emergency treatment will only be available to people who have been living in Jersey for at least 12 months, or six months if they are in regular paid employment or paying income tax former Jersey residents who have lived or worked elsewhere for 5 years or more are not entitled to free treatment until they have been Jersey resident again for the 6 month or 12 month period entitlement extends to spouses and dependent children but not other relatives entitlement to the nursing care element of long-term care packages provided in residential units is only free to those who would also qualify for financial assistance with care costs under existing Social Security criteria.
Resource Implications: Approximately £3,000 will be required for the production of leaflets and posters promoting the new policy.
Action required: Policy to released for publication. To be implemented from 4th January 2011.
Signature:		Position: Minister, Health and Social Services Department
Date Signed:		Date of Decision (If different from Date Signed): 15 December 2010

Hospital treatment and care to residents, non-residents, overseas visitors, and foreign nationals

Overseas patients policy

REGISTRATION NUMBER

Provision of hospital treatment and care to residents, non-residents, overseas visitors and foreign nationals

(including UK nationals and visitors)

Effective from: 4 January 2011

DOCUMENT PROFILE

Document Registration Registration number to be added after ratification

Document Purpose Interim Policy

Short Title Overseas patients policy

Author Ruth Johnson, Assistant Director, Policy, Ministerial Support & Change

Publication Date 1 January 2011

Target Audience HSSD service users (acute and long term care)

Circulation List All HSSD staff

Description Defines entitlement to free health care services in Jersey.

Linked Policies Reciprocal health policies (see Appendix 2)

Approval Route Medical staff committee/CMEX/Ministerial Decision

Review Date 1 year from approval

Contact Details ruth.johnson@health.gov.je

REGISTRATION NUMBER:

CONTENTS LIST:

Introduction Page 3

Policy

Emergency Hospital treatment Page 3

Non-emergency Hospital treatment Page 3

Long term care Page 4

Payment for treatment Page 4

Travel costs Page 5

Non-emergency treatment in the UK Page 5

Disputed charges and exceptional circumstances Page 5

Appendices

1. Description of ordinary residents potentially

eligible for free non-emergency hospital treatment Page 6

2 Countries with which Jersey has a Reciprocal Page 7

Health Agreement

3 Exemptions Page 8

INTRODUCTION

This interim policy supersedes an existing policy introduced in 2004. It aims to define and clarify entitlement to free health care services in Jersey.

This policy applies to all services provided by the Health and Social Service Department. It does not apply to treatment or care provided by General Practitioners or by other States Departments (including Social Security).

This policy may be subject to change at any time. Entitlement to services will be assessed under the policy in force at the time that treatment or care is required.

THE POLICY

1. Emergency HOSPITAL treatment

The Health and Social Service Department (the Department) will provide emergency hospital treatment free of charge to anyone who requires it.

For visitors and non-residents this free treatment is limited to emergency care provided in the General Hospital’s Accident and Emergency Department. It does not include any treatment or services provided elsewhere in the hospital or in the community.

2. NON-emergency HOSPITAL treatment

The Department will provide hospital based treatments and services [1] free of charge to anyone who:

is listed in Appendix 1 AND
has been ordinarily resident [2] in Jersey for a minimum 6 month period immediately preceding treatment AND
is in possession of a valid health card [3] AND
can provide evidence that they have been in paid regular employment in Jersey throughout that 6 month period or that they have been paying income tax in Jersey throughout that six month period

is ordinarily resident2 in Jersey AND
is currently in “J category” employment [4]

has been ordinarily resident2 for a minimum 12 month period AND
is in possession of a valid health card.

If a person is entitled to free treatment, that entitlement is extended to their ordinarily resident spouse and dependent children [5]. It does not include other family members or friends.

Exemptions are listed in Appendix 3. The Minister may exercise discretion to waive the requirements in this policy in exceptional circumstances.

3. Long-term Non-acute CaRe

Long-term non-acute care has two distinct elements, the long-term stay element and the nursing element.

The Department will not meet any of the costs associated with the long term stay element for any individual.

The Department may provide the nursing care element free of charge to anyone who:

has been ordinarily resident2 in Jersey for a minimum 5 year period immediately preceding treatment AND
is in possession of a valid health card3

is ordinarily resident2 in Jersey AND
is currently in “J category” employment4

is entitled to free non-emergency hospital treatment (as outlined in Section 2) AND
has previously lived in Jersey for any consecutive period of at least 10 years

This applies to long-term non-acute care services for older people, people with mental health conditions, people with a disability or life-limiting illness that requires long-term care.

4. Payment fOR treatment

Anyone who is not entitled to free services, as outlined in Section 1, 2 or 3

above, but who needs treatment or care may be treated but will be required to pay for all treatment received and any related expenses. This includes:

anyone who is unable, due to the circumstances of their condition, to consent at the appropriate time to the treatment and the associated charges and/or
where a family member consents to treatment and the associated charges on a patient’s behalf in the event that the patient is unable to consent.

Travel costs

The Department will pay for flights and other travel costs when this is an integral part of the standard service provision for patients entitled to free hospital treatment under this policy.

The Department will not pay for any other patient transport (including repatriation) and will recharge the cost of any travel booked to the patient.

6. NON-EMERGENCY TREATMENT IN THE UK

The Department will only accept financial liability for treatment provided to a patient who is entitled to non-emergency hospital treatment in Jersey under Sections 1 or 2 of this policy and who has been referred to the UK provider by a Health & Social Services Consultant.

7. DISPUTED CHARGES AND EXCEPTIONAL CIRCUMSTANCES

In the event of a patient, or a representative of that patient, disputing any charge levied upon them they should utilise the standard Health and Social Services complaints procedure to express their concerns and identify why they feel they should not be charged. This must be done in writing through the approved complaints procedure. Charges can only be waived in exceptional circumstances and with the approval of the Charges Appeal Board which includes:

the Assistant Minister for Health and Social Services
the Director of Finance, or his/her nominated representative
the Hospital Director, or his/her nominated representative

APPENDIX I: Persons potential eligible for free hospital treatment

For the purposes of this policy the Department will regard the persons listed below as ordinarily resident. Access to free hospital services is limited to individuals who meet the definition of ordinarily resident and the access criteria outlined in Section 2.

A British citizen or a national of another member state of the European Economic Area (EEA) or
a Swiss national who is legitimately employed in Jersey.

EEA members (as at January 2010)

Austria	Greece	Netherlands
Belgium	Hungary	Norway
Bulgaria	Iceland	Poland
Cyprus	Ireland	Portugal
Czech Republic	Italy	Romania
Denmark	Latvia	Slovakia
Estonia	Liechtenstein	Slovenia
Finland	Lithuania	Spain
France	Luxembourg	Sweden
Germany	Malta	United Kingdom

A Commonwealth citizen currently in employment in Jersey who has permission from the Customs and Immigration Service to remain in Jersey

A person currently in employment in Jersey under a work permit issued by the Customs and Immigration Service

A person who is the partner or dependent child5 of a person ordinarily resident and working as defined in number 1 to 3 above who resides with that person and who maintains no other accommodation

A person who maintains his or her principle accommodation in Jersey in which he or she resides and who has been living in Jersey for a minimum of 12 consecutive months prior to treatment

EVIDENCE OF ENTITLEMENT

It will be the responsibility of the individual to provide proof of entitlement (e.g.: copies of employment contracts, tax returns and tax notices, passports, work permits, utility bills, rental contracts, birth and marriage certificates). Failure to provide evidence will result in charges being applied.

FORMER JERSEY RESIDENTS

Former Jersey residents who are returning to Jersey having lived or worked elsewhere for 5 years or more will not be entitled to free care or treatment, unless they qualify under Section 2.

Former Jersey residents who are returning to Jersey after less than 5 years will only be entitled to free care or treatment if they can provide evidence that they had previously lived in Jersey for ten continuous years at some point.

APPENDIX 2: Countries with which Jersey has a reciprocal health agreement

1	Australia
2	Austria
3	Barbados
4	France
5	Guernsey and Alderney
6	Iceland
7	New Zealand
8	Norway
9	Portugal
10	Sweden

Appendix 3: Exemptions

The following individuals (their spouse and dependent children who are ordinarily resident with them) are exempt from restrictions outlined in Section 2

members of the Consular Corps accredited to Jersey.

a member of the UK armed forces who was, immediately prior to enlisting, ordinarily resident in Jersey

a member of another nations’ Armed Forces or Emergency Service who is on official duty in Jersey at the time treatment is required (confirmation of their official capacity must be received from an appropriate Jersey Liaison Officer)

a full time student at an institution (not in Jersey) who was, immediately prior to starting at that institution, ordinarily resident in Jersey

A prisoner detained in prison or by the Customs and Immigration Service in Jersey

any individual living and working abroad (not including in the UK) in the following capacities who was ordinarily resident in Jersey immediately prior to taking up their work:

a member of diplomatic staff working in an embassy
staff working for the British Council or Commonwealth War Graves Commission
a missionary (paid or unpaid) working for an organisation principally based in Jersey
an aid worker (paid or unpaid) working for a recognised charitable organisation

The following individuals will also not have to pay:

those in need of immediate compulsory psychiatric treatment
those requiring treatment for certain contagious diseases.

STATES OF JERSEY DEPARTMENT FOR HEALTH & SOCIAL SERVICES

Page 1 of 8

[1] The Department will not be responsible for the provision or funding of care and/or treatments and/or drugs or equipment which fall outside its policies.

[2] See Appendix 1 for description of ordinary residents potentially eligible for free treatment or care

[3] If you have lived in Jersey for 6 months or more, and are aged 16 or over, then you are entitled to a health card. Health cards are available from the Social Security Department. They entitle the holder to a discount on the fees charged by GPs.

[4] “J category” employment status is only granted in the case of employees who are deemed to be essential to the Island. The Population Office administers the Laws that relate to J Category employment and are the first point of contact in relation to queries about “J category” status.

[5] Dependent children includes children who are ordinarily resident with their parents or legal guardian and are aged 18 years or under OR over 18 years but still in full time education.