REIMBURSEMENT OF PATIENT TRAVEL COSTS POLICY AND PROCEDURES MAY 2018

Transcription

1 REIMBURSEMENT OF PATIENT TRAVEL COSTS POLICY AND PROCEDURES MAY 2018 This policy supersedes all previous procedural documents for patient travel claims

2 Policy title Reimbursement of patient Travel Costs Policy and procedures Policy reference COR47 Policy category Corporate Relevant to All Staff handling patient travel Date published June 2018 Implementation June 2018 date Date last May 2018 reviewed Next review February 2019 date Policy lead Ruth Bottomley Deputy Financial Controller Contact details Telephone: Accountable director Approved by: Ratified by (Committee): Document history Membership of the policy development/ review team Consultation David Wragg, Director of Finance Finance and Operations Quality Committee 20 September 2016 Date Version Summary of amendments April New Policy Sep Updated to reflect current guidance May Routine review Ruth Bottomley, Deputy Financial Controller David Wragg, Director of Finance, Paul Calaminus, Chief Operating Officer DO NOT AMEND THIS DOCUMENT Further copies of this document can be found on the Trust s Intranet. 1

3 Contents PAGE 1. Introduction 3 2. Definitions 3 3. Scope of the Policy 4 4. Eligibility criteria 4 5. Exclusions 4 6. Places of treatment 5 7. Calculating travel costs 6 8. Modes of transport 6 9. Procedure for reimbursement of travel costs 8 10.Fraud prevention Appeals and complaints Dissemination and implementation arrangements Audit and Review References 10 Appendix A: Equality Impact Assessment 11 Appendix B: Eligibility and evidence required table 12 Appendix C: Eligibility for non-benefit claimants 14 Appendix D: Escort Slip 16 Appendix E: Patient travel claim form 18 2

4 1. INTRODUCTION 1.1 For some patients, travel to receive healthcare can present difficulties as the journey may be lengthy or complex, costly or access to public transport may be poor. In particular, patients on a low income or on benefits can find the cost of travelling to hospital or other healthcare premises for treatment or diagnostic tests difficult. This can widen health inequalities and potentially have serious consequences for the health of the patient. 1.2 The Hospital Travel Costs Scheme, now known as the Healthcare Travel Costs Scheme (HTCS) was set up in 1988, as part of the NHS Low Income Scheme, to provide financial assistance to those patients who do not have a medical need for ambulance transport, but who require assistance with their travel costs. Under the scheme, patients on low incomes or receiving specific qualifying benefits or allowances are reimbursed in part or in full for costs incurred in travelling to receive certain NHS services, where the journey meets certain criteria. 1.3 Following the commitment made in the White Paper in 2006, Our Health, Our Care, Our Say, the Hospital Travel Costs scheme was replaced with the Healthcare Travel Costs Scheme and has also been extended to include people who are referred by a health care professional for treatment in a primary care setting, providing that they meet the existing low-income criteria (section 6.68, Our Health, Our Care, Our Say). 1.4 The HTCS is a mandatory scheme as the NHS Regulations 2003, as amended, place a legal requirement on NHS Trusts and NHS Foundation Trusts to pay the NHS travel expenses of eligible patients through HTCS. The regulations also set out the eligibility criteria which are to be applied. 1.5 Universal credit is a new way of claiming benefits if you re on a low income or out of workit is being introduced in stages across Great Britain and at the time of writing this policy, the boroughs of Camden and Islington were not in a full service area. The policy will be further updated to reflect these changes in February Universal credit will replace: Jobseeker s Allowance Housing Benefit Working Tax Credit Child Tax Credit Employment and Support Allowance Income Support 2. DEFINITIONS HTCS Healthcare Travel Costs Scheme Secondary Care Services This refers to services that are not undertaken by your GP or Dentist. Provider Units refers to the units managed by Providers of NHS funded Healthcare services. NHS Travel Expenses means the travel expenses necessarily incurred in attending an appointment for the provision of NHS services which meet the criteria detailed in section 4 Eligibility Criteria. 3

5 NHSBSA NHS Business Services Authority C & I Camden and Islington NHS Foundation Trust 3. SCOPE 3.1 This policy is for the use of Trust staff to; Determine a patient s eligibility for reimbursement under the Healthcare Travel Cost Scheme (HCTS); To assist calculating the actual amount payable to the patient and; To understand the procedure for reimbursing travel costs. 4. ELIGIBILTY CRITERIA 4.1 In order to be eligible for full or partial reimbursement of travel costs, the patient must meet the following three conditions: 1. They must be: Condition one: At the time of your appointment, you or your partner (including civil partners) must receive one of the qualifying benefits or allowances listed in Appendix B, or meet the eligibility criteria of the NHS Low Income Scheme. Condition two: You must have a referral from a healthcare professional for a specialist or to a hospital for further NHS treatment or tests (often referred to as "secondary care"). Condition three: Your appointment must be on a separate visit to when the referral was made. This applies whether your treatment is provided at a different location (hospital or clinic) or on the same premises as where your GP or other health professional issued the referral. 4.2 Where all of the above three conditions are met, in accordance with the 2003 Regulations, the amount of any NHS travel expenses to be reimbursed will be calculated by reference to the cost of the cheapest means of transport which is reasonable, taking into account the persons relevant circumstances. (This condition is not relevant to C & I) 4.3 Patients from abroad who are accepted for NHS treatment may claim help with health costs in the same way as other patients. The patient will also need the appropriate exemption certificate before they are entitled to free treatment. 5. EXCLUSIONS 5.1 The Healthcare Travel Costs Reimbursement Scheme does NOT apply to: Patients attending an establishment to receive primary medical or primary dental services i.e. for repeat medication, initial appointments etc. Ordinarily patients attending an establishment to receive secondary medical services or secondary dental services but who have not been referred for those services by a Doctor or Dentist i.e. Self-referral are excluded. However for a mental health trust this is slightly different as some of the Trust s services are driven by self-referral. Therefore where a patient self refers, if they only attend a service as a one off and the outcome of the referral is that the patient does not require help, then the patient is not entitled to reimbursement of their travel costs. If however the self-referral results in the 4

6 patient receiving treatment, then the patient is entitled to reimbursement under the scheme, as long as they satisfy the criteria in 4.1. Patients who have a medical need for ambulance transport - which is provided through Transport Services, commissioned by Central and rth West London NHS Foundation Trust. Patients being transferred between treatment centres the cost of transferring patients from one hospital to another, or to a clinic or nursing home, whilst their treatment remains the responsibility of an NHS Hospital Consultant should be regarded as part of their treatment costs. Likewise, the travel costs of patients sent home as either part of their treatment or to meet hospitals convenience should be regarded as part of their treatment costs. Patients who discharge themselves from hospital at their own request. Visitors to patients in hospital. However, if the visitor receives one of the qualifying benefits listed in Appendix B or C, they may be able to receive assistance from their local council. Private Patients. Overnight stays. Where an overnight stay away from home is unavoidable, either because of the appointment time or length of travel involved, and the patient is unable to meet the cost of this stay, the expense should be treated as part of the treatment costs and, as such, will not be reimbursed under this policy. Parents needing to stay overnight in hospital with their children. Where accommodation is available, the health body should not charge for this. The cost of overnight accommodation cannot be reimbursed under this policy. (This is not relevant to Camden and Islington NHS Foundation as there are no inpatient wards for children). Patients receiving secondary care services on the same visit and in the same premises as those occupied by the doctor or dentist who during that visit has referred them for that care in the course of providing primary medical or primary dental services, are not entitled to claim reimbursement of expenses under this policy. For example, if an appointment is made with the GP and during this it is established that the patient requires a blood test, which can be taken at the time of the initial visit, as the patient has not made an additional journey to receive the test, reimbursement through the Health Care Travel costs Reimbursement Scheme is not appropriate. 5.2 The HTCS is applicable to patients who are seen as outpatients, day patients, admission patients and also discharge patients (except where the patient discharges themselves). The HTCS does not apply to patients being transferred between treatment centres, whilst their treatment remains the responsibility of an NHS consultant. The scheme therefore does not apply once a patient has been admitted as an inpatient or once they reside in residential or rehabilitation premises. 6. PLACES OF TREATMENT 6.1 Patients entitled to assistance with travel costs under the Healthcare Travel Costs Scheme may claim travel expenses to receive secondary medical or dental services at one of the Trust s sites, regardless of where the treatment is carried out. 6.2 If the reason for attending A&E is in relation to a pre-existing condition for which the patient is under the care of a Consultant, they would be entitled to claim reimbursement 5

7 of their travel costs under the Health Care Travel Costs Reimbursement Scheme. If however they attended A&E for any other reason they would not be eligible for reimbursement. 7. CALCULATING TRAVEL COSTS 7.1 In accordance with the 2003 Regulations, travel costs will be calculated on the cheapest form of transport appropriate to the patient. Upon request for payment, the costs of the travel incurred should be checked to ensure they are reasonable and the patient s personal circumstances should also be taken into account when determining this. 7.2 The assessment of reasonableness is based on the assumption that the patient should be able to reach their healthcare establishment in a reasonable time and without detriment to their condition. Therefore the following criteria should be taken into account: The distance the patient has to travel. The length of time the journey takes to complete. How often the patient has to undertake this journey. The availability, suitability and accessibility of public transport. The patient s medical condition. The patient s age. 7.3 If deemed medically necessary by the patient s referring consultant, GP or another healthcare professional involved in the patient s care, the travelling expenses of an escort may also be claimed as part of the patient s travelling expenses. In cases where a child under 16 attends an appointment, the travelling costs of a parent or guardian can also be claimed. 7.4 Payments for escorts are made on the basis of the patient s eligibility, irrespective of the escort s eligibility. The travel costs for the escort however should be assessed on the same basis as those for the patient s. 7.5 People receiving a benefit providing entitlement to the reimbursement of their travel costs under this scheme are also eligible to claim travel costs where the healthcare appointment has been made for a child or dependent. Such claims should be assessed in the same way as all other claims under this scheme. 8. MODES OF TRANSPORT 8.1 Public Transport and Concessionary Fares The use of public transport and concessionary fares i.e. the elderly, off peak fares etc should be encouraged where they provide convenient links to hospitals and other places of care Where a patient purchases a paper travel card (e.g. daily or weekly) to travel to the Trust, then the full amount will be reimbursed as long as the cost of the travel card is no more than the cost of the single cash journeys as detailed on the TFL website. For example if a patient purchases a peak travel card Zones 1-2 costing 8.00 this should be reimbursed as it is the same cost as the patient purchasing two peak single journeys by cash, which cost 4 each. There are some circumstances where it is cheaper for the patient to purchase two single cash tickets rather than purchasing a travel card. In the event a patient still purchases a travel card, they should only be reimbursed for the cost of two single cash journeys. For example a Zones 1-6 peak travel card costs 15 but two peak single journeys cost 10 ( 5 each journey). In this instance the patient should only be reimbursed 10; the cost of the single cash journeys. However there may be occasions when the staff reimbursing patient s travelling expenses need to use their discretion and reimburse the patient for the cost 6

8 of a travel card, despite this costing more than the cash value of single journeys Patients who already have an electronic travel card for their personal use (e.g. daily, weekly, monthly and annual travel cards - including an Oyster card or contactless card ) and use this to travel to the Trust, should be reimbursed the cost of their journey according to the single Oyster standard rates, as detailed on the TFL website ( Patients who use pay as you go Oyster cards to travel to the Trust will have to become an Oyster online account holder, register their Oyster card and purchase pay as you go credit online or use auto top up so that they are able to print off their journey history and claim their travel expenses. Top-up receipts will not be accepted as evidence of the journey, it must be a statement showing the actual journey made If a patient is not an Oyster online account holder they will have to purchase a ticket and produce a receipt It is important to note that journey history on Oyster cards is only kept on line for 8 weeks; journeys must be printed off regularly in order to claim. Please also note that journeys within the last 48 hours may not show on the journey history For patients using contactless technology, they should either provide a copy of their bank statement or register for a contactless and Oyster account via the Transport for London (TfL) website. Details of fares charged and payments for all journeys will be available for up to 12 months Where the patient has to travel across zones that are not covered by their travel card, the excess travel expense will be reimbursed on the production of relevant receipts of fares. Patients may purchase an extension for the extra zones, in which case a receipt for this will be required, or they may pay-as-you-go on an Oyster card as an Oyster card will allow a patient to pay as they go on top of their current travel card. For the latter, patients have to become an Oyster online account holder, register their Oyster card and purchase pay as you go credit online or sign up for auto top-up. They will then be able to print their journey history statement and submit this as their receipt in order to claim their travel expenses from the Trust. 8.2 Community Transport and Voluntary Care Schemes These provide transport for people who are unable to use, or have difficulty with access to public transport and are therefore unable to make use of concessionary fares. Reimbursement of costs under this mode of transport can be made (excluding reimbursement for annual membership fees) and a receipt for each journey should be produced at the time of reimbursement. 8.3 Private Motor Vehicles If the use of a private motor vehicle is deemed reasonable, mileage will be reimbursed at the Agenda for Change public transport rate regardless of the engine size or type of fuel (currently 28 pence) Mileage calculations will be made using either the AA or RAC journey planners. ( or If the use of a private motor vehicle is not deemed to be reasonable, the reimbursement of the lesser of the following will be made: 7

9 a) The estimated cost of fuel actually used; b) The equivalent public transport cost. 8.4 Car Parking & Toll Charges Patients using their own private motor vehicle will be reimbursed for car park and toll charges Under no circumstances will penalties incurred through illegal parking be reimbursed Where a patient pays parking fees via phone, they should produce either an ed receipts or copy of their bank statement, or any other method which clearly shows the date and cost incurred. 8.5 Congestion Charges The cost of congestion charges in London should be claimed back via the Congestion Charging NHS Reimbursement Scheme, operated by Transport for London. It is the responsibility of the Finance Department to claim the monies from TfL. Where patients pay the congestion charge via phone, no receipt is required but claims must be limited to the actual amount of expense incurred. 8.6 Taxis If the use of a taxi is considered to be reasonable, taking into account the patient s circumstances, reimbursement for the costs incurred will be made. A receipt must be provided as proof. The clinician must authorise this and state that the patient was not fit to use public transport. 9. PROCEDURE FOR REIMBURSEMENT OF TRAVEL COSTS 9.1 The HTCS provides three acceptable payment methods for patients; At the provider unit on the day of travel (where a cashier s facility exists for C&I, this facility is currently available at St Pancras Hospital and Highgate Mental Health Centre) Retrospectively through a HC5 postal claim sent to the address shown on the form Advance payments through a cashier s facility above or by cheque sent to the home address. 9.2 Patients must be encouraged to claim reimbursement on the day of travel. If they do not have the required documentation with them on the day of travel then they may claim reimbursement at their next appointment. Where patients attend regular appointments, for example daily appointments, it is acceptable for them to claim reimbursement for a maximum of 4 journeys are any one time; and reimbursements will only be made within 3 months from date of travel. 9.3 Where a cashier facility is available at a site the following process should be followed; a. The patient is given a controlled stationery claim form by Patient Affairs or the service/site where they have attended for an appointment or treatment. (See Appendix E) b. The clinician or other suitable person should sign and date the claim form to confirm that the patient attended the appointed, also adding contact details and budget code to where travel expenditure should be coded. c. Where the patient has travelled with an escort, the clinician is required to confirm whether they deemed the use of an escort to be medically necessary taking into account the patient s circumstances including medical condition, or confirm if the patient is under 16, They should complete an Escort Slip and give this to the patient (Appendix D) d. The patient takes the claim form to the cashier/patient affairs office. 8

10 e. The claim form is passed to the cashier issuing the reimbursement, along with evidence of their entitlement to claim (see Appendix B or C), receipts for their journey and an Escort Slip, if applicable. f. The cashier administering the reimbursement p h o t o copies all the above d o c u m e n t a t i o n and reimburses the patient out of petty cash. The cashier should sign and date the section at the bottom and record their name and job title. g. Details of the reimbursement is recorded on the petty cash documentation in accordance with the Trust s petty cash policy. h. If the patient is unable to provide evidence of their entitlement to the HTCS, then no reimbursement will be issued and the patient will need to present evidence at their next appointment for the claim to be reimbursed. If they will not be attending the Trust in the near future they will have to claim retrospectively using a HC5(T) postal form. See 9.4 for details. Claims can only be made up to three months after the date of treatment. Any claim received after this time period will not be reimbursed, unless otherwise agreed by the Senior Financial Accountant. i. If the patient is unable to provide evidence of their entitlement to the HTCS they have to claim retrospectively using a HC5 (T) postal form available from the cashier/patient affairs. See 9.4 for details. j. If the patient is unable to provide evidence of their travel costs i.e. if they used their Oyster card and need to print their journey details from the TFL website, then no reimbursement will be made and the patient will need to present evidence at their next appointment for the claim to be reimbursed Incomplete claim forms will not reimbursed. 9.4 The following process should be followed for Requesting Retrospective Payments for Travel using the HC5(T) postal form; A. Patient to obtain HC5(T) refund form from the service/cashier/patient affairs office B. Patient to complete form HC5 (T) refund form. Part 4 of the form identifies where the form should be sent to depending on the patients circumstances. Upon receipt, the NHSBSA will verify eligibility and send the form to the St Pancras Cashiers Office confirming whether a refund is due to the patient. The Cashiers Office will number the form and log the details on a database accordingly. C. The Cashiers Office will then calculate the amount and the costs of reimbursement will be either refunded in cash, and the patient advised when they are able to collect this or, a cheque request will be submitted and posted directly to the patient. D. Claims can only be made up to three months after the date of treatment. Any claim received after this time period will not be reimbursed, unless otherwise agreed. 9.5 Patients on low income or benefits may not be able to afford to travel to their healthcare appointment. Patients may attend places of treatment that do not have cashier or cash handling functions. In such cases an advance payment may be appropriate. Where advance payments are made to patients, C&I should ensure that they have a robust process in place to verify that the patient actually attended the appointment for which payment was made. The patient should be required to show evidence of the appointment they will be attending and evidence that they are in receipt of one of the qualifying benefits or qualify under the low income scheme. If the patient is unable to provide evidence of their entitlement to the HTCS, then no advance payment should be made. 9.6 Time limit for claiming expenses: patients must ensure they claim for expenses within 3 months of the date that charges were paid. If the claim is after 3 months, the NHS 9

11 Business Services Authority will decide if there is a good reason for it being late before it can be accepted. In this case, written explanations along with a HC5 (T) form should be sent to NHS Business Services Authority, Help with Health Costs, Bridge House, 152 Pilgram Street, Newcastle Upon Tyne, NE1 6SN. (This information is also provided on the HC5(T) form.) 10. FRAUD PREVENTION 10.1 Only claims submitted using the controlled stationery claim form (Appendix E) or the HC5 (T) form are acceptable Should fraud be suspected, it should be reported to the Local Counter Fraud Specialist or to the NHS Fraud and Corruption Reporting Line on All calls will be dealt with in the strictest of confidence by trained staff. 11. APPEALS AND COMPLAINTS 11.1 Once the NHSBSA have confirmed eligibility, it is the decision of C & I whether or not the costs incurred for travel are reimbursed. This decision will be made on the basis of reasonableness as described in section 7.2. If considered to be unreasonable, reimbursement will not be made. 12. DISSEMINATION AND IMPLEMENTATION ARRANGEMENTS 12.1 This document will be circulated to all managers who will be required to cascade the information to members of their teams. It will be available to all staff via C&I s intranet. Managers will ensure that all staff are briefed on its contents and on what it means for them. 13. AUDIT AND REVIEW 13.1 Reimbursing Officers are responsible for checking claims made under this policy to ensure they are made in accordance with C&I policy and the HTCS. Internal Audit and the Counter Fraud Service may also undertake audits to check compliance with this policy This review process for this policy will commence April 2017 once the universal credit has been rolled out across the country. 14. REFERENCES Healthcare Travel Costs Scheme, Instructions and Guidance for the NHS, 27 th May 2010 HC11 Help with health costs Applies from 1 April NHS Employers - Mileage allowances Section 17 Transport for London website 10

12 Appendix A: Equality Impact Assessment Tool Yes/ Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? N/A N/A N/A N/A 11

13 APPENDIX B The table below provides details of eligibility under the scheme and the evidence required to support the eligibility. Benefit Eligibility criteria Entitlement covers Proofs of entitlement Income Support (IS) All patients in receipt of Income Support are entitled to payment of NHS travel expenses through HTCS. Recipient, partner or any dependants for whom the recipient or partner is responsible including children and young people under 16 named in the award. Some children and young people will not be included in the IS award but may be covered by Child Tax Credit (CTC). An award letter from their Jobcentre Plus Office OR Any official correspondence that indicates entitlement to the named benefit on the day of the appointment, and dated within a three month period of the appointment Income Employment Support (ESA-IR) Based and Allowance All patients in receipt of income based Employment and Support Allowance Escorts Where deemed medically necessary by health care professional that patient is escorted to receive treatment. Recipient, partner or any dependants for whom the recipient or partner is responsible including children and young people under 16 named in the award. Some children and young people will not be included in the IS award but may be covered by Child Tax Credit (CTC). An award letter from their Jobcentre Plus Office OR Any official correspondence that indicates entitlement to the named benefit on the day of the appointment, and dated within a three month period of the appointment Escorts As for IS above Income Jobseekers (JSA-IB) Based Allowance All patients in receipt of Income Based Jobseekers Allowance Recipient, partner or any dependants for whom the recipient or partner is responsible including children and young people under 16 named in the award. If a child is no longer included, entitlement should be through Child Tax Credit (CTC). An award letter from their Jobcentre Plus Office OR Any official correspondence that indicates entitlement to the named benefit on the day of the appointment, and dated within a three month period of the appointment Escort As for IS above 12

14 Working Tax Credit (WTC) and Child Tax Credit (CTC) Patients who are receiving or are named on an award certificate for; WTC with CTC WTC on its own with a disability element or a severe disability element (check award notice or decision letter); CTC on its own Recipient, partner and any dependants including children and young people under 20 named on the award. Escort As for IS above Certificate (this is a wallet sized plastic card). An award letter if the certificate has yet to be provided In the case of dependants, the tax credit award letter detailing the children included in the award. Pension Credit (Guarantee Credit) Family income for tax credits must be 15,276 or less. Provided that the relevant All patients in receipt of Pension Credit - Guarantee Credit) paid on its own or with Pension Credit (Savings Credit) Recipient, partner and dependants Escort As for IS above Award letter detailing the type of pension credit in payment. Pension Credit Savings Credit on its own does not provide automatic entitlement to assistance through HTCS. However patients in receipt of this benefit may qualify for full or partial reimbursement via the 13

15 APPENDIX C Where patients are not in receipt of any of the benefits listed above, there are four other routes providing eligibility to HTCS as follows; Passport to support Eligibility criteria Entitlement covers Proofs of entitlement People claiming on the grounds of low income Patients who are not in receipt of any qualifying benefits but are on a low income and whose savings, investments or property are less than 16,000 ( 23,250 if in a care home), may be eligible for assistance with their NHS travel expenses. The NHSBSA calculates a patient s entitlement. A patient must submit a HC1 Assessment Form to NHSBSA in order for their entitlement to be assessed. If a patient is in a care home or supported by a Local Authority a HC1(SC) must be completed. Recipient, partner and dependant children or young people under 19 whose names are shown on the notice of entitlement (known as HC2 or HC3 certificate). Escorts Where deemed medically necessary by health care professional that patient is escorted to receive treatment. Escorts costs should be added to the patient s costs and it is the patient s income that will count, not the escort s. HC2 Certificate which provides eligibility to a full refund or HC3 Certificate which provides eligibility to a partial refund The certificates will show; - The amount of NHS travel expenses that each patient is expected to meet in any one week. All costs incurred within the week over this amount may be refunded. Week commences at midnight on Saturday. - The period of validity of the patient s entitlement. - The names of the people covered by the certificate. Persons living permanently in a care home or accommodation provided by a local authority To qualify the claimant must reside in one of the following and satisfied the local authority that they are unable to pay for that accommodation at the standard rate or, as the case may be, the full rate; A care home Residential accommodation Claimant only An official letter from the local authority confirming their status as at the date the travel for healthcare was undertaken. 14

16 Asylum seekers for whom support is provided under Part VI of the Immigration and Asylum Act 1999 Children of 16 or 17 being supported by a local authority provided by a local authority for persons over 18 who by reason of age, illness, disability or any other circumstances are in need to care Residential accommodation for expectant and nursing mothers who are in need to care and attention A person who is an asylum seeker for whom support is provided under Part VI of the Immigration and Asylum Act A child ages 16 or 17 years of age who has been in local authority care and is being supported by a local authority under section 23B of the Children Act 1989 Recipient and any dependants where a dependant is classified as someone in the UK who is: A spouse A child of his or his spouse, who is under 18 and dependent on him Claimant only An official letter from the Home Office confirming their status as an asylum seeker being supported under the 1999 Act as at the date the travel for healthcare was undertaken OR a valid HC2 or HC3 certificate An official letter from the local authority confirming their status as at the date the travel for healthcare was undertaken. 15

17 Policy and Procedure for Reimbursement of Patient Travel Costs under the HTCS APPENDIX D ESCORT SLIP TO BE COMPLETED BY A CLINICIAN PATIENT NAME: SERVICE/TEAM/ WARD ATTENDED:.. ATTENDANCE DATES: ATTENDANCE TIME: ESCORT IS MEDICALLY NECESSARY/ OR PATIENT IS UNDER 16: (CONSULTANT SIGNATURE REQUIRED) YES: (CONSULTANT SIGNATURE) (PRINT NAME) NO:.. (CONSULTANT SIGNATURE) (PRINT NAME) 16

18 APPENDIX E Title: First name: Surname: Address: Patient Travel Claim Form Telephone number: National Insurance Number: Appointment date and time (maximum 3 appt s): Hospital Number: Service/Ward where appointment was held: 1) 2) 3) I declare that the information given on this claim form is true and complete to the best of my knowledge. I understand that action may be taken against me if I make an incorrect claim. I consent to the disclosure of relevant information on this form for the purposes of fraud prevention, detection and investigation. I have provided the following evidence to entitle me reimbursement for travel expenses and provided relevant receipts that back up my claims: Income Support Income-related Jobseeker s Allowance Income-related Employment and Support Allowance A valid HC2/HC3 form Tax Credit Exemption Certificate Pension Credit Guarantee Credit A completed Escort Slip or written confirmation from your Clinician/Doctor of the requirement for an escort. Patient s signature: Authorised signature: Job Title: Date: Print name: Phone number: Expenditure code & Budget code: / OFFICE USE ONLY PAYMENT AUTHORISED AND REIMBURSED BY: Name: Signature Date: / / Total amount reimbursed: Dates reimbursed: / / Receipts attached* Yes / (Delete as appropriate) If no, please state reason why: