Róisín Shortall (Dublin North West, Labour)
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Question 313: To ask the Minister for Health and Children if, in respect of the consideration of applications of medical cards, she will provide a copy of the guidelines followed by staff in respect of applications from terminally ill patients. [29807/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Health Service Executive (HSE) has the operational responsibility for the General Medical Services (GMS) Scheme which includes the medical card and GP visit card benefits.

Terminal illness itself is not a qualifying condition for receipt of a medical card. However, it is an indicator that a person may have exceptional medical expenses and all such expenses and associated costs are considered under the discretionary powers of the HSE to grant cards in exceptional circumstances.

The HSE provides guidance and training for staff on the use of discretionary power to assist staff in providing a consistent and sensitive approach to such cases throughout the country.

The HSE have provided an extract from the National Assessment Guidelines, which is attached below, for the Deputy's information.

Extract from National Assessment Guidelines:

Assessment Process and Discretion:

Where the HSE invokes this discretion they do so in a consistent manner and be cognisant of the potential myriad of circumstances that might prevail in individual cases. The following guidelines have been developed to ensure that fairness and equity is applied to all applicants seeking either a Medical Card or a GP Visit Card.

If a person's means are in excess of the relevant income guidelines then a decision must be taken to grant or refuse either a Medical Card or GP Visit Card. In this context the issues taken into account are additional and exceptional circumstances as outlined as follows.

The process involved in deciding eligibility is as follows:

1. If the applicant's means is in excess of the Medical Card income guidelines the deciding officer must consider whether to refuse would cause undue hardship.

2. If after such consideration the applicant fails to qualify for a Medical Card the deciding officer must consider the applicant for a GP Visit Card.

3. If the applicant's means is in excess of the GP Visit Card guidelines the deciding officer must consider whether it would be unduly burdensome for the applicant to provide for GP Services for him/her self from his/her own resources.

Relevant Factors in Assessing Hardship

The exercise of discretion by the HSE, in favour of the applicant, should be considered where meeting the costs of services covered by a Medical Card or a GP Visit Card compromises the applicant's or his/her family's ability to meet the essential costs associated with:

- maintenance of employment

- provision of reasonable housing

- provision of appropriate nurturing and care for children or dependants

- provision of adequate heating, nutrition and clothing, or

- coping with exceptional personal and financial burdens arising from medical or social circumstances.

The decision makers must act in a reasonable fashion, and take into account only bona fide and relevant considerations.

A decision should only be taken after a sufficient and reasoned assessment of all the circumstances of an individual case to include the nature and extent of personal, medical or social circumstances of the applicant and/or his/her family. A Medical Card/GP Visit Card should be issued, if, having had due regard to all the relevant circumstances, it is considered that "undue hardship" would occur or that it would be "unduly burdensome" to provide GP, medical or surgical services. Where a Medical Card has been granted to a person to prevent undue hardship or where a GP Visit Card is granted because it would be unduly burdensome, eligibility should normally be extended to all dependents of that person. If in the assessment it is obvious that the predominant costs factor for the applicant is the cost associated with GP visits, the case may be dealt with by granting a GP Visit Card.

A number of issues, such as the following, shall be taken into account in making a decision:

- Illness or medical circumstances which results in financial hardship.

- The cost of providing general medical and surgical services.

- The cost associated with the provision of medical, nursing and dental treatment.

- The cost of physiotherapy and speech and language therapy.

- Transport cost to hospitals and clinics.

- Addictions such as drink, drugs and gambling.

- Poor money management.

- Social deprivation – including poor home management.

- The cost of medical aids and appliances.

The decision makers may seek advice from other sources to may include:

- The Applicant's Doctor(s).

- The HSE's Medical Officers.

- The Public Health Nurse.

- The Community Welfare Officer.

- Social Worker.

- The Therapy Services.

- Money Advice and Budgeting Service (MABS).

Please Note: The decision maker must get the prior expressed approval of the applicant before any of the above persons are contacted.

When all of the factors pertinent to a case are taken into account, a decision to grant or refuse a Medical Card or a GP Visit Card is made.

By following the approach provided for in these guidelines, the HSE will ensure that the system is adequate enough to respond to the myriad of circumstances and hurdles faced by a diverse group of individuals in society.