Written answers

Tuesday, 24 May 2016

Department of Health

Cross-Border Health Services Provision

Photo of Pearse DohertyPearse Doherty (Donegal, Sinn Fein)
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446. To ask the Minister for Health regarding the cross-border directive, CBD, if he will outline the way the total cost of comparable treatment in another jurisdiction versus the costs incurred of having the treatment provided here is communicated to persons applying to access the scheme; the way in which a persons are informed of the fact that reimbursement rates are set at whichever cost is the lesser; and if he will make a statement on the matter. [11390/16]

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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The Health Service Executive operates the EU Directive on Patients' Rights in Cross Border Healthcare in Ireland. In line with practice in other EU Member States, the HSE, through the National Contact Point (NCP) office, provides information for patients on the Cross-Border Directive on its website and also by phone. The principal function of the NCP (which is the mechanism specified under the Directive for the dissemination of information on the Directive by Member States) is to facilitate exchange of information for patients concerning their rights and entitlements relating to receiving healthcare in another Member State, in particular the terms and conditions for reimbursement of cost and the procedures for accessing and determining those entitlements.

Under the Directive, insured patients are entitled to have costs of cross-border healthcare service reimbursed if the healthcare service in question is among the benefits to which they are entitled in their Member State of affiliation. The HSE is proactive in advising potential users of the Scheme that reimbursement will be at the cost of the treatment availed of abroad or the cost of providing the healthcare in Ireland whichever is the lesser. The patient is notified of this by the HSE in numerous ways: via the HSE website or in response to phone queries; on the Pro-forma invoice to be used for cases where an overnight in-patient stay is not required; and the letters issued in response to prior authorisation applications for cases involving an overnight in-patient stay will advise the actual amount to be reimbursed, based on the treatment code/s provided by the treating/referring consultant in the application form.

The HSE also advises where a patient is in any doubt as to the need to seek prior authorization before availing of a consultation or treatment abroad to contact the NCP. The NCP is happy at that stage to advise patients of the reimbursement rate that will apply to the assessment/treatment being accessed.

The HSE endeavours to reimburse the cost of treatment incurred or the cost of providing such healthcare in the State, which ever is the lesser, to the applicant within 30 days of receipt of a claim for reimbursement, in line with Prompt Payment Legislation.

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