Written answers

Tuesday, 9 October 2018

Department of Health

Cross-Border Health Services Provision

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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294. To ask the Minister for Health the reason persons on the public waiting list here are being excluded from the cross-border scheme due to the fact an element of their income is an English pension (details supplied). [40918/18]

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Under the Cross Border Directive it is a person's Member State of affiliation which is responsible for the reimbursing of treatment accessed and not the Member State in which they reside.

A person's Member State of affiliation is the State in which the person is, or has been, an insured person within the meaning of Article 2 of EU Regulation 883/2004. A person who has worked and paid their social insurance contributions in one Member State may choose to live in another Member State. However, the State to which they are affiliated remains responsible for reimbursing them for the purposes of the Cross Border Directive. Thus if a person is in receipt of a contributory pension, however small, from another Member State, it is that State and not Ireland which is responsible for reimbursing a person under the terms of the Cross Border Directive.

As the particular details of any case to which the Deputy is referring is a service matter, this question has also been referred to the Health Service Executive for attention and direct reply to the Deputy.

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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295. To ask the Minister for Health the reason administrative staff are changing the code of procedures carried out under the cross-border scheme which is resulting in patients only recovering a percentage of the money they paid (details supplied); and if he will make a statement on the matter. [40919/18]

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Under the Cross Border Directive (CBD) public patients in Ireland can seek to be referred to another EU/EEA country for a treatment that is available in Ireland. The patient pays for the treatment and claims reimbursement from the HSE at the cost of that treatment in Ireland or the cost of it abroad, whichever is the lesser.

It is important to note that reimbursement is confined to the costs of the care itself and that the rates of reimbursement cannot exceed the cost of the provision of the care if it were provided in the Irish public health service.

The HSE has an obligation to check and verify the details of any payments it makes including applications for reimbursement under the Directive. In carrying out due diligence on applications for reimbursement under the Directive the HSE may examine the details of the treatment received to ensure that the treatment claimed for, and the clinical details of the treatment supplied on the application, are consistent with the procedure code which has been supplied. If there is a discrepancy the HSE will query the details in the application and this may lead to an adjustment of the reimbursement based the details of the treatment received.

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