Éamon Ó Cuív (Galway West, Fianna Fail)
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1650. To ask the Minister for Health the reason that there are charges of up to €179 per week charged to patients who have been more than 30 days in hospital and are discharged to community hospitals when that would not be charged if they remained in hospital or were transferred to a private nursing home under the transitional care funding for convalescent beds in private nursing homes; if he intends abolishing such charges in community hospitals in the interest of equity; and if he will make a statement on the matter. [1984/23]

Stephen Donnelly (Wicklow, Fianna Fail)
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The issue raised relates to Residential Support Services Maintenance and Accommodation Contributions (RSSMACs).  These are statutory contributions towards accommodation and maintenance costs that must be paid to the HSE, under the provisions of sections 67A, 67B, 67C and 67D of the Health Act 1970, by certain recipients of non-acute residential support services provided by or on behalf of the Health Service Executive (HSE). 

The applicable contribution rates (current maximum €179 per week) are provided for under the Health (Residential Support Services Maintenance and Accommodation Contributions) Regulations 2016 (S.I. No. 467 of 2016) and related amending regulations (most recently S.I. No. 1 of 2022).

The RSSMACs contribution requirement does not apply to acute in-patient services, out-patient services or long-term residential care services funded under the Nursing Homes Support Scheme Act 2009 (“Fair Deal”), and some exemptions apply under sub-section 67C(7).

The contribution requirement is subject to a 30-day threshold of service provision over a “rolling year”, meaning that these statutory contributions are payable on a given day by service users who have already, during the 12-month period up to that day, received an aggregate of at least 30 days of residential support services. 

The RSSMACs framework includes features to ensure that contributions are reasonable and fair and that service users' contributions are based on what they can afford, taking account of their individual circumstances. For example,

- rates are structured to ensure that service users retain a reasonable amount of income for personal use;

- the rates payable by individuals are based on sliding scales, with proportionally lower rates applying to lower incomes;

- service users may apply for and be granted full or partial waivers, depending on their individual circumstances; and

- service users may appeal RSSMACs decisions, including in relation to rates payable and waiver applications.

To assist in the fair and consistent application of the framework nationally, the HSE has published general implementation guidelines, together with comprehensive waiver guidelines (approved by the Ministers for Health and Public Expenditure and Reform) on the individual circumstances where such contributions may if appropriate be reduced in full or in part. 

The categories of recipients of residential support services provided by or on behalf of the HSE that are liable to pay RSSMACs to the HSE include (inter alia):

- community hospital patients receiving non-acute care;

- patients who remain in acute hospitals following certification that they no longer require acute in-patient services; and

- patients receiving non-acute convalescent care services (including those transferred to nursing homes under transitional care funding).

Comprehensive information about the RSSMACs framework is published by the HSE at: www.hse.ie/longstaycontributions.