The National Health Service (Charges to Overseas Visitors) Regulations 2015

Charges imposed on overseas visitorsE+W

This adran has no associated Memorandwm Esboniadol

7.—(1) The [F1relevant body] must calculate charges made under these Regulations[F2, including where charges are estimated for the purposes of determining an advance payment sum,] in accordance with this regulation.

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(3) [F4Unless paragraph (3A) applies], the charge payable in respect of each relevant service provided to an overseas visitor shall be equal to the tariff for that relevant service multiplied by 150 per cent.

[F5(3A) Where an overseas visitor who is ordinarily resident in an EEA state or Switzerland has—

(a)before IP completion day received relevant services from a relevant body, or

(b)on or after IP completion day received relevant services from a relevant body as part of a course of treatment which commenced before IP completion day,

the charges payable in respect of those services must be calculated in the same way as provided for by regulation 13(1) of the National Health Service (Cross-Border Healthcare) Regulations 2013.]

(4) In this regulation “the tariff” has the meaning set out in paragraphs (5) to (8), subject to paragraphs (9) to (12).

(5) [F6Where] a relevant service is specified in the national tariff under section 116(1)(a) (national tariff) of the 2012 Act, the tariff for the provision of that service to an overseas visitor is such price as is determined in accordance with the national tariff on the basis of the national price specified in the national tariff for that service F7... including any applicable modification referred to in paragraph (10).

(6) Where—

(a)a [F1relevant body] provides a relevant service to an overseas visitor that is included in a bundle of services to which a pathway payment applies in accordance with the national tariff;

(b)that relevant service constitutes part, but not all, of the bundle of services; and

(c)the [F1relevant body] is unable to determine the price of that relevant service as an individual service within the bundle of services to which the pathway payment relates,

the tariff is such reasonable price for the provision of the relevant service that [F8the relevant body] determines having had regard to the matters set out in paragraph (7).

(7) The matters to which the [F1relevant body] must have regard for the purposes of determining the tariff for a relevant service under paragraph (6) are—

(a)the amount of the pathway payment which would be payable to the [F1relevant body] in accordance with the national tariff, by the commissioner with responsibility for commissioning services in respect of the overseas visitor to whom the relevant service was provided, if that overseas visitor were ordinarily resident in the United Kingdom;

(b)the relevant service that the overseas visitor received as a proportion of the bundle of services to which the pathway payment applies; and

(c)the complexity of the relevant service provided to the overseas visitor.

[F9(8) Where a relevant service is not specified in the national tariff under section 116(1)(a) of the 2012 Act and—

(a)the rules specified in the national tariff under section 116(4)(b) of that Act make provision for a unit price to be used as the basis for determining the price payable for that service (even if only in certain circumstances specified in the rules), the tariff is such price as would be determined for that service in accordance with those rules on the basis of that unit price;

(b)where paragraph (6) and sub-paragraph (a) of this paragraph do not apply, the tariff for the provision of that service is such price as is determined in accordance with the rules specified in the national tariff under section 116(4)(b) of the 2012 Act.]

(9) The following variations to the national price of a relevant service made under the 2012 Act shall not apply to the determination of the national price for that relevant service for the purpose of paragraph (5)—

(a)a variation agreed to by the commissioner of the service and the [F1relevant body] that is providing that service in accordance with rules made under section 116(2);

(b)a variation specified in the national tariff under section 116(4)(a), except for a variation—

(i)to reflect regional cost difference; or

(ii)to reflect patient complexity.

(10) An applicable modification is any modification to the price, as determined in accordance with the national tariff, of the relevant service where that modification is—

(a)made in accordance with an agreement made under section 124(1) of the 2012 Act; or

(b)determined by Monitor under section 125(1) of the 2012 Act.

(11) For the purposes of determining the tariff for a relevant service provided to an overseas visitor—

(a)under paragraph (5) F10..., a modification of the kind specified in paragraph (10) will apply to the relevant service only when the modification applies to the price payable to the [F1relevant body] by the commissioner with responsibility for commissioning services in respect of that overseas visitor; and

(b)under paragraph (8), an agreement between a commissioner and the [F1relevant body] made in accordance with the rules [F11specified in the national tariff under section 116(4)(b) of the 2012 Act] will be relevant for the determination of the tariff only when the commissioner which is party to the agreement is the commissioner with responsibility for commissioning services in respect of that overseas visitor.

(12) Where rules made under section 116(6) provide for which specification of a relevant service is to apply in a particular case or cases of any particular description, the [F1relevant body] must comply with those rules when calculating charges under this regulation for that relevant service.

(13) For the purposes of this regulation—

“the 2012 Act” means the Health and Social Care Act 2012 M1;

“national price” has the meaning given in section 115(1) (price payable by commissioners for NHS services) of the 2012 Act;

“national tariff” is the document known as the national tariff published by Monitor under section 116(1) of the 2012 Act M2;

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Textual Amendments

Marginal Citations

M2The 2014/15 national tariff is published on the following website: https://www.gov.uk/government/publications/national-tariff-payment-system-2014-to-2015 or available from the Pricing Team, Monitor, 3rd Floor Wellington House, 133-155 Waterloo Road, London SE1 8UG.