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The National Health Service (Travel Expenses and Remission of Charges) Regulations 2003

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PART IE+W+SGENERAL AND INTRODUCTION

Citation, commencement and applicationE+W+S

1.—(1) These Regulations may be cited as the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 and shall come into force on 6th October 2003.

(2) These Regulations apply to England.

InterpretationE+W+S

2.  In these Regulations—

“the Act” means the National Health Service Act 1977;

“the 1990 Act” means the National Health Service and Community Care Act 1990 M1;

[F1“the 2006 Act” means the National Health Service Act 2006;]

[F2“the 2012 Act” means the Welfare Reform Act 2012;]

“abroad” means any place outside the United Kingdom;

[F3“annuity contract” means a contract that provides for periodic payments starting from a stated or contingent date and continuing for a fixed period or for the life of the annuity;]

[F4“arranger of ICP services” means a party to an integrated care provider contract as mentioned in paragraph 3(3) of Schedule 3A to the General Medical Services Contracts Regulations;]

[F5“assessment period” means the assessment period for the purposes of universal credit as specified in regulation 21 of the Universal Credit Regulations 2013 (assessment periods);]

“capital limit”—

(a)

[F6in the case of a person who lives permanently in—

(i)

a care home, or

(ii)

accommodation provided by a local authority under Part 1 of the Care Act 2014 (care and support),

is the amount prescribed in regulation 12(1) of the Care and Support (Charging and Assessment of Resources) Regulations 2014, and]

(b)

in the case of any other person, means the amount prescribed for the purposes of section 134(1) of the Social Security Contribution and Benefits Act 1992 M2;

[F7“care home” means—

(a)

a care home in England within the meaning given by section 3 of the Care Standards Act 2000, and

(b)

a place in Wales at which a care home service, within the meaning of Part 1 of the Regulation and Inspection of Social Care (Wales) Act 2016, is provided wholly or mainly to persons aged 18 or over;]

F8...

[F9“child” means a person under the age of 16;]

[F5“child element” means the child element of universal credit as specified in regulation 24(1) of the Universal Credit Regulations 2013 (the child element);]

“child tax credit” means a child tax credit under section 8 of the Tax Credits Act 2002 M3;

“claimant” means a person who makes a claim in accordance with regulation 7 or regulation 11;

[F10“the Charges Regulations” means the National Health Service (Charges for Drugs and Appliances) Regulations 2015;]

“couple” has the meaning given in section 137 of the Social Security Contributions and Benefits Act 1992 F11...;

[F12“course of treatment” has the meaning given to it in regulation 2(1) of the National Health Service (Dental Charges) Regulations 2005;]

“date of claim” means the date on which a claim made under regulation 7 or regulation 11 is received by the Secretary of State;

[F13“dependant child or young person” means any child or young person who is treated as the responsibility of the claimant or his partner, where that child or young person is a member of the claimant’s household;]

“disability element” means the disability element of working tax credit as specified in section 11(3) of the Tax Credits Act 2002;

[F5“earned income” means a person’s earned income as defined by Chapter 2 of Part 6 of the Universal Credit Regulations 2013 (calculation of capital and income – earned income);]

[F14“earnings” has the meaning given in regulations 35 and 37 of the Income Support Regulations;]

“family” has the meaning given by section 137(1) of the Social Security Contributions and Benefits Act 1992 as it applies to income support, except that—

(a)

in regulation 5(1)(d), in relation to a person who is receiving income based jobseeker’s allowance it has the meaning given in section 35 of the Jobseekers Act 1995 M4,

(aa)

[F15in regulation 5(1)(cc), in relation to a person who is receiving income-related employment and support allowance it has the meaning given in regulation 2 of the Employment and Support Allowance Regulations 2008],

(b)

in regulations 5(1)(e) and 8(2) it has the meaning assigned to it by regulation 2(2) of the Tax Credits (Definitions and Calculation of Income) Regulations 2002 M5, and

(c)

where a claim has been made for support under Part VI of the Immigration and Asylum Act 1999 M6, it means the asylum-seeker who has made that claim and any dependant, as defined in section 94 of that Act, whom he has included in that claim and the references to “family” in regulations 5(2)(c) and 8(1), (3) and (7) shall be construed accordingly;

F16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“full time student” has the meaning given in regulation 61 of the Income Support Regulations;

[F4“General Medical Services Contracts Regulations” means the National Health Service (General Medical Services Contracts) Regulations 2015;]

“health care professional” means a person who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002 M7;

[F17“health service body” means an NHS trust, an NHS foundation trust, the Board or [F18an integrated care board];]

[F19“household” means—

(a)

a group of people who have a common address as their only or main residence and who either share one meal a day or share the living accommodation at that residence; or

(b)

the only or main residence of a single person who does not share either one meal a day or the living accommodation at that residence with another person;]

“income-based jobseeker’s allowance” has the meaning assigned to it by section 1(4) of the Jobseekers Act 1995;

[F20“income-related employment and support allowance” means an employment and support allowance, entitlement to which is based on section 1(2)(b) of the Welfare Reform Act 2007;]

“income support” means income support under Part VII of the Social Security Contributions and Benefits Act 1992, and includes personal expenses addition, special transition addition and transitional addition as defined in regulation 2(1) of the Income Support (Transitional) Regulations 1987 M8;

“the Income Support Regulations” mean the Income Support (General) Regulations 1987 M9;

[F21“integrated care board” means an integrated care board established under Chapter A3 of Part 2 of the National Health Service Act 2006;]

[F4“integrated care provider” means a person who has entered into an integrated care provider contract with an arranger of ICP services for the provision of health care in England;]

[F4“integrated care provider contract” has the meaning given in Schedule 3A to the General Medical Services Contracts Regulations;]

[F4“integrated care sub-contractor” means a person who has entered into contractual arrangements with an integrated care provider for the provision of health care in England on behalf of that provider in performance of an integrated care provider contract;]

F22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“NHS charge” has the meaning given in regulation 4;

“NHS contract” has the meaning given in section 4(1) of the 1990 Act;

“NHS travel expenses” and “NHS foreign travel expenses” have the meanings given in regulation 3;

“NHS trust” has the meaning given in section 5 of the 1990 Act;

[F23“occupational pension scheme” has the meaning given by section 1 of the Pension Schemes Act 1993;]

“partner” means where a claimant—

(a)

is a member of a F24... couple, the other member of that couple,

(b)

is married polygamously to two or more members of his household, any such member;

“pension credit guarantee credit” shall be construed in accordance with sections 1 and 2 of the State Pension Credit Act 2002 M10;

“pension credit savings credit” shall be construed in accordance with sections 1 and 3 of the State Pension Credit Act 2002;

[F25“personal pension scheme” means a personal pension scheme—

(a)

as defined in section 1 of the Pension Schemes Act 1993; or

(b)

as defined in section 1 of the Pension Schemes (Northern Ireland Act) 1993;]

“port” includes an airport, ferry port or international train station in Great Britain from which an international journey begins;

“provider” means the provider of any services mentioned in regulation 3(1)(a);

[F26“the public health functions of the local authority” means the functions of a local authority under section 2B (functions of local authorities and Secretary of State as to improvement of public health) and 111 (dental public health) of, and paragraphs 1 to 7B of Schedule 1 (further provision about the Secretary of State and services under this Act) to, and pursuant to regulations made under section 6C (regulations as to the exercise by local authorities of certain public health functions) of, the 2006 Act;]

[F26“qualifying young person” has the meaning given in section 10(5) of the 2012 Act (responsibility for children and young persons);]

“relevant date” means—

(a)

in the case of a claim under regulation 7, the date of the claim; and

(b)

in the case of a claim under regulation 11(2) the date when the NHS charge or NHS travel expenses were paid;

“relevant income” has the meaning given in section 7(2) of the Tax Credits Act 2002;

[F12“relevant primary dental services” has the meaning given to it in regulation 2(1) of the National Health Service (Dental Charges) Regulations 2005;]

[F27“severe disability element” means the severe disability element of working tax credit as specified in section11(6)(d) of the Tax Credits Act 2002 (maximum rate).]

[F28“single person” means a person who does not have a partner and is not responsible for, and is not a member of the same household as, a child or young person F11...;]

F16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

[F29“State Pension Credit Regulations” means the State Pension Credit Regulations 2002;]

“trade dispute” has the same meaning as in section 35(1) of the Jobseekers Act 1995;

[F12 “urgent course of treatment” has the meaning given to it in regulation 2(1) of the National Health Service (Dental Charges) Regulations 2005;]

[F30“universal credit” means universal credit under Part 1 of the 2012 Act;]

“week” means a period of 7 days beginning with midnight between Saturday and Sunday; and

“working tax credit” means working tax credit under the Tax Credits Act 2002.

[F31“young person” has the meaning prescribed in regulation 14 of the Income Support Regulations;]

Textual Amendments

Marginal Citations

M21992 c. 4. The relevant regulations are the Income Support (General) Regulations 1987 S.I. 1987/1967.

NHS travel expensesE+W+S

3.—(1) In these Regulations “NHS travel expenses” means the travel expenses which a person necessarily incurs—

(a)in attending—

(i)a health service hospital,

F32(ii). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(iii)any other place in the United Kingdom,

for the provision of any services [F33to which paragraph (1A) applies; or]

(b)in travelling to a port in Great Britain for the purpose of travelling abroad in order to receive services provided pursuant to arrangements made [F34under the 2006 Act by a health service body or a local authority [F35or pursuant to an integrated care provider contract].]

[F36(1A) This paragraph applies to services under the 2006 Act [F37(including sub-contracted services)] which are—

(a)not primary medical services[F38, primary ophthalmic services] or primary dental services;

(b)provided pursuant to a referral by a medical practitioner[F39, ophthalmic practitioner] or dental practitioner; and

(c)[F40in a case where the services are not provided by an integrated care provider or an integrated care sub-contractor, the services are not provided during the same visit] and at the same premises at which the primary medical services[F41, primary ophthalmic services] or primary dental services which lead to the referral by a medical practitioner[F42, ophthalmic practitioner] or dental practitioner are provided.]

(2) In these Regulations “NHS foreign travel expenses” means the travel expenses which a person necessarily incurs in travelling abroad from a port in Great Britain in order to receive services pursuant to arrangements made [F43under the 2006 Act by a health service body or a local authority [F44or pursuant to an integrated care provider contract].]

(3) NHS travel expenses and NHS foreign travel expenses include the travel expenses of a companion in a case where the person to whom services are provided is either—

(a)a child; or

(b)a person whose medical condition is such that, in the opinion of a doctor involved in the provision of the services or, where appropriate, another health care professional so involved, a companion is necessary.

(4) A person who wishes to rely on entitlement to NHS travel expenses must—

(a)unless he is a person who by virtue of regulation 5(1) is not required to make such a claim, make a claim to entitlement under regulation 7; and

(b)make an application for payment of travel expenses under regulation 10.

(5) The amount of any NHS travel expenses to which a person is entitled under these Regulations—

(a)must be calculated by reference to the cost of travelling by the cheapest means of transport which is reasonable having regard to the person’s age, medical condition and any other relevant circumstances; and

(b)where travel is by private car, may include a mileage allowance[F45, road and toll charges] and car parking expenses.

(6) A person is entitled to payment of NHS foreign travel expenses only [F46where the health service body, local authority or arranger of ICP services] which made the arrangements for the provision of services abroad agrees the mode and cost of travel and the necessity or otherwise for a companion before the costs are incurred.

Textual Amendments

Remissible NHS chargesE+W+S

4.—(1) In these regulations “NHS charge” means any charge which would otherwise be payable—

(a)in accordance with regulations made under section 77(1) of the Act, for the supply of drugs, medicines, appliances and pharmaceutical services;

[F47(b)in accordance with regulations made under section 79 of the Act in respect of charges for relevant dental services)]

(2) A person who wishes to rely on entitlement under these Regulations to remission of a NHS charge must—

(a)unless he is a person who, by virtue of regulation 5(1), is not required to make such a claim, make a claim to entitlement under regulation 7 or regulation 11; and

(b)provide any declaration or evidence of entitlement which is required under the Charges Regulations.

Textual Amendments

PART IIE+W+SENTITLEMENT TO PAYMENT OF NHS TRAVEL EXPENSES AND REMISSION OF NHS CHARGES

Entitlement to full remission and paymentE+W+S

5.—(1) Subject to paragraph (3), a person is entitled, without making a claim under regulation 7 (claims to entitlement), to the payment in full of NHS travel expenses and the full remission of a NHS charge if—

(a)he is receiving income support;

(b)he is receiving income based jobseeker’s allowance;

(c)he is receiving pension credit guarantee credit;

[F48(cc)he is receiving income-related employment and support allowance;]

(d)he is a member of the same family as a person who is receiving income support, income based jobseeker’s allowance[F49, income-related employment and support allowance] or pension credit guarantee credit; F50...

(e)he is a member of a family one member of which is receiving—

(i)working tax credit and child tax credit,

(ii)working tax credit which includes a disability element [F51or severe disability element], or

(iii)child tax credit, but is not eligible for working tax credit,

provided that the relevant income of the member or members to whom the tax credit is made under section 14 of the Tax Credits Act 2002 is determined at the time of the award not to exceed [F52£15,276][F53; or]

[F54(f)that person is a relevant universal credit recipient.]

[F55(1A) For the purposes of paragraph (1)(f) “relevant universal credit recipient” means a person who, in the relevant assessment period—

(a)had an award of universal credit, either as a single claimant or as one of joint claimants, where—

(i)the award did not include the child element,

(ii)the single claimant or, as the case may be, both joint claimants, did not have limited capability for work, and

(iii)the single claimant had earned income or, as the case may be, the joint claimants had combined earned income, of £435.00 or less;

(b)had an award of universal credit, either as a single claimant or as one of joint claimants, where—

(i)the award included the child element, and

(ii)the single claimant had earned income or, as the case may be, the joint claimants had combined earned income, of £935.00 or less;

(c)had an award of universal credit, either as a single claimant or as one of joint claimants, where—

(i)the single claimant or, as the case may be, one or both joint claimants, had limited capability for work, and

(ii)the single claimant had earned income or, as the case may be, the joint claimants had combined earned income, of £935.00 or less; or

(d)was a child or a qualifying young person for whom a person referred to in sub-paragraph (b) or (c) is responsible (within the meaning of Part 1 of the 2012 Act (universal credit) and regulations made thereunder).

(1B) Where paragraph (1C) applies, a person is to be treated as entitled to claim repayment of a NHS charge or NHS travel expenses under regulation 11.

(1C) This paragraph applies where the conditions specified in sub-paragraphs (a), (b), (c) or (d) of paragraph (1A) are satisfied in the assessment period in which the NHS charge or NHS travel expense is incurred and—

(a)there is no relevant assessment period; or

(b)none of those conditions were satisfied in the relevant assessment period.

(1D) For the purposes of paragraphs (1A) and (1C)—

“joint claimants” has the meaning given in section 40 of the 2012 Act (interpretation of Part 1);

“limited capability for work” means limited capability for work or limited capability for work and work-related activity as construed in accordance with regulations 39 and 40 respectively of the Universal Credit Regulations 2013 (limited capability for work; limited capability for work and work-related activity);

“relevant assessment period” means the assessment period immediately preceding that in which the NHS charge was paid or NHS travel expenses incurred; and

“single claimant” has the meaning given in section 40 of the 2012 Act (interpretation of Part 1).]

(2) Subject to paragraph (3), the following persons are entitled to the payment in full of NHS travel expenses and the remission in full of a NHS charge but are required to make a claim for such payment or remission in accordance with regulation 7 (claims to entitlement)—

(a)a person who lives permanently in—

(i)a care home, or

[F56(ii)accommodation provided by a local authority under Part 1 of the Care Act 2014 (care and support),

where the personal budget for the person under section 26 of that Act specifies that the local authority must itself pay towards the cost of that accommodation;]

(b)an asylum-seeker for whom support is provided under Part VI of the Immigration and Asylum Act 1999;

(c)a member of the same family as an asylum seeker described in sub-paragraph (b);

(d)a relevant child within the meaning of section 23A of the Children Act 1989M11 whom a responsible local authority is supporting under section 23B(8) of that Act;

(e)any other person who satisfies the Secretary of State in accordance with Part IV that his capital resources do not exceed the capital limit and that his [F57income resources do not exceed his requirements or exceed his requirements by fifty per cent or less of the amount of the charge specified in [F58regulation 3(1)(b) or (c)] (supply of drugs and appliances by chemists) of the Charges Regulations]; and

(f)a member of the same family as a person described in sub-paragraph (e).

(3) A person’s entitlement under paragraph (1) or (2) arises only where he is of a description mentioned in either of those paragraphs at the time when—

(a)the charge is made;

(b)the NHS travel expenses are incurred; or

[F59(c)in the case of a charge for relevant dental services—

(i)the arrangements for the treatment or urgent course of treatment under the Act are made,

(ii)the arrangements for the supply of dentures or other dental appliances under the Act otherwise than as part of relevant primary dental services are made, or

(iii)the charge is made.]

Textual Amendments

Marginal Citations

Entitlement to partial remission and paymentE+W+S

6.—(1) Subject to paragraphs (2) to (4), a person is entitled to the payment in part of any NHS travel expenses and remission in part of a NHS charge provided that at the time the travel expenses are incurred or the charge is made—

(a)his capital resources do not exceed the capital limit; and

(b)either—

(i)his income resources exceed his requirements by less than a third of the charge or, as the case may be, by less than the travel expenses [F60incurred in any week], or

(ii)he is a member of the family of a person described in sub-paragraph (b)(i),

but is required to make a claim for such remission or payment in accordance with regulation 7 (claims to entitlement).

(2) In the case of a NHS charge mentioned in regulation 4(1)(a), the entitlement under paragraph (1) to partial remission applies only to a charge for the supply of an appliance specified in Schedule 1 to the Charges Regulations (fabric supports and wigs) and not to a charge for any other appliance or for drugs, medicines or pharmaceutical services.

(3) Subject to paragraph (4), the amount to which a person is entitled under paragraph (1) is—

(a)in the case of a NHS charge, the difference between the charge and three times the amount by which his income resources exceed his requirements; and

(b)in the case of recoverable travelling expenses, subject to regulation 9 (travel expenses of persons resident in the Isles of Scilly), the difference between the amount of the expenses incurred and the amount by which his income resources exceed his requirements.

[F61(4) In the case of a NHS Charge for relevant dental services, the charge which is partially remissible under this regulation and which must be used for the purposes of the calculation required under paragraph (3)(a) is the charge made—

(a)for one course of treatment or urgent course of treatment, including any charge made for a denture or other dental appliance supplied in that course of treatment; or

(b)for the supply of dentures or other dental appliances under the Act otherwise than as part of relevant primary dental services.]

Textual Amendments

Claims to entitlementE+W+S

7.—(1) Subject to paragraph (3), a person who wishes to claim entitlement under regulation 5(2) (entitlement to full remission and payment) or regulation 6(1) (entitlement to partial remission and payment) must make a claim to the Secretary of State on a form either provided for the purpose by him or approved by him.

(2) On a claim under paragraph (1), the claimant must provide such evidence and information as the Secretary of State may reasonably request within such time as the Secretary of State may reasonably request.

[F62(3) A claim may be made on behalf of another person where that person—

(a)is unable by reason of physical incapacity; or

(b)lacks capacity within the meaning of the Mental Capacity Act 2005 (c.9),

to make the claim himself.]

(4) Where a claimant does not comply with the Secretary of State’s requests in respect of evidence, information and timing mentioned in paragraph (2), the Secretary of State may notify the claimant that the claim will not be determined and must be regarded as closed.

Textual Amendments

Notices of entitlementE+W+S

8.—(1) Where the Secretary of State determines, on a claim made under regulation 7 (claims to entitlement), that the claimant and any member of his family are entitled to any remission of a NHS charge or any payment in respect of NHS travel expenses, he must issue a notice of entitlement to the claimant.

(2) Where a person is entitled to full remission of a NHS charge and payment in full of NHS travel expenses because he is a member of a family described in regulation 5(1)(e) (tax credit families), the Secretary of State must issue a notice of entitlement to that family and in such a case the notice shall apply to all the members of that family.

(3) A notice of entitlement issued under paragraph (1) applies to all members of the claimant’s family and must state—

(a)whether those persons are entitled to full or partial remission or payment; and

(b)in the case of partial remission or payment, the amount of any NHS charge or NHS travel expenses for which there is no entitlement to remission or payment.

(4) A notice of entitlement issued under paragraph (1) or paragraph (2) must state the length of time for which it is valid and the dates on which that time begins and ends.

(5) A notice of entitlement issued under paragraph (1) is valid for 12 months beginning on the date of the claim except that—

(a)in the case of a notice issued to a full time student in the final or only year of a course of study, it is valid from the date of the claim until the last day of that course;

(b)in the case of a notice issued to a relevant child, it is valid for 12 months or until the child’s 18th birthday, whichever is the later; and

(c)in the case of a notice issued to a person mentioned in regulation 5(2)(b) (asylum seeker), it is valid for 6 months beginning on the date of the claim;

[F63(d)in the case of a notice issued to a person mentioned in paragraph (5A) it is valid for the length of time specified in that paragraph.]

[F64(5A) A notice of entitlement issued under paragraph (1) is valid for 5 years beginning on the date of the claim where the claimant is—

(a)a single person aged not less than 65; or

(b)one of a couple where one partner is aged not less than 60 and one partner is aged not less than 65,

who does not receive any—

(i)earnings;

(ii)payments from an occupational pension scheme;

(iii)payments from a personal pension scheme; or

(iv)payments from an annuity contract.

(5B) Paragraph (5A) does not apply to a person who has a dependant child or young person as a member of his household.]

(6) A notice of entitlement issued under paragraph (2) is valid from such date and for such period as the Secretary of State may determine.

(7) Subject to paragraphs [F65(7A),] (9) and (10), any change in the financial or other circumstances of a claimant, or of any member of his family, during the life of a notice of entitlement shall not affect its validity in respect of that period or, in the case of partial remission or payment, the amounts referred to in paragraph (3)(b).

[F66(7A) A claimant who is issued with a notice of entitlement which falls under paragraph (5A) must notify the Secretary of State of any change in the composition of his family or household during the life of the notice of entitlement and the Secretary of State may withdraw the notice of entitlement or vary the amounts referred to in paragraph (3)(b) stated on the notice of entitlement if the claimant no longer meets the requirements of paragraphs (5A) and (5B).]

(8) A claimant who is issued with a notice of entitlement to partial remission may make a further claim in accordance with regulation 7 at any time during the life of the notice if he considers that by reason of a change in his financial circumstances, or those of any member of his family, the amounts referred to in paragraph (3)(b) should be reduced.

(9) A claimant to whom a notice of entitlement has been issued under this regulation must return it to the Secretary of State in any case where his claim is subsequently found to have been based on a false representation.

(10) A notice of entitlement issued under this regulation is effective only for the purpose of entitlement to remission of charges and payment of travel expenses in accordance with these Regulations.

Textual Amendments

Travel expenses of persons resident in the Isles of ScillyE+W+S

9.—(1) Any person who—

(a)is resident in the Isles of Scilly;

(b)incurs NHS travel expenses; and

(c)is not entitled to payment in full of those travel expenses in accordance with regulation 5,

is entitled to payment of his NHS travel expenses but is required to make a contribution in accordance with paragraphs (2) and (3).

(2) A person who would be entitled to payment in part of NHS travel expenses in accordance with regulation 6(1) is required to contribute either the amount which he would have been required to pay under regulation 6(3)(b) or £5, whichever is the less.

(3) Any other person is required to contribute £5.

PART IIIE+W+SPAYMENTS AND REPAYMENTS

Payment of NHS travel expensesE+W+S

10.—[F67(1) Subject to paragraphs [F68(1A) to (1C) and] (3) to (5), where a person is entitled in accordance with regulation 5 or 6 to a payment in respect of NHS travel expenses in relation to services which are provided by a provider pursuant to arrangements made under the 2006 Act with the provider by a health service body—

(a)the person may make an application for payment to the provider or the health service body which made those arrangements; and

(b)either the provider or that health service body may calculate the actual amount payable in accordance with these Regulations and make the payment.]

[F69(1A) Subject to paragraphs (3) to (5), where a person is entitled in accordance with regulation 5 or 6 to a payment in respect of NHS travel expenses, the person may make an application in accordance with paragraph (1B), in relation to services that are provided by—

(a)an integrated care provider; or

(b)an integrated care sub-contractor.

(1B) An application under paragraph (1A) may be made—

(a)where the services are provided by an integrated care provider that is an NHS trust or an NHS foundation trust or by an integrated care sub-contractor providing services on behalf of an NHS trust or an NHS foundation trust, to that NHS trust or NHS foundation trust;

(b)where the services are provided by a local authority, or the arranger of ICP services is a local authority, to the relevant [F18integrated care board];

(c)where the arranger of ICP services is the Board, to the Board; or

(d)where the arranger of ICP services is [F18an integrated care board], to that [F18 integrated care board].

(1C) Where an application has been made under paragraph (1B) to an NHS trust, an NHS foundation trust, the Board, [F18an integrated care board], or the relevant [F18integrated care board], that NHS trust, that NHS foundation trust, the Board, the [F18integrated care board] or the relevant [F18integrated care board], as the case may be, may calculate the actual amount payable and make the payment.]

[F70(2) Subject to paragraphs (3) to (5), where a person is entitled in accordance with regulation 5 or 6 to a payment in respect of NHS travel expenses in relation to services which are provided by a provider pursuant to arrangements made with the provider by a local authority in the exercise of the public health functions of the local authority under the 2006 Act—

(a)if the provider is an NHS trust or NHS foundation trust, the person may make an application for payment to that NHS trust or NHS foundation trust and that NHS trust or NHS foundation trust must calculate the amount payable in accordance with these Regulations; or

(b)if the provider is not an NHS trust or NHS foundation trust, the person may make an application for payment to the relevant [F18 integrated care board] and the relevant [F18integrated care board] must calculate the amount payable in accordance with these Regulations and make the payment.]

[F71(3) In a case falling within regulation 3(1)(b) (travel to a port), the application for payment may be made to, and the calculation and payment must be made by—

(a)where the arrangements referred to in regulation 3(1)(b) were made by a health service body, the health service body which made those arrangements; F72...

(b)where the arrangements referred to in regulation 3(1)(b) were made by a local authority, the relevant] [F18integrated care board] [F73; or]

[F74(c)where the arrangements referred to in regulation 3(1)(b) were made by an arranger of ICP services, an integrated care provider or an integrated care sub-contractor—

(i)where the services were arranged by an NHS trust or an NHS foundation trust or by an integrated care sub-contractor providing services on behalf of an NHS trust or an NHS foundation trust, that NHS trust or NHS foundation trust;

(ii)where the services were arranged by a local authority, or the arranger of ICP services is a local authority, the relevant [F18integrated care board];

(iii)where the arranger of ICP services is the Board, the Board; or

(iv)where the arranger of ICP services is [F18an integrated care board], that [F18integrated care board].]

(4) A person who makes an application for payment in respect of NHS travel expenses must sign a declaration of entitlement and provide such evidence of his entitlement and of his travel expenses as the provider, or as the case may be, the health service body[F75, arranger of ICP services, integrated care provider or integrated care sub-contractor,] which made the arrangements, may require.

(5) Payment of NHS travel expenses may be made before the expenses are incurred.

[F76(6) In this regulation, “relevant [F18integrated care board] ” means the [F18integrated care board] in whose area the person making an application under this regulation was usually resident at the time the application was made.]

Textual Amendments

Claims for repaymentE+W+S

11.—(1) A person who is entitled under these Regulations to full or partial remission of a NHS charge or to full or partial payment in respect of NHS travel expenses and who pays such a charge or such travel expenses without exercising his right to remission or payment, is entitled to be repaid that amount which would have been remitted or paid.

(2) A person who wishes to exercise his right to repayment under paragraph (1) must make a claim to the Secretary of State on a form provided for the purpose by him or approved by him.

(3) A claim under paragraph (2) must be made within three months of the date on which the payment of the NHS charge or the NHS travel expenses was made or within such longer period as the Secretary of State may for good cause allow.

(4) Paragraphs (2) to (5) of regulation 7 (claims to entitlement) apply to a claim under this regulation.

RepaymentsE+W+S

12.—(1) Where the Secretary of State is satisfied that a claimant is entitled to any repayment under regulation 11, he must—

(a)in the case of a repayment to be made—

(i)in respect of a NHS charge made [F77by an NHS trust, an NHS foundation trust, an integrated care provider or an integrated care sub-contractor], for an appliance specified in Schedule 1 to the Charges Regulations (fabric supports and wigs), calculate the amount payable and notify [F78in writing the body that made the charge] of the claimant’s entitlement and the amount to be paid,

[F79(ia)in respect of a NHS charge made by a provider of NHS services under [F80regulation 9] of the Charges Regulations (supply of drugs and appliances by other providers of NHS services) for an appliance specified in Schedule 1 to the Charges Regulations (fabric supports and wigs), calculate the amount payable and notify in writing [F81the health service body or the arranger of ICP services which arranged] with the provider for the provision of those services of the claimant’s entitlement and the amount to be paid,]

[F82(ii)in a case falling within regulation 3(1)(a) where the services are provided by a provider pursuant to arrangements made under the 2006 Act with the provider by a health service body, notify in writing the health service body which made those arrangements of the claimant’s entitlement,]

[F83(iii)in a case falling within regulation 3(1)(a) where the services are provided by a provider pursuant to arrangements made with the provider by a local authority in the exercise of the public health functions of the local authority under the 2006 Act—

(aa)if the provider is an NHS trust or NHS foundation trust, notify in writing that NHS trust or NHS foundation trust, or

(bb)if the provider is not an NHS trust or NHS foundation trust, notify in writing the relevant [F18integrated care board] of the claimant’s entitlement, or]

[F84(aa)in a case falling within regulation 3(1)(a) where the services are provided by an integrated care provider or an integrated care sub-contractor—

(i)where the provider of the services is an NHS trust or an NHS foundation trust, notify in writing that NHS trust or NHS foundation trust,

(ii)where the provider of the services or the arranger of ICP services is a local authority, notify in writing the relevant [F18 integrated care board], or

(iii)where the arranger of ICP services is the Board or [F18an integrated care board], notify in writing the Board or that [F18integrated care board].]

[F85(b)in a case falling within regulation 3(1)(b) (travel to a port) notify in writing—

(i)where the arrangements referred to in regulation 3(1)(b) were made by a health service body, the health service body which made those arrangements, F86...

(ii)where the arrangements referred to in regulation 3(1)(b) were made by a local authority, the relevant [F18integrated care board][F87or]

[F88(iii)where the arrangements referred to in regulation 3(1)(b) were made by an arranger of ICP services, an integrated care provider or an integrated care sub-contractor—

(aa)where the services were arranged by an NHS trust or an NHS foundation trust or by an integrated care sub-contractor providing services on behalf of an NHS trust or an NHS foundation trust, that NHS trust or NHS foundation trust,

(bb)where the services were arranged by a local authority or the arranger of ICP services is a local authority, the relevant [F18integrated care board],

(cc)where the arranger of ICP services is the Board, the Board, or

(dd)where the arranger of ICP services is [F18an integrated care board], that [F18 integrated care board].]]

(c)in any other case, cause a repayment to be made to the claimant in such manner as appears to the Secretary of State to be appropriate in the circumstances of the particular case.

(2) Where an NHS trust[F89, an NHS foundation trust], [F90a relevant [F18integrated care board], other health service body, an integrated care provider, an integrated care sub-contractor or an arranger of ICP services] receives notification as mentioned in paragraph (1), it must calculate any amount payable in respect of NHS travel expenses in accordance with these Regulations and make any repayment due to a claimant in respect of such travel expenses or NHS charge.

(3) A person who is entitled to repayment in respect of NHS travel expenses must sign a declaration of entitlement and provide such evidence of his entitlement and of his travel expenses as the health service body [F91or the arranger of ICP services] which is making the repayment may require.

[F92(4) In this regulation—

“provider of NHS services” has the same meaning as in regulation 2 of the Charges Regulations; and

“relevant [F18integrated care board]” means the [F18integrated care board] in whose area the claimant was usually resident at the time the claim was made.]

F93(4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

Reimbursement of payments made in respect of NHS travel expensesE+W+S

13.  Where a provider makes a payment under regulation 10(1) F94... in respect of NHS travel expenses incurred by a person who is receiving services from the provider, the amount of the payment or repayment in question may be reimbursed to the provider by the health service body for which those services are provided.

Textual Amendments

Payment and repayment of NHS foreign travel expensesE+W+S

14.—(1) [F95Subject to paragraph (1A), a] person who wishes to claim entitlement to payment or repayment for NHS foreign travel expenses must apply in writing to the health service body [F96or the arranger of ICP services] which arranged the services referred to in regulation 3(2) within 3 months of the expenses having been incurred or such further period as that body may for good cause allow.

[F97(1A) A person who wishes to claim entitlement to payment or repayment of NHS foreign travel expenses, where the services in question are provided pursuant to arrangements made under the 2006 Act by a local authority [F98(including as an arranger of ICP services)], must apply in writing to the relevant [F18integrated care board] within 3 months of the expenses having been incurred or such further period as the relevant [F18integrated care board] may for good cause allow.]

[F99(2) Paragraphs (2) to (4) of regulation 7 apply to a claim (whether for payment or repayment) made under this regulation as if the references to the Secretary of State in those paragraphs were—

(a)in the case of a claim made under paragraph (1), references to the health service body [F100or the arranger of ICP services] which arranged the services referred to in regulation 3(2); or

(b)in the case of a claim made under paragraph (1A), references to the relevant [F18integrated care board].]

[F101(3) In this regulation, “relevant [F18integrated care board]” means the [F18integrated care board] in whose area the claimant was usually resident at the time the claim was made. ]

Textual Amendments

PART IVE+W+SCALCULATION OF RESOURCES AND REQUIREMENTS

GeneralU.K.

15.—(1) Where it is necessary that the resources or requirements of a person should be calculated for the purposes of these Regulations, they must be calculated by the Secretary of State according to the provisions of this Part and Schedule 1.

(2) The resources and requirements of a person must be calculated—

(a)in the case of a claim made under regulation 7 (claims to entitlement) by reference to his resources and requirements at the date of claim; or

(b)in the case of a claim for repayment made under regulation 11(2) (claims for repayment) by reference to his resources and requirements at the date when the NHS charge or NHS travel expenses were paid.

(3) Where a claimant is a member of a family, the resources and requirements of the other members of his family must be calculated in the same manner as those of the claimant and must be taken into account as if they were his resources and requirements, and in this Part and in the provisions referred to in Schedule 1, unless the context otherwise requires, any reference to the claimant includes the other members of his family.

(4) In a case where the earnings of any person are to be calculated and those earnings have been affected by a trade dispute, the earnings to be taken into account are the earnings which that person would have received if there had been no trade dispute.

(5) In the application of the Income Support Regulations as mentioned in regulation 16 and regulation 17, the provisions of those Regulations shall be applied as if—

(a)references to income support were to the remission of NHS charges and the payment of any NHS travel expenses,

(b)references in any of those provisions to any other of those provisions were to that other provision as modified in accordance with regulation 16(4) or, as the case may be, regulation 17(4); and

(c)the State Pension Credit (Consequential, Transitional and Miscellaneous Provisions) Regulations 2002 M12 had not been made.

[F102(6) Where the claimant is a member of a polygamous marriage, the resources and requirements of members of that marriage must be calculated in the same manner as those of the claimant and they must be taken into account as if they were the resources and requirements of the claimant, except that the applicable amount shall be calculated in accordance with regulation 18 of the Income Support Regulations.]

Textual Amendments

Marginal Citations

Calculation of resourcesU.K.

16.—(1) A claimant’s resources must be calculated in terms of income and capital.

(2) Income must be calculated on a weekly basis according to the method of calculating or estimating income prescribed by the provisions of the Income Support Regulations, subject to the modifications referred to in paragraph (4).

(3) Capital must be calculated according to the method of calculating or estimating capital as prescribed by the provisions of Chapter VI in Part V of, and Schedule 10 to, the Income Support Regulations, subject to the modifications referred to in paragraph (4).

(4) The provisions of the Income Support Regulations apply and those provisions specified in column 1 of Table A in Schedule 1 shall be applied in accordance with the modifications specified in the corresponding entries in column 2.

Calculation of requirementsU.K.

17.—(1) A claimant’s requirements must be calculated as being the amount referred to in sub-paragraph (a) less, where applicable, the amount referred to in sub-paragraph (b) below, as follows—

(a)the amount which represents the aggregate of—

(i)the weekly applicable amount which would apply to him, including that in respect of any other member of his family, in connection with a claim for income support as specified by the Income Support Regulations, but subject to the modifications referred to in paragraph (4), and

(ii)subject to paragraph (2), the weekly amount of any council tax which the claimant or his partner is liable to pay under Part I of the Local Government Finance Act 1992 M13;

[F103(b)the amount which represents the weekly amount of any housing benefit to which the claimant or any member of his family is entitled under the provisions of Part 7 of the Social Security Contributions and Benefits Act 1992.]

(2) Subject to paragraph (3), where a claimant is jointly and severally liable for council tax in respect of a dwelling in which he is resident with one or more other persons, the claimant’s liability in respect of that tax for the purposes of these Regulations shall be the amount of that tax divided by the number of persons who are jointly and severally liable for that tax.

(3) Paragraph (2) shall not apply where a claimant is jointly and severally liable for council tax in respect of a dwelling with only his partner.

(4) The provisions of the Income Support Regulations apply and those provisions specified in column 1 of Table B in Schedule 1 shall be applied in accordance with the modifications specified in the corresponding entries in column 2.

Textual Amendments

Marginal Citations

PART VE+W+SCONCLUSION

Transitional ProvisionsE+W+S

18.—(1) Any claim made under the National Health Service (Travelling Expenses and Remission of Charges) Regulations 1988 M14 which has not been determined before 6th October 2003 must be treated as if it were a claim under these Regulations and determined accordingly.

(2) A notice of entitlement to remission of a NHS charge or to payment of travelling expenses which has been issued under the National Health Service (Travelling Expenses and Remission of Charges) Regulations 1988 remains valid until its expiry in accordance with the provisions of those Regulations.

Marginal Citations

[F104Transitional provision: amendments made by regulation 3(2) of the National Health Service (Travel Expenses and Remission of Charges) (Amendment) Regulations 2013E+W+S

18A.—(1) Paragraph (2) applies in the case of a student who, in respect of attendance on a course for a period (“the relevant period”) which ends on or after 1st September 2013, continues after this regulation comes into force to be in receipt of a maintenance grant under regulations 38 to 41 of the Assembly Learning Grants and Loans (Higher Education) (Wales) (No. 2) Regulations 2011 (which relate to payment of maintenance grants) by virtue of regulation 3(11) of the Education (Student Support) (Wales) Regulations 2012 (revocation, savings and transitional provisions).

(2) As regards that student—

(a)the amendments made by regulation 3(2) of the National Health Service (Travel Expenses and Remission of Charges) (Amendment) Regulations 2013 (amendments to the 2003 Regulations: students from Wales) only apply with effect from the day after the end of the relevant period; and

(b)until the end of the relevant period, the modification in column 2 of Table A in Schedule 1 of regulation 62 of the Income Support Regulations applies as it had effect immediately before this regulation came into force.]

Textual Amendments

RepealsE+W+S

19.  The Regulations listed in column 1 of Schedule 2 are repealed to the extent indicated in column 2 M15.

Marginal Citations

M15References in any enactment to the regulations so repealed are to be construed as references to the re-enactment in these Regulations. See section 17(2) of the Interpretation Act 1978 (c. 30).

Signed by authority of the Secretary of State for Health

Rosie Winterton

Minister of State,

Department of Health

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