Case studies & success stories
CHC Funding Appeal Success Story
We helped with
CHC funding appeal
We were approached by Mr. X for assistance, after his relative was found not to meet the criteria for CHC funding by the CCG.
We conducted a thorough review of the care and medical records, and prepared a detailed report. We found the CCG’s decision to be patently incorrect and immediately lodged appeal on our client’s behalf. We also submitted a request for retrospective review from date of admission, two years earlier, as the patient had never been considered for CHC funding.
The CCG provided its appeal and retrospective review forms, which we duly submitted alongside a detailed Written Submission. Copy of the records we had obtained was sent to the CCG for consideration.
Such were the clinical facts of this case, the CCG immediately overturned its decision of ineligibility without putting the family through Local Resolution. The CCG also immediately confirmed, without even completing a DST, that the patient had, in fact, been eligible for CHC funding from the date of his admission to the nursing home, some two years earlier!
This case goes to show how wrong CHC assessors can get it, and how often people are not referred for CHC consideration by nursing homes despite being clearly eligible for funding.