Reply To: Absence substantially exceeding 52 weeks


temp absenses for 52 weeks max – so, the bit about not substantially exceeding 15 months comes into paly as follows:

Customer gors into hospital 20 March 2020 and has an intention to come home. the 52 week clock starts ticking.
An OVERNIGHT visit will reset the clock, but popping in during the day doesnt. generally its accepted that the retuen should cover a 24 hour period/overnight bvisit.

fast forward to Mid Jan 2021, LA need to estanblish is customer is likely to be back home by March 2021 ( 52 week point) or if not then, when is likely….. (the 15 month rule)
mnote the intention to return is still there, the customer wants to come home, but is still an inpatient.

info received advising customer unlikley to be discharged by March 2021 but should be home by mid may 2021 – HB can be paid for a maximum of 52 weeks – the 15 month thing gives you the wiggle room to say, well he still has an intention to come back and the absence is unlikely to substanitally exceed 52 weeks, so we can pay no more tghan 52 weeks hb – it stops you having to cancel back and create a whopping overpayment that wouldnt be recoverable.

if your persons first overnight visit was Aug 2020 , then thats quite c;lode to the 15 months….. so potentially you would have entitlement again from August 2020 which resets ghis 52 week clock – the whole point of a CPS is you are avoiding the need for a “new claim” – tghe whole poijnt is you are trying to establish if the customer had HB entitlement on 21 Nove 2021 (the day you found out about the previous change) .
a closed period supersessuion removes the requirement for a new claim.

If you dedicde that the 52 week clock has been reset in Aug 2020, then HB can recommence from the Monday after that – and youd need to know the dates of the overnight passes as each of thoise would re set his clock.

quite clearly you are potentially talking about a susbtantial ovcerpayment – which, realistically, you have very little chance of receovering.
id be looking at any wiggle room to minimise that/keep /preserve the HB award as long as possible.
if theres 2 ways a claim would be interpreted, our job is to take the route whbich maximises benefit entitlement provided it doesnt break any regs.

Mr Thurman and I were typing at the same time, but he is more succinct than I hence his got posted sooner

  • This reply was modified 2 months, 1 week ago by pbirks.