Public Health Commissioned Services –
SEXUAL HEALTH CROSS CHARGING POLICY
Final Version – September 2016
Review Date - September 2017
Contents
1) Introduction
2) Background
3) Cross Charging Arrangements
4) Exclusions
5) Review
CIRCULATED TO: Medway Council Public Health senior team; commissioners of Sexual
Health services in Kent Surrey and Sussex; providers of Sexual Health services in Kent
Surrey and Sussex; English HIV and Sexual Health Commissioners Group; Available at
http://www.abettermedway.co.uk/sexualhealth.aspx
Contact
James
Harman
Senior Public Health
Manager (Commissioning)
Telephone
Email
01634
331384
[email protected],uk
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SEXUAL HEALTH CROSS CHARGING POLICY
1
Introduction
1.1
This document details the council’s policy to manage non contracted
sexual health out of area activity and provide clarity on the conditions
and payment terms for cross charging.
1.2
Due to the open access nature of sexual health services residents
may access services outside their local authority area. Medway
Council has devolved responsibility for the out of area budget to Kent
Community Health NHS Foundation Trust (KCHFT) as part of an
integrated contract. The out of area budget pays for the treatment
received by Medway residents in line with Sexual Health principles for
cross charging1.
2
Background
2.1
Since 1 April 2013, Local Authorities were mandated to ensure that
comprehensive, open access, confidential sexual health services are
available to all people who are present in their area (whether resident
in that area or not). The requirement for Genito-Urinary Medicine
(GUM) and Contraception and Sexual Health (CaSH) services to be
provided on an open access basis is stipulated in the Local Authorities
(Public Health Functions and Entry to Premises by Local Healthwatch
Representatives) Regulations 2013 (“the Regulations”).
2.2
Re-charging by the provider of costs back to the area where the
individual is resident is recommended by Department of Health (DH)
for out-of-area use of services. These arrangements support open
access integrated sexual health services and patient choice in line with
DH recommendations.
2.3
Department of Health issued guidance on cross charging in August
2013 outlining principles for Local Authorities regarding payments for
residents accessing sexual health services outside the area.
2.4
The cross charging guidance suggests that it is for local determination
how these arrangements work and solutions that meet the needs of
local areas and local populations should be in place. The guidance was
developed to encourage a consistent, equitable, fair and transparent
approach to cross-charging and billing for out of area service users
from both a commissioning and provider perspective.
1
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226325/Sexual_He
alth_Key_Principles_for_cross_charging.pdf
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2.5
Public Health Grant allocations are based on resident populations. This
means that they do not include an amount for paying for out-of-area
users of an authority’s open access sexual health services. However,
they will include an amount which can be paid to providers in other
areas in respect of any residents who choose to use open access
services in another authority’s area.
2.6
Due to the mandated open access nature of sexual health services,
Local Authority residents can attend clinics anywhere in the country
and each Council may be billed for the services provided. However this
creates challenges in budgeting for this activity.
3
Cross Charging Arrangements
3.1
Medway Council (Public health) will adopt this policy pending any
regional agreement or national policy.
3.2
Medway Council will maintain confidential open access services and
ensure that local residents can attend a sexual health service of their
choice without geographical boundaries
3.3
Medway Council will reimburse invoices for Genito-Urinary Medicine
treatments which are within the cost envelope of the published
2014/15 Department of Health non-mandatory GUM tariff:
First Appointment £140
Follow Up Appointment £105
Medway Council and KCHFT will not pay more than the local authority
where the treatment took place would be billed for the same
treatment.
3.4
Medway Council will pay, via KCHFT, for the following activity where
the patient is a Medway resident and the treatment occurs outside
Medway:
 STI Intervention A
 STI Intervention B
 STI Intervention C
 T2 Chlamydia & Gonorrhoea Test
 T3 Chlamydia, Gonorrhoea & Syphilis Tests
 T4 Full Screen
 T5 HSV Test
 T6 Hepatitis Test
 TS Microscopy
(https://www.pathwayanalytics.com/sexual-health/231)
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3.5
Medway Council will not cover contraception activity. There was no
cross charging allowance for contraception activity prior to the transfer
of commissioning responsibilities to the local authority on 1 April
2013, in addition there is no recognised national tariff for
contraception. Therefore the assessment is that this activity should
not be cross charged.
3.6
However, Medway Council will pay, via KCHFT, for the contraception
element of a consultation where the patient is a Medway resident and
the Sexual Reproductive Health activity takes place at the same time
as a GU consultation in an integrated service outside Medway AND it
is not possible to dis-aggregate the payment through reasonable
methods.
3.7
Medway Council will not pay for the following activity where the
patient is a Medway resident and the treatment occurs outside
Medway; this is the responsibility of either CCGs, NHS England or the
host local authority:
 Ultrasound
 Medical Gynaecology
 Treatment of menorrhagia or other non-contraceptive
purposes
 Psychosexual health and counselling (neither sexual health
or non-sexual health aspects)
 Any element of the abortion pathway
 Any element of the sterilisation or vasectomy pathway
 Cervical cytology or colposcopy
 HIV treatment and care
 Menopause management or treatment
 STI screening and contraception delivered through GP
practices
 STI screening and contraception delivered through
community pharmacy services
 STI screening, contraception and other sexual health
services delivered solely online
 Genital dermatology where not linked to STI
 Care of prostatitis where not linked to STI
 SRH Standard when not compliant with criteria above
 SRH Complex when not compliant with criteria above
 LARC Procedure when not compliant with criteria above
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3.8
All invoices must include the following information:
a.
b.
c.
d.
e.
3.9
Name of Provider
Date
Bank Details
Invoice Period
Invoice total
Supporting Data for each activity claimed must include the following
before invoices can be reimbursed:
a.
b.
c.
d.
e.
f.
g.
h.
Local Authority Code
Local Authority Name
Genito-Urinary Medicine Number / Identifier
Attendance Type – New / Follow Up / Single / Multi Professional
Activity / Treatment Code
Partial Postcode / Lower Layer Super Output Area
Appointment Date
Tariff
3.10
If the information required is not included then Medway Council, via
KCHFT, will not reimburse this activity
3.11
Invoices for Out of Area Activity must be submitted within 3 months of
the activity taking place. Medway Council, via KCHFT, will not pay
invoices submitted that do not meet this requirement.
4
Exclusions to this policy
4.1
If there is a two-way patient flow between Medway and another area of
a similar level, Medway Council will explore reciprocal arrangements
whereby activity is not invoiced as the administrative burden outweighs
the marginal differences in patient flow between the two areas. Any
such agreements would be included in an amended version of the
Cross Charging Policy.
4.2
There are a small percentage of patients who may wish to remain
anonymous and decline to provide identifiable information. In these
cases the cost should be assigned to the authority in which the provider
is based
4.3
Attendance by people living outside England including overseas
visitors. In these cases these costs will fall to the Medway
commissioned service.
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5
Review
5.1
The policy will be reviewed annually to align with any regional
approach for cross charging and if required updated to reflect changes
to national guidance or recognised efficiencies.
5.2
The first review will be in October 2017
6
Invoicing Address
6.1
Invoices should be sent to:
[email protected]
Kent Community Health NHS Foundation Trust
Payments Department
Trust Offices
Kent & Canterbury Hospital
Ethelbert Road
Canterbury
Kent
CT1 3NG
01227 866 339.
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