Nursing Homes Support Scheme

The role of the NTPF

The NTPF has been designated by the Minister for Health pursuant to Section 40 of the Nursing Homes Support Scheme Act as a body authorised to negotiate with proprietors of registered nursing homes to reach agreement in relation to the maximum price(s) that will be charged for the provision of long-term residential care services to Nursing Homes Support Scheme residents. As part of this function, the NTPF will enter into "Approved Nursing Home Agreements" with registered private and voluntary nursing homes to record the maximum price(s) that have been negotiated. The NTPF will provide the HSE with the details of all Approved Nursing Home Agreements.

Further information about the Nursing Homes Support Scheme is available on the Department of Health and HSE websites

Application Process for Nursing Homes for inclusion in the Nursing Homes Support Scheme

1. Contact NTPF at section40@ntpf.ie with the following details to hand: Nursing Home Name, Nursing Home Address, Nursing Home email address, Proprietor name & contact telephone number 

2. An application form is available from the NTPF. The following information will be required as part of the application process: Business plan / Prospectus, Copy of registration with HIQA, Tax clearance certificate 

3. Once the application form and any requested additional documentation have been received an account manager will be in touch to arrange a visit.

Frequently Asked Questions

What is the Fair Deal Scheme?
The Fair Deal (The Nursing Homes Support Scheme) came into effect on the 27th October 2009. It replaced the previous system of public nursing home charges and the private nursing home subvention scheme. The intent of this scheme is to make residential home care for older people more accessible, affordable and anxiety free, by removing inconsistencies which currently exist in the system and improving the role the State plays in delivering and meeting the costs of this care.

What is NTPF's role?
The NTPF has a specific remit within the scheme which is to negotiate prices with private and voluntary nursing homes on behalf of the State. As part of this function, the NTPF will enter into pricing agreements with registered nursing homes. The NTPF in turn will provide the HSE with the details of pricing agreements to be included in the scheme. The NTPF's role does not include setting standards for Private Residential Facilities or the assessment of individuals for the purposes of determining their eligibility under the Fair Deal Scheme.

Can the NTPF negotiate on behalf of a resident or family?
The function of the NTPF under the Nursing Homes Support Scheme Act 2009 is solely to negotiate prices with private and voluntary nursing homes. Residents of nursing homes or their families, who have a query regarding the operation of the scheme should contact the Health Service Executive at 1850 24 1850

What is the role of HSE?
The role of the HSE will include liaising with applicants, assessing their eligibility for the scheme and determining financial co-payment arrangements between nursing homes and individual residents, and disbursing State payments to private nursing homes. Further information is available from www.hse.ie

What is the role of HIQA?
HIQA will set nursing home standards and will inspect facilities to ensure that these standards are being met. Further information is available from www.hiqa.ie

Any queries from nursing home residents or their families concerning this scheme should contact the HSE helpline number 1850 24 1850

Deed

What is the deed of agreement? 
The deed of agreement is the contract between the nursing home and NTPF specifying the maximum price that the nursing home can charge Fair Deal residents for long-term residential care as defined in the deed. These prices are fixed for the term of the deed.

What happens if any conditions in clause 5.2 of the deed of agreement occur?
If any of the conditions in clause 5.2 of the deed of agreement occur it will trigger a termination of the agreement. However, this does not preclude the parties from entering into another agreement which may continue the existing agreement under the same or changed terms and conditions.

What is the effective date of the deed of agreement? 
The deed of agreement will specify the commencement date and the expiry date of each deed.

GENERAL

Is there any possibility of the prices offered to us by NTPF being actually reduced in the future?  
Prices agreed will be fixed for the term of the deed of agreement. At the end of the agreement term a new process of negotiation on pricing will be entered into with the nursing home and all issues, including price, will be open for discussion and agreement.

What form of information will be made available by the NTPF to our residents and their families regarding the Fair Deal scheme? 
The NTPF will only be dealing with nursing home owners and managers for the purpose of agreeing a maximum Fair Deal price. Residents and families should be advised to contact the HSE on low call 1850 24 1850 or their web site www.hse.ie for information on the scheme.

Will prices be negotiated annually? 
The NTPF will contact each nursing home to agree a Fair Deal price for a further term prior to the expiry date of a current deed of agreement.

What factors do NTPF take into account in agreeing Fair deal prices? 
The following guidelines are taken into account in negotiating prices; (a) costs reasonably and prudently incurred by the nursing home and evidence of value for money, (b) price(s) previously charged, (c) local market price and (d) budgetary constraints and the obligation of the State to use available resources in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public.

What happens if price negotiations break down between NTPF and the nursing home? 
The NTPF Review process will apply as follows

NTPF Fair Deal Review Process_ Revised January 2018

The Department of Health, through the Health Service Executive (“HSE”), supports long-term residential care services through the Nursing Homes Support Scheme (Fair Deal) pursuant to the Nursing Homes Support Scheme Act, 2009 (the Act).

Under Section 41 of the Act the National Treatment Purchase Fund Board (NTPF) is the designated body to agree maximum Fair Deal prices with private and voluntary nursing homes.

The objective of the NTPF is to agree a price with each nursing home that offers value for money to the State having regard to the following criteria:

  1. the costs reasonably and prudently incurred by the home and evidence of value for money;
  2. the price(s) previously charged;
  3. the local market price; and
  4. budgetary constraints and the obligation of the State to use available resources in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public.

(the “Criteria”)

 Negotiations are the responsibility of a nominated NTPF Account Manager. He/she will contact the home before the expiry of the existing deed (where applicable) setting out the information required for the purposes of price negotiations and the timetable for the provision of that information. The Account Manager may also make supplemental requests for information.

  • He/she may conduct one or a number of negotiations (either face to face or otherwise) with a nursing home and may be accompanied by other Account Managers or advisers to the NTPF including forensic accountants. These negotiations will result in agreement in the majority of cases.
  • Where, notwithstanding the best efforts of both parties, agreement is not reached through negotiation, the Account Manager will advise the nursing home in writing that negotiations have concluded without agreement. The Account Manager will set out the final offer proposed (the “Final Offer”) and will explain the legal implications of the failure to come to an agreement on price. All final offers are reviewed and signed off on by the Director of Finance. The Account Manager will also inform the nursing home that it is open to it to request a review of the Final Offer, and will set out the procedure to be followed for such a review (as set out below).
  • Where an existing deed of agreement is due to expire, the written communication from the NTPF containing the Final Offer will also set out the terms on which the NTPF are willing, in the interests of Fair Deal residents in the home, to offer a short term extension of the existing agreement to the home pending the outcome of the review process. This extension will be for a period of at least three months to facilitate the review process and to provide time for the nursing home to consider its position. It will also ensure that the nursing home remains an approved home for the purposes of the Fair Deal Scheme.
  • If the home decides to request a review, it must write to Section 40 in the NTPF (section40@ntpf.ie) setting out the grounds for its request for a review of the Final Offer and provide any additional information in support of its request (the “Nursing Home's Application for Review”).
  • Once the review process is commenced all previous offers made are unconditionally withdrawn and it is possible that the review may result in an offer that is equal, greater or less than that previously made.
  • If an agreement is reached on price after the review process has completed, this price will be applied from the first day of the month following such agreement, notwithstanding that the extended agreement may not have expired.

The following process shall apply during the review:

  1. The review shall be carried out by the CEO of the NTPF. The CEO may be assisted by other NTPF personnel who have not been directly involved in the most recent negotiations with the nursing home.
  2. The NTPF Account Manager will document for the file the negotiation process undertaken to date which shall include the Final Offer, and pass the file to the CEO to commence the review.
  3. Further records or documents may be requested by the CEO pursuant to the National Treatment Purchase Fund Board (Establishment) Order 2004 as amended by Section 41(1) of the Nursing Home Support Scheme Act, 2009.
  4. The CEO will write to the nursing home setting out a proposed timeframe for completing the review and shall request any additional information that may be required at that time.
  5. The CEO may decide to engage third parties, such as forensic accountants or other experts, to assist in examining the records and accounts of the home. The home shall be notified in writing of the appointment of any third party. Such third parties may make direct contact with the home (copying the CEO) in relation to the information required and the timeframe for the provision of that information. The nursing home shall, insofar as is possible comply with the timeframe set by the relevant third party or the CEO for the purpose of responding to requests for information.
  6. If the nursing home fails to fully engage in the review process or if it fails to provide any requested information in a timely manner; this may result in the abandonment of the review process or a delay in the completion of the review by the CEO.
  7. The CEO shall provide the nursing home with a copy of any report produced by a third party in draft format prior to its finalisation to allow the home to point out any factual errors. The CEO shall ordinarily allow the home at least 5 working days to correct any such errors. Following this period, the relevant third party will finalise their report.
  8. The CEO will then carry out a de novo review of the file applying the Criteria and having regard to all matters contained within the nursing home’s file, the report of any third party and any other documents and/or information it deems relevant.
  9. Following this, the CEO will issue its decision on the case along with reasons for its decision. The decision will be in the form of an offer of a Fair Deal price for a fixed period of time and will invite the home to either accept or reject it.
  10. The CEO shall ordinarily allow the home at least 10 working days to communicate its acceptance or rejection of the offer.
  11. The decision of the CEO shall be final and the review process shall conclude upon the expiry of the CEO’s offer or its acceptance or rejection by the nursing home whichever is earlier.

Note:

  1. Nothing in the above procedure shall prejudice the right of the NTPF to make contact by phone or otherwise with the nursing home as it may deem appropriate during the course of the review.
  2. If, at the conclusion of this process, the nursing home does not accept the decision of the CEO, the NTPF will formally write to the nursing home confirming the date from which the home will no longer be an ‘approved’ nursing home for the purposes of the Fair Deal scheme. In all cases, the nursing home will be provided with a further extension to its deed of agreement by a period of at least one month (at the existing price) before they are formally taken off the HSE list of approved nursing homes. This will enable the nursing home to make arrangements with its Fair Deal residents.
  3. In the event that the review process is abandoned due to a failure by the nursing home to fully engage in the process, the NTPF shall issue a Deed of Agreement to the nursing home for a term of one year applying either the existing Fair Deal rate or the local average rate (as defined by the county in which the nursing home resides) whichever is lower. Failure to execute this agreement will result in the nursing home being removed from the list of HSE approved nursing homes for the purpose of the Fair Deal scheme
  4. If the NTPF considers it appropriate, it may modify this procedure. Any changes will not affect reviews already commenced.

What happens to my existing deed if agreement cannot be reached before the expiry date? 
In the interest of the existing Fair Deal residents in the nursing home normally a temporary deed of agreement will be offered so as to provide time for ongoing negotiations and to facilitate the Review process should this be necessary.

What happens if negotiations are inconclusive or if the nursing home decides not to participate in negotiations / review process? 
If a nursing home decides not to engage with NTPF in negotiations or in the review process NTPF will formally write to the nursing home and confirm the date from which the home will no longer be an 'approved' nursing home in respect of the Fair Deal scheme and will set out the implications of this position. NTPF will also advise the HSE of the effective date that the nursing home will no longer be an approved nursing home for the purposes of the Fair Deal scheme.

What happens when a resident's care needs change?
There are no provisions to review prices once the deed has been executed. Prices are fixed for the term of the agreement.

How can a new nursing home apply to be included in the scheme? 
Where a new nursing home opens up and wishes to participate in the Fair Deal scheme they must first register with HIQA and hold a current tax clearance certificate. They should then contact NTPF and an account manager will be appointed to enter into negotiations regarding the maximum price chargeable for Fair Deal residents. See section "Application Process" on the NTPF website.

How do the NTPF intend to address HIQA standards during price negotiations? 
Price negotiations will be based on current operating conditions at the time of the negotiations. The NTPF price agreement covers the provision of Long-term Residential Care Services as defined in the deed. Changes in operating conditions as a result of new regulations or standards will form part of the discussions at the time of the price negotiations. However, once agreed prices will be fixed for the term of the agreement.

Is this scheme just for people over-65? 
No, the legislation does not make a distinction on age grounds.

I have a specialist Alzheimer’s unit; will the negotiations take account of this? 
The existence of a specialist unit may be included as part of the discussions at the time of the price negotiations.

What happens if I make a mistake in the information submitted to the NTPF? 
Negotiations will be based on the forms returned by the nursing home and will be the subject of meetings between NTPF representatives and the nursing home. If a material error is discovered this can be addressed at such meetings and time given to reassess the proposals. If a material error is discovered after the agreement has been executed this can be resolved through the Dispute Resolution provisions of the deed, by mutual agreement.

What is the Whole Time Equivalent? 
The Whole Time Equivalent (WTE) is the ratio of the total number of paid hours in a period divided by the standard number of hours for that period. For example, if you have five people working part time at a rate of 50% (i.e. 20 hours out of a standard 40 hour week) the WTE (number employed) is 2.5 people (5 x 20/40). If you have 5 employees working part time at 60% of standard hours (i.e. 24 out of a standard 40 hour week) for eight months of the year then the WTE is 2 (5 x 24/40 x 8/12). The ratio is intended to establish the number of full time employees.

Do I need a Tax Clearance Certificate? 
A current Tax Clearance Certificate is required.

CONFIDENTIALITY

Why is confidentiality necessary? 
It is normal business practice for confidentiality to be maintained between contracting parties on a need to know basis, other than as may be required by law, court order or any governmental or regulatory authority.

Is the NTPF subject to Freedom of Information acts? 
The NTPF undertakes to use its best endeavors to hold confidential any information provided by the nursing home as part of its negotiation procedure, subject to its obligations under law, including, in particular, the Freedom of Information Acts 1997-2003 (as amended). Should nursing homes wish that any information supplied by them as part of this process not be disclosed because of its commercial sensitivity or confidentiality or otherwise, they must, when providing this information, clearly identify the specific information they do not wish to be disclosed and clearly specify the reasons for its sensitivity. It is not sufficient to include a statement of confidentiality encompassing all the information provided in the response.