Nursing Homes FAQs

The State, through the Health Service Executive (“HSE”), supports long-term residential care services through the Nursing Homes Support Scheme NHSS) (the “Scheme”). The intent of the Scheme is to make residential home care for older people more accessible, affordable and anxiety free, and improving the role the State plays in delivering and meeting the costs of this care. 

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 enters into pricing agreements with HIQA registered nursing homes to record the maximum price(s) that have been negotiated. 

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 About the Fair Deal scheme – HSE.ie  

The NTPF will only be dealing with nursing home proprietors and managers for the purpose of agreeing a maximum Fair Deal price.  Residents and families should be advised to contact the HSE via About the Fair Deal scheme – HSE.ie  for information on the scheme.   

There are no provisions to review prices once the deed has been executed. Prices are fixed for the term of the agreement. 

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

HIQA will set nursing home standards and will inspect facilities to ensure that these standards are being met.  Further information is available from HIQA   

The contract renewal application form will be sent to the email address we have on file. This is issued ahead of contract expiry. If you have not received an application form or wish to negotiate early, email section40@ntpf.ie and request same. It is the responsibility of the nursing home to ensure accurate contact details.  If you are concerned this might not be up to date, contact us on section40@ntpf.ie  

Contact us on Section40@ntpf.ie where we will assist you. It is important to ensure the form is accurate as it will be returned where incomplete or inaccurate.  Your Contract Manager will be able to provide support regarding the renewal and completion of the application form.

The NTPF shall only agree prices with nursing homes where it considers that those prices deliver value for money to the Irish State. In negotiating prices, the NTPF shall have regard to the following considerations (which are in no particular order of priority):   

• costs reasonably and prudently incurred by the nursing home and evidence of value for money
• price(s) previously charged 
• the local market price
• 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 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. 

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. 

The deed of agreement will specify the commencement date and the expiry date of each deed.

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. 

Negotiations are carried out prior to the expiry of the deed. The duration of the deed can vary in agreement with the NTPF.

A temporary contract will be offered in order to provide time for ongoing negotiations and to facilitate the Review process should this be necessary.

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 NHSS 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 NHSS scheme.

Where a new nursing home opens up and wishes to participate in the NHSS scheme, they must first register with HIQA and hold a current tax clearance certificate. They should then contact the NTPF via section40@ntpf.ie and a Contract Manager will be appointed to enter into negotiations regarding the maximum price chargeable under the scheme.   

To be considered as an ‘approved nursing home’ the nursing home must hold a valid HIQA registration number. 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.   

The existence of a specialist unit may be included as part of the discussions at the time of the price negotiations. All negotiations are conducted in line with the standard four criteria. 

Negotiations will be based on the documentation 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.

A current Tax Clearance Certificate is required.

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.  

The NTPF undertakes to use its best endeavours 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 Act 2014 (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.   

Contact the CMT in the NTPF on section40@ntpf.ie who will advise further. 

The NTPF Review process will apply as follows:  

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

Under Section 41 of the Act the (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:  

• the costs reasonably and prudently incurred by the home and evidence of value for money
• the price(s) previously charged 
• the local market price 
• 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 Contract Manager. They 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 Contract Manager may also make supplemental requests for information. 

• They may conduct one or a number of negotiations (either face to face or otherwise) with a nursing home and may be accompanied by other Contract 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 Contract Manager will advise the nursing home in writing that negotiations have concluded without agreement. The Contract 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 Contract 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 Contract 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.