Cross Border Healthcare & Patient Mobility: Public Consultation on Scotland's Transposition and Implementation of Directive 2011/24 EU on the Application of Patients' Rights in Cross-border Healthcare.

Article 9 - Administrative procedures regarding cross-border healthcare

13.1 This Article requires Member States to have administrative procedures for dealing with cross-border healthcare and reimbursement which are objective and non-discriminatory.

The procedures must be made public and must set out reasonable time limits for dealing with requests for authorisation, taking account of the patient's medical condition, urgency and individual circumstances. We propose to set out a decision making period of 21 days in the guidance that will underpin the domestic implementation regulations (unless further information is required). As with the current arrangements, decisions on requests must be challengeable, both by administrative review and judicial proceedings.

13.2 In the guidance we will also capture the way in which NHS Boards should generally approach requests for cross-border healthcare (e.g. applying the principles of transparency, objectivity, non-discrimination etc). These are important principles upon which judgements would be made in any subsequent challenge.

13.3 Article 9 also allows Member States to set up voluntary prior notification schemes, for services which are not subject to mandatory prior authorisation, where the patient can receive confirmation in advance of entitlement and a written estimate of the level of reimbursement they would be due. It also allows Member States to decide whether or not the existing mechanisms under Regulation 883/2004 are more appropriate to the patient's particular circumstances.

13.4 We believe there is a benefit for patients to have a dialogue with their local NHS Board about entitlement and reimbursement levels (and we would encourage them to do so), but we are aware that any mandatory requirement to do so is likely to be disproportionate. However, there may be some merit in a voluntary system, operated by NHS Boards which encourages the correct dialogue to take place between patient and the NHS Board in advance of treatment not subject to mandatory prior authorisation and we welcome views on this proposal

Consultation question

• Is the proposal for a decision making period of 21 days reasonable? If not, what would be a reasonable timescale?
• Would a system of voluntary prior notification for some services not subject to mandatory authorisation be helpful in creating dialogue where cross-border healthcare is being considered?
• What would such a system look like and how could it work in practice?