Payability exceptions: care homes and hospitals
30.—(1) Subject to the following paragraphs, regulation 28(1) or, as the case may be, regulation 29(1) does not apply to C in respect of the first 28 days of any period during which C is someone to whom that regulation applies.
(2) Where, on the day on which C’s entitlement to personal independence payment commences, C meets the condition in section 85(2) of the Act (care home residents: costs of qualifying services borne out of public or local funds) or section 86(2) of the Act (in-patient treatment: costs of treatment, accommodation and related services borne out of public funds), paragraph (1) does not apply to C in respect of any period of consecutive days, beginning with that day, on which C continues to satisfy that condition.
(3) Regulation 28 or, as the case may be, regulation 29 does not apply where C is residing in a hospice and is terminally ill, and the Secretary of State has been informed that C is terminally ill—
(a)on a claim for personal independence payment;
(b)on an application for a revision or a supersession of an award of personal independence payment; or
(c)in writing in connection with an award of, or a claim for, or an application for a revision or a supersession of an award of, personal independence payment.
(4) In paragraph (3), “hospice” means a hospital or other institution whose primary function is to provide palliative care for persons resident there who are suffering from a progressive disease in its final stages, other than —
(a)a health service hospital in England (within the meaning of section 275(1) of the National Health Service Act 2006);
(b)a hospital in Wales vested in –
(i)an NHS trust;
(ii)a Local Health Board; or
(iii)the Welsh Ministers,
for the purpose of functions under the National Health Service (Wales) Act 2006(2);
(c)a health service hospital in Scotland (within the meaning of section 108(1)(3) of the National Health Service (Scotland) Act 1978);
(d)a hospital maintained by the Defence Council; or
(e)an institution similar to a hospital mentioned in any of the preceding sub-paragraphs of this paragraph.
(5) Regulation 28(1) does not apply to a case where, during any period the total cost of the qualifying services(4) are met —
(a)out of the resources of the person for whom the qualifying services are provided, or partly out of that person’s own resources and partly with assistance from another person or a charity(5); or
(b)on that person’s behalf by another person or a charity.
(6) In this regulation —
“NHS trust” means a body established under section 18 of the National Health Service (Wales) Act 2006; and
“Local Health Board” means a body established under section 11 of that Act.
(7) In the application of these Regulations to Scotland, “charity” is to be construed as if these Regulations were an enactment to which section 7 of the Charities Act 2011(6) (application in relation to Scotland) applied.
Section 275 was amended by the Health and Social Care Act 2012 (c.7), Schedule 4, paragraph 138(1) and (2). There are other amendments not relevant to these Regulations.
Section 108 was amended by the Health Services Act 1980 (c.53), Schedule 6, paragraph 6(a) and the National Health Service and Community Care Act 1990 (c. 16), Schedule 9, paragraph 19(22)(b). There are other amendments not relevant to these Regulations.
See section 85(4) of the Act for the meaning of ‘qualifying services’.
See section 1(1) of the Charities Act 2011 (c. 25) for the meaning of ‘charity’ in England and Wales.