Determining responsibility for NHS payments to providers
The Who Pays? guidance sets out the framework for establishing which NHS body is responsible for paying a provider of healthcare services for an individual’s NHS care and treatment.
Who Pays? – A Simple Guide
This video presentation provides a simple guide to the Who Pays? guidance published in August 2020. It sets out what stays the same and what has changed from the previous version of Who Pays?. There is a particular focus on the rules around payment for ‘discharge to assess’, continuing care and Mental Health Act detention and aftercare.
We have also published a transcript of the video presentation.
Who Pays? (August 2020)
Updated Who Pays? guidance has been published, to come into effect from 1 September 2020.
The structure of this updated Who Pays? guidance is broadly similar to the 2013 version and the core rule remains that the commissioner responsible for payment will be the clinical commissioning group of which the patient’s GP practice is a member, with some exceptions to this core rule which are described.
There are important changes in paragraph 13 on stays in hospital, in paragraph 14 on discharge from hospital and continuing care and in paragraph 18 on detention and Section 117 aftercare under the Mental Health Act.
There are also new, mandatory arrangements for dispute resolution which are described in Appendix 1 of the Who Pays? guidance and in Appendix 4, which has been published seperately.
Who Pays? (August 2013)
The previous 2013 Who Pays? guidance is now superseded, but remains available for reference. It was amended in 2016 through the publication of an addendum on the ADASS website which made changes to paragraphs 33 and 34.
Help and support
For help in using the Who Pays? guidance, please email firstname.lastname@example.org
Information on non-contract activity (NCA) can be found in the NHS Standard Contract Technical Guidance (see section 25 of the 2020/21 version).
Information on cross-border healthcare (the England/Wales border and international borders) for the NHS in England and Wales is available on the NHS England website.
The commissioner assignment method (CAM) flowcharts and guidance are designed to assist providers to allocate the correct commissioner code within records they create for the services they provide.