Long term illness. (Health Act 1970)

palmcut

There are 15 medical conditions covered under the Long Term Illness (LTI) scheme. Patients approved for any of these conditions receive their prescribed medication free of any charge. (they don't pay the 2,50 per item that Medical Card patients pay)

The 15 conditions are;
Mental illness(under 16)
Mental Handicap.
Phenylketonuria.
Cystic Fibrosis.
Spina Bifida.
Hydrocephalus.
Haemophilia.
Cerebral Palsy.
Epilepsy.
Diabetes Mellitus.
Diabetes Insipidus.
Multiple Sclerosis.
Acute Leukaemia.
Parkinsonism
Muscular Dystropia.

The procedure for getting approval is to fill out an application form which the GP must sign and stamp. The GP must indicate on the application form which condition the patient has; and which drugs and appliances that the GP wishes to prescribe if those drugs are not on the Core drug lists for each condition.

The difficulty arises when the HSE gets it's hands on the application.
Initially the application goes to the local HSE office.
The local HSE then issues a number and sends that LTI number to the patient. In addition the local office sends that allocated number to a Dublin based section of the HSE called the PCRS.

Between the two offices it can take over a month for the allocated LTI number to receive PCRS approval.

I have a patient whose application was received by the local HSE office on 2/7/2015. The local HSE office sent the LTI number to the patient on the 13/7/2015. The PCRS section has not yet approved the LTI number.

This means that if a pharmacy dispenses any medication or appliance to the patient before PCRS approval they will not be paid.

Why does it take so long to get PCRS approval?

ohnonotgmail

I have no idea why it takes so long but the HSE did refund me when i submitted receipts for medications i paid for while i was awaiting approval.

Harry Palmr

Could it be nothing more (or less) than summer staffing?

echo beach

Summer or winter the problem is the same.
Part of the issue is that when the powers that be decided (or rather were forced to admit) that medical card holders were entitled to a Long Term Illness card there was a massive surge in demand with no additional staffing.
Another part of the problem is that the computers in the local offices, which are the old Health Board offices, can't 'talk' to the computers in the central payments office in PCRS. All the information has to be manually inputted AGAIN and this seems to be where the bottleneck is happening.

Harry Palmr

Why doesn't that come as a surprise!