GUIDE TO THE FUNCTIONS,

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					  GUIDE TO THE FUNCTIONS, RECORDS AND PROCEDURES OF THE
         HEALTH REPAYMENT SCHEME APPEALS OFFICE

This guide is produced to help members of the public in ascertaining and exercising
their rights under the Freedom of Information Acts, 1997 and 2003. It is published in
accordance with sections 15 and 16 of those Acts.

Part 1

contains a guide to the structure and the functions of the Health Repayment Scheme
Appeals Office.

Part 2

contains information on the rules and practices of the Health Repayment Scheme
Appeals Office in exercising its statutory duties.

Part 3

sets out the rights of persons under the Freedom of Information Acts and how
information held by the Health Repayment Scheme Appeals Office may be accessed.




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                                 CONTENTS
         PURPOSE OF THE MANUAL AND GUIDE TO FUNCTIONS

1. INTRODUCTION

1.1 Purpose of this guide

1.2 Explanation of terms

2. THE HEALTH REPAYMENT SCHEME APPEALS OFFICE

2.1 Description and Functions

2.2 Mission Statement

2.3 Organisation

2.4 Structure

       2.4.1 Appeals Officers

       2.4.2 Administration

2.5 Delivery of service

                   RULES AND PRACTICES OF THE OFFICE

3. APPEALS PROCEDURES

3.1 Making an Appeal

       3.1.1 Notification of appeal

       3.1.2 Time for making an appeal

       3.1.3 Acknowledgement of appeal

       3.1.4 Content of appeal

       3.1.5 Withdrawal of appeal

3.2 Predetermination Procedures



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      3.2.1 Submission by the Scheme Administrator

      3.2.2 Referral of appeal to Appeals Officer

3.3 Procedures relating to determining appeals

      3.3.1 Summary procedures or oral hearing

      3.3.2 Venue for oral hearing

      3.3.3 Attendance at oral hearing

      3.3.4 Payment of Costs and Expenses

      3.3.5 Format of oral hearing

      3.3.6 Failure to attend an oral hearing

3.4 Post-determination appeal procedures

      3.4.1 Decision of Appeals Officer

      3.4.2 Notification of decision

4. REVIEW OF THE DECISION OF THE APPEALS OFFICER

4.1 Referral to the Ombudsman

4.2 Review by Courts

                          HOW TO GET INFORMATION

5.1 Routinely Available Information

5.2 Classes of records held

5.3 Application under the Freedom Of Information Acts

      5.3.1 Statutory rights

      5.3.2 Records covered by the Acts

      5.3.3 Where to send your request

      5.3.4 Decisions within 4 weeks



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5.4 Fees

      5.4.1 Upfront fees

      5.4.2 Search and Retrieval / Photocopying fees:

5.5 Rights of Review and Appeal

      5.5.1 Internal Review

      5.5.2 Review by the Information Commissioner

APPENDIX

A Glossary of Terms




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          PURPOSE OF THE MANUAL AND GUIDE TO FUNCTIONS

1. INTRODUCTION

1.1 Purpose of this guide

The Health Repayment Scheme Appeals Office (“the Office”) is a public body within the
meaning of the Freedom of Information Acts. This manual has been prepared in accordance
with the requirements of sections 15 and 16 of those Acts. Its purpose is to facilitate access to
official information held by outlining:

      the structure and functions of the Office,
      details of the service provided and how they may be availed of,
      information on the classes of records held, and
      information on how to make a request to the Office under the Freedom of Information
       Acts.

1.2 Explanation of terms

As some terminology used to describe the work of the Office and the information held may not
be familiar to the general public, an explanation of the more common elements of this
terminology is set out in the glossary in APPENDIX A.

2. THE HEALTH REPAYMENT SCHEME APPEALS OFFICE

2.1 Description and Functions

The Office operates independently of the Department of Health and Children (“the
Department”), the Health Service Executive (“HSE”) and the Scheme Administrator.

It is charged with providing an appeals service to those persons who wish to appeal the
decision of the Scheme Administrator under the Health (Repayment Scheme) Act 2006.

The statutory basis for the appeals process is contained in Section 16 of the Health
(Repayments Scheme) Act 2006 (“the Act”). A copy of the Act may be viewed at
www.appeal.ie.

2.2 Mission Statement

The mission of the Health Repayment Scheme Appeals Office is to provide an independent,
accessible and fair appeals service for the Health Repayment Scheme and to deliver that
service in a courteous and efficient manner.

2.3 Organisation

The Health Repayment Scheme Appeals Office is based on Floor 4, Block 6/7, Irish Life Mall,
Lower Abbey Street, Dublin 1. The office lo-call number is 1890 277 325.



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2.4 Structure

The Office has two distinct facets which combine to provide the appeals process: the statutory
decision-making function of the Appeals Officers and the administrative procedures which
support the exercise of that function.

2.4.1 Appeals Officer

The Appeals Officer is appointed by the Minister for Health and Children (“the Minister”) in
accordance with Section 16(3) of the Act as an independent officer whose function it is to
determine appeals against the decisions of the Scheme Administrator.

The independence of the Appeals Officer(s) in the performance of function is set out explicitly
in Section 16(5) of the Act. The Act specifies that the Appeals Officer shall comply with the
Ministerial guidelines on the procedures to be followed in considering an appeal – see Section
16(5)(b) of the Act.

2.4.2 Administration

The administrative arm of the Office provides the ancillary administrative services for appellants
and other persons involved in the appeals system.

A secure computer system (containing limited identifying personal details) is used to keep track
of individual appeals through the various stages of the appeals process and to ensure
compliance with the terms of the Data Protection Acts 1988 and 2003.

2.5 Delivery of service

As mentioned above, the Office is concerned with the processing of appeals against the
decisions of the Scheme Administrator. Every person who receives such a decision is advised
as a matter of course of the right of appeal.

A fuller description of the procedures, statutory and otherwise, involved in the appeals process
is set out in Part 2 of this manual.




                    RULES AND PRACTICES OF THE OFFICE

3. APPEALS PROCEDURES

The procedures followed in processing an appeal are outlined in this section of the manual.

The statutory procedures are provided for in the Section 16(5) of the Act. References to
"Sections" in the following are to provisions of this Act.

3.1 Making an Appeal


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3.1.1 Notification of appeal

Section 15 of the Act specifies that an applicant under the scheme (and consequently a person
making an appeal) shall be provided in writing with the basis on which the decision of the
Scheme Administrator was arrived at.

Any applicant who is dissatisfied with the decision of the Scheme Administrator may appeal –
See Section 16(1)(a) and (b) of the Act.

There is no charge for making an appeal.

3.1.2 Time for making an appeal

The notice of an intention to appeal must be made within 28 days of receipt of the decision of
the Scheme Administrator. An applicant gives notice of his/her intention to appeal by
completing the form supplied by the Scheme Administrator and returning it to the Scheme
Administrator’s office.

3.1.3 Acknowledgement of appeal

Every notice of intention to appeal notified to the Scheme Administrator is thereafter notified to
the Appeals Office.

The Office will write to each appellant acknowledging their intention to appeal and enclosing an
Appeal Form and a leaflet containing a guide to the appeals process.

The appeals process will commence when the Appeals Office receives the completed Appeal
Form.

Once the Appeal Form has been received, the appeal is recorded on a computerised register of
appeals which is used for monitoring the individual appeal through the appeals process.

3.1.4 Content of appeal

Section 16(2) of the Act specifies that any appeal shall be on the specified form and shall state
the reasons for the appeal.

The statutory procedures require that the appeal form be accompanied by whatever
documentary evidence the appellant wishes to submit in support of the appeal. In practice,
however, documentary evidence submitted subsequent to the submission of the Appeal form
will be considered by the Appeals Officer.

3.1.5 Withdrawal of appeal

A person may withdraw the appeal at any stage by giving notice in writing to the Office.




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In circumstances where the Appeals Office has furnished the Appeal Form to the Appellant for
completion, but the Appeal Form has not been returned to the Office, the practice of the Office
will be to issue two reminder letters, each at 20 working day intervals.

If the Office does not hear from the Appellant during this time, the Office will, on the lapse of 20
working days after the issue of the second reminder letter, formally withdraw the appeal. The
Office will notify the Scheme Administrator that it has withdrawn the appeal and if the appeal
concerns an amount for repayment the Scheme Administrator will thereafter give effect to its
decision.

An appellant shall provide the Appeals Office with contact details which are sufficient for the
purpose of receiving registered post.

3.2 Pre-determination Procedures

3.2.1 Submission by the Scheme Administrator

Section 16(4) of the Act specifies that the Scheme Administrator and the HSE shall provide the
Appeals Officer with such assistance and information as that Officer may reasonably require in
order to determine the appeal.

In practice, once the completed Appeal Form has been received, the Appeals Office will write
to the Appellant acknowledging same and will requisition the application file from the Scheme
Administrator.

3.2.2 Referral of appeal to Appeals Officer

Upon receipt of the file from the Scheme Administrator the complete appeal file will be
compiled and referred to the Appeals Officer for consideration.

The Appeal Officer may also undertake further investigation of any new facts or evidence
arising from the appeal. The Appeals Officer may also request the appellant to furnish further
particulars with respect to the appeal and may allow amendment of the appeal form and of any
submissions received.

3.3 Procedures relating to determining appeals

3.3.1 Summary procedures or oral hearing

The Appeal form allows the appellant the option of having the appeal determined on the basis
of the documentary evidence before the Appeals Officer (“Summary hearing”) or having an Oral
hearing of the appeal.

3.3.2 Venue for oral hearing

Where the appellant requests an oral hearing of an appeal, an Oral Hearing form is included
with the acknowledgement letter. Arrangements are made thereafter to hold the oral hearing
as soon as possible.


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In the Dublin area oral hearings will be heard in the Health Repayment Scheme Appeals Office
in Floor 4, Block 6/7, Irish Life Mall, Lower Abbey Street, Dublin 1.

Outside Dublin, oral hearings may be held at the following locations: - Athlone, Cork, Galway,
Limerick, Sligo, Waterford. Oral hearings may also be held at the other locations if a demand
for a particular location arises in the future.

Timely notices will be sent to all parties concerned.

3.3.3 Attendance at oral hearing

The appellant will ordinarily appear at the oral hearing in person and may be accompanied by a
member of his/her family, a friend, or any other person of his/her choice.

An appellant may also be professionally represented if s/he so wishes.

Members of the public are not admitted.

3.3.4 Payment of Costs and Expenses

There is no provision in the Act for the payment of travel and subsistence expenses; nor is
there provision for compensation for any loss of earnings.

There is no provision in the Act for the payment of the costs of professional representation at
an oral hearing. If an appellant decides to engage a solicitor or other professional
representative, those costs will be borne by the appellant.

3.3.5 Format of oral hearing
Oral hearings are held in private and the aim is to keep the proceedings as informal as
possible.

The Appeals Officer will begin the hearing by introducing him/herself and all other persons
present. The appellant will then outline the nature of and reasons for the appeal.

At the hearing the appellant or his/her representative is afforded every opportunity to set out
his/her case and to present any evidence in support of the appeal.

3.3.6 Failure to attend an oral hearing

Where an appellant has requested an oral hearing, but fails to attend without giving prior notice
of inability to attend, the Appeals Officer will make a decision based upon the information
available at that time. That decision will be issued to the appellant and to the Scheme
Administrator and the HSE in the manner specified by Section 16(5) of the Act.

3.4 Post-determination appeal procedures

3.4.1 Decision of Appeals Officer

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Summary hearing
In the case of a summary hearing it is envisaged that the Appeals officer will make a decision
as soon as possible after the Office receives the appellant’s information from the Scheme
Administrator and as soon as the Appeals Officer has completed his/her consideration of the
case.

Oral Hearing
Where a particular appellant requests an Oral Hearing it is envisaged that the Appeals officer
will make a decision as soon as possible after the completion of the Oral Hearing.

The decision of the Appeals Officer will be in writing and will set out the reasons for the
decision – see Section 16(5)(d) and (e) of the Act.

3.4.2 Notification of decision

Notification of the decision will be sent to the appellant, to the Scheme Administrator and to the
HSE. The Scheme Administrator will thereafter give effect to the Decision, if applicable – see
Section 16(9)(a) of the Act.

4. REVIEW OF THE DECISION OF THE APPEALS OFFICER

4.1 Referral to the Ombudsman

Any complaint regarding the service provided by the Office may be referred to the Ombudsman
– See Section 23 of the Health (Repayments Scheme) Act 2006.

4.2 Review by Courts

A decision of an Appeals Officer may be appealed to the High Court on a point of law – See
Section 16(6) of the Act.

                             HOW TO GET INFORMATION

5. HOW TO GET INFORMATION

5.1 Routinely Available Information

The Health Repayment Scheme Appeals Office is an office independent of the Department of
Health and Children and is a separate public body for the purposes of carrying out its functions
under Section 16 of the Act. It will make information available on its functions and activities in
its annual report and public information leaflets. Please consult the Office website at
www.appeal.ie The following websites contain current information relevant to the Health
Repayment Scheme:

www.repay.ie, www.hse.ie, www.dohc.ie




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5.2 Classes of records held

The following classes of records are held in the Health Repayment Scheme Appeals Office:

Internal administration:

Records in this category involve the day to day management of the Office. Information held in
this area can include subjects such as the provision of accommodation for staff, the provision of
other resources such as office machinery and supplies, the organisation of training courses, the
allocation of leave and the circulation of information documents.

Appeals administration:

Records in this category involve the day to day administration of the appeals system.
Information held in this area will include such subjects as the procedures on the submission of
documentary evidence and statistical material on appeals.

Appeals legislation:

These records will include Acts, Regulations and relevant Court judgments.

Personal records:

Records in this category include the data held on a computerised register of appeals.

This register contains a comprehensive record of each appeal, including personal information,
files and correspondence relating to the appeal and a copy of the decision made. These
records are in compliance with the requirements of the Data Protection Acts 1998 and 2003.

5.3 Application under the FOI Acts

5.3.1 Statutory rights

Statutory Rights
The Freedom of Information Acts 1997 and 2003 (FOI), which came into effect on 21 April,
1998, established three new statutory rights:

      a legal right for each person to access information held by public bodies;
      a legal right for each person to have official information relating to oneself amended
       where it is incomplete, incorrect or misleading;
      a legal right to obtain reasons for decisions affecting oneself.

The Act asserts the right of members of the public to obtain access to official information to the
greatest extent possible consistent with the public interest and the right to privacy of
individuals.




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Under the FOI Acts, anyone is entitled to apply for access to information not otherwise publicly
available. Each person has a right to:

      access to records held by the Office, subject to certain exceptions (e.g. a person is not
       entitled to access personal information about another person without that person's
       permission),
      correction of personal information relating to oneself held by the Office where it is
       inaccurate, incomplete or misleading,
      access to reasons for decisions made by the Office directly affecting oneself.

5.3.2 Records covered by the FOI Acts

The following records come within the scope of the Act:

      all records relating to personal information held by the Office irrespective of when
       created,
      all other records created from commencement date of the FOI Acts i.e. 21st April, 1998,
      any other records necessary to the understanding of a current record.

5.3.3 Where to send your request

Applications for information under the FOI Acts should be addressed to:
FOI Officer,
Health Repayment Scheme Appeals Office
Floor 4, Block 6/7, Irish Life Mall,
Lower Abbey Street,
Dublin 1

Phone: 01-879 2981
LoCall 1890 277 325
Fax: 01-879 2989
E-mail: info@appeal.ie

Applications should be in writing and should indicate that the information is sought under terms
of the Freedom of Information Acts.

Please give as much detail as possible to enable the staff of the Office to identify the record. If
you have difficulty in identifying the precise records which you require, the staff of the Office will
be happy to assist you in preparing your request.

5.3.4 Decisions within 4 weeks

The Office is obliged to respond to the request within 4 weeks.

5.4 Fees

There are two types of charges that apply under the FOI Acts:

      upfront fees; and


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      fees for search and retrieval of records and photocopying

5.4.1 Upfront fees

Such fees only apply to requests for access to non-personal records.

A fee of €15 must accompany a request for records other than records containing only personal
information relating to oneself.

A reduced fee of €10 applies in relation to such a request if you are covered by a medical card.

Neither fee applies if the request is for personal information relating to oneself only.

In the case of requests for non-personal records, there are also fees applicable in relation to
internal review and appeals to the Information Commissioner. Further details included at 6.5.1
and 6.5.2 below.

5.4.2 Search and Retrieval / Photocopying fees

No fee will be charged in respect of personal records, either for the search and retrieval of
records or for photocopying, except where a large number of records are involved.

In respect of other (non-personal) information, fees may be charged in respect of the time
spent in locating and copying records, based on a standard hourly rate (€20.95 per hour). No
charges may apply in respect of the time spent by the Office in considering requests.

A deposit may be payable where the total fee for search and retrieval is likely to exceed
€50.79.

In these circumstances, the Office will notify you and if requested, assist you in amending the
request so as to reduce or eliminate the amount of the fee.

5.5 Rights of Review and Appeal

The FOI Acts set out a series of exemptions to protect sensitive information where its
disclosure may damage key interests of the State or of third parties. In the event that the Office
decides to invoke these provisions to withhold information, that decision may be appealed.
Decisions made by the Office in relation to the deferral of access to information, or fees and
charges form documentation may also be appealed.

Details of the appeals mechanisms are set out in the following paragraphs.

5.5.1 Internal Review

You may seek internal review of the initial decision on your request for information under the
FOI Acts which will be carried out by an official at a higher level if:




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      you are dissatisfied with the initial response received i.e. refusal of information, form of
       access, charges, etc., or
      you have not received a reply within 4 weeks of your initial application. This is deemed
       to be a refusal of your request and allows you to proceed to internal review.

Requests for internal review should be submitted in writing to:

FOI Manager,
Health Repayment Scheme Appeals Office
Floor 4, Block 6, Irish Life Centre, Lower Abbey Street, Dublin 1

Phone: 01-879 2987
LoCall 1890 277 325
Fax: 01-879 2989
E-mail: info@appeal.ie

Such a request for internal review must be submitted within 4 weeks of the initial decision. The
Office must complete the review within 3 weeks. Internal review must normally be completed
before an appeal may be made to the Information Commissioner.

There is no fee for a request for a review in relation to personal records. However, a fee of €75
must accompany most applications for internal review of a decision in relation to non-personal
records. A reduced fee of €25 applies if you are covered by a medical card. There is no fee
payable for cases where a review is sought due to the non-reply of the initial request.

5.5.2 Review by the Information Commissioner
Following completion of internal review, you may seek an independent review of the decision
from the Information Commissioner. Also, if you have not received a reply to your application
for internal review within 3 weeks, this is deemed to be a refusal and you may appeal the
matter to the Commissioner.

Appeals in writing may be made directly to the Information Commissioner at the following
address:

Office of the Information Commissioner
18 Lower Leeson Street
Dublin 2.
Phone: 01-6395689 LoCall 1890 22 30 30
Fax: 01-6395674
foi@ombudsman.irlgov.ie

There is no fee for a request for an appeal in relation to personal records. However, a fee of
€150 must accompany most applications for review by the Information Commissioner in
relation to non-personal records. A reduced fee of €50 applies if you are covered by a medical
card. There is no fee payable for cases where an appeal is being sought due to the non-reply
of the internal review request.




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APPENDIX A

A Glossary of Terms

Appeal:

A request by a person to have a decision of the Scheme Administrator considered afresh and
determined by an Appeals Officer.

Appeals Officer:

An Appeals Officer is an Officer in the Health Repayment Scheme Appeals Office who is
appointed on a statutory basis by the Minister for Health and Children to determine appeals.

Documentary evidence:

The documents, including all correspondence and reports, which are relevant to the questions
under appeal.

Oral hearing:

A hearing of an appeal before an Appeals Officer at which the appellant may present his/her
case either in person or through a family member of professional representative.

Question under appeal:

This is the subject matter of the appeal which the appellant is contesting, typically whether or
not a claimant is eligible to apply under the Act, or the amount determined by the Scheme
Administrator to be payable to a particular eligible claimant.

Statutory:
Relates to conditions, powers or procedures which are provided for in legislation.

Summary decision:

A summary decision is a decision made by an Appeals Officer on the basis of documentary
evidence available without the need for an oral hearing.

Scheme Administrator:

The person with whom the Health Service Executive has entered into an arrangement to
provide services for the purposes of the Act, as set out in S.3, Health (Repayment Scheme) Act
2006.




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