Ordinance on the distribution of the flat-rate payment for expenses incurred by health insurance funds for non-insurance services by the Federal Government (flat-rate settlement ordinance-PauschAV)

Unofficial table of contents

PauschAV

Date of completion: 26.04.2004

Full quote:

" Flat-rate resolution of 26 April 2004 (BGBl. I p. 644) "

Footnote

(+ + + Text evidence from: 1. 1.2004 + + +) 

  

The V was adopted as Article 1 of V v. 26.4.2004 by the Federal Ministry of Health and Social Security with the consent of the Federal Council. She's gem. Article 3 of this V mWv 1.1.2004 is put into effect. Unofficial table of contents

§ 1 Procedure party and central body

(1) Health insurance funds and top associations of health insurance funds within the meaning of this Regulation are the entities referred to in § 4 (2) and § 213 (1) of the Fifth Book of Social Code. (2) The communication of the top associations, who is the central body in accordance with § 221 The second sentence of the second sentence of the Fifth Book of the Social Code is to be applied to the Federal Insurance Office until 15 April 2004. Unofficial table of contents

§ 2 Expenditure to be taken into consideration

Expenditure for non-insurance benefits within the meaning of this Regulation shall be taken into account in respect of the expenditure listed in the Annex, in so far as it is defined in accordance with Article 37 of the General Administrative Regulation on accounting in the social security system. in the version in force during the survey period and in accordance with the provisions of the accounts framework for the institutions of statutory health insurance. (2) The sum of the expenditure referred to in paragraph 1 shall be separate from the sickness insurance funds in of the respective quarterly accounts. The total amount shown in the quarterly accounts for the reporting period 1 January to 31 December shall be the final sum for the calculation of the distribution to the health insurance funds. Unofficial table of contents

§ 3 Distribution rate

(1) The Federal Insurance Office shall determine the distribution rate for the amounts paid by the Federal Government pursuant to section 221 (1) sentence 1 of the Fifth Book of the Social Code. The distribution rate corresponds to the ratio of the sum of the amounts referred to in sentence 1 to the sum of the expenditure referred to in § 2 para. 2 sentence 2. (2) For the payment dates referred to in § 221 (1) sentence 1 of the Fifth Book of Social Code, the Federal Insurance Office a provisional distribution quota with the following conditions:

1.

for the period 1 May, the sum of the expenditure referred to in § 2, shown in the quarterly accounts for the reporting period 1 January to 31 December of the previous year, shall be:

2.

for the date of 1 November, the total amount of repayment for the year and the sum of the expenditure referred to in § 2 shown in the quarterly financial statements for the reporting period 1 January to 30 June

(3) The Federal Insurance Office shall immediately communicate the distribution quota determined in accordance with paragraphs 1 and 2 to the top associations of the health insurance companies. The top associations shall ensure that the health insurance funds for which they are responsible are immediately informed of the distribution quota. The Federal Insurance Office (Bundesversicherungsamt) is aware of the distribution rate in the Federal Gazette Unofficial table of contents

§ 4 Distribution procedure

(1) The Federal Insurance Office shall determine the amount of the annual settlement amount for each health insurance fund by the sum of the expenses of the respective health insurance fund referred to in § 2 (2), second sentence, with the distribution rate determined in accordance with section 3 (1) (2) For the purpose of determining the provisional amounts, paragraph 1 shall apply with the proviso that, instead of the sum referred to in Article 2 (2), second sentence, for the date of 1 May, the sum referred to in § 3 para. 2 no. 1 and for the date of 1 November, the amount referred to in § 3 para. 2 Point 2 shall be the sum of expenditure. The provisional amount of compensation determined on 1 May shall be deemed to be a surcharge on the provisional amount of compensation determined as of 1 November, which shall be deemed to be the result of the annual amount to be deducted pursuant to paragraph 1. (3) The Federal Insurance Office shall forward the provisional amounts to the central body without delay and shall inform the central body of the amounts to be paid to the individual health insurance funds. The amount of the annual repayment shall be taken into account, taking into account the amount of the provisional amounts paid, with the compensation claims and obligations of the sickness funds in the compensation to be carried out for the period of the whole of the previous year in accordance with § 17 The first sentence of the first sentence of the risk structure compensation regulation, in the event that this compensation is not carried out in the monthly compensation (§ 17 of the Risk Structure Compensation Regulation) for the month of April of the following year. (4) The further information on the forwarding the amounts to be paid to the individual health insurance funds shall be determined by the central position in agreement with the Federal Insurance Office. (5) The health insurance company has the amounts of the repayments separately in their respective business and billing results. (6) The Federal Insurance Office may, in agreement with the Top associations of health insurance companies simplify the distribution process. Unofficial table of contents

§ 5 Corrective procedure

If factual or computational errors are found in the calculation basis after the conclusion of the determination of the values in accordance with § 4 (1), the Federal Insurance Office shall take these into account in the next distribution procedure. The Federal Insurance Office (Bundesversicherungsamt), in agreement with the top associations of the health insurance companies, regulates the situation. Unofficial table of contents

Annex (to § 2 para. 1)

(Fundstelle: BGBl. I 2004, 645)

No.	Name of the account group, the account type and account
1	Contengroup 47:	Sickness benefit and contributions from sickness benefit
1a	Account 4710:	Sickness benefit in the care of a sick child -Members up to 12 years of age-
1b	Account 4715:	Sickness benefit in the care of a sick child -Members from 12 years of age-
C	Account 4720:	Sickness benefit in case of preventive care and medical care for mothers
1d	Account 4730:	Sickness benefit for inpatient rehabilitation services and medical rehabilitation for mothers
1e	Account 4740:	Sickness benefit for sterilisation and abortion
2	Contente 53:	Contraception, sterilisation and abortion
2a	Contenart 530:	Medical advice and treatment
2b.	Contenart 531:	Hospital treatment
C	Contente 532:	Medicine and bandage
2d	Contenart 537:	Investment surcharge pursuant to Art. 14 (3) GSG
2e	Contenart 539:	Other expenses
3	Contengroup 55:	Benefits in pregnancy and motherhood
3a	Contenart 550:	Medical care
3b	Contente 551:	Hebammenhilfe
3c	Contente 552:	Fixed decommitment
3d	Contente 553:	Home care due to pregnancy or chili
3e	Contenart 554:	Budgetary support due to pregnancy or chili
3f	Contenart 555:	Other benefits in kind
3g	Contente 556:	Maternity allowance according to § 200 RVO, § 29 KVLG/Contributions to the Federal Employment Agency
3h	Contenart 559:	Investment surcharge pursuant to Art. 14 (3) GSG
4	Contente 56:	Operational, budgetary and home health care
4a	Contenart 564:	Employee budgetary assistance-Regal performance-
4b	Contente 565:	Reimbursements for self-procured household help -RegellPerformance-