Law on the economic security of hospitals and the regulation of hospital care rates (Hospital Finance Act-KHG)

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KHG

Date of completion: 29.06.1972

Full quote:

" Hospital Finance Act as amended by the Notice of 10 April 1991 (BGBl. 886), as last amended by Article 16a of the Law of 21 July 2014 (BGBl). I p. 1133).

Status:	New by Bek. v. 10.4.1991 I 886;
	Last amended by Art. 16a G v. 21.7.2014 I 1133

For more details, please refer to the menu under Notes

Footnote

(+ + + Text proof applicable: 1.1.1986 + + +)
(+ + + Changes due to EinigVtr cf. 4. Away. § § 21-26 u. 5. Sect. + + +)
Heading: IdF d. Art. 1 No. 1 G v. 22.12.1981 I 1568 mWv 1.7.1982

Section 1
General provisions

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§ 1 Principle

(1) The purpose of this law is to ensure the economic security of hospitals in order to ensure that the population can be supplied on demand with efficient, self-responsible hospitals and that they are socially responsible. (2) In the implementation of the law, the diversity of the hospital carriers must be observed. In accordance with the law of the country, in particular, the economic protection of non-profit-making and private hospitals must be guaranteed. The granting of funds under this Act must not be subject to conditions which extend the autonomy and independence of hospitals to the requirements of hospital planning and management of the economy. shall be affected. Unofficial table of contents

§ 2 Definitions

Within the meaning of this Act,

1.

Hospitalsund establishments in which medical and nursing assistance is intended to identify, cure or alleviate diseases, suffering or bodily harm, or to provide birth assistance, and in which the persons to be supplied shall be provided with: can be accommodated and pledged,

1a.

Hospitals that are necessarily linked to the hospitals for training in hospitals for the professions

a)

Ergotherapist, Ergotherapist,

b)

Diätassistent, Diätassistentin,

c)

Hebamme, Entbindungspfleger,

d)

Physiotherapist, physiotherapist, physiotherapist, physiotherapist

e)

Health and Nursing nurse, health and nurse, f) Health care and paediatric nurse, health care and paediatric nurse,

g)

Nurse, nurse,

h)

medical-technical laboratory assistant, medical-technical laboratory assistant,

i)

medical-technical radiology assistant, medical-technical radiology assistant,

j)

Logopäde, Logopädin,

k)

Orthoptist, Orthoptist,

l)

medical-technical assistant for functional diagnostics, medical-technical assistant for functional diagnostics,

if the hospitals are carriers or co-sponsors of the training facility,

2.

Investment costs

a)

the costs of the construction (new construction, conversion, extension) of hospitals and the purchase of the economic goods belonging to the hospital, with the exception of goods intended for consumption (consumer goods),

b)

the cost of recovering the assets of the fixed assets belonging to the hospital (fixed assets);

the costs of investment do not include the cost of land, land acquisition, land closure and financing, as well as the costs of the telematic infrastructure in accordance with Section 291a (7) sentence 4 of the Fifth Book of Social Code,

3.

costs equivalent to investment costs for the purposes of this law

a)

the charges for the use of the assets referred to in point 2,

b)

the interest, the repayment and the administrative costs of loans, to the extent that they have been spent on the financing of the costs referred to in paragraph 2 and in point (a),

c)

the costs referred to in paragraph 2 and in points (a) and (b), in so far as they concern Community institutions of hospitals,

d)

Capital costs (depreciation and interest) for the assets referred to in point 2,

e)

the costs of the species referred to in point 2 and in points (a) to (d), in so far as they concern training centres necessarily connected with the hospitals and are not to be applied in accordance with other provisions;

4.

care levies the fees of the users or their cost carriers for stationary and part-hospital services of the hospital,

5.

The costs of the hospital, the costs of which are not excluded according to this law in the care set.

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§ 3 Scope

This law shall not apply to:

1.

(dropped)

2.

Hospitals in the enforcement or enforcement of measures,

3.

Police hospitals,

4.

Hospitals of general pension insurance institutions and, in so far as the statutory accident insurance bears the costs, hospitals of the institutions of the statutory accident insurance and their associations; this does not apply to specialist clinics Treatment of diseases of the respiratory organs as far as they serve the general care of the population with hospitals.

§ 28 shall remain unaffected. Unofficial table of contents

§ 4

The hospitals are thereby economically assured that:

1.

their investment costs are taken over by public funding and they

2.

Performance-related proceeds from the care sets, which may also include investment costs in accordance with the provisions of this law, as well as allowances for pre-and post-hospital treatment and for out-patient operating procedures.

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§ 5 Non-eligible institutions

(1) According to this law, no support is provided for:

1.

Hospitals, which are funded according to the state regulations for higher education; this applies to hospitals, the tasks of training doctors according to the Approbationsordnung für Ärzte of 27 June 2002 (BGBl. 2405), as last amended by Article 71 of the Law of 21 June 2005 (BGBl I). 1818), only with regard to the measures eligible under national law on higher education institutions,

2.

Hospitals which do not fulfil the conditions laid down in Article 67 of the Tax Code,

3.

facilities in hospitals,

a)

in so far as the conditions laid down in § 2 (1) do not exist, in particular facilities for persons who are considered to be in terms of care,

b)

for persons who are subject to the law of the law on the basis of criminal law provisions,

4.

Tuberculosis hospitals with the exception of specialist clinics for the treatment of diseases of the respiratory organs, insofar as they serve the general care of the population with hospitals after the hospital planning of the country,

5.

Hospitals whose institutions are not already referred to in Article 3, first sentence, No. 4, as far as they do not serve the general care of the population with hospitals, after the hospital planning of the country,

6.

Supply hospitals,

7.

Preventive or rehabilitative bodies according to § 107 (2) of the Fifth Book of the Social Code, insofar as the application of this law is not already excluded in accordance with § 3 sentence 1 no. 4,

8.

the facilities connected to the hospitals which are not directly responsible for inpatient care, in particular the accommodation and recreation rooms which are not essential for the operation of the hospital;

9.

Entities which are held or maintained pursuant to federal law; this does not apply to facilities, insofar as they are based on § 30 of the Infection Protection Act of 20 July 2000 (BGBl. 1045),

10.

institutions, insofar as they are due to the specific needs of civil protection,

11.

Hospitals of the statutory accident insurance institutions and their associations.

(2) It may be determined by national law that the promotion under this Act shall also be granted to the hospitals and institutions referred to in paragraph 1 (2) to (8). Unofficial table of contents

§ 6 Hospital planning and investment programmes

(1) In order to achieve the objectives set out in paragraph 1, the Länder shall set up hospital plans and investment programmes; follow-up costs, in particular the effects on care rates, shall be taken into account. (2) A hospital shall also be responsible for the supply of of the population of other countries is important, so the hospital planning is to be agreed between the participating countries. (3) The countries agree their hospital planning on the nursing performance requirements according to the Eleventh Book Social code, in particular with the aim of hospitals of nursing care cases To relieve the burden on parts of a hospital, which are to be discharged, seamlessly into economically independent outpatient or inpatient care facilities. (4) The further details are determined by the state law. Unofficial table of contents

§ 6a

(dropped) Unofficial table of contents

Section 7 Participation of the parties

(1) In the implementation of this law, the state authorities shall cooperate closely with those involved in hospital care in the country; the hospital concerned shall be consulted. In the case of hospital planning and the establishment of the investment programmes, consensual arrangements with the parties directly involved are to be sought. (2) The further details shall be determined by national law.

Section 2
Principles of investment promotion

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Section 8 Conditions of support

(1) The hospitals shall be entitled to receive support in accordance with this law, as long as they are included in the hospital plan of a country and in the case of investments pursuant to § 9 para. 1 no. 1 in the investment programme. The competent State authority and the hospital carrier may, for an investment project in accordance with § 9 (1), agree to only partial support with residual financing by the hospital carrier; agreement with the regional associations of the health insurance companies, the replacement box and the contracting party pursuant to section 18 (2) shall be sought. The admission or non-inclusion in the hospital plan shall be determined by communication. There is no administrative right to the decision. (2) There is no claim to be included in the hospital plan and in the investment programme. In the event of a necessary choice between several hospitals, the competent national authority shall, taking into account the public interests and the diversity of the hospital ' s institutions, decide on the objectives of the hospital in accordance with the best possible conditions of use. The provisions of this section shall apply in accordance with the training sites referred to in § 2 (1a). Unofficial table of contents

Section 9 Funding facts

(1) Countries shall, at the request of the hospital carrier, promote investment costs incurred in particular:

1.

for the establishment of hospitals, including the initial equipment, with the equipment necessary for hospital operations,

2.

for the re-procurement of fixed assets with an average useful life of more than three years.

(2) Countries shall also grant support at the request of the hospital carrier.

1.

for the use of fixed assets, as far as they are carried out with the consent of the competent State authority,

2.

for start-up costs, for conversion costs in the case of intra-company changes and for the acquisition, development, rental and lease of land, to the extent that, without the support, the admission or continuation of the hospital operation would be at risk,

3.

to the detriment of loans which have been included in the hospital plan for eligible investment costs prior to the hospital's admission;

4.

as compensation for the use of fixed assets, in so far as they were procured with the own resources of the hospital carrier and were present at the beginning of the promotion under this law,

5.

to facilitate the closure of hospitals,

6.

for the conversion of hospitals or hospital departments to other tasks, in particular to their conversion to nursing care facilities or independent, organisational and economic care departments separate from the hospital.

(3) Countries shall promote the recovery of short-term fixed assets and small structural measures by means of fixed annual lump sums with which the hospital can operate freely within the framework of the earmarking of the funds; § 10 remains unaffected. The flat-rate amounts should not be calculated exclusively according to the number of beds included in the hospital plan. They shall be adjusted at regular intervals to the development of costs. (3a) The total amount of the current and the following two annual packages, as approved by the country, shall be subject to the requirements of the hospital, irrespective of any reduction in the amount of the annual costs. the actual number of beds, in so far as the reduction is based on an agreement of the hospital carrier with the national associations of the sickness funds and the cash registers according to § 109 (1) sentence 4 or 5 of the fifth book Social Code and one fifth of the Planbeds do not exceed. § 6 (3) remains unaffected. (4) Resurrection within the meaning of this Act is also the addition of fixed assets, insofar as these are not essential to the usual adjustment of the existing fixed assets to the medical and technical development (5) In accordance with the provisions of this Act and the national law, the funds shall be so dimensioned that they cover the eligible investment costs, which are necessary in accordance with the principles of business management. Unofficial table of contents

Section 10 Development mandate for the reform of investment financing

(1) For hospitals that are included in the hospital plan of a country and receive charges in accordance with § 17b, investment promotion through performance-oriented investment packages shall be granted from 1 January 2012, for psychiatric and Psychosomatic institutions according to § 17d paragraph 1 sentence 1, which are included in the hospital plan of a country, will be made possible from 1 January 2014. To this end, principles and criteria for the determination of an investment case value at the country level will be developed by 31 December 2009. The investment financing of the university hospitals must be taken into account. The details of the further procedure are laid down by the Federal Government and the Länder. The right of countries to decide independently between the promotion of performance-oriented investment packages and the individual promotion of investments, including the flat-rate promotion of short-term fixed capital goods, remains unaffected. (2) The Contracting Parties at the federal level in accordance with Article 17b (2) sentence 1 shall, until 31 December 2009, agree on the basic structures for investment assessment relations and the procedure for their investigation, in particular for the calculation in an appropriate selection of Hospitals. In the investment assessment relations, the investment needs for the full and part-time services are to be accounted for in a flat-rate way; the degree of differentiation should be practicable. The Contracting Parties under the first sentence mandate their DRG Institute, until 31 December 2010 for the DRG remuneration system and until 31 December 2012 for institutions pursuant to § 17d (1) Sentence 1 of the Federal Investment Assessment (DRG) to apply to the Federal Republic of Germany for investment assessment relations. to develop and calculate. Section 17b (5) shall apply mutas to the financing of the tasks. The necessary financial resources shall be charged with the DRG system surcharge, which shall be increased accordingly. Section 17b (7) and (7a) shall apply mutas to the powers of the Federal Ministry of Health. For the publication of the results, § 17b (2) sentence 8 shall apply accordingly. Unofficial table of contents

§ 11 Country law provisions on the promotion

The details of the funding will be determined by national law. It can also be regulated that hospitals have to take on specific tasks in the training of doctors and other health professionals; in so far as this results in additional costs of accommodation and personnel, their Financing shall be guaranteed. Unofficial table of contents

§ § 12 to 15 (omitted)

-

Section 3
Rules on hospital care rates

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Section 16 Regulation on the regulation of the care system

The Federal Government is empowered to adopt provisions by means of a legal regulation with the consent of the Federal Council.

1.

the hospital care records,

2.

the delimitation of the general stationary and partial hospital services of the hospital from the services of pre-and post-hospital treatment (§ 115a of the Fifth Book of Social Code), the outpatient services including the benefits according to § 115b of the Fifth Book of the Social Code, the Electoral Services and the Occupancy Services,

3.

the rates of use (reimbursement and benefit-sharing and similar charges) of the doctors entitled to the hospital for the purpose of calculating their benefits separately, to the extent that such charges are to be taken into account in the maintenance of a level of care,

4.

the consideration of the proceeds from the remuneration for pre-and post-inpatient treatment (§ 115a of the Fifth Book of the Social Code), for outpatient services, including benefits under § 115b of the Fifth Book of the Social Code and for Election services of the hospital as well as the consideration of other charges in the assessment of the care rates,

5.

the further delimitation of the costs, referred to in Article 17 (4), of the costs of maintenance costs,

6.

the procedure laid down in § 18,

7.

the accounting and accounting obligations of the hospitals;

8.

A right of appeal by the Association of Private Health Insurance against unduly high charges for non-medical election services.

The authorization may be transferred to the national governments by means of a legal regulation; it can be determined that the national governments can transfer the authorization further to the supreme state authorities by means of a legal regulation. Unofficial table of contents

Section 17 Principles of the Nursing Home Regulation

(1) The nursing rates and the remuneration for pre-and post-hospital treatment according to § 115a of the Fifth Book of Social Code shall be calculated in a uniform manner for all users of the hospital. The care rates shall be measured in advance. The principle of premium rate stability (§ 71 (1) of the Fifth Book of the Social Code) must be observed in accordance with the provisions of this Act and the Hospital Pay Law. Surpluses remain to the hospital; losses are to be borne by the hospital. A facility located in close proximity to and organizationally connected to a hospital may not require higher fees for general hospital services corresponding to the hospital's supply order than it does according to the regulations of this law, the Hospital Pay Law and the Federal Nursing Regulation would be required. § 17 (1), (2) and (4) of the Hospital Remuneration Act applies to non-medical election services. (1a) For the full or part-time hospital services paid with flat-rate nursing kits, the DRG hospitals shall be subject to the following conditions: Requirements of § 17b and in the field of psychiatric and psychosomatic institutions the requirements of § 17d. (2) Insofar as daily care rates are agreed, these must be medically performanced and a hospital at economic management allows the supply contract to be (2a) (omitted) (3) Do not take into account in the care set

1.

costs of services that are not intended for inpatient or part-inpatient hospital care,

2.

Costs for scientific research and teaching that go beyond the normal hospital operation.

3.

(dropped)

(4) In the case of hospitals fully supported under this law, and in the case of the hospitals referred to in Article 5 (1) (1), first half-sentence, no account shall be taken of the costs in the care set referred to in paragraph 3.

1.

investment costs, with the exception of the costs of the repurchase of economic goods with an average useful life of up to three years,

2.

the cost of land, land acquisition, land closure and its financing;

3.

the cost of delivery and conversion,

4.

the costs of the bodies referred to in Article 5 (1) (8) to (10);

5.

costs for which other public funding is granted;

in the case of the full promotion of parts of a hospital, this shall apply only in respect of the part being promoted. (4a) (4b) Maintenance costs shall be taken into account in the care set. This includes maintenance costs for fixed assets, if in structural units parts of buildings, technical installations and installations, or if external installations are completely or predominantly replaced. The costs referred to in the second sentence shall be financed on a flat-rate basis of an amount of 1.1 per cent of the remuneration agreed for the general hospital benefits. The maintenance capacity for the costs referred to in the second sentence shall not apply to all hospitals in a federal state if the country costs these costs for the hospitals included in the hospital plan by means of individual support or flat-rate funding (5) In the case of hospitals which are not, or are only partially publicly funded under this law, and in the case of pro-rata publicly funded measures with residual financing by the hospital carrier, may be provided by social service providers and others. public-sector payers do not require higher maintenance rates when they are to be paid by them for benefits comparable to those funded under this law. Hospitals, which are not supported under this law only because they do not apply for funding, may also require a hospital user to have no higher care rates than the one resulting from the first sentence. If, in the case of partial support, investments are not publicly funded and a comparable hospital does not exist, the investment costs may be included in the care set, to the extent that the national associations of the health insurance companies and the Replacement cash points of the investment have agreed. The Contracting Parties in accordance with Article 18 (2) agree on the maintenance rates applicable in accordance with sentences 1 and 2. Where hospital services are remunerated with a flat-rate care set in accordance with paragraph 1a, they shall be deemed to be the benefits of comparable hospitals within the meaning of the first sentence. Unofficial table of contents

§ 17a Financing of training costs

(1) The costs of the training centres referred to in § 2 (1a) and the training allowances and the additional costs incurred by the hospital as a result of the training, in particular the additional costs of the practice instructions as a result of the Health Care Law of 16 July 2003, shall be financed, in accordance with the following provisions, by means of surcharges, in so far as these costs are, in accordance with the provisions of this Act, at the cost of maintenance costs and are not to be applied in accordance with other provisions (training costs); the costs of the relevant costs; The country financed part of the training costs is to be deducted. By way of derogation from the first sentence, only the additional costs of the training allowances shall be financed in the case of an invoice in accordance with sentences 3 and 4. In determining the additional costs of the training allowance, persons who are trained in nursing or paediatric nursing are to be included in the ratio of 7 to 1 to the place of a person who is fully trained in these professions; from 1. The ratio of 9,5 to 1 shall apply in January 2005. Persons who are trained in health care assistance are to be included in the ratio of 6 to 1 to the place of a fully trained person in accordance with the second sentence. (2) With the aim of ensuring appropriate financing, close

1.

the Contracting Parties under Article 17b (2), first sentence, at the federal level, a framework agreement, in particular on the facts to be financed, the additional costs incurred as a result of the implementation of the law on the professions in nursing care and amending of other laws and of a calculation scheme for the negotiation of the training budget referred to in paragraph 3;

2.

the parties referred to in Article 18 (1), second sentence, at the national level of supplementary agreements, in particular in order to take account of the provisions of national law for the training and deduction of the part of the training costs financed by the country, the absence of an agreement as specified in paragraph 1, including those which may be agreed in that agreement.

The agreements referred to in the first sentence shall be taken into account in the agreement of the training budget referred to in paragraph 3. If an agreement cannot be reached in accordance with the first sentence, at the request of one of the Contracting Parties, the arbitral body shall decide, in accordance with Article 18a (6) and in the first sentence of sentence 1, no. 2, the arbitration body according to § 18a (1) (3) of the Arbitration Board. the Contracting Parties according to Article 18 (2) for a future period (period of agreement), a hospital-specific training budget with which the training costs are financed; § 11 para. 2 of the Hospital Pay Law applies accordingly. They determine the type and number of training places that are likely to be occupied. The budget is intended to cover the costs of training centres with economic size and management. The cost developments to be expected for the agreement period, including the additional costs incurred as a result of the implementation of the law on the professions in nursing and amending other laws, must be taken into account. From 2010 onwards, the indicative values referred to in paragraph 4b shall also be taken into account in the agreement of the training budget. As far as guidelines are not agreed or are not specified by means of a regulation, the contracting parties agree in accordance with section 18 (2) corresponding funding amounts within the framework of the training budget. Whereas it is necessary to approximate the individual amounts of the funding to the indicative values or, in the case of rate 6, to approximate the amounts of funding in the country; whereas individual variations in the amount of the funding from the hospital are subject to the Country financed part of the training costs. To the extent necessary, the Contracting Parties shall conclude structural contracts which provide financial support for the development, closure or pooling of training centres and which lead to economic training structures, with the agreement of: of the competent State authority. The training in the region must not be jeopardised. To the extent that a training centre is required in the region, for example because the distances and driving times to other training centres are not reasonable, higher amounts of funding can also be paid in the long term; for the examination of the Requirements must be applied in accordance with § 5 (2) of the Hospital Charges Act in accordance with § 17b (1) sentence 6 and 7 of the Hospital Law. At the end of the agreement period, the sum of the payments from the compensation fund referred to in the fifth sentence of paragraph 5 and the remaining deviations referred to in the fifth sentence of paragraph 6, or the sum of the surcharges referred to in the first sentence of paragraph 9, shall be taken from the agreed Training budget, the more or less the proceeds will be fully offset by the training budget of the next possible agreement period. If the amount of compensation is not yet fixed at the time of negotiation, partial amounts must be taken into account to compensate for the compensation. (4) The training budget for the year 2005 will be based on the basis of the Training costs for the year 2004. In addition, the changes to be expected for 2005, in particular the number and type of training places and training contracts, and cost developments, will be taken into account. The costs of training so far included in the hospital budget will be broken down from the hospital budget as of 1 January 2005 (Section 4 (2) (1) (g) of the Hospital Charges Act), the amount of which is to be paid in accordance with the first sentence for the year 2004. Reason to lay down. An estimate of the costs to be broken down in accordance with the first sentence must be taken into account in the budget agreement for the year 2006 as correction of the revenue budget for 2005 and with the corresponding compensation for 2005. (4a) The hospital carrier the other Contracting Parties shall, in good time before the negotiations, give evidence and justification in particular of the nature and number of training places expected to be occupied, the training costs, the amount of the training to be carried out in accordance with paragraph 4. Breakdown of the training budget from the hospital budget and for the To provide additional information in the context of the negotiations, as well as to provide additional information in the context of the negotiations. (4b) The target value for the approximation of the individual financial amounts referred to in the sixth sentence of paragraph 3 shall be determined by the The Contracting Parties according to Article 17b (2) Sentence 1 each year for the individual occupations according to § 2 No. 1a the average cost per training place in the training centres and the other training costs and agree for the following calendar year Appropriate benchmarks, taking into account the expected cost developments; Amounts can be determined in a differentiated way by region. In order to implement the requirements set out in the first sentence, the Contracting Parties shall develop, in particular by using the data in accordance with section 21 (2) (1) (c) of the Hospital Pay Act and data from a selection of hospitals and training centres, the participate in a separate calculation, step by step the procedure for collecting the data required and for calculating and agreeing on the indicative values. If an agreement is not reached in accordance with sentence 1, the Federal Ministry of Health may pretend the procedure or the indicative values by means of a legal regulation in accordance with Section 17b (7). In order to publish the results, section 17b, paragraph 2, sentence 8 shall apply. (5) With the aim of avoiding a disadvantage of developing hospitals in competition with non-forming hospitals, the second sentence of § 18 (1) sentence 2 at the national level

1.

for the first time in 2006, a compensation fund in the amount of amounts declared by hospitals in the country (sentences 3 and 4),

2.

the level of training allowance per full and part-time case financed by the compensation fund,

3.

the necessary procedural arrangements relating to the compensation fund and the surcharges to be charged, in particular the payment of outstanding payments by the hospitals at an interest rate of 8 of the hundred above the Basic interest rates in accordance with § 247 (1) of the Civil Code.

The compensation fund shall be established and administered by the Landeskrankenhausgesellschaft (Landeskrankenhausgesellschaft) and shall have to account for the use of the funds. In order to determine the amount of the compensation fund, the training hospitals shall report the amount of the training budget agreed in accordance with paragraph 3 or 4 for the previous year as well as the type and number of trainee positions and the amount of the additional training budget. Additional expenses for training allowances; in the case of a substantial change in the number of traineeships or the number of trainees, which can be foreseen for the period of agreement, a correspondingly different amount can be reported . As far as reports are missing from hospitals, corresponding amounts are to be estimated. The Landeskrankenhausgesellschaft (Landeskrankenhausgesellschaft) shall pay from the compensation fund the amount of monthly installers notified in accordance with the sentence 3 or estimated in accordance with the sentence 4 in each case to the providing hospital. (6) The training allowance referred to in the first sentence of paragraph 5 shall be provided by All non-training hospitals shall be charged to patients or to patients or their social security institutions. In the case of training hospitals, the surcharge to be charged shall be changed in so far as the amount notified to the compensation fund and paid by that fund deviates from the level of the training budget agreed in accordance with paragraph 3 or 4. The change in the training allowance resulting from this deviation, and thus the corresponding amount of the individual training allowance to be invoied in the invoice, shall be agreed by the contracting parties in accordance with section 18 (2). All hospitals shall have to pay the training allowances they have invoied to the compensation fund in the amount fixed in accordance with the first sentence of the first paragraph of paragraph 5 and have to comply with the procedural rules referred to in the first sentence of paragraph 5 of this Article. A discrepancy between the individual surcharge in accordance with sentence 3 and the surcharge to be paid shall remain for the training hospital. (7) The training budget shall be used for the purpose of the training. In the case of the budget negotiations referred to in paragraph 3, the hospital carrier shall have a statement confirmed by the annual auditor for the past year on the revenue from the compensation fund and the allowances invoied, on: (8) Coming in accordance with paragraphs 3 and 4, or an agreement under paragraph 5, to the amount of the compensation fund, which shall: Training allowances and the procedural arrangements are not to be determined, decided upon request by one of the following: Contracting party to the arbitration body in accordance with Article 18a (1) within six weeks. The approval of the agreement or the setting of the arbitration body shall be requested by one of the contracting parties to the competent State authority. The authorisation has been given to the administrative right. A preliminary procedure does not take place; the action does not have a suspensive effect. (9) If the formation of a compensation fund under paragraph 5 does not apply, the training budgets referred to in paragraph 3 or 4 shall be awarded by a hospital-specific supplement. financed in full and in part, which is charged to the patients or to patients or their social welfare institutions. If, at the beginning of the calendar year, this supplement has not yet been agreed upon individually, the surcharge agreed for the previous year, in accordance with the first sentence or the surcharge applicable for the previous year, shall continue to be billed in accordance with the second and third sentences of paragraph 6; § 15 (1) and (2) sentence 1 of the Hospital Charges Act must be applied accordingly. In order to avoid distortions of competition as a result of these training surcharges, in this case the national governments are authorised to compensate for financial compensation between training and non-training hospitals by means of a legal regulation and To provide for the accounting of the corresponding surcharges for the years for which a compensation fund has not been able to pay. The national governments in countries where there is a corresponding legal regulation in accordance with paragraph 10 in the version valid until 31 December 2004 already for the year 2004 are authorized to enact it for the year 2005. (10) Costs The placement of trainees is not capable of being maintained, unless the parties agree otherwise in accordance with Section 18 (2). If an agreement is reached, the surcharge in the case of training hospitals shall be increased in accordance with the third sentence of paragraph 6. The amount of the increase remains to the hospital. (11) For the training hospitals under the Federal Government Ordinance, § 21 of the Hospital Pay Law applies, with the proviso that the data referred to in paragraph 2 (1) (a) and (c) shall apply. shall be transmitted. Unofficial table of contents

Section 17b Introduction of a lump-sum payment system for DRG hospitals

(1) For the remuneration of general hospital services, provision should be made for a continuous, performance-oriented and lump-sum compensation system; this does not apply to the benefits of the psychiatry in accordance with § 1 (2) of the Psychiatric Staff Regulation. , and the facilities for psychosomatic medicine and psychotherapy, unless otherwise specified in the Regulation pursuant to § 16, sentence 1, no. 1. The remuneration system has to map complexities and comorbidities; its degree of differentiation should be practicable. With the charges in accordance with the first sentence, the general, fully stationary and partially inpatient hospital services for a treatment case are remunerated. In so far as general hospital services cannot be included in the fees provided for in the first sentence, because the financing status is not available in all hospitals, a training allowance in accordance with Article 17a (6) and the Federal Republic of Germany shall be subject to the same conditions. To agree on arrangements for admission or setbacks, in particular for emergency care, the special tasks of centres and focal points according to § 2 para. 2 sentence 2 No. 4 of the hospital pay law and for the admission of accompanying persons according to § 2 2, second sentence, No. 3 of the Hospital Charges Act and Section 2 (2), second sentence, No. 3 of the Hospital Charges Act The Federal Council Regulation; for the calculation and arrangement of surcharges for centres and priorities which can be differentiated by region, the special services must be designated and evaluated and the Contracting Parties shall be informed in advance. , For the participation of hospitals in quality assurance measures on the basis of § 137 of the Fifth Book of the Social Code and the participation of entire hospitals or essential parts of the institutions in cross-compliance Error reporting systems, provided that these correspond to the provisions of the Joint Federal Committee pursuant to Section 137 (1d) sentence 3 of the Fifth Book of Social Code, are to be agreed upon; these may also be included in the case flat rates. In order to ensure that the provision of services necessary for the provision of care to the general public is not financially viable due to the low supply requirement with the charges under the first sentence, uniform recommendations shall be made for the To agree on the conditions under which the facts of the event are to be held and to what extent additional payments should be made. The State Governments shall be empowered to adopt, by means of a regulation, supplementary or deviating provisions on the conditions laid down in the sixth sentence, in particular in order to ensure the maintenance of the power units necessary for the supply; whereas the interests of other hospitals must be taken into account; the national governments may transfer this authorisation to the supreme state authorities by means of a decree-law; In so far as the country does not impose any requirements, the recommendations set out in sentence 6 shall be applied. In accordance with Section 18 (2), the Contracting Parties shall examine whether the conditions for a surcharge have been met on a case-by-case basis and agree on the amount of the surcharges to be deducted. The case groups and their assessment ratios must be laid down in a uniform manner. The valuation ratios shall be defined as relative weights to a reference power; they may be lowered in a targeted manner for services in which, to an increased extent, economically justified case-payment increases have occurred or are to be expected. Depending on the number of cases in these services, the number of cases is staggered. To the extent that this is necessary in order to supplement the case flat rate in limited exceptional cases, the Contracting Parties may agree, in accordance with the first sentence of paragraph 2, additional charges for benefits, performance complexes or medicinal products, in particular for: Treatment of haemorrhage with blood coagulation factors or for dialysis if the treatment of renal failure is not the main performance. They also agree on the level of the charges, which can be differentiated according to regions. In accordance with the provisions of the Hospital Remuneration Act, charges for benefits which are not covered by the remuneration catalogues may be agreed by the contracting parties in accordance with Section 18 (2). Special facilities, the services of which are not yet properly remunerated, especially for medical reasons, because of an accumulation of ill patients or for reasons of the supply structure with the pay catalogues, may be time-limited. shall be exempted from the remuneration system for a limited period. If extremely high costs are incurred in patients with extraordinary examination and treatment processes, which are not properly financed with the flat-rate compensation system (cost outliers), corresponding cases are to be found. To examine the development of appropriate forms of remuneration in greater depth. Until 30 June 2009, it is necessary to consider whether the additional costs associated with continuing medical education and training are necessary for the provision of benefits in respect of the provision of benefits or the surcharges for certain services or performance areas; (2) The top association of the health insurance companies and the association of private health insurance together agree on a common agreement between the Federal Government and the Association of Health Insurance Funds. in accordance with the requirements of paragraphs 1 and 3 with the German Hospital a remuneration system based on an internationally already established remuneration system based on the Diagnosis Related Groups (DRG), its annual further development and adaptation, in particular to medical developments, Cost developments, dwell time reductions and performance shifts to and from other supply areas, and the settlement provisions, insofar as these are not specified in the Hospital Pay Law. They are guided by the quality of the service provision of economic supply structures and procedures. The examination results according to § 137c of the Fifth Book of the Social Code are to be observed. The Bundesärztekammer shall be given the opportunity to participate in the meetings of the Contracting Parties in accordance with the first sentence of paragraph 2 in so far as medical questions relating to the charges and the underlying performance are concerned; this shall apply: as appropriate for a representative of the professional organizations of the nursing profession. The specialist companies concerned and, insofar as their concerns are concerned, the leading organisations of the pharmaceutical industry and the medical device industry are given the opportunity to comment. For the joint decision-making of the top association of the health insurance companies and the association of private health insurance, the top association of the health insurance companies has two votes and the association of private health insurance a vote. The Federal Ministry of Health may take part in the meetings of the Contracting Parties and receive their technical documentation. The Contracting Parties shall publish in an appropriate manner the results of the cost surveys and calculations; the data of individual hospitals underlying the calculation shall be confidential. (3) The Contracting Parties, as referred to in the first sentence of paragraph 2, shall: agree, by 30 June 2000, the basic structures of the remuneration system and the procedure for determining the assessment ratios at the federal level (evaluation procedure), in particular the case groups to be used, and the broad outlines of their Procedure for ongoing maintenance of the system at the federal level. By 31 December 2001, the Contracting Parties shall agree on valuation ratios and the evaluation of the supply and surcharges referred to in the fourth sentence of paragraph 1. The valuation ratios can be calculated on the basis of the case costs of an appropriate selection of hospitals, taken from internationally already established valuation relations, or further developed on the basis of these. In accordance with paragraphs 4 and 6, the new remuneration system shall replace the previously settled charges in accordance with Section 17 (2a). For the first time in 2005, a base case value is agreed upon in accordance with § 18 (3) sentence 3. (4) The remuneration system will be implemented in a budget-neutral way for the year 2003. The Contracting Parties in accordance with paragraph 2 shall, in respect of the application in 2003, agree on a provisional case-flat-rate catalogue on the basis of the Australian catalogue selected by them. At the request of the hospital, the compensation system will be introduced with this provisional flat-rate catalogue on 1 January 2003. (5) To finance the tasks assigned to them under paragraphs 1 and 3, as well as § 10 para. 2 and § 17d the Contracting Parties pursuant to paragraph 2, first sentence

1.

A surcharge for each hospital failure to be paid, which will finance the development, introduction and ongoing maintenance of the remuneration system to be introduced on 1 January 2003 (DRG system surcharge). The contract is used to finance, in particular, the development of the DRG classification and the coding rules, the assessment of the valuation ratios, the evaluation of the surcharges and the reductions, the determination of the guide values in accordance with § 17a (4b), of lump-sum payments for the participation of hospitals or training centres in the calculation and award of contracts, even as far as the contracting parties have the tasks carried out by their own DRG-Institute or the Federal Ministry of Health, referred to in paragraph 7, instead of the Contracting Parties,

2.

measures to ensure that the financial amounts collected by the system surcharge are used exclusively for the purpose of implementing the tasks referred to in this paragraph;

3.

the further transfer of the corresponding revenue of the hospitals to the Contracting Parties,

4.

if an agreement is not reached, the arbitration body shall decide, at the request of one of the parties, in accordance with Article 18a (6)

The Contracting Parties agree on lump-sum payments for the participation of hospitals or training centres in the calculation, which shall include a substantial part of the additional costs incurred; they shall be fixed as a fixed basic amount. Hospital and supplement to be paid as a function of the number and quality of the transferred data sets. The participation of the individual hospital shall be decided by the contracting parties in accordance with the first sentence of paragraph 2 on the basis of the quality of the accounting system or the need for the data to be collected and the right to participate shall not be required. The provisions of the second sentence of paragraph 2 shall apply accordingly. The use of financial resources to cover the general budgets of the Contracting Parties or to finance traditional association tasks in connection with the remuneration system shall be inadmissible. The costs incurred by the Federal Ministry of Health for the preparation of a legal regulation in accordance with paragraph 7 for the development, introduction and ongoing maintenance of the remuneration system shall be without delay from the self-management partners from the The Federal Ministry is responsible for the decisions to be taken in accordance with the first sentence. The DRG system surcharge shall be charged to the self-paying patient or the respective cost carrier by the hospitals for each full and partial hospital failure, in addition to the daily care rates or a case flat rate; he/she shall be responsible for the shall be sent to the Contracting Parties or to a body designated by them. The surcharge is not subject to the limitation of the care rates by § 10 (4) of the Hospital Pay Act or § 10 (3) of the Federal Order of Care (Bundespflegesatzverordnung); it does not go into the total amount and the proceeds of redemption according to the Hospital Law (6) The remuneration system will be introduced on 1 January 2004 for all hospitals with a first version of a German case-flat-rate catalogue. The remuneration system will be implemented in a budget-neutral way for the year 2004. From 2005 onwards, the hospital's revenue budget will be gradually adjusted to the base case value under the provisions of the fifth sentence of paragraph 3. (7) The Federal Ministry of Health shall be authorized to: Legal regulation without the consent of the Bundesrat

1.

to adopt rules on the remuneration system to the extent that an agreement by the Contracting Parties pursuant to paragraph 2 has not been concluded in whole or in part, and in so far as one of the Parties has declared the failure of the negotiations; the The Contracting Parties shall present their views and the views of other persons concerned on the disputed points and submit proposals for solutions,

2.

by way of derogation from point 1, including without declaration of failure by a Contracting Party after the expiry of pre-determined time-limits for work steps, to the extent that this is necessary to introduce the remuneration system and its annual to ensure further development in due time,

3.

determine the benefits or special facilities referred to in paragraphs 14 and 15 of paragraph 1 which cannot yet be properly remunerated with the DRG remuneration system, which may specify the type of remuneration to be applied and the rules applicable to those areas: are adopted in order to determine the level of payment and the negotiating documents to be submitted,

4.

, under the conditions laid down in points 1 and 2, indicative values in accordance with Article 17a (4b) to finance the costs of training.

Agreements of the Contracting Parties pursuant to paragraph 2 may be dismissed as far as this is necessary for the arrangements referred to in the first sentence. The DRG-Institute of the Self-Management Partners is obliged to work immediately and immediately after the instructions of the Federal Ministry for the preparation of regulations under the first sentence. The Federal Ministry may be advised by independent experts. In the event of an agreement by the Contracting Parties pursuant to paragraph 2, the DRG-Institut shall also be obliged, upon request of the Federal Ministry of the Interior, to provide information, in particular on the level of development of the remuneration system, the charges and their (7a) The Federal Ministry of Health is empowered to comply with the requirements of the Federal Council with the consent of the Federal Council for the application of the documents to be submitted by the hospitals in the hospital. for the budget negotiations. (8) The Contracting Parties in accordance with paragraph 2, accompanying research shall be carried out on the effects of the new system of remuneration, in particular on the change in supply structures and on the quality of supply, including the impact on the other To examine supply areas and the nature and scope of performance relocations. They write out research contracts and commission the DRG Institute, in particular, to evaluate the data in accordance with § 21 of the Hospital Law on Hospital Law. The costs of this accompanying research shall be financed with the DRG system surcharge referred to in paragraph 5. The accompanying research is to be agreed with the Federal Ministry of Health. Initial results shall be published in 2005. (9) In 2012, the Contracting Parties shall award a joint research contract with the aim of examining, in particular, the development of performance and existing influencing factors, and develop joint solutions and assess their impact on the quality of supply and the financial impact. In particular, alternatives to the consideration of additional services at the national base case value should be considered. Possibilities for the strengthening of quality-oriented components in the power control are to be developed. In addition, they commission the DRG Institute, in particular the data according to § 21 of the Hospital Pay Law, with the aim stated in sentence 1. The costs of the tasks referred to in sentences 1 to 3 shall be financed with the DRG system surcharge referred to in paragraph 5. The results shall be published by 30 June 2013. (10) On the basis of the in-depth examination of cost outliers to be carried out in accordance with the first sentence of paragraph 1, the Contracting Parties shall, in accordance with the provisions of paragraph 2, mandate the DRG Institute to be held until 31 December 2013. with the establishment of criteria for the identification of cost outliers and a systematic examination on this basis of the extent to which hospitals are burdened with cost outbursts. The DRG Institute is developing a set of rules for case audits of hospitals participating in the DRG calculation. In order to assess the costs outliers in a proper way, the DRG-Institut has to collect detailed case-related costs and performance data from the hospitals participating in the calculation above the calculation data set. The DRG-Institute publishes the audit results annually as part of an extreme cost report, for the first time until 31 December 2014. The report also shows the reasons for cost-outliers and the differences in the levels of stress between hospitals. On the basis of the report, appropriate arrangements shall be developed for the appropriate remuneration of cost outliers under the remuneration system and shall be agreed by the Contracting Parties in accordance with paragraph 2. Unofficial table of contents

§ 17c Examination of the settlement of maintenance records, conciliation committee

(1) The hospital carrier shall, by means of appropriate measures, ensure that:

1.

no patients are admitted to the hospital who are not in need of hospital care, and no patients remain in the hospital who are no longer in the hospital for the billing of day-care-related care sets require hospital treatment (misallocation),

2.

an early transfer or dismissal for economic reasons is not required,

3.

the settlement of the hospital cases reimbursed according to § 17b shall be effected properly.

The health insurance companies can check compliance with the obligations laid down in the first sentence by means of the medical service (§ 275 paragraph 1 of the Fifth Book of Social Code). (2) The top association of the health insurance companies and the Germans Hospital society rules the details of the examination procedure in accordance with § 275 paragraph 1c of the Fifth Book of Social Code; in the agreement deviating regulations are possible for the second sentence of § 275 (1c) sentence 2 of the Fifth Book of Social Code. In particular, they have regulations on the date on which the transfer of payment-based documents to the health insurance funds, the procedure between health insurance companies and hospitals in case of doubt as to the legality of the settlement in advance an assignment of the medical service of the health insurance, about the date of the appointment of the medical service of the health insurance, about the duration of the examination, about the place of examination and about the settlement of the repayment of the medical insurance § § 275 to 283 of the Fifth Book of Social Code remain in the rest of the unaffected. If an agreement cannot be reached by 31 March 2014 in whole or in part, the arbitral body shall, at the request of one of the Contracting Parties, make the outstanding decisions in accordance with Article 18a (6). The agreement or the setting by the arbitration body is directly binding for the health insurance companies, the medical service of the health insurance and the approved hospitals. (3) The top association of the health insurance companies and the German hospital companies form a conciliation committee at the federal level; the DRG Institute and the German Institute for Medical Documentation and Information are members without voting rights. The task of the conciliation committee is the binding clarification of coding and billing issues of fundamental importance. The conciliation committee may also be called upon by the national associations of the health insurance companies and the replacement funds as well as the Landeskrankenhaussocieties; the contracting parties under the first sentence may grant further termination rights. The decisions taken by the DRG Institute and the German Institute for Medical Documentation and Information are to be taken into account in the decisions. The decisions of the conciliation committee shall be published and shall be made directly binding on the health insurance funds, the medical service of the health insurance and the approved hospitals. The second sentence of the fourth sentence of paragraph 4 and the second sentence of Article 18a (6) of the second subparagraph of Article 18a (7) and (8) shall apply If the decisions necessary for the establishment of the conciliation committee are not wholly or partly made by 31 December 2013, the arbitration body shall, at the request of one of the Contracting Parties, make the outstanding decisions to the arbitration body in accordance with Article 18a (6) of the Decisions. To the extent that an agreement cannot be reached on the non-partisan members, they are appointed by the Federal Ministry of Health. (4) The results of the examinations according to § 275 paragraph 1c of the Fifth Book of the Social Code can be obtained by calling a conciliation committee which is common to the national associations of health insurance companies and to the replacement funds. The Conciliation Committee shall be responsible for arbitration between the Contracting Parties. The conciliation committee consists of an impartial chairman as well as representatives of the health insurance companies and the approved hospitals in the same number. The representatives of the health insurance companies are appointed by the national associations of the health insurance companies and the replacement funds and the representatives of the approved hospitals are appointed by the Landeskrankenhausgesellschaft; in the selection of the representatives, both medical expertise as well as special knowledge in questions of settlement of the DRG case flat rates. The national associations of the health insurance companies and the substitute funds and the Landeskrankenhausgesellschaft shall agree on the non-partisan chairpersons; § 18a (2) sentence 4 shall apply accordingly. In the event of a tie, the Chairman's vote shall indicate the rash. The conciliation committee shall examine and decide on the basis of case-related, non-insurance-related data. The state associations of the health insurance companies and the replacement funds agree with the Landeskrankenhausgesellschaft (Landeskrankenhausgesellschaft) the more detailed information on the procedure of the conciliation committee as well as regulations for the financing of the tasks to be performed. If no agreement is reached, the arbitral body shall decide in accordance with Article 18a (1) at the request of a Contracting Party. If a conciliation committee is not called up by 31 August 2014, the task of the conciliation committee until its formation is to be carried out in a transitional manner by the arbitration body in accordance with Article 18a (1). For this period of time, the Arbitration Board may set up a provisional Conciliation Committee in accordance with Section 18a (1), taking into account the provisions of sentence 3. (4a) The top association of the health insurance companies and the German Hospital Association shall develop and test the performance of the abatement tests on the basis of data in accordance with § 21 of the Hospital Pay Law until 31 December 2014. In calculating charges for the treatment of patients who are no longer in need of hospital care (secondary misoccupancy), this is intended to be a procedure based on statistical abnormalities. and be rehearsed in a model-like way. Until 31 March 2014, the detailed arrangements for the implementation and evaluation of the model testing shall be agreed by the Contracting Parties in accordance with the first sentence, in particular the criteria for checking for abnormalities and the selection of the tests. a sufficient number of participating hospitals. The results of the model testing shall be published by the Contracting Parties in accordance with the first sentence in a joint report up to 31 March 2015. If an agreement in accordance with the third sentence does not apply in full or in part on time, at the request of either a Contracting Party or the Federal Ministry of Health, the arbitral body shall take the outstanding decisions pursuant to Section 18a (6). (4b) Against the Decisions of the arbitral body referred to in the third sentence of paragraph 2, the third sentence of paragraph 3 and the fifth sentence of paragraph 4a, and of the conciliation committee at the federal level referred to in paragraph 3, and the conciliation committees referred to in paragraph 4, shall be the social rights path. A pre-trial procedure shall not take place; the action shall not have suspensive effect. In the case of lawsuits with which, after carrying out a transfer examination in accordance with Article 275 (1c) of the Fifth Book of the Social Code, a disputed remuneration is required, the dispute settlement procedure referred to in paragraph 4 shall be carried out before the action is brought. if the value of the claim does not exceed EUR 2 000. (5) The hospital shall have self-paying patients, the diagnoses, procedures and other information required for the settlement of the flat-rate and additional charges for the purpose of invoicing. submit. Insofar as insured persons of private health insurance make use of the possibility of direct settlement between the hospital and the private health insurance company, the data are in accordance with § 301 of the Fifth Book The Social Code shall be transmitted to the private health insurance undertaking by means of electronic data exchange if the insured person has declared his/her consent in writing, which may be revoked at any time. Unofficial table of contents

§ 17d Introduction of a lump-sum payment system for psychiatric and psychosomatic institutions

(1) For the remuneration of general hospital services of specialist hospitals and self-employed, area-based departments at somatic hospitals for the fields of psychiatry and psychotherapy, child and adolescent psychiatry and psychotherapy (psychiatric institutions) as well as psychosomatic medicine and psychotherapy (psychosomatic institutions) is a consistent, performance-oriented and sweeping remuneration system based on daily-related To introduce charges. It is necessary to check whether other billing units can be introduced for certain performance ranges. It is also necessary to examine the extent to which the services of psychiatric inpatient assessments to be performed in the hospital can also be included in accordance with § 118 of the Fifth Book of Social Law. [0050] The compensation system has the different expense for the treatment of certain, medically distinguishable patient groups; its degree of differentiation should be practicable. The evaluation relations are to be defined as relative weights. The definition of the charges and their assessment ratios must be laid down in a uniform manner. (2) The general hospital benefits of full and part-time hospitalization shall be remunerated with the charges referred to in paragraph 1. To the extent that this is necessary in order to supplement the charges in very limited exceptional cases, the Contracting Parties may, in accordance with paragraph 3, agree on additional charges and their level. Fees for services which have not been assessed at the federal level shall be agreed by the Contracting Parties in accordance with Section 18 (2). The provisions of section 17b (1) sentence 4 and 5 for a training allowance in accordance with § 17a (6) and regulations for allowances and surcharges as well as § 17b (1) sentence 15 and 16 on special facilities and for the examination of extraordinary examination and examination procedures. Treatment sequences with extremely high cost undercovers apply accordingly. § 17b (1) sentences 6 to 9 and § 5 (2) of the Hospital Charges Act apply accordingly for the financing of the provision of a provision of services necessary for the provision of care to the general public. Within the framework of the fourth sentence, the agreement of regulations for admission or deductises for participation in the regional supply obligation must also be examined. (3) The Contracting Parties in accordance with § 17b (2) sentence 1 agree in accordance with the requirements of paragraphs 1, 2 and 4 the charging system, its fundamentally annual further development and adaptation, in particular to medical developments, changes in supply structures and cost developments, and the accounting provisions, insofar as these are not by law. A common system of remuneration should be developed, in addition to the data referred to in paragraph 9 and for institutions applying the Psychiatry Staff Regulation, in addition to the treatment areas under the Psychiatry Staff Regulation. With the implementation of the development tasks, the contracting parties are responsible for the DRG Institute. Section 17b (2) sentence 2 to 8 shall apply accordingly. In addition, the Federal Psychotherapist Chamber will be given the opportunity to participate in the meetings in an advisory role to the extent that psychotherapeutic and psychosomatic issues have been affected. (4) The Contracting Parties at the Federal level agree to the extent to which At the end of 2009 the basic structures of the remuneration system as well as the procedure for determining the valuation ratios at the federal level, in particular for the calculation in a proper selection of hospitals. Until 30 September 2012, they will agree on the first charges and their assessment ratios. In accordance with sentences 4 to 9, the new compensation system replaces the previously calculated charges in accordance with Section 17 (2). The compensation system will be implemented in a budget-neutral manner for the establishment for the years 2013 to 2018, for the first time for 2013. The remuneration system will be introduced at the request of the hospital on 1 January 2013, 1 January 2014, 1 January 2015 or 1 January 2016. The hospital shall have its request at the time of the invitation to negotiate by the social service providers, but at the earliest by 31 December of the respective previous year, the other Contracting Parties in accordance with section 18 (2) (1) or (2) in writing. . The compensation system will be introduced for all institutions on 1 January 2017. For the first time in 2019, a nationwide base pay value is agreed upon in accordance with Section 18 (3) sentence 3. From 2019 onwards, the basic pay value and the revenue budget of the institutions according to the provisions of the Federal Ordinance on the maintenance of the sick leave will be gradually added to the national base pay value and the resulting volume of revenue. adjusted. By 30 June 2018, the Federal Ministry of Health shall submit a joint report to the Federal Ministry of Health on the effects of the new remuneration system, initial application experiences and on the number and initial findings. Model projects according to § 64b of the Fifth Book of the Social Code. The report shall include the opinions of the professional associations of psychiatry and psychosomatics. The Federal Ministry of Health shall submit the report to the German Bundestag. (5) In order to finance the tasks assigned to the Contracting Parties at the federal level, Section 17b (5) shall apply accordingly. The necessary financial resources must be raised with the DRG system surcharge; this must be increased accordingly. (6) The Federal Ministry of Health is authorized to do so by means of a legal regulation without the consent of the Federal Council

1.

to adopt rules on the remuneration system to the extent that an agreement by the Contracting Parties pursuant to paragraph 3 has not been concluded in whole or in part, and in so far as one of the Parties has declared the failure of the negotiations; the The Contracting Parties shall present their views and the views of other persons concerned on the disputed points, and submit proposals for solutions;

2.

by way of derogation from point 1, including without declaration of failure by a Contracting Party after the expiry of pre-determined time-limits for work steps, to the extent that this is necessary to introduce the remuneration system and its annual to ensure further development in due time;

3.

to determine the benefits referred to in the third sentence of paragraph 2, or the special bodies referred to in the fourth sentence of paragraph 2, which may not yet be properly remunerated with the new system of remuneration, which may specify the type of remuneration to be applied; and Rules for the determination of the level of remuneration and of the negotiation documents to be submitted shall be adopted.

The Federal Ministry may derogate from agreements of the Contracting Parties pursuant to paragraph 3, to the extent that this is necessary for the provisions of the first sentence. It may be advised by independent experts. The DRG-Institute of the Self-Management Partners is obliged to work immediately and immediately after the instructions of the Federal Ministry for the preparation of regulations under the first sentence. It is also obligated in the case of an agreement by the contracting parties under paragraph 3, at the request of the Federal Ministry for Information, in particular on the level of development of the remuneration system, the charges and their changes as well as on the (7) The Federal Ministry of Health is empowered to comply with the provisions of the Federal Council with the consent of the Federal Council for the application of the documents to be submitted by the hospitals for the budget negotiations. (8) The Contracting Parties at the Federal level carry out an accompanying research on the effects of the new remuneration system, in particular on the change of supply structures and the quality of the supply. The impact on the other supply areas, as well as the nature and extent of performance relocations, should also be investigated. Section 17b (8) sentences 2 to 4 shall apply accordingly. The first results shall be published in 2016. (9) For the bodies referred to in the first sentence of paragraph 1, Article 21 of the Hospital Law on Hospitals shall apply, with the proviso that the data shall be transmitted in accordance with the provisions of paragraph 2 (1) (a) and (2) (a) to (h). . In addition, facilities that apply the Psychiatry Staff Regulation are the day-related classification of the patient in the treatment areas in accordance with Appendices 1 and 2 of the patient's treatment areas for each full-and part-time treatment case. Psychiatry-Personnel Regulation; for the underlying documentation, a classification is sufficient at the beginning of the treatment and every change in the treatment area. Unofficial table of contents

Section 18 Care-of-care procedures

(1) The maintenance rates to be negotiated in accordance with this law for the individual hospital shall be agreed between the nurse and the social service providers in accordance with paragraph 2. The Landeskrankenhausgesellschaft (Landeskrankenhausgesellschaft), the national associations of the health insurance companies, the replacement funds and the Land Committee of the Association of Private Health Insurance can participate in the care-and-care-process. The care set agreement requires the approval of the national associations of the health insurance companies and of the Land Committee of the Association of Private Health Insurance. The consent shall be deemed to have been granted if the majority of the parties to the agreement do not object to the agreement within two weeks after the conclusion of the contract. (2) Parties to the Nursing Staff Agreement (Contracting Parties) shall be the nurse and

1.

Social security institutions, to the extent that they are alone, or

2.

Working groups of social benefit institutions, to the extent that their members are

(3) The agreement is to be made only for future periods. (3) The agreement is to be made only for future periods. In accordance with the provisions of the Hospital Law and the Regulation pursuant to § 16 sentence 1 no. 6, the hospital carrier has the necessary documents for the agreement of the budgets and maintenance records on services as well as the costs of the non-compliance by the to provide services covered by flat-rate care. The parties referred to in the second sentence of paragraph 1 shall agree on the level of the charges assessed by valuation ratios in accordance with Articles 17b and 17d with effect for the Contracting Parties pursuant to paragraph 2. (4) Agreement on care rates or the amount of the fees shall be the fees referred to in the third sentence of paragraph 3 shall not be concluded within six weeks after a Contracting Party has requested in writing to hold the maintenance-level negotiations, the arbitral body shall, in accordance with Article 18a (1), issue at the request of one of the Contracting Parties the care rates shall be fixed immediately. The arbitration board may also be called separately for the investigation of comparable hospitals in accordance with § 17 (5). (5) The agreed or established nursing kits are approved by the competent national authority if they comply with the regulations shall comply with this law and other law; the authorisation shall be granted without delay. The authorisation has been given to the administrative right. A pre-trial procedure shall not take place; the action shall not have suspensive effect. Unofficial table of contents

Section 18a Arbitration

(1) The Landeskrankenhaussocieties (Landeskrankenhaussocieties) and the national associations of health insurance companies form an arbitration board for each country or for parts of the country respectively. Where more than one arbitral body has been established for a country, the parties to the award shall determine, in accordance with the first sentence, the competent arbitral body for decisions to be taken by the national authorities. (2) The arbitrators shall consist of a neutral chairman. as well as representatives of hospitals and health insurance companies in the same number. The arbitrator shall also include a representative from the Land Committee of the Association of Private Health Insurance, who shall be credited with the number of representatives of the sickness funds. The representatives of the hospitals and their deputies are appointed by the Landeskrankenhausgesellschaft, the representatives of the health insurance companies and their deputies from the state associations of the health insurance companies. The chairman and his deputy are jointly appointed by the participating organisations; if an agreement is not reached, they shall be appointed by the competent State authority. (3) The members of the arbitrators shall carry out their duties as Honorary Office. They shall not be bound by instructions in the exercise of their official duties. Each member shall have one vote. Decisions shall be taken by a majority of the members; if there is no majority, the chairman shall vote. (4) The national governments shall be authorized to take account of the provisions of the law.

1.

the number, the appointment, the term of office and the official management of the members of the arbitration body, as well as the reimbursement of the cash expenses and the compensation for loss of time,

2.

the conduct of the business of the arbitration board,

3.

the distribution of the costs of the arbitration board;

4.

the procedure and the procedural fees

(5) The legal supervision of the arbitration body shall be the responsibility of the competent State authority. (6) The Federal Government of the Health Insurance Funds and the German Federal Government shall be responsible for the supervision of the competent authority. (6) A hospital company shall form an arbitration body which shall decide on the tasks assigned to it in accordance with the provisions of this Act or the Federal Government Regulations on the Obligations of Hospitals. The arbitration board consists of representatives of the top association Confederation of the sickness funds and the German Hospital Association in the same number as well as a non-partisan chairman and two other non-partisan members. The Arbitration Board shall include a representative appointed by the Association of Private Health Insurance, which shall be credited to the number of representatives of the health insurance funds. The non-partisan members shall be appointed jointly by the participating organisations. The non-partisan members shall be appointed by the President of the Federal Social Court to the extent that an agreement is not reached. Persons previously rejected by the parties concerned cannot be called. Paragraph 3 shall apply accordingly. The top association of the health insurance companies and the German Hospital Association agree to the details of the number, the order, the term of office, the official management, the reimbursement of the cash outlays and the compensation for the time spent by the German hospital. Members of the arbitration board as well as the management, the procedure, the amount and the levying of charges and the distribution of costs. If an agreement does not come into effect after the sentence 8 to 31 August 1997, the Federal Ministry of Health shall determine its content by means of a regulation of the law. The Federal Ministry of Health is responsible for the legal supervision of the arbitration board. The decision of the arbitral body shall be the administrative right. A pre-trial procedure shall not take place; the action shall not have suspensive effect. Unofficial table of contents

§ 18b

(repealed) Unofficial table of contents

§ 19

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§ 20 Non-application of Nursing Home Regulations

The provisions of the third section, with the exception of section 17 (5), do not apply to hospitals which are not supported pursuant to § 5 (1) No. 2, 4 or 7. Section 17 (5) is to be applied in the case of hospitals not subsidiarized pursuant to § 5 (1) no. 4 or 7, with the proviso that in place of the nursing records of comparable hospitals fully subsidised hospitals, the care rates of comparable of public hospitals.

Section 4
(dropped)

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§ § 21 to 26 (omitted)

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Section 5
Other provisions

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Section 27 Rules of jurisdiction

The tasks assigned to the national associations of the health insurance companies in this law shall take account of the agents designated pursuant to section 212 (5) of the Fifth Book of the Social Code, for the German health insurance scheme, the German Pension insurance Knappschaft-Bahn-See and for the health insurance of farmers the social insurance for agriculture, forestry and horticulture is true. Unofficial table of contents

§ 28 Information and statistics

(1) The institutions of the hospitals approved for hospital treatment in accordance with Section 108 of the Fifth Book of the Social Code are obliged to provide the Federal Ministry of Health and the competent authorities of the countries with responsibility for the hospital treatment. Ask for information on the circumstances required for the assessment of the assessment and development of the care set in accordance with this Act. The obligation to provide information shall include, in particular, the staffing and factual equipment and the costs of hospitals, hospital and outpatient services, as well as general information about patients and patients. their diseases. In addition, the competent national authorities may require the hospital authorities to provide information on circumstances which they require in order to carry out their tasks in hospital planning and hospital financing in accordance with this law. (2) Federal Government is authorized to carry out annual surveys on hospitals, including hospitals and institutions listed in § § 3 and 5, for the purposes of this Act with the consent of the Federal Council, as federal statistics , The Federal Statistics on the basis of these surveys may include the following facts:

1.

the nature of the hospital and the sponsorship,

2.

people working in hospitals by sex, employment, activity, employment, education and training,

3.

factual equipment and organisational units of the hospital,

4.

costs according to cost types,

5.

In-patient and outpatient services,

6.

Patients by age, sex, place of residence, disease after main diagnosis,

7.

Training places at the hospital.

The health care providers are obliged to provide information to the statistical offices of the Länder; the regulation may provide for exceptions to the obligation to provide information. The institutions of the hospitals approved in accordance with Section 108 of the Fifth Book of the Social Code for the Treatment of Hospitals share the facts of the statistics at the same time as the state authorities responsible for hospital planning and financing. The same applies to the institutions of the institutions approved in accordance with Section 111 of the Fifth Book of the Social Code for the treatment of care or rehabilitation. (3) The power of the Länder, additional surveys not covered by paragraph 2, on facts of the health system as national statistics, remains (4) The Federal Statistical Office shall carry out an annual evaluation as Federal Statistics on the following facts, using the data transmitted by the DRG Data Centre pursuant to Section 21, Section 3, Sentence 1, sentence 1, sentence 1 of the Hospital Pay Act:

1.

the identification characteristics of the institution,

2.

Patients on the grounds and grounds of reception, further treatment, transfer and dismissal as well as weight of the under one-year intake, diagnoses including secondary diagnoses, respiration hours, pre-and post-hospital treatment, type of operations and procedures, as well as an indication of the provision of services by a staff surgeon, anesthesiologist or midwife,

3.

Specialist departments,

4.

Billing of benefits per treatment case according to the level of charges in total, the DRG case flat rates, additional charges, surcharges and other charges,

5.

the number of DRG cases, the sum of the valuation ratios and the compensatory amounts in accordance with Article 5 (4) of the Hospital Pay Law,

6.

Number of apprentices and trainees, broken down by job title according to § 2 no. 1a and the number of trainees by job title, in addition, broken down by the respective year of training.

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§ 29

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§ 30 Loans from federal funds

At the request of the hospital carrier, at the request of the hospital carrier, at the request of the hospital carrier, the burden of loans granted before the hospital's hospital plan for eligible investment costs from federal funds shall be issued before the 1. It was not otherwise exempted from these charges in January 1985 and as long as the hospital has been included in the hospital plan. In the case of the training centres referred to in § 2 (1a), the first sentence shall apply. Unofficial table of contents

Section 31 Berlin-clause

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Section 32

(Entry into force)