Social Code Book (SGB)-Eleventh Book (XI)-Social care insurance (Article 1 of the Law of 26 May 1994, BGBl. I p. 1014)

Unofficial table of contents

SGB 11

Date of completion: 26.05.1994

Full quote:

" The Eleventh Book of Social Code-Social Care Insurance-(Article 1 of the Law of 26 May 1994, BGBl. I p. 1014, 1015), which is provided by Article 7 of the Law of 17 July 2015 (BGBl. I p. 1368).

Status:	Last amended by Art. 1 G v. 17.12.2014 I 2222
Note:	Amendment by Art. 8 G v. 23.12.2014 I 2462 (No 64) has been documented in a textual, documentary form not yet concludedly
	Amendment by Art. 2 para. 24 G v. 1.4.2015 I 434 (No 14) in a textual proof, not yet concludedly processed in a documentary form
	Amendment by Art. 5 G v. 16.7.2015 I 1211 (No 30) not yet taken into account
	Amendment by Art. 6 G v. 17.7.2015 I 1368 (No 31) not yet taken into account
	Amendment by Art. 7 G v. 17.7.2015 I 1368 (No 31) not yet taken into account

For more details, please refer to the menu under Notes

Footnote

(+ + + Text evidence from: 1.6.1994 + + +) 

  

The rules on access to statutory care insurance are incompatible with the GG in accordance with the decision formula; cf. BVerfGE v. 3.4.2001 I 774-1 BvR 81/98-
The G was decided by the Bundestag with the consent of the Bundesrat. It's gem. Article 68 (1) G v. 26.5.1994 I 1014 (Care VG) entered into force on 1 January 1995, to the extent that there is no derogation in paragraphs 2 to 4 and in Article 69 of this Article. Unofficial table of contents

Content Summary

First chapter
General provisions
§ 1	Social care insurance
§ 2	Self-determination
§ 3	Priority of home care
§ 4	Type and extent of benefits
§ 5	Priority of prevention and medical rehabilitation
§ 6	Personal responsibility
§ 7	Education, advice
§ 7a	Care consulting
§ 7b	Advice vouchers
§ 8	Joint responsibility
§ 9	Tasks of the countries
§ 10	Federal Government's Care Report
§ 11	Rights and obligations of care institutions
§ 12	Tasks of the care insurance funds
§ 13	Ratio of the benefits of the nursing care insurance to other social benefits
Second chapter
Persons entitled to benefit
§ 14	Concept of the need for care
§ 15	Levels of dependency
§ 16	Authorisation
§ 17	Guidelines of the care insurance funds
§ 18	Procedure for the determination of the need for care
Section 18a	Forwarding of the rehabilitation recommendation, reporting obligations
§ 18b	Service orientation in the review process
§ 19	Concept of carers
Third chapter
Persons subject to insurance
§ 20	Insurance obligation in the social care insurance for members of the statutory health insurance
Section 21	Insurance obligation in the social care insurance for other persons
Section 22	Exemption from compulsory insurance
Section 23	Insurance obligation for insured persons of private health insurance companies
§ 24	Insurance obligations of Members
Section 25	Family insurance
Section 26	Further insurance
Section 26a	Accession law
§ 27	Termination of a private care insurance contract
Fourth chapter
Care insurance benefits
First section
Overview of benefits
§ 28	performance types, principles
Second section
Common rules
§ 29	Economic bid
§ 30	Dynamisation, regulation empowerment
Section 31	Priority of rehabilitation before care
Section 32	Provisional benefits for medical rehabilitation
§ 33	Performance requirements
§ 33a	Performance exclusion
Section 34	Rest of benefit claims
§ 35	Deletion of benefit claims
§ 35a	Participation in a cross-member personal budget according to § 17 para. 2 to 4 of the Ninth book
Third Section
Benefits
First Title
Benefits for home care
§ 36	Care Performance
Section 37	Care allowance for self-procured nursing aids
§ 38	Combination of cash performance and physical performance (combination performance)
Section 38a	Additional services for those in need of care in outpatient residential groups
§ 39	Home care in case of prevention of caring
§ 40	Nursing aids and housing improvement measures
Second Title
Partial inpatient care and short-term care
Section 41	Day care and night care
§ 42	Short Term Care
Third Title
Full-time care
Section 43	Performance Content
Fourth Title
Care in fully-stationary facilities for assistance for disabled people
§ 43a	Content of benefits
Fourth Section
Services for carers
Section 44	Services for the social security of carers
Section 44a	Additional services in the event of long-term care and short-term work prevention
§ 45	Care courses for relatives and voluntary carers
Fifth Section
Benefits for insured persons with considerable general care requirements, additional care and relief services and further development of the care structures
§ 45a	Eligible persons
§ 45b	Additional care and discharge services, Regulation empowerment
§ 45c	Further development of supply structures, regulation empowerment
§ 45d	Promotion of volunteer structures and self-help
Sixth Section
Own initiative programme Promotion of new forms of housing
§ 45e	Start-up financing for the establishment of outpatient housing groups
§ 45f	Further development of new living forms
Fifth chapter
Organization
First section
Institution of the care insurance
Section 46	Care funds
§ 47	Statutes
Section 47a	Bodies to fight misconduct in healthcare
Second section
Jurisdiction, membership
§ 48	Responsibility for insured persons of a sickness insurance fund and other insured persons
§ 49	Membership
Third Section
Notifications
§ 50	Reporting and disclosure requirements for members of the social care insurance
Section 51	Notifications to members of private nursing care insurance
Fourth Section
Perception of the association tasks
Section 52	Tasks at the country level
Section 53	Tasks at the federal level
§ 53a	Cooperation between medical services
Section 53b	Commissioning of other independent reviewers by the care insurance funds in the procedure for determining the need for care
Sixth chapter
Financing
First section
Contributions
§ 54	Principle
§ 55	Contribution Rate, Contribution Rate Limit
§ 56	Freedom of contributions
Section 57	Contributor revenue
Section 58	Registration of contributions for employees subject to compulsory insurance
§ 59	Contributions to other Members
§ 60	Contribution Payment
Second section
Contribution grants
Section 61	Contribution grants for voluntary members of statutory health insurance and private insured persons
Third Section
Use and management of funds
Section 62	Funds from the care fund
§ 63	Resources
Section 64	Backsheet
Fourth Section
Equalisation Fund, Financial Compensation
Section 65	Equalisation Fund
Section 66	Financial compensation
Section 67	Monthly compensation
Section 68	Annual compensation
Seventh chapter
Relationships between the caregivers and the service providers
First section
General principles
Section 69	Backup Order
Section 70	Contribution rate stability
Second section
Relations with the care institutions
Section 71	Care facilities
Section 72	Admission to care by supply contract
Section 73	Conclusion of Supply Contracts
Section 74	Termination of supply contracts
§ 75	Framework agreements, federal recommendations and agreements on nursing care
Section 76	Arbitration
Third Section
Relations with other service providers
Section 77	Home care by individuals
Section 78	Contracts for health care products
Fourth Section
Economic impact assessments
§ 79	Economic impact assessments
§ 80	(dropped)
§ 80a	(dropped)
§ 81	Procedural rules
Eighth chapter
Care allowance
First section
General provisions
Section 82	Financing of care facilities
§ 82a	Training allowance
Section 82b	Volunteer support
Section 83	Regulation on the treatment of care allowances
Second section
Remuneration of inpatient care services
Section 84	Measurement principles
§ 85	Care Kit
§ 86	Caregivers ' Commission
Section 87	Accommodation and catering
§ 87a	Calculation and payment of the Heimentgelt
§ 87b	Allowance surcharges for additional care and activation in stationary care facilities
Section 88	Additional benefits
Third Section
Remuneration of ambulatory care services
§ 89	Principles governing the remuneration system
§ 90	Fee order for outpatient care services
Fourth Section
Reimbursement of expenses, Landesnursing committees, foster-secret comparison
Section 91	Reimbursement of expenses
§ 92	National care committees
§ 92a	Care secret comparison
Fifth Section
Integrated care and care points
Section 92b	Integrated supply
§ 92c	Care Points
Ninth chapter
Data protection and statistics
First section
Information bases
First Title
Principles of data usage
Section 93	Rules to be applied
Section 94	Personal data at the care insurance funds
§ 95	Personal data at the associations of the care insurance companies
§ 96	Joint processing and use of personal data
Section 97	Personal data in the medical service
§ 97a	Quality assurance by experts and inspection bodies
§ 97b	Personal data in the case of the supervisory authorities responsible for legal provisions and the institutions of social assistance
§ 97c	Quality assurance by the audit service of the association of private health insurance e. V.
§ 97d	Peer review by independent reviewers
Section 98	Research projects
Second Title
Information bases for the care insurance funds
§ 99	Insurance directory
§ 100	Proof of proof of family insurance
§ 101	Care insurance number
Section 102	Performance requirements information
Section 103	Licence plates for service providers and service providers
Second section
Submission of performance data
Section 104	Obligations of service providers
Section 105	Billing of nursing services
Section 106	Divergent Agreements
§ 106a	Participation obligations
Third Section
Data deletion, duty of information
Section 107	Deleting data
Section 108	Information on insured persons
Fourth Section
Statistics
§ 109	Care Statistics
Tenth chapter
Private care insurance
§ 110	Regulations for private nursing care insurance
Section 111	Risk balancing
Eleventh chapter
Quality assurance, other arrangements for the protection of those in need of care
Section 112	Quality responsibility
Section 113	Standards and principles for safeguarding and further developing the quality of care
§ 113a	Expert standards for the protection and further development of quality in care
§ 113b	Arbitration Board Quality Assurance
Section 114	Quality checks
§ 114a	Performance of quality audits
§ 115	Results of quality checks
Section 116	Cost arrangements
Section 117	Cooperation with supervisory authorities in accordance with the rules of law
Section 118	Participation of interest groups, regulation empowerment
§ 119	Contracts with nursing homes outside the scope of the living and care contract law
§ 120	Care contract for home care
Twelfth chapter
Fine
Section 121	Fine
§ 122	Transitional arrangements
§ 123	Transitional arrangements: Improved nursing care for people with significantly reduced everyday skills
Section 124	Transitional arrangements: home care
§ 125	Model projects for the testing of services of home care by care services
Thirteenth chapter
Support for private nursing care
§ 126	Entitled
§ 127	Care allowance allowance; eligibility conditions
§ 128	Procedure; liability of the insurance undertaking
Section 129	Waiting time for eligible maintenance-additional insurance
§ 130	Authorisation
Fourteenth chapter
Formation of a care pension fund
Section 131	Care insurance funds
Section 132	Purpose of the pension fund
§ 133	Legal Form
Section 134	Management and investment of funds
§ 135	Supply of appropriations
Section 136	Use of special assets
Section 137	Asset separation
§ 138	Annual accounts
Section 139	Resolution

First chapter
General provisions

Unofficial table of contents

§ 1 Social care insurance

(1) Social protection insurance is created as a new independent branch of social security for the social protection of the risk of the need for care. (2) In the protection of social care insurance, force law is all included. that are insured in statutory health insurance. If you are insured with a private health insurance company against illness, you have to take out a private care insurance. (3) Social care insurance institutions are the caregivers; their tasks will be carried out by the health insurance companies (§ 4 of the (4) The nursing care insurance has the task of providing assistance in need of care, which is dependent on solidarity support because of the seriousness of the need for care. (4a) In the care insurance scheme, the aim is to provide care insurance. gender differences in the care needs of men (5) The benefits of the care insurance are introduced in stages: the benefits of the care insurance are provided in the following steps: (6) The expenses of the nursing care insurance are financed by contributions from the members and the employer. The contributions shall be based on the contributor's contribution to the contribution. Contributions are not collected for insured family members and registered partners (life partners). Unofficial table of contents

§ 2 Self-determination

(1) The benefits of the nursing care insurance should help those in need of care, despite their need for assistance, to lead a life that is as independent as possible and self-determined, which corresponds to the dignity of the human being. The aid must be directed towards regaining or maintaining the physical, mental and mental forces of those in need of care. (2) In need of care, the persons in need of care can choose between facilities and services of different institutions. To the extent that they are appropriate, their wishes for the design of aid should be met in the context of the right of performance. The needs of those in need of care after same-sex care have to be taken into account if possible. (3) consideration should be given to the religious needs of those in need of care. At their request, they are to receive inpatient services in a facility where they can be cared for by the clergy of their confession. (4) The persons in need of care must be informed of the rights referred to in paragraphs 2 and 3. Unofficial table of contents

§ 3 Priority of home care

With its services, the nursing care insurance is intended primarily to support the home care and care of the relatives and neighbours so that those in need of care can stay in their home environment for as long as possible. Services of part-time care and short-term care go to the services of full-time nursing care. Unofficial table of contents

§ 4 Type and extent of benefits

(1) The benefits of the nursing care insurance are service, cash and cash benefits for the need for basic care and domestic care as well as reimbursement of expenses as far as this book provides. The type and extent of the services depends on the severity of the need for care and on whether residential, part-inpatient or fully-patient care is taken up. (2) In the case of home and part-time care, the services of the Care insurance the family, neighbourly or other honorary care and care. In the case of part-and full-time care, the care needs are relieved of expenses, which are required for their care according to the type and severity of the care needs (care-related expenses), the expenses for accommodation and Care should be taken by the caregivers themselves. (3) Nurses, care institutions and those in need of care must work to ensure that the services are provided in an effective and economic way and that they are only used to the extent necessary. Unofficial table of contents

§ 5 Priority of prevention and medical rehabilitation

(1) The care funds shall inform the competent service providers that all appropriate services of prevention, medical treatment and medical rehabilitation are initiated at an early stage in order to ensure the entry of care needs. (2) In the context of their right of benefit, the service providers also have to use their services for medical rehabilitation and supplementary benefits in full and to work towards them, even after the need for care has been taken into account. To overcome the need for care, to reduce the need for care and to reduce the need for a worsening prevent. Unofficial table of contents

§ 6 Responsibility

(1) The insured should contribute to the need for care by means of a health-conscious lifestyle, by early involvement in preventive measures and by active participation in medical treatment and medical rehabilitation services. (2) After the need for care, the patients in need of care have to participate in medical rehabilitation and activating care in order to overcome the need for care, to reduce or to exacerbate the need for care. prevent. Unofficial table of contents

§ 7 Enlightenment, advice

(1) The caregivers have the responsibility of the insured by providing information and advice on a healthy lifestyle that preventively prevenes the need for care and to work towards participation in health-promoting measures. (2) The caregivers have the insured persons and their relatives and life partners in the matters relating to the need for care, in particular on the services of the caregivers as well as on the benefits and assistance of other institutions, in for them teaching, advising and clarifying, in an understandable way, that there is a claim to the transmission

1.

the opinion of the Medical Service of the Health Insurance, or of another expert appointed by the care fund, and

2.

the separate recommendation for rehabilitation in accordance with Article 18a (1).

With the consent of the insured person, the attending physician, the hospital, the rehabilitation and prevention facilities and the social security institutions shall immediately notify the competent care fund if the entry of Care needs to be taken off or if the need for care is determined. Personal data required for consultation may only be collected, processed and used with the consent of the insured person. (3) In order to assist the person in need of care in exercising his right to vote in accordance with § 2 para. 2 and for the promotion of the person in need of care. of the competition and the visibility of the existing offer, the competent care fund shall immediately, after receipt of his application for benefits in accordance with this book, have a comparison list of the benefits and allowances of the persons in need of care for the person in need of care. authorised care facilities in the catchment area of which care to be provided (performance and price comparison list). At the same time, the person in need of care is to be informed about the nearest care centre (§ 92c), the nursing advice (§ 7a) and about the fact that the advice and support provided by the nursing care centre and the nursing advice are free of charge. The performance and price comparison list shall be made available to the care fund by the national association of the nursing staff and must be updated promptly; it has at least the provisions applicable to the care facilities in each case of the To include remuneration agreements in accordance with the Eighth Chapter and for the provision of care in accordance with § 92c, and is to be supplemented by the Care Fund in order to supplement the provisions contained in the contracts for the integrated supply in accordance with § 92b, in which it is involved. At the same time, the person in need of care is to offer advice on which nursing care for him in his/her personal situation can be considered. In addition, the need for care should be pointed out to the publication of the results of quality checks. Insured persons with considerable general care needs and those in need of care must be informed and advised in the same way, in particular through recognized low-threshold care and discharge offers. (4) The care insurance funds can be used to To carry out their advisory duties in accordance with this book, from their administrative resources, in the financing and division of the work of other institutions ' advisory services; the neutrality and independence of the advice is to be guaranteed. Unofficial table of contents

§ 7a Care counseling

(1) Persons who receive benefits under this book shall be entitled to individual advice and assistance from 1 January 2009 through a caregiver or a caregiver in the selection and use of a variety of or other services. Social benefits as well as other ancillory services that are geared to the support of people with care, supply or care needs (care counselling). The task of nursing advice is in particular:

1.

systematically record and analyse the need for assistance, taking into account the findings of the assessment by the medical service of health insurance,

2.

to draw up an individual supply plan with the social benefits and health-promoting, preventive, curative, rehabilitative or other medical and nursing and social assistance required in each individual case,

3.

to work towards the measures necessary for the implementation of the supply plan, including their approval by the relevant service provider;

4.

to monitor the implementation of the supply plan and, if necessary, to adapt it to changes in the needs and

5.

to evaluate and document the help process in case of particularly complex case designs.

The plan shall, in particular, make recommendations on the measures required in each case in accordance with the second sentence of sentence 2, references to the available local services, and the review and adaptation of the recommended measures. In the preparation and implementation of the supply plan, agreement is to be sought with the help-seekers and all those involved in the care, care and care. To the extent that services are required in accordance with other national or national regulations, the competent service providers shall be included at an early stage with the aim of the vote. Close cooperation with other coordinating bodies, in particular the joint service points according to § 23 of the Ninth book, must be ensured. The care advice can be transferred to third parties in whole or in part; § 80 of the Tenth Book remains unaffected. A right to care advice exists even if a request for benefits has been made according to this book and there is a clear need for help and advice. Prior to 1 January 2009, care counseling may be granted if and to the extent that a care fund has set up a corresponding structure. It is to be ensured that in the respective nursing care point according to § 92c nursing advice in the sense of this provision can be used and the independence of the advice is guaranteed. (2) On request, the nursing counseling is carried out under Involvement of third parties, in particular relatives and life partners, and in the home environment or in the institution in which the claimant lives. An insured person may also provide a benefit for this or the fifth book in relation to the nurse or the nurse's counsellor. The application must be submitted without delay to the responsible care or health insurance fund, which immediately forwards the notification of benefit to the applicant and, at the same time, to the nurse or nurse. (3) The number of care advisors and It shall be sufficient to ensure that the tasks referred to in paragraph 1 can be carried out in a timely and comprehensive manner in the interest of those seeking help. The care funds set up qualified staff for personal counselling and care provided by caregivers and nurses, in particular nursing staff, social security specialists or social workers with the respective staff. required additional qualification. To the required number and qualification of nursing counsellors and nurses, the Association of the Association of Nursing Care Providers (Association of the Association of Nursing Insurance) has made recommendations by 31 August 2008. The qualification requirements according to the second sentence must be met by 30 June 2011 at the latest. (4) The care funds in the country have nurses and caregivers to ensure an economic task perception in the care-based points by number and by local competence, and by uniform and collective agreements, by 31. October 2008. The care insurance funds can transfer this task to the regional associations of the care insurance funds. If an agreement is not reached in whole or in part until the date stated in the first sentence, the regional associations of the care funds shall have to decide within one month; Section 81 (1) sentence 2 shall apply accordingly. The care insurance funds and the statutory health insurance funds can make use of the possibility of assignment in accordance with § § 88 to 92 of the Tenth Book to the task perception by caregivers and nurses. Expenses incurred as a result of the activities of care counsellors and nursing care counsellors are borne by the caregivers and half of them are credited to the administrative cost flat rate in accordance with § 46 para. 3 sentence 1. (5) Private insurance companies that carry out private care-compulsory insurance can use caregivers and caregivers of the caregivers for the persons insured with them. This presupposes a contractual agreement with the care funds on the nature, content and extent of the use, as well as on the remuneration of the expenses incurred in each case. In so far as agreements with the care funds do not materialize, the private insurance companies carrying out the private care compulsory insurance may conclude agreements with one another on a coordinated provision of care advisors and nurses. (6) nurses and nurses, and other bodies involved in the performance of tasks referred to in paragraph 1, in particular:

1.

in accordance with the law of the country, for the provision of care in the context of local assistance for the elderly and for the provision of care to be taken in accordance with the Twelfth Book;

2.

Companies of the private health and nursing care insurance,

3.

Care facilities and individuals according to § 77,

4.

Members of self-help groups, volunteers and other people and organizations that are willing to engage in civic engagement, as well as

5.

Agencies for work and support for basic job-seekers,

social data may only be collected, processed and used for the purposes of care consulting, insofar as this is necessary for the performance of the tasks provided for in this book or by the legislation of the Social Code or regulations of the insurance contract-or of the Insurance Supervision Act. (7) The Federal Ministry of Health's Association of Nursing Advice provides the Federal Ministry of Health with the experience of providing nursing advice by 30 June 2011 under scientific and scientific advice. Monitoring to be accompanied by a report. He may use this means in accordance with Section 8 (3). Unofficial table of contents

Section 7b Consultative vouchers

(1) The care fund shall either have the applicant, immediately after receipt of a first application for benefits under this book, either:

1.

provide a specific appointment with a contact person to be carried out at the latest within two weeks of receipt of the application, or

2.

to issue a counseling voucher in which advice centres are designated in which they can be redeemed at the expense of the caregiver within two weeks after receipt of the application; § 7a (4) sentence 5 shall apply accordingly.

The advice is based on § § 7 and 7a. At the request of the insured person, the counseling in the home environment has to take place and can also be carried out after the expiry of the period referred to in the first sentence; over these possibilities the care fund has to inform him. (2) The care fund has to ensure that the advisory bodies comply with the requirements for advice according to § § 7 and 7a. For this purpose, the care fund shall conclude contractual agreements with independent and neutral advisory bodies, alone or in cooperation with other care funds, which shall in particular make arrangements for:

1.

the requirements for advisory services and advisors,

2.

liability for damages incurred by the care fund through erroneous advice, and

3.

the remuneration.

(3) In accordance with the first sentence of paragraph 1, point 2, personal data may only collect, process and use personal data insofar as this is necessary for the purpose of providing advice in accordance with § § 7 and 7a, and the insured person or his legal representative has consented to it. In addition, the insured person or his legal representative shall be informed at the beginning of the consultation that the consent may be revoked at any time. (4) The provisions of paragraphs 1 to 3 shall apply to private insurance companies which have private insurance companies. Maintenance-compulsory insurance, accordingly. Unofficial table of contents

Section 8 Joint responsibility

(1) The nursing care of the population is a task for society as a whole. (2) The countries, the municipalities, the nursing care institutions and the caregivers cooperate closely with the participation of the Medical Service in order to provide a powerful, Regionally structured, local and coordinated outpatient care and nursing care for the population. They contribute to the development and further development of the necessary care structures; this applies in particular to the addition of domestic and stationary care by means of new forms of part-patient care and Short-term care as well as for the maintenance of an offer of supplementary services for medical rehabilitation. In addition, they support and promote the readiness to provide humane care and care by the main professional and voluntary caregivers, as well as by relatives, neighbours and self-help groups, and thus act on a new culture of helping and the human contribution. (3) The top association of the caregivers ' association can take measures, such as model projects, studies, scientific expertise, from the compensation fund of the nursing care insurance with 5 million euros in the calendar year. Specialist conferences on the further development of nursing care insurance, in particular Development of new quality-assured forms of care for people in need of care, carrying out and reconciling them with service providers. As a priority, the possibilities of a personal budget as well as new housing concepts for those in need of care are to be tested in a model-like way. In the case of the agreement and implementation of pilot projects, the provisions of the seventh chapter as well as § 36 and the development of particularly flat-rate care rates can be deviated from § 84 para. 2 sentence 2 in individual cases. Additional burdens on long-term care insurance resulting from the fact that those in need of care, who receive care allowance, receive higher benefits than the care allowance by being included in a model project, are included in the amount of support provided for in the first sentence . In so far as the appropriations referred to in the first sentence have not been used in the relevant financial year, they may be transferred to the following year. The model projects are to be limited to a maximum of five years. The Association of the Association of Nurses determines the objectives, duration, content and implementation of the measures, taking into account regional model projects of individual countries. The measures are to be coordinated with the Federal Ministry of Health. To the extent that financial interests of individual countries are affected, they shall be involved. More information about the procedure for disbursing the funds to be financed from the compensation fund is regulated by the Association of the Federal Government of the Care Insurance Funds and the Federal Insurance Office by agreement. A scientific monitoring and evaluation shall be provided for the pilot projects. Section 45c (4) sentence 6 shall apply accordingly. Unofficial table of contents

§ 9 Tasks of the Länder

The countries are responsible for the maintenance of a powerful, numerically sufficient and economic care structure. The details of the planning and the promotion of the care facilities are determined by national law; by national law it is also possible to determine whether and to what extent a national law provided and of the economic performance of the Financial support in need of care

1.

the person in need of care in carrying out the necessary investment costs, calculated by the care facilities, or

2.

the care facilities in carrying out their necessary investment expenses

the promotion of care facilities. In order to finance the investment costs of the care facilities, savings are to be made to the social welfare institutions through the introduction of the care insurance scheme. Unofficial table of contents

§ 10 Maintenance Report of the Federal Government

Starting in 2011, the Federal Government will report on the development of the nursing care insurance and the state of nursing care in the Federal Republic of Germany at a distance of four years from the federal government. Unofficial table of contents

§ 11 Rights and obligations of the care institutions

(1) The care facilities maintain, provide and care for those in need of care who take advantage of their services, in accordance with the generally accepted status of medical-care findings. The content and organization of the services must ensure humane and activating care while respecting human dignity. (2) In the implementation of this book, the diversity of the carriers of care facilities must be uphold and the diversity of the institutions must be maintained. Independence, self-understanding and independence. It is necessary to take account of the mission of ecclesiastic and other carriers of the free administration of welfare, sick, frail and dependent people, to take care of, to comfort them and to accompany them in the dying. Non-profit-making and private institutions take precedence over public institutions. (3) The provisions of the Living and Support Contract Act remain unaffected. Unofficial table of contents

§ 12 Tasks of the care insurance funds

(1) The care funds are responsible for ensuring the nursing care of their insured persons. They work closely together with all those involved in nursing, health and social care and work, in particular through care-based points in accordance with § 92c, on a cross-linking of regional and municipal supply structures, in order to improve the care and care of people in need of care. In order to carry out the tasks assigned to them by law, the care funds are to form local and regional working groups. § 94 (2) to (4) of the Tenth Book applies accordingly. (2) The care funds cooperate in partnership with the institutions of the outpatient and the inpatient health and social care in order to provide the patients in need of care for the care-care needs. to coordinate assistance. In particular, they shall ensure that in individual cases basic care, treatment care, medical treatment, specialist palliative care, services for prevention, medical rehabilitation and participation are guaranteed in individual cases. as well as domestic supply, seamlessly and smoothly intertwine. In addition, the care funds use the instrument of integrated care in accordance with § 92b and work to ensure the care of the patients in need of home, subject and dental care in order to ensure that the nursing care facilities are in place Enter into cooperation with established physicians or apply § 119b of the Fifth Book. Unofficial table of contents

§ 13 Ratio of benefits of the nursing care insurance to other social benefits

(1) The benefits of the nursing care insurance cover the compensation benefits due to the need for care.

1.

according to the Federal Supply Act and under the laws which provide for a corresponding application of the Federal Supply Act,

2.

from the statutory accident insurance, and

3.

from public coffers due to statutory accident care or accident prevention

(2) The benefits of the home nursing care according to § 37 of the Fifth Book remain unaffected. (3) The benefits of the nursing care insurance are provided by the care services for the care of the nursing care.

1.

according to the twelfth book,

2.

in accordance with the Burden Balancing Act, the Reparation Damage Act and the Refugee Assistance Act,

3.

according to the Federal Supply Act (War Opferersorge) and according to the laws, which provide for a corresponding application of the Federal Supply Act,

before. Care provided under these laws shall be granted if and to the extent that the care insurance benefits are not provided or if these laws provide for the basic or the amount of benefits further than the nursing care insurance. The benefits of the integration aid for disabled persons according to the Twelfth Book, the Federal Supply Act and the Eighth Book remain unaffected, they are not subordinated in relation to the nursing care insurance; the necessary assistance in the (3a) The services provided for in § 45b shall not be taken into account for the care provided for in the first sentence of paragraph 3. (4) Meeting maintenance services with the services of the Integration assistance or with further care services according to the Twelfth Book together, the caregivers and the social welfare institution are to agree that in proportion to the person in need of care, only one body takes over the benefits and the other body reimburses the costs of the benefits to be borne by it. (5) The Care insurance benefits remain unaccounted for as income in the case of social benefits and in the case of benefits under the Asylum Seeker Benefits Act, the granting of which is dependent on other income. The first sentence shall apply, in the case of contractual services from private care insurance, which are equivalent to the type and extent of the benefits provided by the social care insurance scheme. Legislation which excludes further or supplementary benefits from personal care insurance from the determination of income shall remain unaffected. (6) If a care allowance is paid according to § 37 or a comparable amount of money is paid to a carer (§ 3). 19), this shall not be taken into account in the determination of maintenance claims and maintenance obligations of the carer. This shall not apply

1.

in the cases of § 1361 (3), § § 1579, 1603 (2) and § 1611 (1) of the Civil Code,

2.

for maintenance rights of the caregister, if he/she can be expected to cover, in whole or in part, the maintenance needs of his/her own income, and the person in need of care is not in a straight line with the maintenance person.

Second chapter
Persons entitled to benefit

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§ 14 Concept of the need for care

(1) In the sense of this book, persons in need of care are persons who, because of a physical, mental or mental illness or disability, are permanently and regularly in the course of daily life in the course of their daily life, (2) Diseases or disabilities within the meaning of paragraph 1 are:

1.

Loss, paralysis or other malfunctions in the musculos-musculos-musculosa,

2.

Functional disorders of the internal organs or of the sensory organs,

3.

Disorders of the central nervous system such as driving, memory or orientation disorders as well as endogenous psychoses, neuroses or mental disabilities.

(3) The assistance referred to in paragraph 1 shall consist of assistance, partial or complete adoption of the directions in the course of daily life, or supervision or guidance with the aim of taking over the same. (4) Ordinary and recurrent directions within the meaning of paragraph 1 are:

1.

in the area of personal care, washing, shower, bathing, dental care, combing, shaving, emptying of bowels or blisters,

2.

in the field of nutrition, the right to food or to the intake of food,

3.

in the area of mobility, self-standing and to-bed walking, walking, walking, standing, climbing stairs or leaving and relocating the apartment,

4.

in the area of domestic supply, shopping, cooking, cleaning of the apartment, rinsing, changing and washing the laundry and clothes or heating.

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§ 15 Levels of need for care

(1) For the granting of benefits under this Act, persons in need of care (§ 14) are to be assigned to one of the following three levels of care:

1.

People in need of nursing care level I (significantly in need of care) are persons who need assistance at least once a day for personal care, nutrition or mobility for at least two directions from one or more areas, and in addition several times a week, they need assistance in the provision of domestic services.

2.

People in need of care level II (those in need of care) are persons who require assistance at least three times a day in the course of personal care, nutrition or mobility at different times of the day, and in addition several times during the week in the case of domestic supply.

3.

Persons in need of nursing care level III (in need of care) are persons who need assistance 24 hours a day for personal care, nutrition or mobility, even at night, and in addition several times during the week help with the in-house care.

For the provision of services according to § 43a, it is sufficient to establish that the conditions of the nursing level I are fulfilled. (2) In the case of children, the allocation of the additional need for assistance is decisive in relation to a healthy, same-age child. (3) The Time spent by a member of the family or by another person not trained as a caregivers for the necessary services of basic care and domestic care must be on average weekly on average

1.

at least 90 minutes in stage I, where the basic care must be more than 45 minutes,

2.

at least three hours in the level of care, where the basic care must be at least two hours,

3.

at least five hours in the care level III, where the basic care must be at least four hours.

When determining the amount of time required, it is necessary to take account of the time required for the required health-specific care measures, even if the need for assistance leads to achievements in accordance with the fifth book. Treatment-related disease-specific care measures are measures of treatment care in which the treatment care needs are an inseparable part of an extension according to § 14 para. 4 or with such a direction of treatment is necessary in a direct temporal and factual context. Unofficial table of contents

Section 16 Regulation empowerment

The Federal Ministry of Health is authorized, in agreement with the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth and the Federal Ministry of Labour and Social Affairs, by means of a regulation with the consent of the Federal Council for the further delimitation of the characteristics of the need for care in accordance with § 14, the nursing steps according to § 15, as well as the application of the hardship case regulations of § 36 (4) and § 43 (3). Unofficial table of contents

§ 17 Guidelines of the care insurance funds

(1) The top association of the nursing insurance funds is issued with the aim of promoting a uniform application of the law, with the participation of the Medical Service of the Leading Association of the Health Insurance Funds guidelines for the more detailed delimitation of the provisions of § 14 , in accordance with § 15, and on the procedure for determining the need for care, the following characteristics are required. He has the Bundesarbeitsgemeinschaft der Freie Wohlfahrtspflege (Federal Association of Nursing Care and Disabled People), the Federal Association of Nursing Care and Disabled People, the Federal Working Group of the Local Social Welfare Agency (Bundesarbeitsgemeinschaft der übertopical Carrier), the German National Association of Social Welfare. municipal top associations at the federal level, the federal associations of private old and nursing homes as well as the associations of private outpatient services to participate. With the participation of the Medical Service of the Leading Association of the Health Insurance Funds, the Confederation of Nursing Funds provides guidelines for the application of the hardship regulations of § 36 (4) and § 43 (3). (2) The guidelines for Paragraph 1 shall not take effect until the Federal Ministry of Health approves it. The authorisation shall be deemed to have been granted if the Directives are not contested within one month after being submitted to the Federal Ministry of Health. Complaints from the Federal Ministry of Health must be remedied within the time limit set by the Federal Ministry of Health. Unofficial table of contents

Section 18 Procedure for the determination of the need for care

(1) The care insurance funds entress the medical service of the health insurance or other independent reviewers with the examination as to whether the conditions of the care need are met and what level of care need is present. In the course of these examinations, the Medical Service or the experts commissioned by the care fund shall determine, by examining the applicant, the restrictions on the directions within the meaning of Article 14 (4), and the nature, scope and the probable duration of the need for assistance and the existence of a considerably restricted everyday competence in accordance with § 45a. In addition, findings must also be made as to whether and to what extent measures to eliminate, reduce or prevent a worsening of the need for care, including medical rehabilitation services, should be taken into account. are suitable, necessary and reasonable; in this respect, insured persons have a claim against the competent institution for medical rehabilitation services. (2) The medical service or the reviewers commissioned by the care insurance fund have the To examine insured persons in his/her living area. If the insured person does not give his consent, the care fund may refuse the services requested. § § 65, 66 of the First Book shall remain unaffected. The examination in the residential area of the person in need of care may exceptionally be prevented if the result of the medical examination has already been determined on the basis of a clear file situation. The examination must be repeated at reasonable intervals of time. (3) The care fund shall immediately forward the applications for the determination of the need for care to the medical service of the health insurance company or the persons responsible for the care insurance. Verifier further. No later than five weeks after receipt of the application, the applicant shall be informed in writing of the decision of the caretaker's fund. If the applicant is in the hospital or in a stationary rehabilitation facility, and

1.

, there are indications that an evaluation in the facility is required in order to ensure the provision of ambulatory or inpatient care and care, or

2.

the use of the care period has been announced in accordance with the nursing-age law with regard to the employer of the caring person, or

3.

has been agreed with the employer of the caring person a family care period in accordance with § 2 paragraph 1 of the Family Care Time Act,

the evaluation shall be carried out without delay, at the latest within one week of receipt of the application from the competent care fund; the time limit may be shortened by regional agreements. The shortened evaluation period shall also apply if the applicant is in a hospice or is provided with an outpatient palliative care. If the applicant is in a home environment without being provided with any palliative care, the use of the nursing care period in accordance with the Care-Time Act has been announced to the employer of the caring person or with the employer of the A family care period according to § 2 (1) of the Family Care Time Act is agreed upon, is a review by the medical service of the health insurance or the reviewers commissioned by the care fund no later than from two weeks after receipt of the application to the competent care insurance fund , and inform the applicant in writing, on the part of the Medical Service or the reviewers commissioned by the care fund, on the recommendation of the Medical Service or the recommendation of the care fund Forwarding reviewers to the care insurance fund. In the cases of sentences 3 to 5, the recommendation must contain only the determination as to whether the need for care is in the sense of § § 14 and 15. The decision of the care fund shall be notified to the applicant in writing immediately after receipt of the recommendation of the medical service or the authorised reviewers with the care fund. The applicant shall have the right to communicate the opinion with the communication. When assessing whether the applicant wishes to make use of this right, it is necessary to determine whether the applicant wishes to exercise this right. The applicant may also request the submission of the opinion at a later date. (3a) The care fund shall be obliged to appoint the applicant for selection at least three independent reviewers,

1.

where, in accordance with paragraph 1, independent verifiers are to be charged with the examination, or

2.

if no evaluation has been carried out within four weeks from the date of application.

The qualification and independence of the reviewer shall be pointed out to the insured person. If the applicant has opted for a notified expert, the request will be taken into account. The applicant shall inform the nurse of his/her decision within one week of the name of the reviewers, otherwise the care fund may appoint a reviewer from the list sent to the care fund. In the performance of their duties, the reviewers are only subject to their conscience. Sentence 1 (2) shall not apply if the carer is not responsible for the delay. (3b) If the carer does not inform the written communication of the application within five weeks of receipt of the application, or if one of the claims referred to in paragraph 3 is not taken After the expiry of the deadline for each week of exceeding the deadline, the care fund must pay the applicant immediately 70 euros to the applicant for each week of the deadline. This does not apply if the care insurance fund has not been responsible for the delay or if the applicant is in stationary care and is already recognised as at least significantly dependent (at least care level I). The same applies to the private insurance companies which carry out private maintenance compulsory insurance. Each year, by 31 March of the year following the reference year, the institution of the care insurance scheme and the private insurance undertakings shall publish a statistical report on compliance with the periods referred to in paragraph 3. (4) The Medical Service or the reviewers appointed by the caregivers, to the extent that the insured person consents, the doctors of the insured person, in particular the family doctors, to be included in the review and medical information and documents relating to those for which the insured person is to be treated. Assessment of the need for care of important pre-diseases as well as the type, extent and the duration of the need for assistance. With the consent of the insured person, caregiver relatives or other persons or services who are involved in the care of the insured person should also be questioned. (5) The care and health insurance funds as well as the service providers are obliged to to provide the medical service or the reviewers responsible for the assessment with the necessary documentation and to provide the necessary information. § 276 (1) sentence 2 and 3 of the Fifth Book applies accordingly. (6) The Medical Service of the sickness insurance or the reviewers commissioned by the care insurance fund have the care fund the result of his or her examination to determine the The need for care should be immediately communicated. In his or her opinion, the Medical Service or the experts appointed by the care fund shall also have the result of the examination as to whether and where appropriate which measures of prevention and of medical rehabilitation are appropriate, necessary and reasonable, to be informed and to recommend the type and extent of nursing care and an individual care plan. The findings on medical rehabilitation are to be documented in a separate rehabilitation recommendation by the medical service or the reviewers commissioned by the care insurance fund. If the nursing care allowance is requested, the opinion must also cover whether the home care is ensured in a suitable way. (7) The tasks of the medical service are to be carried out by doctors in close cooperation with Nursing staff and other appropriate professionals. The examination of the need for care of children is usually due to specially trained reviewers with a qualification as a health and paediatric nurse or health and pediatric nurse or as a pediatrician or pediatrician. , The Medical Service shall have the power to transmit the personal data necessary for their respective participation to the nursing staff or other appropriate professionals who are not members of the Medical Service. For other independent reviewers, the rates 1 to 3 shall apply accordingly. Unofficial table of contents

§ 18a Forwarding of the rehabilitation recommendation, reporting obligations

(1) At the latest with the notification of the decision on the need for care, the care fund shall forward the separate rehabilitation recommendation of the medical service or the reviewer commissioned by the care fund to the applicant and shall take the decision Fully and justifies the extent to which the implementation of a medical rehabilitation measure is indicated on the basis of the recommendation. In addition, the care fund has to inform the applicant that a communication on the rehabilitation needs of the responsible rehabilitation support will be used to supply a communication on the application procedure for medical rehabilitation services. in accordance with the provisions of the Ninth Book, provided that the applicant agrees to this procedure. (2) For the financial years 2013 to 2015, the care funds shall report annually on the experience gained with the implementation of the recommendations of the medical services of the health insurance or of the representatives Evaluator for medical rehabilitation. In particular, the following shall be reported:

1.

the number of recommendations of the medical services of the health insurance and the reviewers responsible for medical rehabilitation services in the context of the assessment of the need for care,

2.

the number of applications to the competent rehabilitation carrier in accordance with § 31 (3) in conjunction with § 14 of the Ninth book,

3.

the number of decisions approved and the number of rejected performance decisions taken by the competent rehabilitation institutions, including the grounds for refusals, and the number of appeals and appeals; and

4.

the number of medical rehabilitation measures carried out.

Until 31 March of the year following the reporting year, the notification by the nursing staff will be sent to the top association of the nursing insurance funds. More information about the reporting procedure and the content is developed by the Confederation of Nurses in agreement with the Federal Ministry of Health. (3) The top association of the care funds prepares the data and directs the processed data. and for plausibility, data reviewed by 30 June of the year following the reporting year to the Federal Ministry of Health. The association shall also send the processed data of the national insurance institutions to the supreme administrative authorities of the countries responsible for social security, or to the authorities designated by them at the request. On the basis of the reported data and other findings, the Association of the Confederation of Nursing Homes publishes a report annually up to 1 September of the year following the reporting year. Unofficial table of contents

§ 18b Service orientation in the assessment procedure

(1) The top association of the nursing funds is responsible for strengthening the service orientation of the insured persons in the review process until 31 March 2013 for binding guidelines for all medical services. The Medical Service of the Confederation of Health Insurance Funds and the organisations responsible for the perception of the interests and self-help of those in need of care and disabled persons at the federal level are to be involved. (2) The In particular,

1.

general principles of conduct for all those involved under the responsibility of the medical services in the peer review process,

2.

the obligation of the medical services to provide individual and comprehensive information to the insured person on the review procedure, in particular on the conduct, legal bases and complaints procedures;

3.

the regular conduct of insurance surveys and

4.

a uniform procedure for dealing with complaints concerning the behaviour of the staff of the medical services or the procedure in the assessment.

(3) The Directives shall not take effect until the Federal Ministry of Health approves them. The authorisation shall be deemed to have been granted if the Directives are not contested within one month after being submitted to the Federal Ministry of Health. Complaints from the Federal Ministry of Health must be remedied within the time limit set by the Federal Ministry of Health. Unofficial table of contents

§ 19 Concept of carers

In the sense of this book, care persons are persons who do not acquire a person in need of care in the sense of § 14 in his or her home environment. Benefits for social protection in accordance with § 44 shall only be provided by a caregier if he or she maintains one or more persons in need of care at least 14 hours a week.

Third chapter
Persons subject to insurance

Unofficial table of contents

§ 20 Insurance obligation in the social care insurance for members of the statutory health insurance

(1) insured persons in the social care insurance are the members of the statutory health insurance subject to insurance. These are:

1.

workers, employees and their vocational training employees who are employed in respect of remuneration; whereas the obligation to insure insurance remains unaffected for the time of the payment of short-time work in accordance with the third book;

2.

Persons in the period for which they receive unemployment benefit under the Third Book, even if the decision which led to the performance of the benefit has been retroactively cancelled or the benefit has been recovered or repaid; from the beginning of the second month until the twelfth week of a blocking period (§ 159 of the Third Book) or from the beginning of the second month of the time of rest on account of a holiday discourse (Section 157 (2) of the Third Book), the benefits shall be deemed to be related to:

2a.

Persons during the period for which they receive unemployment benefit II in accordance with the Second Book, insofar as they are not covered by family insurance in the statutory health insurance, unless this benefit is only granted in the manner of a loan, or only benefits in accordance with the first sentence of Article 24 (3) of the Second Book,

3.

farmers, their co-working family members and old-age farmers who are subject to insurance under Section 2 of the Second Law on the Health Insurance of Farmers,

4.

self-employed artists and publicists according to the provisions of the Künstlersozialversicherungsgesetz,

5.

persons who are to be empowered in institutions of youth welfare, in vocational training centres or in similar institutions for disabled persons,

6.

Participants in the benefits of participation in working life, as well as for career or work experience, unless the benefits are provided in accordance with the provisions of the Federal Supply Act,

7.

disabled persons working in recognised workshops for disabled persons or in blind workshops within the meaning of § 143 of the Ninth book or for these institutions in home work,

8.

Persons with disabilities who, in institutions, homes or similar institutions, perform in certain regularity with a performance equivalent to one fifth of the performance of a fully-employable employee in the same type of employment; also include services for the institution of the institution,

9.

Students enrolled at state or state-recognised universities, to the extent that they are subject to compulsory health insurance in accordance with Section 5 (1) (9) of the Fifth Book of Sickness insurance,

10.

Persons who are employed for their vocational training without pay or who attend a technical school or vocational school or who do a professional activity without pay prescribed in studies or examination regulations (Trainees); trainees of the Second Educational Trail, who are in a part of a training section eligible under the Federal Training Assistance Act, are equivalent to interns,

11.

Persons who fulfil the conditions for entitlement to a pension from the statutory pension insurance scheme and who have applied for this pension, insofar as they are required pursuant to § 5 (1) No. 11, 11a or 12 of the Fifth Book of Health Insurance are subject to

12.

Persons who, because they have not previously been entitled to protection in the event of illness, according to § 5 (1) No. 13 of the Fifth Book or pursuant to § 2 (1) No. 7 of the Second Law on the Health Insurance of the farmers of the health insurance obligation are subject to

(2) Workers and employees within the meaning of paragraph 1 (1) employed for remuneration in respect of remuneration shall be entitled to an early retirement benefit if they were subject to insurance immediately before receipt of the early retirement pension and the early retirement pension shall be paid at least in the amount of 65 per cent of the gross earnings in the sense of Section 3 (2) of the early retirement act. The first sentence shall not apply to persons residing or habitually resident in a Member State who are not domicated or habitually resident in a country where the State is not subject to any national or international rules governing the use of such residence or habitual residence in that State (2a) The persons employed for their vocational training within the meaning of the second sentence of paragraph 1 shall apply to persons who are not members of the clerical cooperatives or similar religious communities in the form of non-statutory members of the the service in such a cooperative or similar religious community (3) Volunteer members of the statutory health insurance are subject to insurance in the social care insurance. (4) Take persons who do not have at least ten years in the social care insurance or If the statutory health insurance is subject to insurance, an employment or self-employment of minor economic importance which is subject to an external appearance, the rebuttable presumption exists that: Employment based on compulsory insurance in accordance with paragraph 1 (1) or an independent activity subject to insurance pursuant to paragraph 1 (3) or (4), in fact it is not exercised. This applies in particular to employment in the case of family members or partners. Unofficial table of contents

§ 21 Insurance obligation in the social care insurance for other persons

The insurance obligation in the social care insurance scheme also exists for persons with domials or habitual residence in Germany who are

1.

in accordance with the Federal Law on the Supply of Health, or in accordance with laws which provide for a corresponding application of the Federal Supply Act, have a right to medical treatment or medical treatment,

2.

Claims for war damage or comparable benefits under the Burden Balancing Act or the Reparation Damage Act or ongoing aid in accordance with the Refugee Assistance Act,

3.

Supplementary assistance for the livelihood of the victims of war victims in accordance with the Federal Supply Act or in accordance with laws which provide for a corresponding application of the Federal Supply Act,

4.

-current services related to the maintenance and benefits of hospital assistance according to the Eighth Book,

5.

Are entitled to health care under the Federal Compensation Act,

6.

have been called into the service of a soldier at a time,

if they are not insured against the risk of illness either in statutory health insurance or in a private health insurance company. Unofficial table of contents

Section 22 Liberation of the obligation to insurance

(1) Persons who are subject to insurance in accordance with Article 20 (3) of the social care insurance scheme may, on application, be exempted from the insurance obligation if they prove that they are against a private insurance undertaking against In the case of an insured person and their relatives or partners who are insured under the insurance obligation in accordance with § 25, they can claim benefits equivalent to the benefits of the fourth chapter in accordance with the nature and scope of the insurance scheme. . The liberated persons are obliged to maintain the insurance contract as long as they are insured with health insurance. Persons who receive aid in the event of a need for care are obliged to conclude a corresponding pro-rata insurance within the meaning of the sentence 1. (2) The application can only be made within three months from the date of the insurance obligation be placed at the care fund. The exemption shall be effective from the beginning of the insurance obligation, if no benefits have been received since that date, otherwise from the beginning of the calendar month following the application. The exemption cannot be revoked. Unofficial table of contents

Section 23 Insurance obligation for insured persons of the private health insurance undertakings

(1) Persons who are against the risk of sickness in a private health insurance undertaking with entitlement to general hospital benefits or under insurance contracts which are subject to the insurance obligation under Section 193 (3) of the Subject to the provisions of paragraph 2, insurance contracts are subject to the obligation to conclude and maintain an insurance contract with this company in order to secure the risk of the need for care. The contract must, from the date of the entry of the insurance obligation, provide for the contract benefits for them and their relatives or partners for whom a family insurance is provided in the social care insurance in accordance with § 25, which shall be subject to the following conditions: The nature and extent of the performance of the fourth chapter are equivalent. In this case, the amount of the benefits in kind shall be replaced by the same amount of reimbursement. (2) The contract referred to in paragraph 1 may also be concluded with another private insurance undertaking. The right to vote shall be exercised within six months. The period begins with the entry of the individual insurance obligation. The right to terminate the contract shall not be affected by the expiry of the period; however, in the case of a continuing insurance obligation referred to in paragraph 1, termination of the contract shall take effect only if the policyholder proves that the (3) Persons entitled to aid in accordance with the provisions of the civil service law or principles relating to the need for care shall be awarded a corresponding pro rata; Insurance within the meaning of paragraph 1, provided that they are not in accordance with Section 20 (3). The insurance cover must be designed in such a way that its contractual services, together with the aid benefits resulting from the application of the rates of assessment laid down in Article 46 (2) and (3) of the Federal Aid Regulation, shall be as defined in paragraph 1. (4) The provisions of paragraphs 1 to 3 shall apply by analogy to:

1.

Persons entitled to health care who are not subject to insurance in the social care insurance scheme,

2.

Members of the Postal Officials ' Health Insurance Fund and

3.

Members of the health care of the Federal Railway Officers.

(5) Paragraphs 1, 3 and 4 shall not apply to persons who are permanently cared for for an unforeseeable period of time and who are already nursing care pursuant to Section 35 (6) of the German Federal Law of Supply, pursuant to § 44 of the Seventh Book, according to § 34 of the German Federal Law for the Protection of the Rights of the Federal Republic of Germany. Civil servants ' supply law or in accordance with the laws which provide for a corresponding application of the Federal Supply Act, provided that they do not have family members or partners for which the social care insurance in accordance with § 25 has a Family insurance. (6) The private health insurance undertaking or another the insurance undertaking operated by the care insurance undertaking is obliged to:

1.

for the determination of the need for care as well as for the assignment to a nursing level the same standards as in social care insurance to be applied and

2.

the period of insurance of the Member and of his/her family or life partner in accordance with § 25 of the Family Care Insurance shall be counted on the waiting period.

Unofficial table of contents

Section 24 Insurance obligation of Members

Members of the Bundestag, the European Parliament and the parliaments of the Länder (Members of the European Parliament) are obliged, without prejudice to an insurance obligation already in accordance with Section 20 (3) or § 23 (1), to apply to the respective members of the Bundestag. Parliament's President-in-law to prove that they have been insured against the risk of need for care. The same applies to the recipients of pension benefits in accordance with the respective laws of the Federal Government and the Länder. Unofficial table of contents

§ 25 Family insurance

(1) The spouse, life partner and children of members as well as the children of family-insured children shall be insured if they are members of the family

1.

have their place of residence or habitual residence in the country,

2.

are not subject to insurance pursuant to § 20 (1) (1) to (8) or (11) or section 20 (3);

3.

shall not be exempted from the obligation to provide insurance pursuant to § 22 or are insured under § 23 in the private nursing care insurance scheme,

4.

are not primarily self-employed, and

5.

have no total income exceeding one-seventh of the monthly reference quantity in accordance with Article 18 of the Fourth Book; in the case of pensions, the amount of the payment shall be taken into account without the part falling on the basis of charges for child-raising periods; For a small number of employees according to § 8 (1) No. 1, § 8a of the Fourth Book, the total allowable income is 450 euros.

§ 7 (1) sentence 3 and 4 and section 2 of the second law on the health insurance of farmers and § 10 para. 1 sentence 2 to 4 of the fifth book apply accordingly. (2) Children are insured:

1.

up to the completion of the 18. Life Year,

2.

up to the completion of the 23. years of life if they are not in employment,

3.

up to the completion of the 25th years of life if they are in school or vocational training, or if they have a voluntary social year or a voluntary ecological year in the sense of the Youth Voluntary Service Act or the Federal Voluntary Service; will the school or If vocational training is interrupted or delayed by fulfilling the child's statutory duty of service, the insurance shall also cover a period corresponding to the duration of this service over the 25. This shall apply from 1 July 2011 also in the event of an interruption by the voluntary service in accordance with § 58b of the Soldatengesetz (Soldatengesetz), a voluntary service under the Federal Voluntary Service Act, the Youth Voluntary Service Act or a comparable recognised voluntary service or an activity as a development aid worker within the meaning of Article 1 (1) of the Development Helpers Act for a maximum period of twelve months,

4.

without age limit, if they are unable to entertain themselves on account of physical, mental or psychological disabilities (§ 2 para. 1 of the Ninth book); the condition is that the disability (§ 2 para. 1 of the Ninth book) at one time in which the child was insured under number 1, 2 or 3.

§ 10 (4) and (5) of the Fifth Book applies accordingly. (3) Children are not insured if the spouse or partner of the member related to the children is exempt from the obligation to provide insurance pursuant to § 22 or in accordance with § 23 in the private care insurance is insured and its total income is regularly higher than one twelfth of the annual earnings limit according to the fifth book per month and is regularly higher than the total income of the member; in the case of pensions, the (4) The insurance referred to in paragraph 2 (1), (2) and (3) shall remain in the case of persons who: Basic statutory duty military service or civil service or the services or exercises in accordance with the fourth section of the Soldatengesetz (Soldatengesetz) provide for the duration of the service. This also applies to persons in a military service of a special kind pursuant to § 6 of the Use-Further Use Act. Unofficial table of contents

§ 26 Further insurance

(1) Persons who have been excreted from the insurance obligation pursuant to § 20 or § 21 and who have been insured for at least 24 months in the last five years prior to leaving or immediately prior to leaving for at least 12 months may apply to: Insure the application in the social care insurance, provided that they do not have an insurance obligation pursuant to § 23 (1). This also applies to persons whose family insurance is issued pursuant to § 25 or does not exist only because the conditions set out in § 25 (3) are fulfilled. The application shall be made in the cases of the first sentence within three months of the termination of the membership, in the cases of the second sentence after the termination of the family insurance or after the birth of the child with the competent care fund. (2) Persons who leave the insurance obligation on account of the transfer of their residence or habitual residence abroad may, upon request, reassure themselves. The application shall be made by the nursing home at the latest one month after leaving the insurance obligation, where the insurance was last. The further insurance also extends to the members of the family or life partner insured pursuant to § 25 who, together with the member, transfer their residence or habitual residence to another country. For family members or life partners who remain in the country, the family insurance shall end in accordance with § 25 with the date on which the member of the family relocates his or her normal residence abroad. Unofficial table of contents

Section 26a of the Accession Law

(1) Persons resident in the country who are not insured because at the time of the introduction of the care insurance on 1 January 1995, in spite of their domials, they are not subject to compulsory insurance or co-insurance in the country of residence. social or private nursing care insurance, are entitled to apply for voluntary membership in one of the social care insurance funds eligible under section 48 (2) or a nursing insurance contract with a private nursing home to conclude insurance undertakings. Excluded are persons who receive ongoing support for living according to the twelfth book, as well as persons who are not themselves able to pay a contribution. Accession shall be declared in writing by 30 June 2002 with regard to the nurse's elected carer or private insurance undertaking, and shall have a retroactive effect on insurance on 1 April 2001. The pre-insurance periods in accordance with section 33 (2) are deemed to be fulfilled. § 110 (1) applies to the private insurance contract. (2) Persons domicated in Germany who are not insured until after 1 January 1995 until the date of entry into force of this law, and which does not constitute a crime of the Compulsory insurance pursuant to this book are entitled to apply for the voluntary membership of any of the social care insurance funds eligible under section 48 (2) or a care insurance contract with a private insurance company. complete. The persons referred to in the second sentence of paragraph 1 and persons who are not insured for reasons of accession are excluded from the law of accession on the grounds that, after 1 January 1995, they have ceased to be covered by private health and care insurance without compelling reasons. or have not made use of any further insurance in the statutory health insurance or in the social care insurance. Accession shall be declared in writing by 30 June 2002 in relation to the selected carer's fund or to the chosen private insurance undertaking. It will start insurance as of 1 January 2002. § 110 para. 3 apply to the private insurance contract. (3) From 1 July 2002 there is a right of accession to social or private care insurance only for non-care insured persons who are in the form of a migrant or a foreign returnee Residence in Germany does not comply with the obligation to insure insurance pursuant to this book and the 65. In the case of non-insured persons residing in the country where the grounds for exclusion referred to in the second sentence of paragraph 1 are not completed, the following year shall be completed. Accession shall be made in writing within three months from the date of residence in the country or after removal of the grounds for exclusion referred to in the second sentence of paragraph 1, in respect of the nursing insurance fund or the private insurance company elected pursuant to section 48 (2) of this Regulation, Effect of 1. of the month following the accession declaration. § 110 (3) applies to the private insurance contract. The right of accession provided for in the first sentence shall not apply in cases where, without compelling reason, no use has been made of the right of accession as provided for in paragraphs 1 and 2 or in which the grounds for exclusion listed in the second sentence of paragraph 2 have not been used exist. Unofficial table of contents

Section 27 Termination of a private care insurance contract

Persons who are subject to insurance under § § 20 or 21 and who are insured with a private health insurance company against a need for care may apply their insurance contract with effect from the entry of the insurance obligation cancel. The right of termination shall also apply to family members or life partners if they are insured for family insurance pursuant to § 25. Section 5 (9) of the Fifth Book shall apply accordingly.

Fourth chapter
Care insurance benefits

First section
Overview of benefits

Unofficial table of contents

§ 28 Performance Types, Principles

(1) The care insurance shall provide the following benefits:

1.

Care allowance (§ 36),

2.

Care allowance for self-procured nursing aids (§ 37),

3.

Combination of cash performance and physical performance (§ 38),

4.

Home care in the event of prevention of the caring person (§ 39),

5.

Nursing aids and housing improvement measures (§ 40),

6.

Day care and night care (§ 41),

7.

Short-term care (§ 42),

8.

Full-patient care (§ 43),

9.

Care in fully stationary facilities for the assistance of disabled people (§ 43a),

10.

Social security benefits for carers (§ 44),

11.

Additional benefits in the case of long-term care and short-term work prevention (§ 44a),

12.

Care courses for relatives and voluntary carers (§ 45),

13.

additional care and discharge services (§ 45b),

14.

Services of the Personal Budget pursuant to § 17 para. 2 to 4 of the Ninth book,

15.

additional services for those in need of care in outpatient housing groups (§ 38a).

(1a) insured persons have the right to care counselling in relation to their caregivers or their insurance company (§ 7a). (1b) Until the date mentioned in § 45e (2) sentence 2 has been reached, care in need of care under the conditions of § 45e (1) The right to start-up financing in the event of the establishment of outpatient housing groups. Insured persons with a significantly reduced daily competence shall be entitled to the entry into force of a law governing the granting of benefits on the basis of a new concept of nursing care and an appropriate assessment procedure. improved care services (§ 123). (2) Persons who are entitled to aid or health care according to official legal regulations or principles in the event of illness and care receive half of the benefits to which they are entitled; this also applies to the value of benefits in kind. (3) The care insurance funds and the Providers shall ensure that the services referred to in paragraph 1 are provided in accordance with the generally accepted level of medical and nursing knowledge. (4) The care should also be used to activate the person in need of care, in order to: to obtain existing skills and, as far as possible, to recover lost skills. In order to counteract the danger of the need to uncover the need for care, the needs of the person in need of care after communication should also be taken into account in the service provision.

Second section
Common rules

Unofficial table of contents

Section 29 Economic range

(1) The benefits shall be effective and economic; they shall not exceed the level of the necessary. Care providers who do not fulfil these conditions cannot claim to be in need of care, are not allowed to grant the care insurance and are not allowed to bring the service providers to the detriment of the social care insurance. (2) Services may not be required be used only in the case of service providers with whom the caregivers or the associations working for them have concluded contracts. Unofficial table of contents

§ 30 Dynamisation, Regulation empowerment

(1) The Federal Government shall examine every three years, again in 2017, necessity and amount of an adjustment of the benefits of the nursing care insurance. The cumulative price trend in the last three calendar years shall be considered as an orientation value for the adjustment need, while ensuring that the increase in the amount of benefit is not higher than the increase in the number of prices. Gross wage development over the same period. The general economic conditions can be taken into account during the examination. The Federal Government submits a report to the legislative bodies of the Federal Government on the outcome of the examination and the underlying reasons. (2) The Federal Government is authorized, after submission of the report, to take into account any possible measures taken by the Federal Government in the light of the above. Opinions of the Federal Government's legislative bodies the amount of the benefits of the nursing care insurance as well as the remuneration laid down in § 37 (3) by means of a regulation with the consent of the Federal Council on 1 January of the following year. The legal regulation is to be adopted at the earliest two months after the submission of the report, in order to give the legislative bodies of the federal government an opportunity to comment. Unofficial table of contents

§ 31 Priority of rehabilitation before care

(1) In the individual case, the care funds shall examine what benefits are suitable and reasonable for medical rehabilitation and supplementary benefits, to overcome the need for care, to reduce or to prevent their worsening. If services are granted in accordance with this book, the question of suitable and reasonable services for medical rehabilitation is to be examined in the case of follow-up examinations. (2) The care insurance funds have to take care of the care provided during the initiation and execution of the services. In the case of counselling, information and education, to work closely with the rehabilitation institutions in order to avoid, overcome, diminish, or prevent the worsening of care needs. (3) If a care fund is to be provided by the expert Findings of the medical service of health insurance (§ 18 para. 6) or in any other way determines that in individual cases services for medical rehabilitation are indicated, it immediately informs the insured person and with his consent to the treating physician and, with the consent of the physician, informs the physician and the physician. Insured a corresponding communication to the responsible rehabilitation carrier. At the same time, the care fund points to the insured person's own responsibility and duty of participation. To the extent that the insured person has consented, the notification to the rehabilitation carrier shall be deemed to be an application for the procedure in accordance with § 14 of the Ninth book. The care fund shall be informed immediately of the performance decision of the responsible rehabilitation carrier. It shall examine at an appropriate time interval whether appropriate measures have been carried out; if necessary, it shall provide provisional services for medical rehabilitation in accordance with section 32 (1). (4) (omitted) Unofficial table of contents

Section 32 Preliminary benefits for medical rehabilitation

(1) The care fund provides provisional services for medical rehabilitation if immediate benefit is required in order to avoid imminent care needs, an existing need for care (2) The Care Fund has previously to inform the competent institution and to the need for urgent care of the services. (2) The care fund must inform the competent institution and the the granting of benefits shall not be made in good time, but at the latest, four weeks after the application, the care insurance fund shall provide the services provisionally. Unofficial table of contents

§ 33 Performance requirements

(1) insured persons receive the benefits of the nursing care insurance on request. Benefits shall be granted from the date of application, but not at the earliest from the date on which the eligibility conditions are met. If the application is submitted later than one month after the receipt of the need for care, the benefits shall be granted from the beginning of the month of application. The assignment to a nursing level, the recognition as a case of hardship as well as the granting of benefits can be limited and end with the expiry of the period. The term "temporary" shall be carried out if and to the extent that a reduction in the need for assistance is to be expected according to the assessment of the medical service of the health insurance. The term may be repeated and does not exclude changes in the allocation to a nursing level, recognition as a hardship case, as well as in the case of approved services in the period of grace, to the extent that this is due to the legislation of the Social Code is arranged or allowed. The duration of the temporary period may not exceed three years. In order to ensure a seamless performance, the care fund must check in good time before the expiry of a period of time, and inform the person in need of care, as well as the caregivers who care for them, whether care will continue to be granted for the care. (2) The right to care is to be assigned to the care needs of the patients:

1.

in the period from 1 January 1996 to 31 December 1996, when the insured person has at least one year before the application,

2.

in the period from 1 January 1997 to 31 December 1997, if the insured person has at least two years prior to the date of application,

3.

in the period from 1 January 1998 to 31 December 1998, when the insured person is at least three years prior to the date of application,

4.

in the period from 1 January 1999 to 31 December 1999, when the insured person is at least four years prior to the date of application,

5.

in the period from 1 January 2000 to 30 June 2008, if the insured person has at least five years in the last ten years prior to the application,

6.

in the period from 1 July 2008, when the insured person has been insured for at least two years in the last 10 years prior to the application

as a member or pursuant to § 25 family insurance. Periods of further insurance pursuant to Article 26 (2) shall be taken into account in the determination of the pre-insurance period required by the first sentence. For insured children, the pre-insurance period according to the first sentence is deemed to be fulfilled if a parent fulfils them. (3) Persons who are from the private nursing care insurance because of the entry of insurance obligation in the social care insurance scheme , the period of insurance completed without interruption shall be taken into account for the pre-insurance period referred to in paragraph 2. (4) (omitted) Unofficial table of contents

§ 33a Performance exclusion

There is no entitlement to benefits if persons go to the scope of this Code in order to be abusive in an insurance pursuant to § 20 (1) sentence 2 No. 12 or on the basis of this insurance in an insurance pursuant to § 25 To be eligible for benefits. The care fund regulates the details of the implementation in its articles of association. Unofficial table of contents

Section 34 Ruhen of benefit claims

(1) The right to benefits shall be based on:

1.

as long as the insured person stays abroad. In the case of a temporary stay abroad of up to six weeks in the calendar year, the care allowance is to be granted in accordance with § 37 or a part-care allowance in accordance with § 38. This only applies to nursing care, insofar as the nursing power, which otherwise provides care for the nursing care, accompanies the person in need of care during the stay abroad,

2.

To the extent that insured persons receive compensation due to the need for care directly in accordance with § 35 of the Federal Law of Supply, or according to the laws providing for the corresponding application of the Federal Supply Act, from the statutory Accident insurance or from public health insurance companies on the basis of statutory accident care or accident insurance. This also applies if comparable services are obtained from abroad or from an inter-governmental or superstate institution.

(1a) The right to care allowance in accordance with § 37 or the partial care allowance in accordance with § 38 does not rest with insured persons in need of care who are in a Member State of the European Union, a State Party to the Agreement on the European Economic Area (2) The right to benefits in domestic care shall also be based, as far as the right to home nursing care (§ 37 of the Fifth Book), is also entitled to basic care and home-care care , as well as for the duration of the stay in a facility in the sense of Section 71 (4), insofar as § 39 does not determine any deviation. In the first four weeks, care allowance according to § 37 or a part-care allowance in accordance with § 38 is a full-patient hospital treatment, a home nursing care with a right to basic care and domestic care or a reception in To continue to pay for preventive or rehabilitation facilities in accordance with § 107 (2) of the Fifth Book; in the case of those in need of care who ensure their care by special caregivers employed by them, and in which § 66 (4) sentence 2 of the Twelfth Book application, the care allowance according to § 37 or the part-care allowance according to § 38 (3) Services for social protection according to § § 44 and 44a do not rest for the duration of home nursing, in the case of a temporary stay abroad of the insured person or a rest holiday the caregider of up to six weeks in the calendar year as well as in the first four weeks of a full-time hospital treatment or a stationary performance for medical rehabilitation. Unofficial table of contents

Section 35Erdeleting the benefit claims

The right to benefits shall be issued with the end of membership, unless otherwise specified in this book. Section 19 (1a) of the Fifth Book shall apply accordingly. Unofficial table of contents

§ 35a Participation in a cross-carrier personal budget according to § 17 para. 2 to 4 of the Ninth book

In accordance with § § 36, 37 (1), § § 38, 40 (2) and § 41 of the Ninth Book in connection with the Budget Ordinance and § 159 of the Ninth book, dependent persons may, upon request, also be able to benefit from the services provided for in § § 36, 37 (1), § § 38, 40 (2) and § 41 of the ninth book. In the case of the combination performance in accordance with § 38, only the pro-rata and in advance certain care allowance shall be budgetable, the benefits in kind pursuant to § § 36, 38 and 41 may only be made available in the form of vouchers, authorizing the use of approved care facilities in accordance with this book. The commissioned service provider in accordance with § 17 (4) of the Ninth book has to ensure that a performance permit and the use of the services by the person in need of care is guaranteed in accordance with the provisions of this book. Any entitlement to benefits other than those referred to in the first sentence shall remain unaffected, in the same way as the other provisions of this Book.

Third Section
Benefits

First Title
Benefits for home care

Unofficial table of contents

§ 36 Nursing care

(1) In the case of home care, those in need of care are entitled to basic care and domestic care as a physical benefit (home care assistance). Benefits of home care are also permitted if care in need of care is not maintained in their own household; they are not allowed if care in need of care in a stationary care facility or in a facility within the meaning of § 71 Paragraph 4 shall be maintained. Home care assistance is provided by suitable nursing staff, who are employed either by the care insurance fund or by ambulatory care facilities with which the care fund has concluded a supply contract. Also by individuals with whom the care fund has concluded a contract in accordance with § 77 para. 1, domestic care assistance can be provided as a kind of benefit. A number of people in need of care can benefit from care and care services as well as in-house care as a benefit. The right to care services in kind presupposes that the basic care and the domestic care are ensured in individual cases. Care services as benefits in kind provided for in the fifth sentence may not be used by the caregivers if these benefits are provided by the competent institution within the framework of the assistance for the integration of disabled persons in accordance with the Twelfth Book (2) Basic care and domestic care include assistance in the case of the guidelines referred to in § 14; the orientation-related assistance Disease-specific care measures are not included as far as these in the context of of the home nursing care in accordance with § 37 of the Fifth Book. (3) The entitlement to home nursing care shall comprise per calendar month

1.

for patients in need of care level I care assignments up to a total value of

a)

420 Euro from 1 July 2008,

b)

440 Euro from 1 January 2010,

c)

450 Euro from 1 January 2012,

d)

468 Euro from 1 January 2015,

2.

for patients in need of care level II care assignments up to a total value of

a)

980 Euro from 1 July 2008,

b)

EUR 1 040 from 1 January 2010,

c)

1 100 Euro from 1 January 2012,

d)

1 144 Euro from 1 January 2015,

3.

for patients in need of care level III care assignments up to a total value of

a)

EUR 1 470 from 1 July 2008,

b)

EUR 1 510 from 1 January 2010,

c)

EUR 1 550 from 1 January 2012,

d)

1 612 Euro as of 1 January 2015.

(4) In order to avoid hardship, the caregivers can grant long-term care interventions up to a total value of € 1,995 per month in particularly stored individual cases in order to avoid hardship. , which far exceeds the usual level of care level III, for example, when in the final stage of cancers, aid must be regularly provided on a regular basis during the night. The derogation in sentence 1 may be applied to no more than 3 of the hundreds of all insured persons in need of care in the care level III, who are cared for at home. The Confederation of Nursing Homes is responsible for monitoring compliance with this maximum rate and, if necessary, has to take appropriate measures to comply with these requirements. Unofficial table of contents

§ 37 Care allowance for self-procured nursing aids

(1) In lieu of home care assistance, caregivers can apply for a care allowance. The claim presupposes that the person in need of care, by means of the care allowance, ensures the extent to which the necessary basic care and domestic care are provided in a suitable manner. The care allowance is per calendar month

1.

For those in need of nursing care level I

a)

215 Euro from 1 July 2008,

b)

225 Euro from 1 January 2010,

c)

235 Euro from 1 January 2012,

d)

244 Euro from 1 January 2015,

2.

For those in need of care level II

a)

420 Euro from 1 July 2008,

b)

430 euro from 1 January 2010,

c)

440 Euro from 1 January 2012,

d)

458 Euro from 1 January 2015,

3.

for patients in need of care grade III

a)

EUR 675 from 1 July 2008,

b)

EUR 685 from 1 January 2010,

c)

700 Euro from 1 January 2012,

d)

728 Euro from 1 January 2015.

(2) If the claim referred to in paragraph 1 does not apply for the full calendar month, the amount of money shall be reduced accordingly; the calendar month shall be set at 30 days. Half of the nursing care received so far is continued for up to four weeks per calendar year during a short-term care according to § 42 and a prevention care according to § 39. The care allowance will be paid until the end of the calendar month in which the person in need of care has died. § 118 (3) and (4) of the Sixth Book shall apply mutatily if care allowance has been paid for the period after the month in which the person in need of care has died. (3) In need of care, the care allowance referred to in paragraph 1 shall have

1.

in the case of nurses I and II, once a year,

2.

at stage III, once a quarter

advice in their own house by means of an approved care facility, through a counseling body recognised by the national associations of the nursing staff in accordance with paragraph 7, with proven care professional competence or, if this is done by a Approved care facility on site or a counseling body recognised by the national associations of the nursing staff with proven competence in care cannot be guaranteed by a person commissioned by the care fund, but by the nurse to retrieve non-employed nursing staff. The counselling serves to ensure the quality of home care and the regular assistance and practical care professional support of the home caregivers. In the case of eligibility for the aid, the remuneration for the consultation shall be provided by the competent care fund, in the case of private carers, by the competent private insurance undertaking, in proportion to the aid levels of the aid. It is up to 22 euros in the nursing stages I and II and up to 32 euros in the nursing level III. Persons in need of care who have a considerable need for general supervision and supervision in accordance with § 45a are entitled to use the advisory service twice within the time periods specified in sentence 1. Persons who have a considerable need for general supervision and supervision in accordance with § 45a and who do not yet meet the requirements of the nursing level I can take part in a counselling visit once a year; The remuneration for the consultation is the same as for the levels of care I and II as set out in the fourth sentence. In these cases, advice can also be provided by counseling bodies recognised by the regional associations of the care funds, without the need for recognition of a care professional competence. (4) The care services and the recognised advisory bodies and the responsible nursing staff have to confirm the implementation of the advisory services to the care insurance fund or the private insurance company, as well as the findings obtained during the consultation visit on the possibilities of improving the home care situation to the person in need of care and with his/her consent to the care fund or to the private insurance undertaking, in the case of eligibility for the aid, also to the competent State aid control body. The Association of the Confederation of Nursing Homes and the private insurance companies provide them with a uniform form for this communication. The responsible nursing service and the recognised advisory body have to ensure that nursing staff are employed for a visit to the home, the specific knowledge of the health and disability image as well as of the contribute to the needs of the person in need of care and have special advisory competence. In addition, during the planning for the consultation visits, it is to be ensured to the greatest possible extent that the counselling visit to a person in need of care is carried out as long as possible by the same caring force. (5) The top association of the care insurance funds and the association of private health insurance e. V., together with the associations of the providers of the outpatient care facilities at the federal level, with the participation of the Medical Service of the Leading Association of the Health Insurance Funds, decide on recommendations for quality assurance of the counselling visits referred to in paragraph 3. The recommendations shall apply to the recognised counselling centres. (6) In the case of a person in need of care in accordance with the first sentence of paragraph 3, the care fund or the private insurance undertaking shall reduce the care allowance in an appropriate manner and in the case of a person who is in need of assistance. (7) The regional associations of the caregivers have to recognise neutral and independent counselling centres for the purpose of carrying out the advice referred to in paragraphs 3 and 4. The application for recognition shall be accompanied by proof of the necessary professional competence of the counselling centre and a concept for quality assurance of the advisory service. The regional associations of the care insurance companies regulate the further recognition of the counselling centres. For the purpose of carrying out the deliberations referred to in the sixth sentence of paragraph 3, the national associations of the caregivers may recognise appropriate counselling centres without the need for proof of competence in the field of nursing care. (8) The nurse or the Care aterin (§ 7a) can carry out the prescribed advisory assignments and certify these. Unofficial table of contents

§ 38 Combination of cash performance and physical performance (combination performance)

If the person in need of care only partially takes advantage of the benefits in kind under § 36 (3) and (4), he will receive a partial care allowance in the sense of § 37. The allowance is reduced by the percentage in which the person in need of care has taken advantage of the benefits in kind. The person in need of care is bound for a period of six months to decide in what proportion he intends to make use of the money and in kind. Part-time care allowance shall be paid for up to four weeks per calendar year in the amount of half of the amount paid prior to the start of the short-term or prevention maintenance period during a short-term care pursuant to § 42 and a prevention maintenance according to § 39. Persons in need of care in fully-stationary facilities of the assistance for disabled persons (§ 43a) are entitled to an unpaid care allowance in proportion to the days when they are in home care. Unofficial table of contents

§ 38a Additional services for persons in need of care in residential groups supervised by the ambulance

(1) In need of care, entitlement to a flat-rate surcharge of 205 euros per month, if:

1.

They shall live in an outpatient housing group with at least two and at most eleven other persons in a common apartment for the purpose of joint-organized nursing care, and of which at least two other persons shall be resident in a joint flat. are in need of care in the sense of § § 14, 15, or a significant limitation of the everyday competence according to § 45a has been found in them,

2.

they relate to benefits in accordance with § § 36, 37, 38, 45b or § 123,

3.

a person is jointly mandated by the members of the housing group to carry out, independently of the individual care provision, general organizational, administrative, care or community life-promoting activities or in-house economic support, and

4.

no form of supply is available in which the provider of the housing group or a third party offers or guarantees the services in need of care, the benefits agreed in the respective framework contract pursuant to § 75 (1) for full-time care , the provider of an outpatient housing group shall inform the person in need of care before entering the housing group in an appropriate manner to ensure that he or a third party does not benefit from this scope of service in the housing group. , but also through the active involvement of its to our own resources and their social environment.

(2) The care insurance funds are entitled to collect, process and use the following data in order to determine the eligibility requirements of the applicant, and to request the following documents:

1.

a formal confirmation by the applicant that the conditions laid down in paragraph 1 (1) are met,

2.

the address and the date of birth of the housing group;

3.

the rental contract, including a floor plan of the apartment and the maintenance contract in accordance with § 120,

4.

First name, name, address and telephone number, and signature of the person referred to in paragraph 1 (3), and

5.

the agreed duties of the person referred to in paragraph 1 (3).

Unofficial table of contents

§ 39 Häusliche nursing care in the event of prevention of the carer

(1) If a caregivers is prevented from caring for a period of rest, illness or other reasons, the care fund shall pay the proven costs of a necessary replacement care for a maximum of six weeks per calendar year; § 34 (2) Sentence 1 shall not apply. The condition is that the care person has nurtured the person in need of care for at least six months in his/her home environment before the first-time prevention. The expenses of the caregivers can be up to EUR 1 470 in the calendar year from 1 July 2008, up to EUR 1 510 from 1 January 2010, up to EUR 1 550 from 1 January 2012 and up to 1 612 Euro from 1 January 2015 if the Replacement care is ensured by carers who are not related to the patient to the second degree or are not insured and who do not live with him in the home community. (2) In the case of a replacement care by carers, who are the person in need of care is related to the second degree, or is not in a household, or is in a household Community life, the expenses of the caregiver may not exceed the amount of the nursing care for up to six weeks in accordance with § 37 (1) sentence 3, unless the replacement care is carried out in the acquisition; in such cases it shall be the amount of benefit referred to in the third sentence of paragraph 1. In the case of a care benefit for a replacement care by caregivers, who are related to the patient to the second degree or are not in need of care, or who live with him in a domestic community, the care fund can be used by the care fund. Proof of the necessary expenses incurred by the carer in connection with the replacement treatment. The expenses incurred by the care fund under sentences 1 and 2 shall not exceed the amount referred to in the third sentence of paragraph 1. (3) In the event of a replacement after paragraph 1, the amount of the benefit may be up to € 806 from the amount not yet taken up. Funds for short-term care in accordance with § 42 (2) sentence 2 shall be increased to a total of up to € 2 418 in the calendar year. The increase in the amount of the increase in entitlement to the preventive maintenance is credited to the amount of benefit for short-term care in accordance with § 42 (2) sentence 2. Unofficial table of contents

§ 40 nursing aid and housing improvement measures

(1) In need of care, care needs to be provided with care aids, which contribute to the facilitation of care or to alleviate the complaints of the person in need of care or enable him to conduct a self-employed lifestyle, insofar as the aids are are not to be provided by health insurance or other competent service providers due to illness or disability. The care insurance fund checks the need for care with the nursing aids applied for with the participation of a nursing care professional or the medical service. If insured persons decide to equip the care assistant, which goes beyond the measure of the necessary, they will have to bear the additional costs and the resulting costs themselves. § 33 (6) and (7) of the Fifth Book applies accordingly. (2) The expenses of the caregivers for the use of nursing aids for consumption must not exceed the amount of 40 euros per month. The service can also be provided in the form of a reimbursement of expenses. (3) The care insurance funds are to leave technical care aids in all appropriate cases as a priority for the loan. They may make the authorisation subject to the need for care to adapt to the care aid, or to allow the person to train himself or the caregivers in his/her use. The claim also includes the necessary modification, repair and replacement of nursing aids as well as the training in their use. Insured, the 18. In accordance with paragraph 2 of this Article, a payment of ten per cent, but not more than EUR 25 per nurse, shall be paid to the issuing body at the cost of the care aid, with the exception of the care aid referred to in paragraph 2. In order to avoid hardship, the care fund may exempt the insured person from the surcharge in full or in part in the corresponding application of § 62 (1) sentence 1, 2 and 6, as well as (2) and (3) of the Fifth Book. Insured persons who have reached the limit of the charge applicable to them in accordance with Article 62 of the Fifth Book or, having regard to the surcharge provided for in the fourth sentence, shall be subject to the surcharge exceeding the limit of the charge for payment in accordance with of this book. If insured persons refuse to leave a nursing home without compelling reason, they have to pay the costs of the care assistant to the full extent. (4) The caregivers may subsidise financial support for measures to be taken by the To improve the individual living environment of the person in need of care, for example for technical assistance in the household, if this makes it possible for domestic care to be carried out in individual cases or to make it considerably easier or as independent as possible Life management of the person in need of care is restored. The grants may not exceed an amount of EUR 4 000 per measure. If several people in need of care live in a common apartment, the subsidies for measures to improve the common housing environment must not exceed EUR 4 000 per person in need of care. The total amount per measure under sentence 3 is limited to EUR 16 000 and is divided among more than four eligible beneficiaries on a pro rata basis. (5) For aids and care aids, which are both available in § 23 and § 33 of the Fifth Book and the purposes referred to in paragraph 1 may be used, the service provider, in which the service is requested, shall examine whether a claim exists in relation to the health insurance fund or the care fund and decides on the Approval of aids and care aids. In order to ensure that the performance obligations of the statutory health insurance and the social care insurance are defined in accordance with the first sentence of paragraph 1, the expenditure on aids and care funds shall be between the respective The sickness insurance fund and the care fund established by it are divided into a fixed ratio in a fixed proportion. The Confederation of Health Insurance Funds, the Association of Health Insurance Funds, lays down guidelines which are to be adopted for the first time by 30 April 2012, the aids and care aids according to the first sentence, the ratio in which the expenditure is to be divided, and the details of the scheme. for the implementation of the lump sum. It takes into account the previous expenditure of the health and care insurance funds and ensures that the objective of the regulations of the Fifth Book and this book on the supply of aid as well as the interests of the insured persons in the apporation is divided up into the distribution of the costs. shall be preserved. The guidelines require the approval of the Federal Ministry of Health and will enter into force on the first day of the month following the approval; the permit may be subject to conditions. The directives are binding on health and care insurance funds. In the case of the aids and care aids determined in accordance with the third sentence, the payment shall be determined in accordance with § § 33, 61 and 62 of the Fifth Book; for the examination of the right to benefits, Section 275 (3) of the Fifth Book shall apply. The provisions of this paragraph do not apply to claims on aids or care aids of persons in need of care who are in full-patient care, as well as those in need of care in accordance with § 28 (2).

Second Title
Partial inpatient care and short-term care

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Section 41 Day care and night care

(1) In-patient care is entitled to part-time care in facilities of day care or night care, if home care cannot be ensured to a sufficient extent or if this is to supplement or strengthen the home care is required. The part-inpatient care also includes the necessary transport of the person in need of care from the apartment for the establishment of the day care or the night care and back. (2) The care fund takes over as part of the benefit amounts according to sentence 2 the care-related expenses of the part-inpatient care, the expenses of the social care and the expenses for the services of the medical treatment care required in the institution. The right to partial inpatient care includes per calendar month

1.

for patients in need of care level I a total value up to

a)

420 Euro from 1 July 2008,

b)

440 Euro from 1 January 2010,

c)

450 Euro from 1 January 2012,

d)

468 Euro from 1 January 2015,

2.

for patients in need of nursing level II, a total value of up to

a)

980 Euro from 1 July 2008,

b)

EUR 1 040 from 1 January 2010,

c)

1 100 Euro from 1 January 2012,

d)

1 144 Euro from 1 January 2015,

3.

for patients in need of care level III, a total value of up to

a)

EUR 1 470 from 1 July 2008,

b)

EUR 1 510 from 1 January 2010,

c)

EUR 1 550 from 1 January 2012,

d)

1 612 Euro as of 1 January 2015.

(3) In addition to outpatient nursing care, care allowance or the combination benefit according to § 38, persons in need of care may take part-in-patient daycare and night care without taking into account any of these claims. (4) (dropped) (5) (dropped) (6) (dropped) (7) (dropped) Unofficial table of contents

§ 42 Short-term care

(1) If domestic care cannot be provided at times, not yet or not to the required extent, and is not sufficient for part-time care, there is a right to care in a fully inpatient facility. This applies:

1.

for a transitional period following a steady-state treatment of the person in need of care or

2.

in other crisis situations in which temporary home or part-time care is not possible or is not sufficient.

(2) The right to short-term care is limited to four weeks per calendar year. The care fund takes care of the care-related expenses, the expenses of the social care as well as the expenses for medical treatment services up to the total amount of 1 470 euros from 1 July 2008, 1 510 euros as of 1 January 2010, EUR 1 550 as from 1 January 2012 and EUR 1 612 from 1 January 2015 in the calendar year. The amount of benefit in accordance with the second sentence may be increased by up to EUR 1 612 from the non-eligible costs of the prevention maintenance in accordance with § 39 (1) sentence 3 to a total of EUR 3 224 in the calendar year. By way of derogation from the first sentence, the right to short-term care in this case shall be limited to a maximum of eight weeks per calendar year. The amount of the increase for short-term care shall be deducted from the amount of benefit for the prevention maintenance pursuant to § 39 (1) sentence 3. (3) By way of derogation from paragraphs 1 and 2, the right to short-term care shall consist of: , also in appropriate facilities of assistance for disabled persons and other appropriate facilities, if the care in a nursing home is authorised for short-term care by the nursing care insurance funds Care facility is not possible or appears to be unreasonable. § 34 (2) sentence 1 shall not apply. If the fee for the institution includes costs for accommodation and catering, as well as expenses for investments, without being shown separately, 60 of the hundreds of charges shall be eligible for payment. In duly substantiated individual cases, the care fund may, in view of the costs of accommodation and catering, as well as the expenses for investments, carry out a flat-rate surcharge. (4) By way of derogation from paragraphs 1 and 2, the claim shall be: on short-term care also in institutions providing in-patient services for medical care or rehabilitation if, during a measure of medical care or rehabilitation for a carer, simultaneous accommodation and care for the patient in need of care.

Third Title
Full-time care

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§ 43 Content of the performance

(1) In-patient care is entitled to care in full-patient facilities when home or part-time care is not possible or is not eligible for the special nature of the individual case. (2) For care in need of care in In the context of the flat-rate benefit amounts in accordance with the second sentence, the care fund takes over the care-related expenses, the expenses of the social care and the expenses for medical treatment care services. The entitlement shall be per calendar month

1.

for those in need of care 1 064 Euro,

2.

for those in need of care level II 1 330 Euro,

3.

for patients in need of care grade III

a)

EUR 1 470 from 1 July 2008,

b)

EUR 1 510 from 1 January 2010,

c)

EUR 1 550 from 1 January 2012,

d)

EUR 1 612 from 1 January 2015,

4.

for those in need of care which are recognised as a case of hardship in accordance with paragraph 3,

a)

EUR 1 750 from 1 July 2008,

b)

EUR 1 825 from 1 January 2010,

c)

EUR 1 918 from 1 January 2012,

d)

1 995 Euro as of 1 January 2015.

The amount to be paid by the care fund, including a dynamisation in accordance with § 30, may be 75 per cent of the total amount of the care set, remuneration for accommodation and catering and the separately predictable investment costs in accordance with § 82 (3) and (4) (3) In exceptional cases in order to avoid hardship, the caregivers may pay the care-related expenses, the expenses of the social care and the expenses for medical treatment services in a flat-rate way. in the amount of the amount in force referred to in the second sentence of paragraph 2, point 4, if a Exceptionally high and intensive care is required, which far exceeds the usual level of care grade III, for example in the case of apallics, severe dementia or in the final stage of cancers. The derogation from the first sentence may be applied to no more than 5 from the hundreds of all insured persons in need of care in nursing care level III, who are in need of inpatient care. The Confederation of Nursing Homes is responsible for monitoring compliance with this maximum rate and, if necessary, has to take appropriate measures to comply with it. (4) Select fully-patient care in need of care, although this is after the determination of the In the case of a temporary absence of care in need of care, it is not necessary to receive a subsidy in the amount of the total value provided for in section 36 (3) for the respective nursing care level. Nursing home is provided the services for full-time care, as long as the The requirements of § 87a (1) sentences 5 and 6 are fulfilled.

Fourth Title
Care in fully-stationary facilities for assistance for disabled people

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Section 43a Content of performance

For those in need of care in a full-time facility of assistance for disabled people, in which participation in working life and in life in the community, school education or the upbringing of disabled people in the foreground of the In order to comply with the provisions of Section 71 (4), the Care Fund shall reimburse the expenses referred to in § 43 (2) of 10 of the Hundred of the Heimentgelts agreed upon in accordance with Article 75 (3) of the Twelfth Book. The expenses of the caregivers may not exceed 266 euros in each individual case per calendar month. The days of arrival and departure are considered to be full days of home care for the days when the handicapped people are cared for and cared for at home.

Fourth Section
Services for carers

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§ 44 Benefits for the social protection of carers

(1) In order to improve the social security of carers within the meaning of § 19, the care insurance funds and the private insurance companies in which a private care-compulsory insurance is carried out as well as the other in § 170 para. 1 (6) of the sixth book shall make contributions to the competent institution of the statutory pension insurance scheme if the caregiver is regularly employed no more than thirty hours per week. More detailed rules § § 3, 137, 166 and 170 of the Sixth Book. The Medical Service of the Health Insurance shall determine in individual cases whether and to what extent domestic care is required by a carer, and shall ask in cases where the care of the person in need of care takes the duration of It is less than 14 hours, whether the caregion cares for other people in need of care. The person in need of care or the caregivers must explain and, on request, make it credible that care services are actually provided in this temporal extent. This is particularly the case when nursing care benefits (§ 36) are used. During the nursing profession, the caregisters are included in the insurance cover of statutory accident insurance in accordance with § § 2, 4, 105, 106, 129, 185 of the Seventh Book. Carers who wish to return to the working life after being cared for, can, in the case of continuing vocational training, be encouraged in accordance with the conditions laid down in the third book. (2) For carers who are responsible for the A compulsory membership of a professional pension scheme is also exempt from the obligation to provide insurance in the statutory pension insurance scheme or if it is in the statutory health insurance scheme Pension insurance would be subject to insurance and a request for exemption was made , the contributions to be paid under the first and second sentences of paragraph 1 shall be paid on application to the professional pension scheme. (3) The care fund and the private insurance undertaking shall be responsible for the contributions to the pension and accident insurance scheme. to report to the responsible pension and accident insurance institutions. The message for the caregier contains:

1.

their insurance number, where known;

2.

their family and first names,

3.

their date of birth,

4.

their nationality,

5.

their address,

6.

Start and end of caring,

7.

the care level of the person in need of care and

8.

the amount of contributions to be made available in accordance with Article 166 of the Sixth Book, taking into account the extent of the caring activities.

The top association of the care insurance companies and the association of private health insurance e. V. (4) The content of the notification referred to in the second sentence of the second sentence of paragraph 3 is the person responsible, the content of the notification according to the following conditions: (5) The care fund and the private insurance undertaking have the right to be paid in cases in which a non-working caregiver maintains a person in need of care. Aid or benefits of health care, and for which the contributions to the Statutory pension insurance in accordance with § 170 (1) (6) (c) of the Sixth Book are carried out on a pro rata basis, in the application procedure for benefits of the nursing care insurance from the person in need of care as of 1 June 2005 the competent arrest office for to issue the aid or to the servant's head, having regard to the intended transmission of the information referred to in the second sentence, to that body. In the event of a determination of the obligation to contribute, the specified fixing point for the aid or the service of the person concerned shall be notified of the information referred to in the second sentence of paragraph 3, points 1 to 5 and 8, as well as the beginning of the obligation to pay contributions. Paragraph 4 shall apply to the second sentence. (6) In cases where the minimum number of hours of 14-hour weekly care for a carer's pension obligation is achieved only by the care of a number of persons in need of care, have the top association of the care insurance companies, the association of private health insurance e. V. and the German Pension Insurance Association (Deutsche Rentenversicherung Bund) to regulate the procedure and the notification requirements between the care funds and insurance companies involved in the addition of care periods by agreement. The caregivers and insurance undertakings shall be entitled to the data referred to in points 4 and 5 of the second sentence of paragraph 3, points 1 to 3 and 6 and, where this is necessary for the safe identification of the caregivers, as well as the indication of the data referred to in points 4 and 5. the time-scale of caring for the caregivers to other caregivers and insurance companies involved in the addition of care periods for the purpose of checking the conditions of the caregivers ' pension obligation and to process and use data transmitted to them. Unofficial table of contents

§ 44a Additional services in the case of long-term care and short-term work prevention

(1) Employees who have been fully exempted from work performance in accordance with § 3 of the nursing-time act or whose employment by reducing working time to a minor employment within the meaning of § 8 (1) No. 1 of the Fourth Book , receive grants for health and nursing care insurance upon application. Grants are granted for voluntary insurance in statutory health insurance, compulsory insurance in accordance with § 5 (1) No. 13 of the Fifth Book or pursuant to § 2 (1) No. 7 of the Second Law on the Health Insurance of the farmers, insurance with a private health insurance company, insurance with the post-office sickness insurance fund or the health care of the Federal Railways Officers, to the extent that non-contributory family insurance is not possible in individual cases, as well as for a related care compulsory insurance. The grants amount to the amount of the minimum contributions paid by persons voluntarily insured in the statutory health insurance to the statutory health insurance (§ 240 para. 4 sentence 1 of the Fifth Book) and to the social insurance company. care insurance (§ 57 (4)) are to be paid and may not exceed the actual amount of the contributions; from 1 January 2009 for the calculation of the minimum contributions to statutory health insurance, the general contribution rate shall be paid on the basis of In the period from 1 July to 31 December 2008, members of the statutory health insurance scheme will be responsible for the general contribution rate of the respective health insurance fund (§ 241 of the Fifth Book), in the case of members of the agricultural health insurance scheme of the the average general contribution rate of the health insurance funds, as well as the additional contribution rate of 0.9 of the hundred (§ 241a of the Fifth Book). In the case of persons who are not members of the statutory health insurance, the average general contribution rate of the health insurance funds in accordance with § 245 (1) of the Fifth Book and of the additional health insurance funds will be available in the period from 1 July to 31 December 2008. Contribution rate of 0.9 of the hundred (§ 241a of the Fifth Book) is based on the principle of the contribution rate. Employees shall immediately inform the carer or the private insurance undertaking in which the person in need of care is entitled to make changes in the conditions that may affect the grant. (2) Care Persons are insured in accordance with the provisions of the Third Book according to the law of the employment promotion during the use of a period of care in accordance with the nursing-time law. (3) For short-term work prevention according to § 2 of the nursing-time law, a Employed or employed persons within the meaning of Section 7 (1) of the Nursing-time law, which is not paid for this period by the employer and no sickness or injury-benefit in case of illness or accident of a child according to § 45 of the Fifth Book or pursuant to § 45 paragraph 4 of the Seventh Book Entitlement to compensation for lost pay (maintenance support allowance) for up to a total of ten working days. If several employees assert the right under § 2 (1) of the nursing care law for a close family in need of care, their entitlement to care support allowance is limited to a total of up to ten working days. The care support allowance shall, upon application to be submitted immediately, under the submission of the medical certificate pursuant to § 2 (2) sentence 2 of the nursing-time law, by the care insurance fund or the insurance company of the dependent close to care Members granted. For the amount of the care support allowance, § 45 (2) sentences 3 to 5 of the Fifth Book shall apply. (4) Employees receiving care support allowance in accordance with paragraph 3 shall receive for the duration of the benefit from those referred to in paragraph 3. shall apply to health insurance in the event of application. Grants are granted for insurance with a private health insurance company, insurance with the Postal Sickness Insurance Fund or the health care of the Federal Railways Officers. The grants amount to the amount that would be paid in the case of compulsory insurance in the statutory health insurance as a part of the service according to § 249c of the Fifth Book, and may not exceed the actual amount of the contributions. For the purposes of the calculation referred to in the third sentence, the general contribution rate in accordance with Section 241 of the Fifth Book and the average additional contribution rate in accordance with Section 242a (2) of the Fifth Book shall be used. In the case of employees who receive care support allowance in accordance with paragraph 3 and are exempt from compulsory insurance in the statutory pension insurance scheme due to a compulsory membership of a professional pension scheme, they shall pay in Article 170 (1) (2) (e) of the Sixth Book, upon request, contributions to the relevant professional pension scheme, such as those relating to the entry of compulsory insurance pursuant to § 3, first sentence, point 3 of the Sixth Book to the statutory pension insurance. (5) The care insurance fund or the private care insurance undertaking of the close family in need of care, the benefit person shall, in accordance with paragraph 3, provide the benefit certificate with a certificate covering the period of the reference and the amount of the aid granted Care support money. The benefit person shall immediately submit this certificate to his employer. In the cases referred to in Article 170 (1) (2) (e) (e) (cc) of the Sixth Book, the care insurance fund or the private insurance company certifies the entire amount of the benefit. (6) Agricultural entrepreneurs within the meaning of Section 2 (2) (b) (b) 1 (1) and (2) of the Second Law on the Health Insurance of Farmers, which are prevented from running the company, because they meet the needs of a close family in need of care in an acute care situation. Organize care or ensure a nursing care in this time shall be granted for up to ten working days in accordance with Section 9 of the Second Law on the Health Insurance of Farmers, instead of the maintenance support money. The cost of the service for the assistance will be reimbursed to the agricultural caregivers from the nursing care insurance of the close relatives in need of care; within the social care insurance scheme, a refund shall be waiving. Privately insured agricultural entrepreneurs who are prevented from running the company because this is necessary in order to meet the needs of a close family in need of care in an acute care situation To organise care or to ensure a nursing care in this period, receive from the care insurance fund of the person in need of care or in the amount of the rate of refund from the private insurance company of the person in need of care a Reimbursement of costs for up to ten working days of operational assistance; shall be based not on the actual costs but on a lump sum of EUR 200 per day of operational assistance. (7) The care fund and the private insurance undertaking shall have in those cases where a benefit referred to in paragraph 3 A close relative who is in need of care, who is entitled to benefits or benefits of health care, and who is proportionally worn for the contributions, in the application procedure for care support money from the person in need of care, who are the competent authorities responsible for the aid or the dientherrn, for the intended information of this body on the contributor to the contributor to the care support allowance. In the event of a determination of the obligation to pay the aid, the specified point of order for the aid or the specified dienser shall be informed of the following information on the benefit:

1.

the insurance number, where known,

2.

the family and the first name,

3.

the date of birth,

4.

nationality,

5.

the address,

6.

the beginning of the reference to care support money and

7.

the amount of the lost pay on the basis of the care support allowance.

Unofficial table of contents

§ 45 Care courses for relatives and volunteer carers

(1) The care funds should offer training courses free of charge for relatives and other persons interested in voluntary caring activities, in order to promote and strengthen social commitment in the field of care, care and support for facilitate and improve care-related physical and mental stress. The courses are intended to provide skills for the independent implementation of care. The training should also take place in the home environment of the person in need of care. (2) The care insurance fund can carry out the courses either themselves or together with other care funds or other suitable other facilities with the implementation (3) On the uniform implementation as well as on the content-related design of the courses, the regional associations of the caregivers can conclude framework agreements with the institutions of the institutions which carry out the nursing courses.

Fifth Section
Benefits for insured persons with considerable general care requirements, additional care and relief services and further development of the care structures

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Section 45a Authorised persons

(1) Unless otherwise specified, the benefits in this section concern those in need of care in home care where, in addition to the need for assistance in the area of basic care and domestic care (§ § 14 and 15), a significant amount of care is required. There is a need for general supervision and care. These are:

1.

Care units I, II and III in need of care, and

2.

persons who have a need for assistance in the area of basic care and domestic care who do not reach the level of care grade I,

With dementia-related disability, mental disabilities or mental illness, in which the medical service of the health insurance or the reviewers commissioned by the care insurance fund as part of the evaluation according to § 18 as a result the disease or disability has had an impact on the activities of daily life, which have led to a significant reduction in everyday competence. (2) For the evaluation, whether the restriction of everyday competence is significant in the long term, the following damage and inability to perform authoritative:

1.

uncontrolled abandonation of the living area (trend tendency);

2.

Disguising or convicting situations which are dangerous;

3.

incorrect handling of dangerous objects or potentially hazardous substances;

4.

aggressively or verbally aggressive behaviour in the face of the situation;

5.

appropriate behaviour in the situational context;

6.

Inability to perceivate their own physical and mental feelings or needs;

7.

Inability to cooperate with therapeutic or protective measures as a consequence of a therapy-resistant depression or anxiety disorder;

8.

Disorders of the higher brain functions (impairments of memory, reduced judgment), which have led to problems in coping with everyday social services;

9.

Disturbance of the day/night rhythm;

10.

Inability to independently plan and structure the daily routine;

11.

Disregard everyday situations and inadequately react in everyday situations;

12.

distinct, unstable or uncontrolled emotional behaviour;

13.

predominantly low-time, tenderness, helplessness, or hopelessness due to a therapy-resistant depression.

The daily competence is considerably restricted if the reviewer of the medical service or the reviewers commissioned by the care fund in the person in need of care at least in two areas, of which at least once in one of the areas 1 up to 9, permanent and regular damage or capability disorders. The top association of the nursing insurance companies decides with the Association of Private Health Insurance (private health insurance). V. with the participation of the municipal top associations at the federal level, the relevant organizations for the perception of the interests and self-help of those in need of care and disabled persons at the federal level and the medical service of the Top association of the health insurance companies in addition to the guidelines in accordance with § 17 the more detailed evaluation and determination of the significant and lasting needs for general supervision and supervision. Unofficial table of contents

Section 45b Additional care and discharge services, Regulation empowerment

(1) insured persons who fulfil the conditions laid down in § 45a may, depending on the extent of the considerable general care requirement, benefit from additional care and relief services. The costs will be replaced, but not more than 104 euros per month (basic amount) or 208 euros per month (increased amount). The amount of the respective entitlement in accordance with the second sentence shall be determined by the care fund on a case-by-case basis on the recommendation of the Medical Service of the Health Insurance, and shall be communicated to the insured person. The top association of the nursing funds decides, with the participation of the Medical Service of the top association of the health insurance companies, the association of private health insurance e. V., the municipal leaders ' associations at the federal level and the relevant organizations for the perception of the interests and self-help of those in need of care and disabled people at federal level guidelines on uniform standards for the Evaluation of the assistance needs due to damage and disability in the areas listed in § 45a (2) (1) to (13) for the recommendation of the Medical Service of the Health Insurance for the assessment of the respective levels of the The amount of care and relief; § 17 para. 2 shall apply accordingly. The amount is to be used for the purpose of quality-assured services of care or discharge. It shall be used to reimburse expenses incurred by the insured in connection with the use of benefits

1.

of day or night care,

2.

short-term care,

3.

the approved care services, in so far as they are special offers of general guidance and care or offers of domestic care, and not basic care services, or

4.

the low-threshold care and discharge services recognised under national law, which are eligible or eligible pursuant to § 45c.

Expenses shall also be reimbursed if funds for the maintenance of the care and discharge services referred to in § 39 are used for the financing of the care and discharge services referred to in sentence 6. (1a) In need of care, those in need of care who do not fulfil the conditions of the § § § 45a may also take additional care and discharge services as referred to in paragraph 1. The costs for this will be reimbursed up to an amount of EUR 104 per month. (2) The beneficiaries will receive the additional financial resources at the request of the competent care insurance fund or the competent private Insurance undertakings and, in the case of entitlement to aid, pro rata from the State aid control body against presentation of the relevant documents relating to the personal charges incurred in connection with the use of the benefits referred to in paragraph 1. The performance referred to in paragraphs 1 and 1a may be used within the respective calendar year; if the benefit is not exhausted in a calendar year, the amount not consumed may be transferred to the following calendar half-year . If the amount of additional care has not been exhausted after the law applicable until 30 June 2008, the non-consumed calendar amount can be transferred to the second half of 2008 and to 2009. (3) To the extent that no out-patient care benefits have been received for the corresponding benefit amounts in accordance with § § 36 and 123 in the relevant calendar month, the insured persons entitled to the benefit under paragraph 1 or paragraph 1a may be credited with the appropriate amounts. their entitlement to outpatient care services Benefits of low-threshold the provision of care and discharge services in addition to the amounts referred to in paragraphs 1 and 1a. The amount used in the case of low-threshold care and discharge services in accordance with the first sentence shall not exceed 40 per calendar month of the maximum amount for out-patient care provided for the level of care in question. The basic care and the domestic care in individual cases must be ensured. The expenses incurred by the claimant in connection with the use of the low-threshold care and relief services as set out in the first sentence shall be reimbursed; the first sentence of paragraph 2 shall apply accordingly. The remuneration for outpatient care services is to be deducted as a priority. In the context of the combination performance in accordance with § 38, the reimbursement of expenses shall be deemed to be the use of the in-kind benefits to the claimant in accordance with § 36 (3) and (4) and § 123. If beneficiaries receive the benefit in accordance with the first sentence, § 37 (3) to (5), (7) and (8) shall apply; § 37 (6) shall apply with the proviso that a reduction or withdrawal shall be made in respect of the reimbursement of expenses in accordance with sentence 4. Article 13 (3a) shall not apply to the use of the benefit provided for in the first sentence. The Federal Ministry of Health shall evaluate the possibility of using the benefits provided for in § § 36 and 123 for the provision of outpatient care services, including for the services of low-threshold care and care services. (4) The national governments are authorized, by means of a regulation, to provide for the recognition of the low-threshold care and care and Relief offers, including the requirements for regular quality assurance of the To determine offers. Low-threshold offers, which meet the requirements of § 45c (3) and § 45c (3a), may receive joint recognition as a service and relief offer, subject to compliance with the respective conditions of recognition. Unofficial table of contents

Section 45c Further development of supply structures, regulation empowerment

(1) In order to further develop the supply structures and supply concepts, in particular for people in need of dementia care, the Association of the Association of Nursing Care Funds (Confederation of Nursing Care Funds) is funding the compensation fund by means of equity financing with 25 million Euro per calendar year the establishment and expansion of low-threshold support services as well as pilot projects for the testing of new supply concepts and supply structures, in particular for dementia sufferers. Similarly, from the funds referred to in the first sentence, low-threshold relief offers can be provided for those in need of care with at least Care Level I as well as for insured persons without a level of care who, due to their significantly reduced daily life skills, are Meet the requirements of § 45a. The private insurance companies carrying out private nursing care insurance are participating in this support with a total of 10 per cent of the funding volume referred to in the first sentence. (2) The grant from social and private funds Care insurance supplements the promotion of the low-threshold care and discharge offers and the model projects for the further development of the care structures for those in need of care with at least Care Level I as well as for insured persons without Maintenance level, which is the result of considerably reduced everyday competence According to § 45a, by the respective country or the respective municipal authority. The grant will be granted at the same level as the grant awarded by the country or by the local authority for the individual funding measure, so that a total funding volume of 50 million euros in the calendar year is reached. To the extent that funds are used for the purpose of promoting a project, these are equivalent to a grant paid by the country or by the municipality. (3) Low-threshold childcare services within the meaning of the first sentence of paragraph 1 are services provided by: Helpers and helpers under the guidance of caregivers for the care of persons in need of care with at least Care Level I as well as insured persons without a level of care who, due to their considerably reduced everyday competence, are subject to the requirements of § 45a , take over in groups or in the home, as well as caring for To relieve and advise relatives and comparably close-up carers. The promotion of these low-threshold care services is carried out as a project grant and serves in particular to finance expenses for the voluntary caregivers, as well as the necessary personnel and material costs, which are provided by the The coordination and organisation of the aid and the technical guidance and training of carers by professionals are connected. The application for funding shall be accompanied by a concept for quality assurance of the care provision. The concept must show that adequate training and further training of the helpers, as well as continuous technical support and support for the volunteers, are secured in their work. As a generally eligible, low-threshold care provision come into consideration in particular care groups for dementia sufferers, helpers ' fees for the hours of relief of caring relatives in the home area, day care in Small groups or individual care by recognised helpers, agencies for the provision of care services for those in need of care with at least Care Level I as well as for insured persons without a level of care, which are due to considerably reduced everyday competence. meet the requirements of § 45a, and Family-relieving services. (3a) Low-threshold relief offers within the meaning of the second sentence of paragraph 1 are offers for persons in need of care with at least Care Level I and for insured persons without a level of care, which are significantly reduced Fulfil the requirements of § 45a, which meet the requirements of the beneficiaries of support in the household, in particular in the case of domestic care, in the management of general or care-related Requirements of everyday life or of the self-responsible organisation Individually required assistance services, or which help to relieve relatives or comparable close-up people in their capacity as caregivers. Low-threshold relief offers include the provision of services, an existing resources and skills strengthening or stabilizing everyday support, organizational assistance, support services for Relatives and comparable close-up persons in their capacity as caregivers to cope with the daily care routine or other appropriate measures. The provisions of the second sentence of paragraph 3 shall apply accordingly. As a general principle, eligible low-threshold relief offers come in particular into consideration service offers for household-related services, daily attendants, as well as foster attendants. (4) As part of the model support provided for in the first sentence of paragraph 1 In particular, the aim is to test the possibilities of an effective networking of the necessary aid for dementia patients in need of care and the conditions laid down in § 45a of the insured person without a nursing level in individual regions. In this case, stationary supply offers can also be taken into account. The model projects are to be limited to a maximum of five years. In the case of the agreement and implementation of pilot projects, the regulations of the seventh chapter can be used to deviate from the agreement. A scientific monitoring and evaluation shall be provided for the pilot projects. To the extent that personal data are required within the framework of the model projects, these can only be collected, processed and used without the consent of the insured person who is in need of care or the conditions of § 45a without a nursing level. (5) In order to ensure a fair distribution of care insurance funds to the countries, the funds of the social and private nursing care insurance are allocated according to the king's key. Funds which are not used in a country in the respective financial year can be transferred to the following year. (6) The top association of the nursing insurance companies decides with the Association of Private Health Insurance (private health insurance). V. after hearing the associations of the disabled and those in need of care at the federal level, recommendations on the conditions, objectives, duration, content and implementation of the funding, as well as on the procedure for the award of the funding for the low-threshold Care and discharge offers and the model projects. The recommendations also indicate, inter alia, that in each individual case it is necessary to consider whether funds and opportunities for the promotion of employment can be used within the framework of the new care and discharge options and supply concepts. The recommendations are subject to the approval of the Federal Ministry of Health and the Länder. The national governments are empowered to determine, by means of a legal regulation, the details of the implementation of the recommendations. (7) The share of finance which is attributable to private insurance companies may be provided by the Association of Private Insurance Companies. Health insurance e. V. is transferred directly to the Federal Insurance Office for the benefit of the compensation fund of the nursing care insurance scheme (§ 65). The Federal Insurance Office, which is responsible for the payment and settlement of the financing part of the private insurance undertakings, shall regulate the payment and settlement of the financing provided by the private insurance undertakings. Top association of the care insurance funds and the association of private health insurance e. V. by agreement. Unofficial table of contents

§ 45d Promotion of volunteer structures and self-help

(1) In the appropriate application of Section 45c, the funds of the compensation fund provided for there, which are the leading association of the caregivers ' association, may be used to promote the further development of the supply structures and supply concepts, in particular for: dementia sufferers are available, also used to promote and develop groups of volunteers as well as other persons who are prepared to engage in civic engagement, who support, general care and relieving the care of those in need of care, of persons with a significant general interest (2) Each insured person will use EUR 0.10 per calendar year for the promotion and development of self-help groups, organisations and contact points, which are supported by the support provided by the of those in need of care, of persons with considerable general care needs and their relatives. In this connection, the requirements of § 45c and the procedure there are applied accordingly. Self-help groups are voluntary, neutral, independent and non-profit groups of individuals who, either on the basis of their own concern or as members, pursue the goal, through personal, mutual support, Also with the assistance of offers of voluntary and other persons prepared for the civic engagement, the living situation of persons in need of care, of persons with considerable general care needs as well as their relatives. . Self-help organizations are the associations of self-help groups in associations. Local or regional professional advisory services with full-time staff, which pursue the goal of the living situation of people in need of care, of persons with considerable general knowledge of the general public, are self-help centres. the need to improve care and their dependants. A promotion of self-help according to this provision is excluded, insofar as for the same purpose a grant is made according to § 20c of the Fifth Book. (3) § 45c (6) sentence 4 applies accordingly.

Sixth Section
Initiative programme for the promotion of new forms of housing

Unofficial table of contents

§ 45e start-up financing for the establishment of outpatient housing groups

(1) In order to promote the establishment of outpatient residential groups, those in need of care who are entitled to benefits in accordance with § 38a and who are involved in the joint establishment shall be required to redesign the shared flat in addition to the amount pursuant to § 40 paragraph 4, an amount of up to € 2 500 is granted once. The total amount per housing group is limited to EUR 10 000 and is divided among more than four eligible persons in proportion to the insurance institutions of the beneficiaries. The application shall be submitted within one year of the existence of the eligibility requirements. In this case, the redesign measure can also be carried out before the foundation and the drawing-in. The rates 1 to 4 apply to the insured persons of the private care compulsory insurance. (2) The caregivers pay the amount of funding if the establishment of an outpatient caravan is proven. The claim ends with the end of the month in which the Federal Insurance Office (Bundesversicherungsamt) and the Association of Private Health Insurance (Bundesversicherungsamt) are responsible for the health insurance. V. has announced that a total of 30 million euros has been achieved with the aid. Details of the conditions and the procedure for the promotion are regulated by the Association of the Confederation of Nursing Societies in agreement with the Association of Private Health Insurance ("Verband der Private Krankenversicherung" e. V. Unofficial table of contents

§ 45f Further development of new residential forms

(1) In addition, 10 million euros will be made available for the scientifically supported further development and promotion of new forms of living. In particular, such concepts are to be included, which make it possible, as an alternative to stationary facilities, to offer individual care services outside the full-patient care system. (2) Institutions which, for this reason, are responsible for this have already received a model support, in particular in accordance with Article 8 (3), are exempted from the support provided for in the first sentence of paragraph 1. § 8 (3) shall apply mutatily for the promotion.

Fifth chapter
Organization

First section
Institution of the care insurance

Unofficial table of contents

Section 46 Care funds

(1) Care insurance institutions are the care insurance funds. For each health insurance company (§ 4 para. 2 of the Fifth Book), a care fund is established. The Deutsche Rentenversicherung Knappschaft-Bahn-See as institution of the health insurance carries out the care insurance for the insured persons. (2) The care insurance companies are legal entities of the public law with self-administration. The organs of the caregivers are the organs of the health insurance companies in which they are established. The employer (dienstherr) of the employees working for the care fund is the health insurance fund at which the care fund is built. Health insurance funds and care insurance funds can set the amount of contributions to health insurance and nursing care insurance in a joint statement of contributions for members who have to pay their health insurance contributions themselves. The member should be informed that the notice of the contribution to the care insurance is given on behalf of the care insurance fund. In the execution of this book, the First Chapter of the Tenth Book is to be applied. (3) The administrative costs, including the personnel costs incurred by the health insurance funds on the basis of this book, shall be provided by the care funds in the amount of 3.5 from the A hundred of the average value of benefits and contribution income shall be reimbursed; the amount of the refund for the individual health insurance fund shall be half of the expenses of the respective care fund for nursing advice in accordance with Section 7a (4) sentence 5 and by reduce the expenditure on payments in accordance with section 18 (3b). In the calculation of the refund, the contribution income shall be reduced by the contribution income intended to be transferred to the Social Care Insurance Fund in accordance with Section 135. The total amount of the administrative costs of all health insurance funds to be reimburzed in accordance with the first sentence shall be allocated to the health insurance funds in accordance with the expenditure actually incurred (contribution to/benefit of benefits). The top association of the nursing funds determines the details of the distribution. In addition, the caregivers take over 50 of the costs of the medical service provided by the health insurance medical service. Personnel administration costs, which are reimbursed by a health insurance fund, are to be passed on to the employer if he or she carries the personnel costs of the occupational health insurance fund in accordance with section 147 (2) of the fifth book. The administrative burden in the social care insurance is to be reviewed after the expiration of one year after the entry into force of this law. (4) The Federal Ministry of Health is authorized to act by means of a legal regulation with the consent of the Federal Council For more information on the reimbursement of administrative costs, and to redefine the amount of the administrative expenses, if the review of the administrative expenses as referred to in paragraph 3 sentence 6 justifies it. (5) For association, dissolution and closure a health insurance company, § § 143 to 172 of the Fifth Book for the Book of the (6) The supervision of the care insurance funds shall lead to the supervision of the health insurance funds. At least every five years, the Federal Insurance Office and the top administrative authorities of the Länder responsible for social security have the business, accounting and operational management of the care funds under their supervision and their supervision. To examine working groups. The Federal Ministry of Health can examine the federal direct care funds and their working communities, the top administrative authorities of the Länder responsible for social security can check the countrydirect Caregivers and their communities are transferred to a public audit institution which is independent in the conduct of the audit. The audit shall cover all business operations and shall include the verification of its legality and economic viability. The caregivers and their working groups shall, on request, submit all the documents and provide all the information necessary for carrying out the examination. Section 274 (2) and (3) of the Fifth Book shall apply accordingly.

Footnote

Section 46 (6) sentence 1 G v. 28.5.2008 I 874 mWv 1.7.2008: Bayern-Deviation by Article 7 (2) sentence 2 of the Law on the Implementation of the Social Acts (SGAG BY) v. 8.12.2006 GVBl BY 2006, 942 mWv 1.1.2010 (cf. BGBl I 2010, 8) Unofficial table of contents

§ 47 Statute

(1) The Articles of Association shall contain provisions on:

1.

the name and seat of the care fund,

2.

District of the care insurance fund and circle of members,

3.

the rights and obligations of the institutions,

4.

the nature of the decision-making of the representative assembly;

5.

Measurement of compensation for organ members as far as they carry out the tasks of the nursing care insurance,

6.

annual audit of the holding and accounting management and acceptance of the annual accounts,

7.

the composition and seat of the office of opposition; and

8.

Type of notices.

(2) The Articles of Association may contain a provision under which the care fund may provide the conclusion of private care supplementary insurance between its insured and private health insurance undertakings. (3) The Articles of Association and their amendments shall require the authorisation of the authority responsible for approving the statutes of the health insurance fund at which the care fund is established. Unofficial table of contents

Section 47a-Combating misconduct in the health sector

(1) § 197a of the Fifth Book applies accordingly; § 197a (3) of the Fifth Book applies with the proviso, also with the institutions of social assistance determined by national law, which are responsible for the assistance in the sense of the seventh chapter of the Twelfth Book to work together. The organisational units in accordance with § 197a (1) of the Fifth Book are the places to combat misconduct in the health care system of the nursing care funds, their national associations and the top association of the care insurance funds. (2) The institutions in accordance with the second sentence of paragraph 1, personal data collected or transmitted or transmitted to them for the performance of their tasks may be transmitted to each other, to the extent that this is necessary for the determination and control of: Healthcare misconduct is required by the recipient. The institutions referred to in the second sentence of paragraph 1 may only transmit personal data to the social assistance providers under national law responsible for the care provided for in accordance with the seventh chapter of the Twelfth Book, to the extent that this is not the case. necessary for the identification and combating of wrongdoing in connection with the provisions of the Seventh Chapter of the Twelfth Book, and in individual cases there are specific indications of this. The recipient may process and use this data only for the purpose for which it has been transmitted to it. Likewise, the social assistance institutions designated under national law responsible for the care provided for in the seventh chapter of the twelfth book may have personal data collected or collected by them for the purpose of carrying out their duties or tasks, , to the institutions referred to in the second sentence of paragraph 1, to the extent that this is necessary for the identification and combating of misconduct in the health care system at the recipient's disposal. The bodies referred to in the second sentence of paragraph 1 may process and use them only for the purpose for which they have been sent to them. The bodies referred to in the second sentence of paragraph 1, as well as those responsible under national law, of the social assistance which are responsible for the care provided for in the seventh chapter of the twelfth book shall ensure that the personal data only to be authorized or to be passed on to them only.

Second section
Jurisdiction, membership

Unofficial table of contents

§ 48 Responsibility for insured persons of a sickness insurance fund and other insured persons

(1) The care insurance is responsible for the implementation of the nursing care insurance, which is established by the health insurance company, where there is a compulsory membership or voluntary membership. The care fund of the member is responsible for family insured persons in accordance with § 25. (2) For persons insured under § 21 (1) to (5), the care insurance fund is responsible for the health insurance, which is provided by the service provider in the The disease trap is charged. If no health insurance is charged with the provision of services in case of illness, the insured person can choose the care fund in accordance with paragraph 3. (3) Persons who are insured under § 21 no. 6 may choose the membership of the Care Fund, which shall

1.

of the health insurance company which would belong to them if they were subject to insurance in the statutory health insurance,

2.

the General Local Sickness Fund of their place of residence or habitual residence is established,

3.

if they belong to the group of members who are allowed to take up the selected replacement payment.

From 1 January 1996 they can choose the membership of the care insurance fund, which is set up by the health insurance company, which they could choose according to § 173 para. 2 of the Fifth Book if they would be subject to insurance in the statutory health insurance. Unofficial table of contents

§ 49 Membership

(1) The membership of a care insurance fund begins with the day on which the conditions of § 20 or § 21 are fulfilled. It shall end with the death of the member or on the expiry of the day on which the conditions of § 20 or § 21 are deleted, unless the right to further insurance is exercised in accordance with § 26. § § 186 (11) and § 190 (13) of the Fifth Book apply mutah. (2) For the continued existence of membership, § § 189, 192 of the Fifth Book and Section 25 of the Second Law are applicable to the continued existence of the membership. Health insurance of farmers according to. (3) Membership of voluntary insurers according to § § 26 and 26a ends:

1.

with the death of the Member, or

2.

by the end of the next calendar month, calculated from the month in which the member declares the withdrawal, if the statutes do not determine an earlier date.

Third Section
Notifications

Unofficial table of contents

§ 50 Reporting and disclosure requirements for members of the social care insurance

(1) All members subject to an insurance obligation pursuant to § 20 shall immediately register themselves with the care fund responsible for them. This does not apply if a third party already has a notification in accordance with § § 28a to 28c of the Fourth Book, § § 199 to 205 of the Fifth Book or § § 27 to 29 of the Second Act on the Health Insurance of Farmers for the statutory health insurance ; the notification of statutory health insurance shall include the notification of social care insurance. In the case of voluntarily insured members of the statutory health insurance, the declaration of accession to the statutory health insurance shall be deemed to be a notification of social care insurance. (2) For the members of the statutory health insurance pursuant to § 21 of the members of the statutory health insurance Report to the responsible care fund:

1.

the supply office for beneficiaries under the Federal Supply Act or in accordance with the laws providing for the corresponding application of the Federal Supply Act,

2.

the Compensation Office for beneficiaries of war-related or comparable benefits under the Burden-Equalisation Act or the Reparation Damage Act or the ongoing aid under the Refugee Assistance Act,

3.

the carrier of the POW for recipients of current benefits of supplementary assistance for subsisting in accordance with the Federal Supply Act or in accordance with the laws which provide for the corresponding application of the Federal Supply Act,

4.

the service provider of youth assistance for recipients of current benefits for maintenance according to the Eighth Book,

5.

the service provider for health care workers according to the Federal Indemnity Act,

6.

the Dienstherr for soldiers on time.

(3) Persons who are insured or are considered as insured persons shall have the care insurance fund, insofar as they are not subject to information according to § 28o of the Fourth Book,

1.

, at the request of all the facts required for the determination of the obligation of insurance and contribution and for the performance of the tasks entrusted to the caretaker ' s fund, to provide immediate information,

2.

Any changes in the conditions which are significant for the determination of the insurance and contribution obligation and which are not reported by third parties shall be notified immediately.

They shall, on request, submit without delay the documents from which the facts or the change in the circumstances emerge shall be submitted to the caretaker in their premises. (4) The care fund shall be created by a breach of the obligations laid down in paragraph 1. 3 additional expenses, it can request the refund from the pledge. (5) The health insurance funds shall transmit the personal data necessary for the performance of their tasks to the caregivers. (6) For the reports of the care insurance funds to the Pension insurance institutions shall apply in accordance with § 201 of the Fifth Book. Unofficial table of contents

Section 51 Notifications in the case of members of the private nursing care insurance

(1) The private insurance undertaking shall have persons insured with him against sickness and, in spite of a request, within six months of the entry into force of the Care Insurance Act, in the case of new financial statements of Health insurance contracts within three months of the conclusion of the contract, have not concluded a private health insurance contract, to report immediately to the Federal Insurance Office (Bundesversicherungsamt). The insurance company also has to report to policyholders who are in default with the payment of six monthly premiums. The Federal Insurance Office can be registered with the Association of Private Health Insurance. More information about the reporting procedure. (2) The Dienstherr has to report to the Federal Insurance Office for health-care persons who are not insured for private health insurance or are members of the statutory health insurance. The Postal Officers ' Health Insurance Fund and the health care of the Federal Railway Officers shall notify the Federal Insurance Office of the members and members of the insured family who are insured with these bodies at the time of the entry into force of the law. (3) The reporting requirements also apply to cases in which an existing private nursing care insurance is terminated and the conclusion of a new contract is not established with another insurance company.

Fourth Section
Perception of the association tasks

Unofficial table of contents

Section 52 Tasks at the country level

(1) The regional associations of the local health insurance funds, the occupational health insurance funds and the inhealth insurance funds, the Deutsche Rentenversicherung Knappschaft-Bahn-See, which as a national association pursuant to Article 36 of the Second Law on the Health Insurance of Farmers Agricultural health insurance as well as the replacement coffers shall carry out the tasks of the regional associations of the care insurance funds. § 211a and § 212 (5) sentences 4 to 10 of the Fifth Book apply accordingly. (2) For the tasks of the national associations pursuant to paragraph 1, § 211 of the Fifth Book shall apply accordingly. In particular, the national associations have to support the Association of the Association of Nurses in the performance of their duties. (3) For the supervision of the national associations in the field of the tasks referred to in paragraph 1, § 208 of the Fifth Book is applicable. (4) As far as in this book the national associations of the nursing staff perform tasks, the bodies listed in paragraph 1 shall act. Unofficial table of contents

Section 53 Tasks at the federal level

The top association of the health insurance companies is responsible for the tasks of the top association of the nursing funds. § § 217b, 217d and 217f of the Fifth Book apply accordingly. Unofficial table of contents

Section 53a Cooperation of medical services

The top association of the nursing insurance companies provides guidelines for the area of social care insurance policies

1.

on the cooperation of the caregivers with the medical services,

2.

to carry out and ensure a uniform assessment,

3.

on the reports and statistics to be transmitted by the medical services,

4.

on quality assurance of evaluation and advice, as well as on the procedure for carrying out quality audits and quality assurance of quality audits,

5.

on the principles of continuing education and training.

The guidelines require the approval of the Federal Ministry of Health. They are binding for the medical services. Unofficial table of contents

Section 53b Appointment of other independent reviewers by the care funds in the procedure for determining the need for care

(1) By 31 March 2013, the Confederation of Nursing Homes shall issue directives for the cooperation of the caregivers with other independent experts in the procedure for the determination of the Need for care. The directives are binding on the caregivers. (2) The guidelines regulate in particular the following:

1.

the requirements for the qualification and independence of the verifiers;

2.

the procedure to ensure that the independent reviewers appointed by the caregivers, in determining the need for care and assigning them to a level of care, are the same standards as the Medical Service of the Apply health insurance,

3.

ensuring the provision of services in the appraisal process; and

4.

the inclusion of the expert opinions of the reviewers appointed by the care funds in the quality assurance procedure of the medical services.

(3) The guidelines require the approval of the Federal Ministry of Health.

Sixth chapter
Financing

First section
Contributions

Unofficial table of contents

§ 54 Principle

(1) The funds for the care insurance are covered by contributions and other income. (2) The contributions shall be based on a percentage (contribution rate) of the contributory income of the members up to the ceiling for the assessment of contributions (§ 55). collected. The contributions shall be paid for each calendar day of membership, provided that this book does not determine any deviating. For the calculation of the contributions, the week shall be seven, the month to 30 and the year to 360 days. (3) The provisions of the Twelfth chapter of the Fifth Book shall apply accordingly.

Footnote

Section 54 (1) and 2: In accordance with the decision formula, incompatible with the GG. BVerfGE v. 3.4.2001 I 774-1 BvR 1629/94- Unofficial table of contents

§ 55 Contribution rate, contribution rate limit

(1) The contribution rate shall be equal to 2.35 per cent of the contributions of the members, which shall be subject to contributions, and shall be fixed by law. For persons in which § 28 (2) applies, the contribution rate shall be half the contribution rate in accordance with the first sentence. (2) Contributor income shall be subject to the amount of 1/360 of the amount specified in Section 6 (7) of the Fifth Book. (3) The contribution rate referred to in the first and second sentences of paragraph 1 shall be increased for members after the end of the month in which they shall be 23. Have completed a contribution surcharge of 0.25 contribution rate points (contribution surcharge for childless). Sentence 1 shall not apply to parents within the meaning of Article 56 (1), first sentence, No. 3 and (3) Nos. 2 and 3 of the First Book. The parent's property shall be shown in a suitable form with regard to the post office, of self-payers to the care fund, provided that the parent's property is not already known for other reasons. The Association of the Covenant of Nurses provides recommendations on which evidence is appropriate. If the proof of proof is submitted within three months of the birth of the child, proof shall be deemed to have been provided at the beginning of the month of birth, otherwise the proof shall have effect from the beginning of the month following the month in which the proof of the child's birth has been completed. is provided. Evidence of children born before 1 January 2005, to be provided by 30 June 2005, shall be effective from 1 January 2005. The first sentence shall not apply to members who were born before 1 January 1940, to persons performing military or civil service and to persons receiving unemployment benefit II. (3a) The parents referred to in the second sentence of paragraph 3 do not belong to the parents.

1.

Adoptive parents if the child has already reached the age limits laid down in § 25 (2) at the time of the adoption of the adoption,

2.

Stepparents, if the child has already reached the age limits provided for in § 25 (2) at the time of marriage with the parent of the child or if the child does not enter the common household with the child before reaching these age limits Member has been admitted.

(4) The contribution surcharge for the months of January to March 2005 on pensions of the statutory pension insurance scheme shall be paid for pensioners born after 31 December 1939 in such a way that the contribution surcharge for the month of April 2005 1 of the annuity of the pension to be paid in April 2005. For pensioners who are temporarily not subject to contributions or surcharges in the months of January to April 2005, the contribution surcharge of the month of April 2005 will be reduced according to the duration of this period. (5) For agricultural products By way of derogation from paragraphs 1 to 3, in the form of a surcharge on the health insurance contribution provided for in accordance with the rules laid down in paragraphs 1 to 3, entrepreneurs and members of the family who are members of the Agricultural Health Insurance Fund shall be responsible for the contribution of the Second Law on the health insurance of farmers from the Labour income from agriculture and forestry is to be paid. The amount of the supplement shall be determined by the ratio of the contribution rate referred to in the first sentence of paragraph 1 to the general contribution rate increased by the average additional contribution rate in accordance with Section 241 of the Fifth Book. Where the conditions for a supplement for childless contribution are met, the supplement referred to in the second sentence shall be increased by the ratio of the contribution surcharge for the childless person referred to in the first sentence of paragraph 3 to the contribution rate referred to in the first sentence of paragraph 1. Unofficial table of contents

§ 56 Freedom of Contribution

(1) Family members and life partners are free of contributions for the duration of the family insurance according to § 25. (2) Freedom of contributions consists of the date of the pension provision up to the beginning of the pension including a pension under the law on the Farmers ' pension rights for:

1.

the surviving spouse of a pensioner who has already received a pension when a survivor's pension is requested;

2.

the orphan of a pensioner who has already received a pension before the completion of the 18. for orphans whose deceased parent has acquired a pension under the old-age pension scheme of farmers,

3.

the surviving spouse of a pensioner of a pension under the law on the retirement of farmers, if the marriage is before the completion of the 65. of the death of the deceased,

4.

the surviving spouse of a beneficiary of land-based pension rights.

Sentence 1 shall not apply if the pension claimant receives its own pension, remuneration, work income or pensions. (3) Free of contributions are members for the duration of the term of maternity, parental or child care allowance. The freedom of contribution extends only to the benefits referred to in the first sentence. (4) On request, non-contributory members are members who are in steady-state care for an unforeseeable period of time and who are already in service pursuant to Section 35 (6) of the German law. Federal Supply Act, according to § 44 of the Seventh Book, in accordance with § 34 of the Civil Service Act or under the laws providing for a corresponding application of the Federal Supply Act, if they do not have family members for which Insurance pursuant to § 25. (5) Free of contributions are members for the duration of the cover of Care support money. The freedom of contribution shall be limited to the benefits referred to in the first sentence. Unofficial table of contents

Section 57 Revenue by contributions

(1) In the case of members of the nursing home who are insured under the statutory health insurance, the amount of contributions shall be governed by § § 226 to 232a, 233 to 238 and § 244 of the Fifth Book, as well as sections 23a and 23b (2) to (4) of the Fourth Book. In the case of persons receiving unemployment benefit II, by way of derogation from § 232a (1), first sentence, No. 2 of the Fifth Book of the 30. (2) In the case of recipients of sickness benefit, 80 shall be deemed to be contributor to 80 of the hundred of the pay which is the basis for the assessment of the sickness allowance. This also applies to the receipt of the sickness benefit of a member of the family of an agricultural entreprenate who is subject to pension insurance. In the case of the sickness benefit of a member of the family who is not subject to pension insurance, the payment amount shall be based on the performance of the contribution assessment. In the case of persons receiving sickness benefit in accordance with § 44a of the Fifth Book, the remuneration or earnings on which the benefit is based shall be taken as the basis; if this sickness benefit is paid in accordance with § 47b of the Fifth Book, the rates 1 to 3 shall apply. In the case of persons who are responsible for the failure of working income from a private health insurance undertaking, by a federal state aid carrier, by another public service provider of costs in cases of illness at the federal level, by the institution of health care in the federal state, by the institution of the troop medical care or by a public service institution of costs in cases of illness at the state level, in so far as national law provides for this, in connection with a Donation of the donation of the German Transplant Act pursuant to § § 8 and 8a of the Tran In the case of organs or tissues, the remuneration or labour income on which these benefits are based shall be taken as a basis. In the case of persons receiving sickness benefit in accordance with Article 45 (1) of the Fifth Book, 80% of the income which has been lost during the exemption or the amount of the benefit on which the allowance is based shall be deemed to be the contributor to the allowance. Labour income. (3) For the assessment of the contribution of the Altenteiler referred to in § 20 (1) sentence 2 (3), § 45 of the Second Law on the Health Insurance of Farmers applies. (4) For voluntary members of the statutory health insurance and in the case of members of the social care insurance, who are not in the legal Health insurance is insured for the contribution measurement § 240 of the Fifth Book accordingly. In addition, § § 238a and 239 of the Fifth Book are applicable to the contribution measurement of the pension claimants and voluntarily insured pensioners insured in the statutory health insurance. By way of derogation from the first sentence, in the case of Members pursuant to Section 20 (1) (10) who are voluntarily insured under the statutory health insurance, § 236 of the Fifth Book shall be applied accordingly; as a contributory income of the statutory members mindful cooperatives, deaconesses and similar persons who are voluntarily insured in statutory health insurance, are the value of the benefits in kind or that to obtain the immediate life needs of the apartment, catering, clothing and the like paid for. In the case of voluntary members of the statutory health insurance, who receive injury money, pension funds or transitional allowance from a rehabilitation carrier, the provisions of Section 235 (2) of the Fifth Book shall apply mutagenically to the contribution assessment; for § 46 of the Second Law on the Health Insurance of Farmers. (5) The calculation of the contribution of persons who are insured pursuant to section 26 (2) shall be calculated for the following: Calendar day of 180. Part of the monthly reference quantity according to § 18 of the Fourth Book on the basis of the reference. Unofficial table of contents

Section 58 Traction of contributions for employees subject to compulsory insurance

(1) The employees subject to compulsory insurance pursuant to Article 20 (1), second sentence, no. 1 and 12, who are insured in statutory health insurance, and their employers shall pay half of the contributions to be paid according to the remuneration. To the extent that employees are required to pay contributions for short-time work, the employer shall pay the contribution alone. The contribution surcharge for childless persons in accordance with Article 55 (3) is borne by the employees. (2) In order to compensate for the burdens on the economy associated with the employers ' contributions, the Länder become a national public holiday, which always applies to a national holiday. (3) The employees referred to in paragraph 1 shall bear the contributions equal to 1 per hundred only if the place of employment lies in a country where the number of statutory countrywide as of 31 December 1993 is situated. Holidays were not reduced by a holiday which always fell on a working day. In cases of Section 55 (1) sentence 2, the contributions shall be carried in the amount of 0.5 of the hundred alone. In addition, paragraph 1 shall apply to the second sentence of paragraph 5 in so far as it is not an employment subject to a fixed monthly salary within the track zone in accordance with Article 20 (2) of the Fourth Book. The contributions of the employees do not increase if countries in 2017 collect the Reformation Day once for a statutory public holiday. (4) The cancellation of a holiday affects the entire calendar year. If it is a holiday which is in the current calendar year before the date of entry into force of the settlement of the deletion, the repeal will only act in the following calendar year. (5) Section 249 (2) of the Fifth Book applies accordingly. Section 249 (4) of the fifth book shall apply with the proviso that, instead of the contribution rate of the sickness fund, the rate of contribution of the nursing care insurance and the employees referred to in paragraph 3, first sentence, shall be used for the calculation of the contribution of the employer a contribution rate of 0.7 of the hundred shall be applied. Unofficial table of contents

Section 59 contributing to the contribution of other members

(1) For the members of the social care insurance insured pursuant to § 20 (1) sentence 2 no. 2 to 12, who are insured in the statutory health insurance, the contributions shall be governed by Section 250 (1) and (3) and (3) and Article 251 of the Fifth Framework Programme Book as well as § 48 of the Second Law on the health insurance of farmers accordingly; the contributions from the pension of the statutory pension insurance are to be borne by the member alone. In the case of persons receiving a pension under the pension scheme of farmers who are insured under Article 20 (1), second sentence, no. 3, and in the case of recipients of production expenses or compensatory allowances, which are insured under Section 14 (4) of the Law on the Promotion of the The contributions from these services are borne solely by the recipients of the benefit. (2) The contributions for recipients of sickness benefit shall be paid by the benefit recipients and by the persons receiving the allowance. Sickness funds paid in half as far as they are accounted for by the sickness benefit and this is not in The amount of benefits paid by the Federal Employment Agency is to be paid by the sickness funds; the contributions will be borne by the health insurance funds even if the monthly salary on which the sickness benefit is based does not exceed 450 euros. The contributions for recipients of sickness benefit pursuant to § 44a of the Fifth Book or for the failure of work income related to a donation of organs or tissues following the § § 8 and 8a of the Transplantation Act shall be replaced by (3) The contributions to the beneficiaries insured pursuant to § 21 (1) to (5) shall be paid by the respective service provider. . Contributions due to the benefit cover in the context of the victims of war victims are considered to be expenses for the victims of war victims. (4) Social care insurance members who are voluntarily insured in the statutory health insurance, and Members whose membership is maintained pursuant to § 49 (2) sentence 1 or who are voluntarily insured pursuant to § § 26 and 26a, and the soldiers insured pursuant to § 21 no. 6 on time bear the contribution alone. By way of derogation from the first sentence,

1.

the contributions to be paid by the competent rehabilitation carrier on the basis of the payment of injury or pension sickness benefit or transitional allowance;

2.

the contributions to statutory members of religious cooperatives, deaconesses and similar persons, including contributions to further insurance pursuant to § 26 of the Community

(5) The contribution surcharge for childless persons in accordance with section 55 (3) shall be borne by the Member. Unofficial table of contents

§ 60 Contribution payment

(1) Unless otherwise provided by law, the contributions shall be paid by the person who has to bear it. § 252 (1) sentence 2, § § 253 to 256a of the Fifth Book and the § § 50, 50a of the Second Law on the Health Insurance of Farmers shall apply accordingly. The contributions to be paid from a pension under the age-saving law of farmers and an ongoing cash benefit under the law on the promotion of the cessation of agricultural activity shall be paid by the old-age pension fund. § 28g sentence 1 of the Fourth Book applies accordingly. (2) For recipients of sickness benefit, the health insurance funds pay the contributions; for the contribution withdrawal, § 28g sentence 1 of the fourth book shall apply accordingly. In order to support the contributions for the members referred to in § 21 Nos. 1 to 5, they may commission a third party with the payment of the contributions and agree with the caregivers about the payment and settlement of the contributions. (3) The Contributions shall be paid to the health insurance funds; in the cases regulated by Section 252 (2) sentence 1 of the Fifth Book, they shall be paid to the Health Fund, which shall immediately forward them to the compensation fund. The health insurance contributions received in accordance with the first sentence shall be forwarded by the sickness insurance fund immediately to the carer's insurance fund. In the cases of § 252 (2) sentence 1 of the Fifth Book, the Federal Insurance Office is the custodian of the Health Fund, and in addition the care funds are entitled to check the proper payment of contributions; § 251 (5) sentences 3 to 7 of the The fifth book shall apply accordingly. Section 24 (1) of the Fourth Book applies. § 252 (3) of the Fifth Book is valid with the proviso that the contributions to the nursing care insurance are equivalent to the contributions to health insurance. (4) The German Pension Insurance Association conducts all care insurance contributions from the pension benefits of the General pension insurance on the fifth working day of the month following the month in which the pension was due, to the compensation fund of the nursing care insurance scheme (§ 65). If pension benefits are paid on the last bank working day of the month preceding the month in which they become due (Section 272a of the Sixth Book), the German Pension Insurance Association shall direct the care insurance contributions paid on it at the The fifth working day of the current month to the compensation fund of the nursing care insurance. (5) The contribution surcharge pursuant to § 55 para. 3 shall be paid by the person who has to pay the contributions. If the health insurance contribution is paid by a third party, the third party shall be entitled against the member to the contribution surcharge to be borne by the member. This claim may be claimed by the third party by deducting from the cash benefit to be provided to the member. (6) If no deduction is possible under paragraph 5, because the third party does not have to provide a current cash benefit to the member, he/she shall be entitled to (7) The contribution surcharges for the recipients of unemployment benefit, maintenance allowance and short-time allowance, training allowance, transitional allowance and, as far as the The Federal Employment Agency is subject to a payment obligation, for recipients of vocational training allowance after the Third Book is transferred from the Federal Employment Agency (Bundesagentur für Arbeit) in a flat-rate amount of 20 million euros per year to the compensation fund of the nursing care insurance (§ 66). The Federal Employment Agency may, with the agreement of the Federal Ministry of Labour and Social Affairs, take recourse to the above-mentioned benefits under the third book with regard to the amounts taken over. The Federal Employment Agency can agree with the Federal Insurance Office (Bundesversicherungsamt) for the payment of the flat rate.

Second section
Contribution grants

Unofficial table of contents

Section 61 Contribution grants for voluntary members of statutory health insurance and private insured persons

(1) Employees who are voluntarily insured in statutory health insurance receive, under the conditions laid down in § 58 of their employer, a contribution subsidy, which is limited in amount, to the amount deemed to be an employer's share. in accordance with § 58. Where there are several employment relationships within the same period, the employers concerned shall be obliged to pay the contribution subsidy in proportion to the ratio of the level of the respective work charges. For employees who receive short-time work in accordance with the third book, in addition to the grant in accordance with the first sentence, half of the amount payable by the employer as a contribution to the insurance obligation of the employee pursuant to section 58 (1) sentence 2 (2) employees who are insured pursuant to § § 22 and 23 of their insurance obligation in the case of a private health insurance company and for themselves and their relatives or partners who are insured by the insurance company in accordance with § § 22 and 23 of the Employees in the social care insurance under § 25 would be insured, Under the conditions laid down in § 58, the contractual services which are equivalent to the services provided by this book may be subject to a contribution grant from their employer. The grant shall be limited to the amount to be paid as an employer's share of compulsory insurance in the social care insurance scheme, but not more than half of the amount of the employee's contribution to his or her insurance in the form of a contribution to the insurance scheme. private care insurance has to pay. In the case of employees who receive short-time work in accordance with the third book, the third sentence of paragraph 1 shall apply with the proviso that they shall receive at most the amount which they actually have to pay. If several employment relationships exist within the same period, the participating employers are obliged to pay the contribution subsidy proportionally according to the ratio of the amount of the respective work fees. (3) For recipients of Early retirement benefits, which, as employees, were entitled to the full or pro rata contribution under paragraph 1 or 2 before early retirement benefits, as well as for persons receiving benefits pursuant to § 9 (1) (1) and (2) of the Eligibility and entitlement transfer law and recipients of a transitional supply According to § 7 of the collective agreement on socially acceptable staff reductions in the area of the Federal Ministry of Defence of 30 November 1991, the claim for the duration of the early retirement benefits remains against the payment of the early retirement pension Consigned to. The grant is half of the contribution that recipients of early retirement benefit have to pay as insurance employees without the contribution surcharge in accordance with § 55 para. 3, but at most half of the amount that they have without the contribution surcharge. Contribution surcharge pursuant to section 55 (3) must be paid. The second sentence of paragraph 1 shall apply accordingly. (4) The persons referred to in Article 20 (1), second sentence, No. 6, 7 or 8, for whom insurance obligations in accordance with § 23 are insured in private nursing care insurance, shall receive a grant from the competent service provider to their Private health insurance contribution. The amount to be paid by the service provider as a contribution to the insurance obligation in the social care insurance scheme is to be paid as a grant, but at most the amount to be paid to the private insurance undertaking. (5) The The grant referred to in paragraphs 2, 3 and 4 shall be paid for a private care insurance only if the insurance undertaking:

1.

the care insurance in the form of life insurance,

2.

undertakes to use the predominant part of the surpluses resulting from the self-concluded insurance business for the benefit of the insured,

3.

the care insurance only operates together with the sickness insurance scheme, not together with other insurance savings, or, if the insurance undertaking has its registered office in another Member State of the European Union, the part of the premiums, for the person entitled to receive the subsidy, only used for health and nursing care insurance.

6. The sickness insurance undertaking shall issue to the policyholder a certificate certifying that the supervisory authority has confirmed to him that it is the insurance contract which is the basis of the insurance contract, in accordance with the provisions of paragraph 5. Conditions. The policyholder shall submit this certificate to the person responsible for payment of the contribution grant at the end of three years. (7) Persons who are entitled to sickness and care according to the provisions of the civil service law or the principles of sickness and care to aid or health care insurance and to a private insurance undertaking, as well as to persons for whom the half-contribution rate applies in accordance with Article 55 (1), second sentence, to the employer or to the person who is responsible for the aid, and Health care granted on expenses arising from the cause of care, no claim to a contribution grant. With regard to contributions for Members, former Members and their survivors, reference is made to the provisions in the relevant Members ' legislation.

Third Section
Use and management of funds

Unofficial table of contents

§ 62 Funds of the care insurance fund

The funds of the care insurance fund comprise the operating resources and the reserve. Unofficial table of contents

Section 63 Operating appropriations

(1) The operating resources may be used only:

1.

for the tasks provided for by law or by the statutes, as well as for administrative costs,

2.

to repleniate the reserve and to finance the compensation fund.

The operating appropriations shall not exceed, on average for the financial year, the simple amount of the amount of expenditure referred to in paragraph 1 (1) referred to in paragraph 1 (1) according to the budget of the caretaker ' s fund for one month. In determining the existing resources, account must be taken of the requirements and obligations of the caretaker's fund, provided that they are not attributable to the reserve. (3) The resources must be kept at the necessary level and, moreover, must be made available in such a way as to be available for the purpose specified in paragraph 1. Unofficial table of contents

Section 64 Backsheet

(2) The reserve shall be 50 per cent of the average amount of expenditure incurred in accordance with the budget for the month (return duty). (3) The amount of the return shall be equal to 50% of the total expenditure (3). A caretaker has funds from the reserve to be supplied to the operating resources if it is not possible to compensate for the fluctuations in the income and expenditure within a financial year. (4) If the reserve exceeds the return duty, then the amount of the reserve must be reduced to a maximum of 30%. the excess amount of the operating resources up to the amount referred to in § 63 (2) . In addition, the remaining surpluses are up to 15. (5) The reserve shall be established separately from the other means in such a way as to be available for the purpose determined in accordance with paragraph 1. It is managed by the care fund.

Fourth Section
Equalisation Fund, Financial Compensation

Unofficial table of contents

Section 65 Compensation Fund

(1) The Federal Insurance Office (Bundesversicherungsamt) shall, as a special fund (compensation fund), manage the amounts received:

1.

the contributions from the pension payments,

2.

the surpluses of resources and reserves transferred by the caregivers (section 64 (4)),

3.

the contributions of the insured persons referred to by the Health Fund.

(2) The capital gains arising in the course of one year shall be credited to the special assets. (3) The funds of the compensation fund shall be invested in such a way that they are available for the purpose specified in § § 67, 68. Unofficial table of contents

Section 66 Financial compensation

(1) The performance expenditure and the administrative costs of the care insurance funds shall be borne jointly by all care funds in accordance with the ratio of their contribution income. To this end, financial compensation shall be provided between all care funds. The Federal Insurance Office (Bundesversicherungsamt) carries out the financial compensation between the care funds. It has to agree more about the implementation of the financial compensation with the Association of the Confederation of Nursing Care Funds. The agreement is binding on the care fund. (2) The Federal Insurance Office may make further arrangements with the German Pension Insurance Association for the purpose of carrying out payment transactions. Unofficial table of contents

Section 67 Monthly compensation

(1) Each care fund shall be determined by the 10. of the month

1.

the expenditure booked up to the end of the previous month,

2.

the revenue booked up to the end of the previous month (contribution rate);

3.

the operating medium and rear-load duty,

4.

the resources available on the first of the current month (resources) and the amount of the reserve.

(2) If the expenditure plus the operating appropriations and the reserves is higher than the revenue plus the existing operating resources and the reserve on the first of the current month, the caretaker shall receive up to the end of the month Difference in amount from the compensation fund. Where the revenue plus the operating resources available on the first day of the month and the reserve are higher than the expenditure plus the amount of the operating appropriations and the reserves, the caretaker shall transfer the difference to the amount of the difference to the Compensation fund. (3) The care insurance fund must inform the Federal Insurance Office of the necessary calculation bases. Unofficial table of contents

§ 68 Annual compensation

(1) After the end of the calendar year, an annual compensation is carried out between the care funds. According to the results of the business and invoice results of all care funds and the annual accounts of the Deutsche Rentenversicherung Knappschaft-Bahn-See as the institution of the health insurance cover for the past calendar year, the following shall be: (2) If, after the end of the annual equalization, factual or computational errors are found in the calculation basis, the Federal Insurance Office shall have these errors in the calculation of the next annual compensation according to the to take account of the provisions in force at this point. (3) Federal Ministry of Health may, with the consent of the Federal Council, by means of a legal regulation, the following:

1.

the definition of the content and time limits and the determination of the amounts in accordance with § § 66 to 68;

2.

the maturity of the amounts and interest in the event of delay,

3.

the procedure for the implementation of the financial compensation and the information to be provided for this purpose by the care insurance funds

rules.

Seventh chapter
Relationships between the caregivers and the service providers

First section
General principles

Unofficial table of contents

§ 69 Order of backup

In the context of their obligation to perform, the care insurance funds have to ensure that the insured persons receive adequate and uniform care in accordance with the generally accepted level of medical-care-related findings. (Backup Order). They include supply contracts as well as compensation agreements with the institutions of care institutions (§ 71) and other service providers. The diversity, independence and independence, as well as the self-image of the institutions of care institutions, must be respected in the aim and performance of their tasks. Unofficial table of contents

§ 70 Contribution rate stability

(1) In the contracts with the service providers, the care providers ensure that their performance expenditure does not exceed the contribution income (principle of premium rate stability). (2) Agreements the level of remuneration, which is contrary to the principle of premium rate stability, is ineffective.

Second section
Relations with the care institutions

Unofficial table of contents

Section 71 Care facilities

(1) Ambulant care facilities (care services) within the meaning of this book are self-employed entities which maintain in their home and economically in need of care in their home under the permanent responsibility of a trained nursing care professional. (2) Stationary care facilities (nursing homes) within the meaning of this book are self-employed institutions in which care needs to be taken:

1.

shall be maintained under the permanent responsibility of a trained nursing staff,

2.

all-day (full-time) or during the day or at night (partially stationary) can be accommodated and caterable.

(3) In addition to the completion of a training, recognition as a responsible care professional within the meaning of paragraphs 1 and 2 shall be deemed to be a

1.

health and health care nurse, health care and nurse,

2.

Health and paediatric nurse or health and paediatric nurse, or

3.

Elderly nurse or senior caregiver

a practical professional experience in the learned training occupation of two years is required within the last eight years. In the case of outpatient care facilities, which care for and care for the majority of disabled people, also according to state law trained nursing care providers as well as healers and healer teachers with a practical Professional experience of two years within the last eight years as a trained nursing professional. The frame period referred to in the first or second sentence shall begin eight years before the day on which the responsible nurse is to be appointed within the meaning of paragraph 1 or 2. For recognition as a responsible nurse, it is also a prerequisite that a training measure for senior functions with a minimum number of hours, which should not be less than 460 hours, has been successfully carried out. (4) Stationary institutions in which services for medical care, medical rehabilitation, participation in working life or life in the community, schooling or the education of sick or disabled persons are at the forefront of the facility's purpose, as well as hospitals no care facilities within the meaning of paragraph 2. Unofficial table of contents

§ 72 Admission to care by supply contract

(1) The care insurance funds may only provide out-patient and inpatient care by means of care facilities with which a supply contract exists (approved care facilities). The supply contract shall specify the nature, content and extent of the general care services (Section 84 (4)) to be provided by the carer for the insured person during the period of the contract (supply contract). (2) The The contract of supply shall be concluded between the institution of the caregiver or a representative association of the same institutions and the national associations of the caregivers in agreement with the local social assistance institutions in the country, in so far as the local authorities do not have the responsibility for the care facility under national law ; for several or all of the self-employed entities (§ 71 (1) and (2)) of a caregider, who are organizationally connected to each other on the spot, a single supply contract (contract of supply) may be provided for closed. It is directly binding for the care facility and for all care funds in Germany. (3) Supply contracts may only be concluded with care facilities which

1.

meet the requirements of § 71,

2.

provide a guarantee of efficient and cost-effective care as well as pay to their employees a working allowance which is customary in care facilities, provided that they are not subject to a regulation on minimum rates of remuneration due to of the law on mandatory working conditions for cross-border posted workers and workers employed on a regular basis in Germany (employees ' posting of workers),

3.

undertake to introduce and develop a quality management system internally in accordance with the agreements referred to in § 113,

4.

undertake to apply all expert standards in accordance with § 113a;

a right to the conclusion of a supply contract shall exist, to the extent and as long as the care facility fulfils these conditions. If there is a need for a choice between several suitable care facilities, the supply contracts should be concluded primarily with non-profit-making and private institutions. In the case of ambulatory care services, the supply contracts must be defined in the catchment area in which the services are to be provided. (4) With the conclusion of the supply contract, the care facility will be responsible for the duration of the contract for nursing care. Supply of insured persons admitted. Within the scope of its supply contract, the approved care facility is obliged to provide care for the insured persons. In the case of outpatient care services, this also includes the implementation of nursing care interventions in accordance with § 37 para. 3 on request of the need for care. The care funds are obliged to reimburse the services provided by the care facility in accordance with the Eighth Chapter. (5) (repealed) Unofficial table of contents

Section 73 Conclude of supply contracts

(1) The supply contract shall be concluded in writing. (2) The legal path to the social courts is given against the rejection of a supply contract by the regional associations of the nursing care funds. A preliminary procedure does not take place; the action does not have a suspensive effect. (3) With care facilities which before 1 January 1995 outpatient care, part-time care or short-term care due to agreements with social service providers , a supply contract shall be deemed to have been concluded. Sentence 1 shall not apply if the nursing facility does not comply with the requirements of § 72 (3) sentence 1 and the competent national associations of the caregivers do so in agreement with the competent institution of social assistance (§ 72 (2) sentence 1) up to the 30. The Commission shall make a written claim to the institution of the institution in June 1995. Sentence 1 shall not apply even if the care facility obviously does not meet the requirements of § 72 (3) sentence 1. The carer shall, no later than 31 March 1995, have the requirements for the protection of the protection referred to in the first and second sentences of 1 and 2 by the submission of agreements with benefit institutions and appropriate documentation for the examination and assessment of the Proof of performance and efficiency in relation to a national association of care insurance funds. The supply contract remains effective until it is replaced by a new supply contract or terminated in accordance with § 74. (4) For fully inpatient care facilities, paragraph 3 applies accordingly, with the proviso that the person responsible for the presentation of the documents shall be subject to the following conditions: The date of 30 September 1995 and the date of the second sentence of 30 June 1996 shall be the relevant date of the first sentence of 30 September 1995. Unofficial table of contents

Section 74 Termination of supply contracts

(1) The supply contract may be terminated in whole or in part by each Contracting Party with a period of one year, but only if the approved care facility does not only temporarily provide one of the The conditions laid down in § 72 (3) sentence 1 are not or no longer fulfilled; this also applies if the care institution repeatedly violates its obligation to offer life-care needs as independent and self-determined life as possible, the aid to align the physical, mental and mental forces of the To regain or receive care in need of care and to meet the needs of those in need of care in order to design the aid. Before dismissal by the regional associations of the care funds, the agreement with the competent institution of social assistance (§ 72 para. 2 sentence 1) shall be established. In order to avoid the termination of the supply contract with the institution of the caregivers, the regional associations of the care funds may, in agreement with the competent institutions of social assistance, agree, in particular, that:

1.

the responsible nursing staff as well as other management staff successfully complete appropriate training and further training measures in a timely manner,

2.

The care, care and care of other people in need of care, until the grounds for dismissal are completely or partly provisionally excluded.

(2) The supply contract may also be terminated by the regional associations of the caregivers without the observance of a period of notice if the institution is responsible for their legal or contractual obligations to the persons in need of care or to the persons in need of such a contract. Cost carriers so grossly breached that adherence to the contract is not reasonable. This is particularly true if the person in need of care is to be damaged as a result of the breach of duty or if the institution does not pay off services to the cost carriers. The same shall apply if the institution of a nursing home is deprived of the type-approval or the operation of the home is prohibited in accordance with the provisions of the law. The second sentence of paragraph 1 shall apply accordingly. (3) The dismissal shall be subject to the written form. In the case of claims against the termination of the contract § 73 para. 2 shall apply accordingly. Unofficial table of contents

Section 75 Framework contracts, federal recommendations and agreements on nursing care

(1) The regional associations of the care insurance companies conclude with the participation of the medical service of the health insurance and the association of private health insurance e. V. in the country with the associations of the providers of outpatient or inpatient care facilities in the country jointly and uniformly framework contracts with the aim of ensuring an effective and economic care of the insured persons. For care facilities belonging to a church or religious community of public law or other voluntary non-profit-making bodies, the framework contracts may also be provided by the church or religious community or by the The charitable association is a member of the caring body. In the case of framework contracts for out-patient care, the working groups of the local social assistance providers, the local social assistance institutions and the local organisations of the local institutions of the social assistance system of the framework contracts for inpatient care shall be the Social assistance as a contracting party to the conclusion of the contract. The framework contracts are directly binding on the care insurance funds and the approved care facilities in Germany. (2) The contracts regulate in particular:

1.

the contents of the care services and, in the case of steady-state care, the distinction between the general care services, the provision of accommodation and catering services and the additional benefits,

2.

the general conditions of care, including the assumption of costs, the settlement of charges and the certificates and reports required for that purpose,

3.

Standards and principles for an economic and performance-related personal and causal equipment of the care facilities, oriented to the supply contract,

4.

the review of the need and duration of care,

5.

Surcharges from the care allowance in the case of temporary absentia (hospitalization, leave of absence) of the patient in need of care from the nursing home,

6.

the access of the medical service and other auditor appointed by the care funds to the care facilities,

7.

the principles of procedure and audit for performance audits;

8.

the principles for determining the local or regional catchment areas of the care facilities in order to offer care services without long distances as close as possible to the locality and to the citizen,

9.

the possibilities, among which members of self-help groups, voluntary carers and other persons and organizations ready for civic engagement in home care, as well as in outpatient and inpatient care Care facilities in the care of need for care in need of assistance.

According to Article 33 of the Fifth Book, the provision of the Saxon equipment in the first sentence of the first sentence of sentence 1 shall not be abolished or restricted. (3) As part of the contracts referred to in paragraph 2 (3), the following shall be considered: either

1.

National procedures for determining staffing requirements or for measuring care times, or

2.

country-wide personnel guidelines

. The special care and care needs of patients with mental disabilities, mental illness, dementia-related abilities disorders and other diseases of the nervous system must be observed. In the case of the agreement of the procedures set out in the first sentence of the first sentence, the international experience which has been tried and tested in Germany must be taken into account The personnel guidelines referred to in the first sentence of no. 2 may be agreed as bandwidths and shall include, in the case of part-or full-time care, at least

1.

the ratio between the number of people living in the home and the number of nurses (converted into full-time staff), broken down by level of care (staff salary), and

2.

in the area of care, social care and medical treatment care, in addition the proportion of trained professionals at the nursing and care staff.

The Home Personality Ordinance shall remain unaffected in all cases. (4) If a contract in accordance with paragraph 1 is not concluded in whole or in part within six months after a Contracting Party has requested in writing for contract negotiations, the contract shall be Content shall be fixed at the request of a Contracting Party by the arbitration body in accordance with Section 76. The first sentence shall also apply to contracts with which existing framework contracts are to be amended or replaced by new contracts. (5) The contracts referred to in paragraph 1 may be terminated in whole or in part by each Contracting Party with a period of one year. The first sentence shall apply in accordance with the rules laid down by the arbitral body referred to in paragraph 4. These can be replaced without notice at any time by means of a contract in accordance with paragraph 1. (6) The top association of the nursing insurance funds and the associations of the institutions of the care institutions at the federal level are to be held with the participation of the medical device. Service of the top association of the health insurance companies, the association of private health insurance e. V. as well as independent experts, together with the Federal Association of Local Government Associations and the Federal Working Community of the Local Social Assistance Support, make recommendations on the content of the contracts referred to in paragraph 1. They work closely with the associations of nursing professions as well as the associations of the disabled and those in need of care. (7) The top association of the care insurance funds, the Bundesarbeitsgemeinschaft der übertopical bearer of social assistance, which The Federal Association of Local Government Associations and the associations of the institutions of the care institutions at the federal level agree jointly and uniformly principles of proper nursing care for the outpatient and inpatient care Care facilities. The agreement referred to in the first sentence shall enter into force immediately after the repeal of the legal regulation adopted pursuant to section 83 (1), first sentence, No. 3, and shall immediately be the approved care institution operating in the country by the regional associations of the caregivers. to be known. It is directly binding for all caregivers and their associations as well as for the approved care facilities. Unofficial table of contents

Section 76 Arbitration

(1) The regional associations of the caregivers and the associations of the institutions of the caregivers in the country shall form a joint arbitration body for each country. The arbitration body shall consist of representatives of the caregivers and caregivers in the same number, as well as an impartial chairman and two other impartial arbitrators. members; for the chairman and non-partisan members, substitutes may be appointed. The arbitration body also includes a representative of the association of private health insurance e. V. as well as the local or, where national law so determines, a local institution of social assistance in the country which is credited to the number of representatives of the carers ' funds. The representatives of the caregivers and their deputies shall be appointed by the regional associations of the caregivers, the representatives of the caregivers and their deputies by the associations of the caregivers of the care services and nursing homes in the country; When ordering the representatives of the care facilities, the carrier variety must be taken into account. The Chairperson and the other non-partisan members shall be appointed jointly by the participating organisations. If an agreement is not reached, it shall be determined by lot. In so far as organizations involved do not appoint a representative or nominate candidates for the office of chairman or other non-partisan members in the procedure provided for in sentence 4, the competent State authority shall, at the request of one of the following, appoint a candidate for the the representatives and names the candidates. (3) The members of the Arbitration Board are responsible for their duties as an honorary office. They shall not be bound by instructions. Each member shall have one vote. Decisions shall be taken by a majority of the members. If there is no majority, the Chairman's vote gives the rash. (4) The competent national authority shall be responsible for the legal supervision of the arbitral body. (5) The national governments shall be authorized by means of a legal regulation to provide further information on the number, which shall be: The appointment, the term of office and the administration, the reimbursement of the cash outlays and the compensation for the time spent by the members of the arbitration board, the management, the procedure, the collection and the amount of the fees, and the distribution of the fees of the costs. (6) By way of derogation from Section 85 (5), the parties to the Caretaker Agreement (§ 85 para. 2) jointly order an independent Schiedsperson. This shall determine the care rates and the date of their entry into force no later than the expiry of 28 calendar days after their order. A request for annulment can only be made against the decision of the law if the establishment of the public order is contrary to the law. The costs of the arbitration proceedings shall be borne by the contracting parties in equal parts. Section 85 (6) shall apply accordingly.

Third Section
Relations with other service providers

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§ 77 Häusliche Care by Individuals

(1) In order to ensure domestic care and care as well as the provision of domestic services, the care fund should conclude contracts with individual suitable nursing staff in order to help the person in need of care, as independent as possible and as independent as possible. to lead a self-determined life or to meet the special needs of the person in need of care in the form of assistance; contracts with relatives or persons in need of care up to the third degree, as well as persons with whom the person is entitled to People in need of care in the home community are inadmissible. The contract shall govern the content, scope, quality, quality assurance, remuneration and examination of the quality and cost-effectiveness of the agreed services; § 112 shall be applied accordingly. The remuneration is to be agreed for the benefits of basic care and domestic care as well as for care services in accordance with § 36 (1). The Treaty also states that caregivers should not enter into employment with the person in need of care, who is responsible for the provision of domestic care and home-care services. To the extent that contracts are closed, they shall be terminated. Sentences 4 and 5 shall not apply if:

1.

the employment relationship existed prior to 1 May 1996, and

2.

the care provided before 1 May 1996 has been remunerated by the competent care fund on the basis of a contract concluded with the carer.

In the care contracts between the person in need of care and the nursing staff, at least the type, content and scope of the services, including the remuneration agreed upon with the cost carriers, must be described. § 120 (1) sentence 2 shall apply. (2) The care funds may, if necessary, place individual caregivers to ensure the home care, for which the same requirements with regard to the economic efficiency and quality of their services as applicable to the approved care services provided for in this book. Unofficial table of contents

Section 78 Contracts for the treatment of nursing care products

(1) The top association of the caregivers ' association concludes contracts with the service providers or their associations on the provision of care for the insured with care aids, insofar as these do not comply with the provisions of the Fifth Book on Aid be remunerated. By way of derogation from the first sentence, the caregivers may conclude contracts for the provision of care for the insured with care aids, in order to take greater account of the economic offer. § § 36, 126 and 127 of the Fifth Book apply accordingly. (2) The Association of the Covenant of Nurses, as an annex to the Directory of Relief funds in accordance with § 139 of the Fifth Book, creates a systematically structured nursing home directory. This includes the care funds included in the obligation to pay the nursing care insurance, provided that these are not already included in the list of assistants. Care aids, which are suitable for a loan to the insured, are to be identified separately. In addition, § 139 of the Fifth Book applies accordingly, with the proviso that the associations of the nursing professions and the disabled are also to be heard before the preparation and continuation of the nursing home directory. (3) The regional associations the caregivers agree with each other or with the appropriate care facilities for the purpose of lending the necessary care, including their procurement, storage, maintenance and control, to the care facilities appropriate for this purpose in accordance with the fourth sentence of paragraph 2. The care providers and the approved care facilities must be informed by the care funds or their associations in a suitable form about the possibility of borrowing. (4) The Federal Ministry of Health is authorized to do so. The list of nursing assistants referred to in paragraph 2 and the fixed amounts referred to in paragraph 3 by means of a regulation in agreement with the Federal Ministry of Labour and Social Affairs and the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth and with the consent of the Federal Ministry of Labour and Social Affairs Federal Council to determine; § 40 (5) remains unaffected.

Fourth Section
Economic impact assessments

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Section 79 Economic performance audits

(1) The regional associations of the caregivers may have the economic efficiency and effectiveness of the outpatient, partially inpatient and fully inpatient care services examined by experts appointed by them; prior to the appointment of the experts, the carrier of the care facility. An examination shall only be admissible if there are actual indications that the care facility does not or no longer meet the requirements of § 72 (3) sentence 1 in whole or in part. The evidence shall be notified to the care institution in good time before the hearing. Personal data are to be anonymized. (2) The institutions of the nursing care institutions are obliged to provide the expert with the necessary documents for the performance of his/her duties and to provide information. (3) The result of the examination shall be taken into consideration in the next possible remuneration agreement with effect for the future, irrespective of the consequential consequential dismissal of the supply contract in accordance with § 74. Unofficial table of contents

§ 80 (omitted)

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§ 80a (omitted)

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Section 81 Rules of Procedure

(1) The regional associations of the care funds (§ 52) jointly fulfil the tasks assigned to them in accordance with the seventh and eighth chapters. If agreement is not reached in whole or in part, the majority of the bodies referred to in the first sentence of section 52 (1) shall take the decision, provided that the decisions are made by three representatives of the local health insurance funds and by two representatives. (2) In the case of decisions taken by the regional associations of the caregivers with the working groups of the local social assistance providers or the local authorities of the local authorities, the Social assistance to be met shall be the working groups or the A local institution with two representatives shall be involved in the decision-making referred to in the second sentence of paragraph 1. If, in the case of two resolutions, an agreement with the representatives of the social assistance institutions is not achieved one after the other, each party to the decision may, in accordance with the first sentence, take the decision of the chairman and the other impartial members of the arbitration body. in accordance with § 76. They shall make a binding decision on the points under exclusion for all parties concerned, excluding the legal route. The costs of the proceedings in accordance with the second sentence and the chairman's fee shall be borne by all the parties concerned. (3) In the case of decisions taken under the Seventh Chapter, which is the top association of the carers ' association with the representatives of the institutions of the In the appropriate application of the first sentence of paragraph 2 in conjunction with the second sentence of paragraph 1, nine and the representatives of the social welfare institutions shall be entitled to two votes in favour of social assistance together. The second sentence of the second sentence of paragraph 2 shall apply with the proviso that, in the event of a non-agreement, an arbitrator shall be chosen by common accord of the parties to the decision.

Eighth chapter
Care allowance

First section
General provisions

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Section 82 Financing of care facilities

(1) admitted nursing homes and care services shall be provided in accordance with this Chapter

1.

a performance-based remuneration for the general care allowance (care allowance) and

2.

in the case of stationary care, an appropriate fee for accommodation and meals.

The care allowance shall be borne by the person in need of care or their cost carriers. In the case of stationary care, it also includes the social care and, insofar as there is no entitlement to nursing care in accordance with § 37 of the Fifth Book, the medical treatment care. Care must be paid to the person in need of accommodation and food in the case of inpatient care. (2) In the care allowance and in the charges for accommodation and food, no charges may be taken into account for

1.

measures, including capital costs, intended to produce, create, supplement, maintain, maintain or maintain the buildings and other depreciable assets necessary for the operation of the care facility; or , with the exception of goods intended for consumption (consumer goods), which are to be attributed to the maintenance allowance referred to in the first sentence of paragraph 1,

2.

the acquisition and development of land,

3.

Rent, lease, inheritance, use or co-use of land, buildings or other fixed assets,

4.

the start-up or the intra-company conversion of care facilities,

5.

the closure of care facilities or their conversion to other tasks.

(3) Insofar as necessary investment expenses as referred to in paragraph 2 (1) or expenses for rent, lease, hereditary building interest, use or co-use of buildings or other depreciable assets as referred to in paragraph 2 (3) by public funding In accordance with § 9, the care facility may separately calculate this part of the expenses to the person in need of care. The same applies to the extent to which the expenditure under the first sentence of the country is financed by loans or other repayable grants. The separate calculation shall be subject to the agreement of the competent State authority; the details of this, in particular also on the type, amount and duration of the calculation, and the distribution of the separately calculable expenses on the person in need of care, including the Consideration of flat-rate maintenance and repair expenses as well as the underlying occupancy rate shall be determined by national law. The flat-rate packages must be proportionate to the actual level of maintenance and repair costs. (4) Nursing facilities which are not supported by national law may be required to provide the necessary equipment for the maintenance of the maintenance and repair costs. Investment expenses shall be calculated separately for those in need of care without the consent of the competent authority. The separate calculation is to be communicated to the competent national authority. (5) Public subsidies for the current expenses of a care facility (operating grants) are to be deducted from the nursing allowance. Unofficial table of contents

Section 82a Training allowance

(1) The training allowance within the meaning of this provision shall include the remuneration resulting from legislation, collective agreements, general remuneration schemes, or contractual agreements to persons who, according to the provisions of the Federal law in the care of the elderly or according to national law in the care of the elderly, is to be paid for the duration of their practical or theoretical training, as well as to be reimburse pursuant to § 17 para. 1a of the Senior Care for the elderly Further training costs. (2) Insofar as a care facility approved under this law According to federal law for training in the care of the elderly or in accordance with the law of the country for training in the care of the elderly, the training allowance of the persons who are entitled to the training in accordance with a corresponding training contract shall be entitled to If the institution or its institution is active for the purpose of training in the institution, the duration of the training relationship shall be taken into account in the remuneration of the general nursing services (Section 84 (1), section 89). If the institution also supervises persons who are not in need of care within the meaning of this book, only the proportion of the total amount of the training allowances which is equal to the total amount of the training allowances shall be taken into account in the maintenance allowance in accordance with the first sentence. Distribution of the total sum to all persons in need of care in the sense of this book is no longer necessary. To the extent that the training allowance is to be taken into account in the care set of an approved nursing home, the proportion which is attributable to the person in need of care in the sense of this book is to be distributed equally among all home residents in need of care. Sentence 1 shall not apply where:

1.

the training allowance or a corresponding remuneration shall be applied in accordance with other provisions; or

2.

the training allowance is financed by a national legal repayment procedure in accordance with paragraph 3.

The remuneration of the training is to be given separately in the remuneration agreement on the general care services; § § 84 to 86 and 89 apply accordingly. (3) If the training allowance is wholly or partly due to a national legal system The transfer in the remuneration of the general care services shall be taken into account only in so far as it is determined on the basis of the following calculation principles:

1.

The costs of the training allowance shall be distributed uniformly in accordance with uniform principles to all approved outpatient, partially stationary and stationary care facilities and the elderly care homes in the country. In the design and distribution of the situation, it must be ensured that the distribution scale is not unilaterally weighted at the expense of the approved care facilities. In addition, the second sentence of paragraph 2 and 3 shall apply accordingly.

2.

The overall level of the transfer must not exceed the expected funding requirements for the financing of an adequate supply of training places.

3.

Expenses for the maintenance, repair or maintenance of training centres (§ § 9, 82 (2) to (4)), for their running costs (personnel and material costs) as well as for the administrative costs of the according to national law for the transfer procedure competent authority shall not be taken into account.

(4) The amount of the transfer in accordance with paragraph 3 as well as its calculation factors shall be communicated to the regional associations of the care insurance funds in good time before the start of the nursing home negotiations by the competent authority according to the country's law. It is sufficient for the communication to be sent to a national association, which shall forward the communication immediately to the other national associations and to the competent institutions of social assistance. In the event of disagreement between the parties to the sentence 1 on the correct assessment and the amount of the proportion of the transfer to be paid by the approved care facilities, the arbitral body shall decide, in accordance with Article 76, excluding the Legal path. The decision shall be binding on all parties concerned in accordance with the first sentence and for the parties to the remuneration agreements in accordance with the Eighth Chapter; § 85 (5), first sentence, and 2, first half-sentence, and (6) shall apply accordingly. Unofficial table of contents

Section 82b Official support

(1) As long as and as long as a care facility approved under this Act, in particular:

1.

for the preparatory and accompanying training,

2.

for the planning and organisation of the use or

3.

for the replacement of the appropriate effort

the members of self-help groups as well as the voluntary and other persons and organizations who are willing to engage in civic engagement, for the benefit recipients provided by the nursing care insurance not otherwise covered expenses , these are capable of being taken into account in nursing homes (§ 84 para. 1) and in outpatient care facilities in the remuneration (§ 89) in the case of inpatient care facilities. The expenses can be reported separately in the remuneration agreement on the general care services. (2) Stationary care facilities can be used for voluntary support as a supplementary commitment to general care services. Pay allowance. Paragraph 1 shall apply accordingly. Unofficial table of contents

Section 83 Regulation on the provision of care allowances

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

1.

the care allowance of the care facilities, including the procedural arrangements for their agreement under this Chapter;

2.

the content of the care services and, in the case of steady-state care, the distinction between the general care services (section 84 (4)), the provision of accommodation and catering services (§ 87) and the additional services (§ 88),

3.

the accounting and accounting rules of the care facilities, including a cost and benefit calculation; in the case of approved care facilities, which, in addition to the benefits provided for in this book, also include other social benefits in the sense of the first book (mixed establishment), the scope of the Regulation may be extended to cover the whole of the operation;

4.

Standards and principles for an economic and performance-related personal equipment of the care facilities oriented on the supply contract (section 72 (1)),

5.

the further delimitation of the performance expenditure according to point 2 of the investment expenses and other expenses in accordance with § 82 (2).

§ 90 remains unaffected. (2) Following the adoption of the regulation, framework contracts and arbitration rules are no longer admissible pursuant to § 75 of the regulatory areas covered by the regulation.

Second section
Remuneration of inpatient care services

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Section 84 Tax principles

(1) Care rates are the fees of the home residents or their expenses for the partial or full-time nursing care services of the nursing home as well as for the social care and, insofar as no entitlement to nursing care according to § 37 of the Fifth Book is for medical treatment. The care sets must not take into account expenses which are not subject to the financial responsibility of the social care insurance. (2) The care rates must be performanty. They are to be divided into three care classes according to the amount of care required by the person in need of care according to the nature and severity of his care needs; for those in need of care who are recognised as a case of hardship, surcharges can be added to the care set of the Care class 3 is agreed up to the amount of the daily difference in the amount of the difference, which results from § 43 (2) sentence 2 nos. 3 and 4. In the case of the assignment of the person in need of care to the nursing classes, the care levels shall be based on the basis of § 15, unless the assignment to an other care class is necessary or sufficient. The nursing records must enable a nursing home in the event of an economic management to finance his expenses and to fulfil his/her supply contract. The payment of remuneration contractually agreed upon as well as corresponding remuneration in accordance with ecclesiastic labour law regulations cannot be rejected as uneconomical. Surpluses remain to the nursing home; losses are to be borne by him. The principle of premium rate stability must be observed. In the calculation of the care set of a care facility, the care kits of those care facilities, which are essentially similar in nature and size and in terms of the performance and quality characteristics referred to in paragraph 5, may be used: (3) The care rates are to be calculated according to uniform principles for all home residents of the nursing home; differentiation according to cost carriers is inadmissible. (4) The care kits are all for the care of the nursing home. Need for care in the manner and severity of their care needs Care services of the nursing care facility (general care services). In the case of general care services, unless otherwise specified, only the care rates agreed in accordance with § 85 or § 86 or fixed pursuant to Article 85 (5) may be calculated, regardless of who is to pay for their payment. (5) The basic performance and quality characteristics of the institution shall be laid down in the care set agreement. These include in particular:

1.

the allocation of the likely to be served group of persons, as well as the nature, content and scope of the services expected by the institution during the next care period;

2.

the personal equipment to be reserved by the institution for the group of persons expected to be supplied individually, broken down by occupational groups, and

3.

The type and extent of equipment of the facility with consumer goods (§ 82 para. 2 no. 1).

(6) The institution of the institution shall be obliged to ensure the care of the person in need of care at any time with the agreed staffing equipment. In the event of a staff shortage or failure, it shall take appropriate measures to ensure that care is not taken to the care of those in need of care. At the request of one of the Contracting Parties, the institution of the institution shall demonstrate in a staff agreement that the agreed staffing is actually made available and used in accordance with its intended purpose. The details of the implementation of the staff balance shall be laid down in the contracts in accordance with § 75 (1) and (2). (7) The institution of the institution shall be obliged, in the event of an agreement on the basis of the remuneration of the employees, to pay the employees in accordance with the conditions laid down in tariff contractually agreed remuneration as well as corresponding remuneration in accordance with ecclesiastic employment law regulations, the corresponding remuneration of the employees at any time. At the request of one of the Contracting Parties, the institution of the establishment shall demonstrate this Personal data are to be anonymized. The details of the performance of the proof shall be laid down in the contracts referred to in § 75 (1) and (2). Unofficial table of contents

Section 85 Care-of-care procedures

(1) The type, amount and duration of the care rates shall be agreed between the institution of the nursing home and the service providers referred to in paragraph 2. (2) Parties to the Nursing Home Agreement (Contracting Parties) shall be the institution of the individual approved nursing home. and

1.

the care funds or other social security institutions,

2.

the social assistance institution responsible for the inhabitants of the nursing home, and

3.

the working groups of the institutions referred to in paragraphs 1 and 2;

insofar as more than five of the hundred of the calculation days of the nursing home are in each case applicable to the respective cost carrier or to the working group in the year before the start of the maintenance-record negotiations. The care set agreement shall be concluded separately for each approved nursing home; section 86 (2) shall remain unaffected. The associations of nursing homes in the country, the regional associations of the nursing home and the association of private health insurance e. V. in the country can participate in the care process. (3) The nursing home agreement is in advance to meet before the beginning of the respective economic period of the nursing home, for a future period (maintenance period). The nursing home shall state the nature, content, scope and cost of the benefits for which it claims remuneration, through care documentation and other appropriate evidence, in good time before the start of the maintenance negotiations; it also has the To submit a written statement of the representation of the interests of the residents according to the provisions of the secret law. To the extent that this is necessary in order to assess its economic efficiency and performance in individual cases, the nursing home shall, at the request of one of the Contracting Parties, provide additional documents and provide information. This includes nourishing information on the annual accounts, in accordance with the principles of proper care management, the staffing and factual equipment of the nursing home, including the costs, and the actual costs of the nursing home. Job vacancy and grouping. Personal data are to be anonymized. (4) The maintenance agreement shall be concluded by agreement between the institution of the nursing home and the majority of the cost carriers referred to in the first sentence of paragraph 2 which have taken part in the care-record hearing. It shall be concluded in writing. To the extent that Contracting Parties may be represented by third parties in the course of the maintenance negotiations, they shall submit to the other Contracting Parties a written negotiating and closing power before the start of the negotiations. (5) In accordance with § 76, the Arbitration Board shall, at the request of one of the Contracting Parties, immediately establish the care rates immediately after a Contracting Party has requested in writing for the maintenance of the maintenance-record negotiations. The first sentence shall also apply to the extent to which the social assistance institution responsible for social assistance referred to in the first sentence of paragraph 2 contradicts the maintenance agreement within two weeks after the conclusion of the contract; the institution of social assistance may require in advance that it be replaced by the as a whole, only the chairman and the two other impartial members, or only the chairman, decide on their own. The legal route to the social courts is to be found against the fixing. A pre-trial procedure shall not take place; the action shall not have suspensive effect. (6) Care set agreements and arbitral decisions referred to in the first or second sentence of paragraph 5 shall be taken with due regard to the interests of the Nursing homes are in force at a certain point in time; they are directly binding for the nursing home as well as for those who are in need of care in the home and their cost carriers. A retroactive entry into force of care records shall not be allowed. After the period of care has expired, the agreed or established maintenance rates shall continue to apply until the entry into force of new maintenance rates. (7) In the event of unforeseeable substantial changes in the assumptions underlying the agreement or the fixing of the The maintenance rates shall be renegotiated at the request of one of the Contracting Parties for the current period of care; paragraphs 3 to 6 shall apply mutatily. Unofficial table of contents

Section 86-Nursing Home Commission

(1) The regional associations of the caregivers, the Association of Private Health Insurance, the local or a national law of certain social welfare providers and the associations of the care providers in the country are regional or national. Nursing staff committees operating in place of the Contracting Parties in accordance with Article 85 (2) may agree to the nursing kits with the consent of the nursing home-related secret carriers concerned. Section 85 (3) to (7) shall apply. (2) For nursing homes located in the same administrative district or in the same county, the Nursing Home Commission may, with the agreement of the persons concerned, uniform for the same benefits. Nursing kits agree. The nursing homes involved are empowered to offer their services below the care rates agreed in accordance with the first sentence. (3) The nursing staff commission or the contracting parties under Section 85 (2) may also conclude framework agreements, which in particular: determine their rights and obligations, the preparation, the start and the procedure of the maintenance negotiations as well as the nature, scope and timing of the performance certificates and other negotiation documents to be provided by the nursing home. Sentence 1 shall not apply to the extent to which binding provisions have been made for the nursing home in accordance with § 75. Unofficial table of contents

§ 87 Accommodation and catering

The service providers affected as caregivers (§ 85 para. 2), together with the institution of the nursing home, agree on the charges for the accommodation and for the catering, which are to be borne by the care-care providers. The charges must be proportionate to the benefits. § 84 (3) and (4) and § § 85 and 86 shall apply accordingly; § 88 shall remain unaffected. Unofficial table of contents

Section 87a Calculation and payment of the home pay

(1) Care rates, charges for accommodation and catering, as well as the separately predictable investment costs (total remuneration) shall be made for the day when the person in need of care is received in the nursing home, as well as for each further day of the Home stay calculated (calculation day). The obligation to pay the home residents or their payers ends with the day when the home-dweller is released from the home or dies. If a person in need of care moves to another home, only the receiving nursing home may charge an overall fee for the day of the relegation. Agreements deviating from sentences 1 to 3 between the nursing home and the home-dweller or its cost-bearer are void. In the case of temporary absences, the nursing home shall be kept free of care for the person in need of care for an absence period of up to 42 days in the calendar year. By way of derogation, the period of absence shall be extended in the case of hospital stays and, in the case of stays in rehabilitation facilities, for the duration of those visits. In the framework contracts referred to in Article 75, the periods of absence determined in accordance with sentences 5 and 6 shall, to the extent that three calendar days are exceeded, shall be at least 25 per cent of the maintenance allowance, the charges for accommodation and (2) there is evidence that the resident resident is to be assigned to a higher level of care on the basis of the development of his condition, he shall be invited to request a written request from the Home carrier obliged to assign to a higher level of care with his care fund apply. The request shall be justified and shall also be forwarded to the competent institution of social assistance to the caregivers and to social assistance recipients. If the home resident refuses to submit the application, the home institution may provisionally calculate the rate of care after the next higher care class from the first day of the second month following the request. If the conditions for a higher level of care are not confirmed by the Medical Service and the care fund refuses a upgrading, the nursing home has to reimburse the patient in need of the overpaid amount without delay; the Repayment amount is retroactive from the date referred to in the third sentence with at least 5 of the hundred. (3) The benefit amounts due to the dependent home resident in accordance with § § 41 to 43 are from his care fund with liberating Effect immediately to be paid to the nursing home. The amount of the amount of benefit to be paid shall be determined by the performance notice of the care fund, regardless of whether the decision is final or not. The amounts to be paid by the caregivers are to be paid in the case of full-time care (§ 43) to the 15th. (4) Care facilities which provide services within the meaning of § 43 shall, in addition, receive the amount of EUR 1 597 from the care fund if the person in need of care after the implementation of activating or rehabilitative measures has been downgraded to a lower level of care or from significant to insignificant care needs. The amount will be adjusted according to § 30. The amount paid by the care insurance fund must be repaid by the carer if the person in need of care is classified within six months to a higher level of care or to a not significant degree of care in need of care. Unofficial table of contents

§ 87b Remuneration Allowances for additional care and activation in inpatient care facilities

(1) In derogation from § 84 (2) sentence 2 and (4) sentence 1 and with the corresponding application of § § 45a, 85 and 87a for the additional care and activation of the nursing home residents as well as the Insured persons who have a need for assistance in the area of basic care and domestic care who do not reach the level of care level I, (eligible persons) are entitled to an agreement for the benefit of the benefit of the benefits. Care allowance. The agreement of the remuneration surcharges shall require that:

1.

the persons entitled to claim are additionally cared for and activated in addition to the care required in the manner and severity of the care needs,

2.

the inpatient care facility for the additional care and activation of the eligible persons with additional care staff, in fully inpatient care facilities in employment subject to social insurance and the Expenses for this staff are not taken into account either in the assessment of the maintenance rates or in the additional services provided for in § 88,

3.

the remuneration allowances are agreed on the basis that, as a general rule, the twenty-first part of the personnel expenses for each eligible person is financed for an additional full-time force; and

4.

the Contracting Parties have agreed that the agreed remuneration allowance may not be calculated, provided that the additional care and activation is not provided for persons entitled to receive the remuneration.

In addition, an agreement may only be reached with inpatient care facilities, the eligible persons and their dependants can be checked in the course of the negotiation and conclusion of the home contract and clearly on this Notes that there is an additional offer of care for which a remuneration allowance is paid in accordance with paragraph 1. The performance and price comparison list in accordance with § 7 (3) shall be supplemented accordingly. (2) The remuneration allowance shall be borne by the care fund and shall be reimbursed by the private insurance undertaking within the scope of the agreed insurance cover; Section 28 (2) shall apply accordingly. The remuneration allowances shall include all additional services of care and activation for eligible persons within the meaning of paragraph 1. The persons entitled to the allowance and the institutions of social assistance shall not be subject to any or all of the charges in respect of remuneration. With the payment of the remuneration allowance from the care fund to the care facility, the eligible person is entitled to the provision of the additional care and activation to the care facility. (3) The top association of the federal government of the For the additional care staff to be employed on the basis of § 45c (3), care funds must decide on the qualification and tasks in stationary nursing facilities; in this connection, he has the federal associations of the institutions responsible for the qualification and the tasks in the nursing care institutions. to listen to stationary care facilities and to the generally accepted level of care to observe medical-care findings. The guidelines are effective for all carers and their associations as well as for the stationary nursing care facilities only after approval by the Federal Ministry of Health; § 17 para. 2 shall apply accordingly. Unofficial table of contents

Section 88 Additional services

(1) In addition to the nursing care according to § 85 and the charges in accordance with § 87, the nursing home with the person in need of care may, beyond the necessary services agreed in the supply contract (§ 72 (1) sentence 2), separately reported surcharges for

1.

Special comfort in accommodation and board as well as

2.

Additional care-care services

agree (additional services). The contents of the necessary services and their delimitation of the additional services are laid down in the framework contracts according to § 75. (2) The granting and calculation of additional services is only permissible if:

1.

in this way, the necessary stationary or partially stationary services of the nursing home (§ 84 para. 4 and § 87) are not impaired,

2.

the offered additional services have previously been agreed in writing between the nursing home and the person in need of care, in accordance with the nature, extent, duration and time of the year, as well as the amount of the surcharges and the conditions of payment,

3.

the range of services and the conditions of service have been notified in writing to the regional associations of the care funds and to the local social assistance institutions in the country before the start of the service.

Third Section
Remuneration of ambulatory care services

Unofficial table of contents

Section 89 principles governing the remuneration system

(1) The remuneration of the outpatient care services and the provision of domestic services shall, in so far as not the fees regulations pursuant to § 90 apply, be between the institution of the nursing service and the service providers in accordance with paragraph 2 for all Persons in need of care are agreed in accordance with uniform principles It must be effective. The remuneration must enable a nursing service in the case of economic management to finance its expenses and to fulfil its supply contract. The payment of remuneration contractually agreed upon as well as corresponding remuneration in accordance with ecclesiastic labour law regulations cannot be rejected as uneconomical. A differentiation in the remuneration according to cost carriers is inadmissible. (2) Contracting parties to the remuneration agreement are the providers of the nursing service as well as

1.

the care funds or other social security institutions,

2.

the social assistance institutions responsible for the care services provided by the care service, and

3.

the working groups of the institutions referred to in paragraphs 1 and 2;

as far as the respective cost carrier or the working group in the year before the commencement of the remuneration negotiations, more than 5 of the hundred of the nursing staff cared for by the nursing service are in each case eliminated. The remuneration agreement shall be concluded separately for each care service and shall apply to the catchment area agreed in accordance with section 72 (3) sentence 3, unless expressly agreed otherwise. (3) The remuneration may, depending on the nature and nature of the service. the extent of the maintenance performance, the amount of time required for this, or the amount of time required for the performance of the respective care use, after complex services or, in exceptional cases, also according to individual benefits; other services such as domestic services, government agencies or Travel costs can also be reimbursed with flat-rate packages. The remuneration has to take into account the fact that services can be called up and used jointly by a number of people in need of care; the time and cost savings resulting from a common performance benefit are to be taken into account. People in need of care. In addition, remuneration for care services pursuant to section 36 (1) must also be agreed. The second sentence of Article 84 (4) and (7), Article 85 (3) to (7) and Article 86 shall apply accordingly. Unofficial table of contents

Section 90 Fee regulations for outpatient care services

(1) The Federal Ministry of Health is authorized, in agreement with the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, and the Federal Ministry of Labour and Social Affairs, by means of a legal regulation with the consent of the Federal Council, to: Fee order for the remuneration of the outpatient care services and the provision of the domestic care of the nursing care workers to be issued in so far as the care is covered by the duty of the nursing care insurance. The remuneration must be performance-based, comply with the design principles in accordance with § 89 and take regional differences into account in terms of their level. Section 82 (2) shall apply accordingly. The regulation also regulates the payment of compensation between the caregivers and the care services. (2) The fee regulation does not apply to the remuneration of out-patient care services and the provision of domestic care services. by family members and other persons who live in the home community with the need for care. To the extent that the fees regulations apply, the care facilities and caregiers concerned are not entitled to make further claims to the person in need of care or their cost carrier beyond the calculation of the fees.

Fourth Section
Reimbursement of expenses, Landesnursing committees, foster-secret comparison

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Section 91 Costing of expenses

(1) admitted care facilities which dispense with a contractual provision of the nursing allowance in accordance with § § 85 and 89 or with which such a scheme does not come about may be the price for their outpatient or inpatient services agree directly with the person in need of care. (2) The costs for the care-related expenses, calculated by the institutions referred to in paragraph 1, shall be reimbursed to those in need of care. However, the refund shall not exceed 80 per cent of the amount paid by the caregivers for each person in need of care in accordance with the nature and seriousness of the need for care in accordance with the third section of the fourth chapter. A further reimbursement by a institution of social assistance is inadmissible. (3) Paragraphs 1 and 2 shall apply to persons in need of care who are insured with a private insurance undertaking in accordance with the provisions of this book. (4) The Persons in need of care and their dependants shall be informed of the legal consequences of paragraphs 2 and 3 in good time by the care fund and the care institution. Unofficial table of contents

Section 92 Land care committees

For each country or for parts of the country, a state care committee is set up for advice on matters relating to nursing care insurance. The Committee may make recommendations for the implementation of the nursing care insurance scheme. The State Governments are empowered to determine, by means of a legal regulation, the details of the Land Care Committees; in particular, they shall be entitled to the organisations belonging to the Land Nursing Committees, taking into account the interests of all the organizations concerned. Care in the country involved. Unofficial table of contents

§ 92a Care secret comparison

(1) The Federal Government is empowered to order a care-secret comparison by means of a legal regulation with the consent of the Bundesrat, in particular with the aim of:

1.

the national associations of the caregivers in the performance of economic and quality audits (§ 79, Eleventh Chapter),

2.

the Contracting Parties in accordance with Section 85 (2) in the assessment of remuneration and charges as well as

3.

the care insurance funds in the preparation of the performance and price comparison lists (§ 7 para. 3)

. The nursing homes are country-related, set up for establishment, in particular with regard to their performance and occupancy structures, their care rates and charges as well as their separately calculated investment costs. (2) In of the Regulation referred to in paragraph 1 shall be laid down in particular:

1.

the organization and implementation of the care secret comparison by one or more bodies commissioned by the Association of the Covenant of the Nurses or the regional associations of the care funds,

2.

the financing of the provision of care insurance from the management funds of the care funds,

3.

the collection of the comparative data, including its processing.

(3) For the purposes of determining the comparative data, priority shall be given to the available data from the supply contracts and to the maintenance and pay arrangements

1.

the supply structures, including the personnel and the material,

2.

the benefits, care rates and other charges for nursing homes

and back to the data from the agreements on additional services. In so far as this is necessary for the purposes of foster-care comparison, the nursing homes of the body responsible for carrying out the care secret comparison shall, on request, provide additional documents and provide information, in particular: on the investment costs separately calculated (Article 82 (3) and (4)). (4) The Regulation referred to in paragraph 1 shall ensure that the comparative data

1.

the competent national authorities,

2.

the associations of the caregivers in the country;

3.

the national associations of the care funds,

4.

the medical service of health insurance,

5.

the association of private health insurance e. V. in the country and

6.

the social assistance institutions responsible under national law

shall be made accessible. The parties referred to in the first sentence shall be empowered to submit the comparative data to their associations or associations at the federal level; the national associations of the caregivers shall be obliged to provide the comparative data necessary for the purposes of the test to the extent necessary for the purposes of the investigation. (5) Before the adoption of the legal regulation in accordance with paragraph 1, the top association is the Confederation of Nursing Homes, the Association of Private Health Insurance (BfB). V., the Bundesarbeitsgemeinschaft der überlocalbearer der Sozialhilfe ("Bundesarbeitsgemeinschaft der überlocalbearer der Sozialhilfe"), the Federal Association of Local Government Associations and the associations of the providers of nursing homes at the federal level. Within the scope of the hearing, these may also submit proposals for a legal regulation pursuant to paragraph 1 or for individual provisions of such a regulation. (6) The top association of the nursing insurance funds or the regional associations of the nursing care insurance companies are shall be entitled to publish annually lists of nursing homes with the performance, occupancy and remuneration data determined in the comparison of nursing homes. (7) Personal data shall be available prior to the transmission of data or to the provision of information (8) The Federal Government is empowered to Ordinance with the consent of the Federal Council to arrange a country-by-country comparison of the approved care services (care service comparison) in the appropriate application of the preceding paragraphs.

Fifth Section
Integrated care and care points

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§ 92b Integrated supply

(1) In accordance with § 140b (1) of the Fifth Book, the care funds may conclude contracts for integrated supply with approved care institutions and the other contracting parties or with the agreement of the contractual partners. (2) In the Treaties referred to in paragraph 1, it is necessary to regulate the nature, content and scope of the services to be provided for the integrated supply and the remuneration thereof. These contracts may be subject to the provisions of Sections 75, 85 and 89, if they correspond to the meaning and nature of the integrated supply, the quality, the effectiveness and the economic efficiency of the supply by the -improvement of care facilities or other reasons for the implementation of integrated care. Care allowances shall not take into account expenses which are not subject to the financial responsibility of the social care insurance. To the extent that care facilities are created by the integrated supply of additional expenses for care services, the parties agree on performance-related surcharges to the care allowances (§ § 85 and 89). § 140b (3) of the Fifth Book applies to the benefits of carers ' benefits in relation to their caregivers. (3) § 140a (2) and (3) of the Fifth Book applies to the information rights of the caregivers in relation to their caregivers; and for the participation of carers in the integrated forms of care. Unofficial table of contents

§ 92c Care-based points

(1) In order to provide advice, care and care for the insured persons close to the place of residence, the nursing care funds and health insurance funds shall set up care-based points, provided that the competent supreme state authority determines this. The institution shall be established by the supreme authority within six months of the date of the destination. If the necessary contracts are not concluded within three months from the date of the determination by the supreme state authority, the national associations of the caregivers have to determine the content of the contracts within a further month; They shall also be responsible for the interests of the replacement funds and of the national associations of the health insurance companies. With regard to the majority ratios in decision-making, Section 81 (1) sentence 2 shall apply accordingly. Opposition and challenge action against measures taken by the supervisory authorities to set up care-based points have no suspensive effect. (2) The tasks of the care-based points are:

1.

Comprehensive and independent information and advice on the rights and obligations under the Social Code and on the selection and use of social benefits and other offers of social benefits and other offers of assistance,

2.

Coordination of all health-promoting, preventative, curative, rehabilitative and other medical, nursing and social assistance and support services to be considered for the provision of accommodation and care for the benefit of the place of residence and care , including assistance in the use of benefits,

3.

Networking of nursing and social care and care services coordinated with each other.

Access to existing networked consulting structures is to be used. The care funds shall, at any time, seek to ensure that the

1.

in accordance with the law of the country to be determined by local authorities in the context of local care for the elderly and for the provision of assistance for care in accordance with the Twelfth Book,

2.

-approved and operating care facilities in the country,

3.

Companies active in the country of private health insurance and nursing care insurance

participate in the care-based points. The health insurance companies have to take part in the care-based points. The costs and service providers involved are responsible for the care-based points. The carriers

1.

should involve nurses in the work of the care-based points,

2.

Have, as far as possible, members of self-help groups, as well as voluntary and other people and organisations ready to engage in civic engagement, in the activities of the care-based points,

3.

should enable interested ecclesiastic as well as other religious and social institutions and organisations to participate in the care-based points,

4.

shall be able to serve third parties in carrying out their duties,

5.

With a view to the placement and qualification of the appropriate forces for the care and care of the job seeker in accordance with the third book and the institutions of the basic insurance for jobseekers according to the second book work together.

(3) The cost carriers and service providers involved in the care points may conclude contracts for the integrated care close to the place of residence for the catchment area of the care-based points; in this respect, § 92b shall be applied accordingly, (4) The care centre may be established in the case of a nurse approved and active in the country, if this does not result in an inadmissible impairment of competition between the care facilities. The costs required for the operation of the care centre shall be borne by the institutions of the care-based points, taking into account the eligible expenditure for the staff employed on the basis of a contractual agreement. carried out proportionally. The distribution of the expenditure necessary for the operation of the care centre shall be agreed with the proviso that the proportion falling on a single care fund shall not be higher than that of the health insurance fund in which it is established is to carry the share. To the extent that private insurance undertakings carrying out private-care compulsory insurance do not participate in the financing of the care-based points, they shall have the type, content and scope of the care-based points with the institutions of the care-based points. To make use of the care-based points by private care-compulsory insured persons as well as the remuneration of the expenses incurred in each case for this purpose; this applies to private insurance companies, which are the private insurance companies (5) The structure of the joint sponsorship of care and health insurance funds as well as the care points to be determined in accordance with country law is within the limits of the available funds up to 30 June 2011 according to the respective needs with a grant of up to 45.000 Euro per The need also includes the start-up costs of the nursing care centre. The funding needs to be increased by up to EUR 5,000, if members of self-help groups, voluntary and other people and organisations that are willing to engage in civic engagement have a lasting impact on the activities of the Support points are included. The requirements, the amount of the grant applied for, the payment plan and the payee shall be communicated to the Association of the Nurses ' Association of the Care Centre within the framework of their application for support referred to in sentence 1. The Federal Insurance Office (Bundesversicherungsamt) pays the funds after receipt of the examination notification of the top association of the Confederation of Nursing Care Funds on the fulfilment of the conditions for payment of the payment to the payee. At the latest one year after the last payment, the applicants have to submit proof of the appropriate use of the funding. (6) The Federal Insurance Office (Bundesversicherungsamt) is responsible for the funding of the funding. from the compensation fund of the nursing care insurance up to a total amount of EUR 60 million, but up to the maximum level for the country concerned, up to the level resulting from the division by the king's key. The payment of the individual funding amounts shall be effected according to the date of receipt of the applications by the Association of the Association of the Care Insurance Funds. The Federal Insurance Office (Bundesversicherungsamt) regulates the payment procedure and the use of the funds by agreement with the Association of the Confederation of Nursing Insurance Funds. (7) Persons working in the nursing care centre as well as other persons with the perception of Tasks referred to in paragraph 1, in particular:

1.

in accordance with the law of the country, for the provision of care in the context of local assistance for the elderly and for the provision of care to be taken in accordance with the Twelfth Book;

2.

Companies of the private health and nursing care insurance,

3.

Care facilities and individuals according to § 77,

4.

Members of self-help groups, volunteers and other people and organizations that are willing to engage in civic engagement, as well as

5.

Agencies for the work and support of the basic insurance for jobseekers

may only collect, process and use social data to the extent that this is necessary for the performance of the tasks provided for in this book or by legislation of the Social Code or regulations of the insurance contract-or of the (8) The Landesfederations of the caregivers can with the national associations of the health insurance funds as well as the substitute funds and the authorities to be determined under national law of the elderly and the assistance to the Maintenance according to the Twelfth Book Framework contracts for the work and financing of the care-based points agree. The provision made by the competent supreme authority for the establishment of care points and the recommendations referred to in paragraph 9 shall be taken into account. The framework contracts are in the work and financing of nursing care points in the joint sponsorship of the statutory health and care insurance funds and the authorities to be determined under national law for the care of the elderly and for the help for care according to the twelfth book. (9) The Association of the Covenant of Nurses, the Confederation of Health Insurance Funds, the Federal Working Group of the Local Social Welters and the Federation of Local Government Associations (Bundesvereinigung der municipal Spitzenverbände) Joint and consistent recommendations on work and financing agree on nursing care points in the joint sponsorship of statutory health and care insurance funds, as well as the bodies of old and social welfare assistance that are to be determined by national law.

Ninth chapter
Data protection and statistics

First section
Information bases

First Title
Principles of data usage

Unofficial table of contents

Section 93 Applicable Provisions

§ 35 of the First Book, § § 67 to 85 of the Tenth Book as well as the provisions of this book apply to the protection of personal data in the collection, processing and use in the care insurance. Unofficial table of contents

Section 94 Personal data relating to the care insurance funds

(1) The care insurance funds may only collect, process and use personal data for the purposes of care insurance, insofar as this is for:

1.

the determination of the insurance relationship (§ § 20 to 26) and the membership (§ 49),

2.

the determination of the obligation to pay contributions and the contributions, their traation and payment (§ § 54 to 61),

3.

the examination of the obligation to provide services and the granting of benefits to insured persons (§ § 4 and 28) as well as the implementation of reimbursement and replacement claims,

4.

The participation of the Medical Service (§ § 18 and 40),

5.

the settlement with the service providers and the reimbursement of expenses (§ § 84 to 91 and 105),

6.

the monitoring of economic efficiency and quality of service provision (§ § 79, 112, 113, 114, 114a, 115 and 117),

6a.

the conclusion and implementation of maintenance-level agreements (§ § 85, 86), remuneration agreements (§ 89) as well as contracts for integrated care (§ 92b),

7.

advice on services of prevention and participation, as well as on benefits and assistance for care (§ 7),

8.

the coordination of nursing assistance (§ 12), the care advice (§ 7a), the delivery of advice vouchers (§ 7b) as well as the performance of the tasks in the care-based points (§ 92c),

9.

accounting with other service providers,

10.

statistical purposes (§ 109),

11.

the support of insured persons in the prosecution of claims for damages (§ 115 (3) sentence 7)

(2) The personal data collected and stored in accordance with paragraph 1 may only be processed or used for other purposes, insofar as this is arranged or permitted by legislation of the Social Code. At the request of the Court of Supervisors, the Care Fund shall, in accordance with Article 282 (1) of the Law on the Procedure in Family Matters and in the Matters of Voluntary Jurisdiction, comply with the provisions of Section 18 of the Act of (3) The insurance and performance data of the employees employed for the tasks of the caregivers, including the data of their co-insured members may be persons who have internal To make personnel decisions or participate in it, be neither accessible nor disclosed to persons who have access to it. Unofficial table of contents

§ 95 Personal data for the associations of the care insurance funds

(1) The associations of the caregivers may only collect, process and use personal data for the purposes of care insurance, insofar as these data are for:

1.

the monitoring of economic efficiency and quality assurance of service provision (§ § 79, 112, 113, 114, 114a, 115 and 117),

2.

the conclusion and implementation of supply contracts (§ § 72 to 74), maintenance-level agreements (§ § 85, 86), remuneration agreements (§ 89) as well as contracts for integrated care (§ 92b),

3.

the performance of the tasks assigned to them in accordance with § § 52 and 53;

4.

the support of insured persons in the prosecution of claims for damages (§ 115 (3) sentence 7)

(2) § 94 (2) and (3) shall apply accordingly. Unofficial table of contents

§ 96 Joint processing and use of personal data

(1) The care insurance funds and the health insurance companies may jointly process and use personal data which is required for the performance of statutory tasks of each location. In this regard, § 76 of the Tenth Book does not apply in relation to the health insurance fund in which it is established (§ 46). (2) § 286 of the Fifth Book applies to the nursing care funds accordingly. (3) Paragraphs 1 and 2 apply. according to the associations of the nursing and health insurance companies. Unofficial table of contents

Section 97 Personal data relating to the medical service

(1) The Medical Service may only collect, process and use personal data for the purposes of care insurance, insofar as this is for the examinations, deliberations and expert opinions pursuant to § § 18, 40, 112, 113, 114, 114a, 115 and 117. is required. The data may only be processed and used for other purposes, insofar as this is arranged or permitted by the legislation of the Social Code. (2) The Medical Service may provide personal data for the performance of the tasks referred to in the following: collect, process or use the Fifth or Eleventh Book, also process or use for the tasks of the other book in each case, if without the existing data these tasks cannot be properly fulfilled. (3) The personal data are to be deleted after five years. § 96 (2), § 98 and § 107 (1) sentence 2 and 3 and (2) apply to the medical service accordingly. The Medical Service has to store social data for the identification of the insured person separately from the medical social data of the insured person. Technical and organisational measures shall ensure that the social data are accessible only to those persons who need it to carry out their duties. The key for the merging of the data is to be kept by the Data Protection Officer of the Medical Service and may not be made available to other persons. Each merger shall be recorded. (4) § 25 of the Tenth Book shall apply mutagenally to the right of access to the file of the insured person. Unofficial table of contents

§ 97a Quality assurance by experts and verifiers

(1) Other experts (Section 114 (1) sentence 1) as well as experts and test institutions within the meaning of section 114 (4) sentence 2 are entitled to use data for the purposes of quality assurance and verification by the national associations of the care insurance funds. § § 112, 113, 114, 114a, 115 and 117 are to be collected, processed and used; they may submit the data to the caregivers and their associations, as well as to the bodies referred to in § § 112, 114, 114a, 115 and 117, insofar as this is to the satisfaction of the Statutory tasks in the field of quality assurance and quality control of these jobs is required. The data shall be treated confidentially. (2) § 107 shall apply accordingly. Unofficial table of contents

§ 97b Personal data in the case of the supervisory authorities responsible for legal provisions and the institutions of social assistance

The supervisory authorities responsible for legal regulations and the competent institutions of social assistance shall be entitled to the personal data collected for the purposes of long-term care insurance in accordance with § § 112, 113, 114, 114a, 115 and 117 shall be processed and used in so far as this is necessary for the performance of their statutory tasks; § 107 shall apply accordingly. Unofficial table of contents

§ 97c Quality assurance by the audit service of the Association of Private Health Insurance e. V.

In the performance of the tasks in the field of quality assurance and quality assurance in the sense of this book by the audit service of the Association of Private Health Insurance e. V., the audit service shall be deemed to be the body within the meaning of § 35 (1) sentence 1 of the First Book. § § 97 and 97a shall apply accordingly. Unofficial table of contents

§ 97d Review by independent reviewers

(1) Independent reviewers shall be entitled to collect, process and use personal data of the applicant in accordance with § 18 (1) sentence 1, insofar as this is necessary for the purposes of the assessment pursuant to § 18 is. The data shall be treated confidentially. Technical and organisational measures shall ensure that the data are only accessible to persons who require them to fulfil the contract awarded to the reviewer by the caregivers in accordance with Article 18 (1) sentence 1. (2) The independent Verifiers may submit the results of the examination for the determination of the need for care as well as the rehabilitation recommendation in accordance with § 18 to the caregivers who are assigned to them, insofar as this is done in order to fulfil the statutory tasks of the care insurance fund § 35 of the First Book shall apply accordingly. In this context, it is necessary to ensure that the result of the examination for the determination of the need for care and the rehabilitation recommendation are made available only to those persons who need it to carry out their tasks. (3) The personal Data must be deleted after five years. Article 107 (1), second sentence, shall apply accordingly. Unofficial table of contents

Section 98 Research projects

(1) With the permission of the supervisory authority, the caregivers may evaluate the data sets of the providers-and case-related-for temporary and limited research projects themselves and to carry out a research project. (2) Personal data are to be anonymized.

Second Title
Information bases for the care insurance funds

Unofficial table of contents

Section 99 Insurance list

The care insurance fund has to lead an insurance list. It shall include in the list of insured persons all information relating to the determination of the obligation or entitlement to insurance and the right to family insurance, to the assessment and recovery of contributions and to the determination of the Entitlement to benefits is required. Unofficial table of contents

§ 100 obligation to provide proof of family insurance

The care fund may collect the data required for the proof of family insurance (§ 25) from the family member or with the consent of the member. Unofficial table of contents

§ 101 nursing insurance number

The caregivers use an insurance number for each insured person, which may be entirely or partially the same as the health insurance number. In the case of the award of the number for insured persons in accordance with § 25, it shall be ensured that the reference to the family member who is a member can be established. Unofficial table of contents

Section 102 Information on performance requirements

The care fund shall record information on the services necessary to verify the conditions for subsequent performance. This shall include, in particular, information on the determination of the conditions for entitlement to benefits and the performance of grants. Unofficial table of contents

§ 103 license plate for service providers and service providers

(1) The care insurance funds, the other social insurance institutions and the contractual partners of the care funds, including their members, are used in correspondence and for accounting purposes with one another. (2) § 293 para. 2 and 3 of the Fifth Book shall apply accordingly.

Second section
Submission of performance data

Unofficial table of contents

Section 104 obligations of service providers

(1) The service providers are entitled and obliged:

1.

in the case of the review of the need for care aids (Article 40 (1)),

2.

in the case of a test procedure, in so far as the cost-effectiveness or the quality of the services are to be assessed on a case-by-case basis (Articles 79, 112, 113, 114, 114a, 115 and 117),

2a.

in the case of the conclusion and implementation of supply contracts (§ § 72 to 74), maintenance-level agreements (§ § 85, 86), remuneration agreements (§ 89) and contracts for integrated care (§ 92b),

3.

in the case of accounting of nursing services (§ 105)

to record the information required for the performance of the tasks of the caregivers and their associations, and to communicate to the caregivers and to the associations or bodies responsible for processing them. (2) Insofar as this is the case in paragraph 1, 2 and 2a, the service providers shall be entitled to transmit the personal data to the medical services and to the bodies referred to in § § 112, 113, 114, 114a, 115 and 117. (3) Carrier associations may process and use personal data to the extent that this is the case for their Participation in quality checks or quality assurance measures according to this book is required. Unofficial table of contents

§ 105 Accounting of nursing services

(1) The service providers participating in the care supply shall be obliged to:

1.

to record in the accounting documents the services they provide according to the type, quantity and price, including the date and time of the provision of services,

2.

indicate in the accounting documents its mark (§ 103) as well as the insurance number of the person in need of care,

3.

use the names of the list of auxiliaries in accordance with § 78 in the invoicing of the delivery of assistance funds.

As of 1 January 1996, machine-readable accounting documents shall be used. (2) Details of the form and content of the accounting documents as well as details of the exchange of data are to be provided by the Association of the Association of the Care Insurance Funds, in agreement with the to the associations of service providers. Section 302, paragraph 2, sentences 2 and 3 of the Fifth Book shall apply mutatily. Unofficial table of contents

Section 106 Variant agreements

The national associations of the caregivers (§ 52) may agree with the service providers or their associations that:

1.

the extent of the accounting documents to be transmitted is restricted,

2.

except in whole or in part in the invoicing of services provided by individual data

if this does not jeopardise proper accounting and the fulfilment of the statutory tasks of the care funds. Unofficial table of contents

Section 106a Notification of notification

Approved nursing facilities, recognised counseling centres and responsible nursing staff who carry out nursing care in accordance with § 37 para. 3 are entitled and obliged, with the consent of the insured person, to carry out the tasks of the Information on the quality of the care situation and on the need to improve the care system and the private insurance companies should be provided to the care insurance companies and the private insurance companies. The form according to § 37 (4) sentence 2 is drawn up with the participation of the Federal Commissioner for Data Protection and Information Freedom and the Federal Ministry of Health.

Third Section
Data deletion, duty of information

Unofficial table of contents

Section 107 Delete of data

(1) In order to delete the personal data stored for the tasks of the care funds and their associations, § 84 of the Tenth Book shall apply accordingly, with the proviso that:

1.

the data referred to in § 102 at the latest after ten years,

2.

Other data from the accounting of nursing services (§ 105), from performance audits (§ 79), from examinations for quality assurance (§ § 112, 113, 114, 114a, 115 and 117) and from the conclusion or the execution of contracts (§ § 72 bis 74, 85, 86 or 89) at the latest after two years

are to be deleted. The time limits shall start at the end of the financial year in which the benefits were granted or settled. For the purposes of the care insurance, the care insurance funds can keep performance data for longer if it is ensured that a reference to natural persons can no longer be established. (2) In the case of the exchange of the care insurance fund, the previously responsible On request, the Care Fund requires the information required for the continuation of the insurance to be communicated in accordance with § § 99 and 102 of the new care insurance fund. Unofficial table of contents

Section 108 Information on insured persons

The care funds shall inform the insured persons at their request of the benefits and their costs of the services used in the last financial year. A communication to the service providers on the provision of information to the insured person is not permitted. The caregivers may, in their statutes, regulate the details of the procedure for informing them.

Fourth Section
Statistics

Unofficial table of contents

§ 109 Care statistics

(1) The Federal Government is empowered to arrange annual surveys on outpatient and inpatient care facilities as well as on domestic care as federal statistics for the purpose of this book by means of a legal regulation with the consent of the Federal Council. Federal statistics may include the following facts:

1.

the nature of the care facility and the sponsorship,

2.

the nature of the service provider and of the private insurance undertaking,

3.

persons employed in outpatient and inpatient care by sex, year of birth, employment relationship, area of activity, employment, professional qualifications on the basis of training, further training or retraining, in addition to apprentices and The type of education and training year, the beginning and end of the caring activities,

4.

factual equipment and organisational units of the care facility, training centres for care facilities,

5.

Persons in need of care and persons with a significantly reduced daily competence according to gender, year of birth, place of residence, type, cause, degree and duration of the need for care, type of insurance relationship,

6.

maintenance services in accordance with the nature, duration and frequency as well as the nature of the cost carrier,

7.

Costs of the care facilities according to cost types as well as proceeds according to type, height and cost carriers.

The providers of care facilities, the institutions of the nursing care insurance and the private insurance companies are responsible for providing information to the statistical offices of the Länder; the legal regulation may provide for exceptions to the obligation to provide information. (2) The Federal Government is empowered to arrange annual surveys on the situation of nursing and volunteer care as federal statistics for the purpose of this book by means of a legal regulation with the consent of the Federal Council. Federal statistics may include the following facts:

1.

Causes of dependency,

2.

Care and care needs of those in need of care,

3.

Care and care services provided by nurses, relatives and volunteers,

4.

prevention and participation services,

5.

Measures to maintain and improve the quality of care,

6.

Need for care aids and technical assistance,

7.

Measures to improve the living environment.

The Medical Service shall be obliged to provide information to the statistical offices of the Länder; the second sentence of the second subparagraph of paragraph 1 shall apply. (3) The third sentence of the third sentence of paragraph 1 and the third sentence of the third sentence shall be those provided for by the relevant statistics. At the same time, the competent authorities responsible for the planning and investment financing of the nursing care institutions are involved. The power of the Länder to arrange additional surveys, not covered by paragraphs 1 and 2, on matters of care as national statistics shall remain unaffected. (4) Data of persons in need of care, of persons working in the care sector, of For the purpose of federal statistics, nationals and volunteers may only be sent to the statistical offices of the Länder in an anonymised form. (5) The statistics referred to in paragraphs 1 and 2 shall be used in the areas of outpatient care and to submit short-term care for the first time in 1996 for the year 1995, for the area of Stationary care in 1998 for the year 1997.

Tenth chapter
Private care insurance

Unofficial table of contents

§ 110 Regulations for private care insurance

(1) In order to ensure that the interests of persons who are required to conclude a care insurance contract with a private health insurance undertaking in accordance with § 23 are sufficiently safeguarded and that the contracts can be fulfilled in the long term , without neglecting the interests of the insured persons of other tariffs, the private health insurance undertakings authorised to operate the care insurance scheme under this law shall be obliged to:

1.

to conclude, on request, an insurance contract which provides for insurance cover in the extent specified in section 23 (1) and (3) (contract of counterparties) with all the persons covered by the insurance referred to in § 22 and section 23 (1), (3) and (4); this shall also apply to the insurance undertakings selected pursuant to section 23 (2),

2.

in the contracts concluded by insurance companies in the amount prescribed in accordance with Article 23 (1) and (3),

a)

No exclusion from pre-illness of the insured,

b)

No exclusion of persons in need of care,

c)

no longer waiting times than in social care insurance (§ 33 para. 2),

d)

no staggering of premiums by sex and state of health of insured persons,

e)

no premium level exceeding the maximum contribution of the social care insurance scheme, in the case of persons who have completed a partial cost tariff in accordance with section 23 (3), no premium amount equal to 50 per cent of the maximum contribution of the social care insurance scheme exceeds,

f)

the non-contributory insurance of the children of the policyholder under the same conditions as laid down in § 25,

g)

no premium of more than 150 per cent of the maximum amount of the maximum contribution of the social care insurance scheme for spouses or partners from the date of proof of the circumstances entitling the spouse or a partner to take advantage of the contribution reduction, if a A spouse or a partner does not have a total income which exceeds the income limits referred to in Article 25 (1), first sentence, point 5, point 5,

(2) The conditions laid down in paragraph 1 shall apply to insurance contracts concluded with persons who are members of a private health insurance undertaking at the date of entry into force of that law, General hospital services, or in accordance with Article 41 of the Care Insurance Act, can be exempted from the obligation of insurance in the social care insurance scheme within six months of the entry into force of this Act. The conditions referred to in paragraph 1 (1) (1) and (2) (a) to (f) shall also apply to contracts with persons insured in the basic tariff in accordance with Section 12 of the Insurance Supervision Act. For persons insured in the basic rate according to § 12 of the Insurance Supervision Act and whose contribution to health insurance is reduced according to § 12 (1c) sentence 4 or 6 of the Insurance Supervision Act, the contribution may be 50 of the hundred of the in accordance with paragraph 1 (2) (e), the contribution limit for spouses or life partners referred to in paragraph 1 (2) (g) shall not apply to such insured persons. Article 12 (1) (5) or (6) of the Insurance Supervision Act shall apply mutagenically to the application of the contributions reduced in accordance with the third sentence, with the proviso that the competent institution shall pay the amount, which shall also apply to a person concerned by: Unemployment benefit II is to be borne in the social care insurance scheme. If the payment of the contribution to the long-term care insurance in accordance with the second sentence or the twelfth book provides for assistance in accordance with the second or twelfth book, the sentences 3 and 4 shall apply; the need for assistance shall be determined by the competent institution after the second or second book. (3) For insurance contracts concluded with persons who, only after the entry into force of this law, are members of a private health insurance undertaking with a claim to to general hospital services or to Insurance obligations according to § 193 (3) of the Insurance Contract Act are sufficient, provided that they are concluded in compliance with the obligation to provide advance care pursuant to § 22 (1) and § 23 (1), (3) and (4) and contract benefits in the provisions of § 23 (1) and (3) , the following conditions shall be laid down:

1.

Contraction force,

2.

No exclusion from pre-illness of the insured,

3.

no staggering of the premiums by sex,

4.

no longer waiting times than in social care insurance,

5.

for policyholders who have a pre-insurance period of at least five years in their private care insurance or private health insurance, no premium level exceeding the maximum contribution of the social care insurance scheme; Paragraph 1 (2) (e) shall apply:

6.

non-contributory co-insurance of the policyholder's children under the same conditions as specified in § 25.

(4) The rights of resignation and dismissal of insurance undertakings shall be excluded as long as the counterparty has been imposed. (5) Insurance undertakings shall have the right to inspect the documents. They shall inform the beneficiaries of the right to access to the file if they communicate the result of an examination of the need for care. Section 25 of the Tenth Book shall apply accordingly. Unofficial table of contents

Section 111 Risk equalisation

(1) The insurance undertakings operating a private nursing care insurance within the meaning of this book must ensure the permanent guarantee of the regulations for private care insurance in accordance with § 110 as well as for the provision of the funds according to § § § 110 45c to compensate for the insurance risks and to create and maintain a compensation system to which they belong. Whereas the compensation system must ensure a durable and effective compensation of the different loads; it must not complicate the market access of new providers of private care insurance and must take part in the system; Allow balancing system on equal terms. In this system, contributions are determined without costs on the basis of common calculation bases for all enterprises operating a private care insurance scheme. (2) The establishment, design, modification and the The compensation is subject to the supervision of the Federal Financial Supervisory Authority (Bundesanstalt für Finanzdienstleistungsaufsicht).

Eleventh chapter
Quality assurance, other arrangements for the protection of those in need of care

Unofficial table of contents

Section 112 Quality responsibility

(1) The providers of the care facilities shall remain responsible for the quality of the services provided by their institutions, including the safeguarding and further development of the quality of care, without prejudice to the guarantee by the care insurance funds (§ 69). Standards for the assessment of the performance of a care facility and the quality of its services are the requirements binding on them in the agreements according to § 113 as well as the agreed performance and quality characteristics (§ 84 para. 5). (2) The approved care facilities are obliged to carry out quality assurance measures as well as quality management in accordance with § 113 agreements, to apply expert standards according to § 113a as well as in the case of quality checks in accordance with § 114. In the case of stationary care, the quality assurance in addition to the general care services also extends to the medical treatment care, the social care, the services of accommodation and catering (§ 87) as well as to the additional services (§ § 87). 88). (3) The Medical Service of the Health Insurance and the Audit Service of the Association of Private Health Insurance e. V. advise the nursing care institutions in matters of quality assurance with the aim of preventing quality defects in good time and the personal responsibility of the care institutions and their carriers for the securing and further development of the care quality. . Unofficial table of contents

§ 113 Standards and Principles for the Securing and Development of Care Quality

(1) The top association of the nursing insurance funds, the federal working group of the local social welfare agencies, the federal association of local top associations and the associations of the institutions of the care institutions at the federal level The Association of Health Insurance Funds, the Association of Private Health Insurance, shall be jointly and uniformly jointly and jointly agreed by 31 March 2009 with the participation of the Medical Service of the Association of the Federal Government of the Health Insurance Funds. V., the associations of nursing professions at the federal level, the relevant organizations for the perception of the interests and self-help of the dependent and disabled people, as well as independent expert standards and principles for the Quality and quality assurance in outpatient and inpatient care as well as for the development of a single-directional quality management system, which is aimed at a continuous assurance and further development of the care quality. The agreements shall be published in the Federal Gazette and shall apply from the first day of the month following the publication. They are directly binding for all care funds and their associations as well as for the approved care facilities. In the agreements referred to in the first sentence, requirements shall in particular also be laid down

1.

Care documentation, which supports the care process and promotes care quality, which can not go beyond a reasonable and economic measure for the care facilities,

2.

to experts and test institutions in accordance with § 114 (4) with regard to their reliability, independence and qualification,

3.

to the methodical reliability of certification and testing procedures in accordance with § 114 (4), which are the applicable guidelines of the Association of the Federal Association of Nurses for the Examination of the Services provided in Nursing Facilities and their the quality and quality of

4.

an indicator-based method for the comparative measurement and presentation of results quality in the stationary sector, which is based on a structured data collection within the framework of internal quality management. Quality reporting and external quality control.

(2) The agreements referred to in paragraph 1 may be terminated in whole or in part by each party with a period of one year. Upon expiry of the agreement period or period of notice, the agreement shall continue to apply until the conclusion of a new agreement. (3) Agreements referred to in paragraph 1 shall be concluded within six months after a Contracting Party has agreed in writing. Any party or the Federal Ministry of Health may refer the matter to the Arbitration Board in accordance with § 113b. The arbitral body shall, within three months, determine the content of the agreements by a majority of its members. Unofficial table of contents

§ 113a Expert standards for the protection and further development of quality in care

(1) The Contracting Parties in accordance with § 113 shall ensure the development and updating of scientifically substantiated and technically coordinated expert standards for the safeguarding and further development of the quality in care. Expert standards contribute to the concretization of the generally accepted state of the medical-care findings. The Medical Service of the Federal Association of Health Insurance Funds, the Association of Private Health Insurance (BGN). V., the associations of nursing professions at the federal level, the relevant organizations for the perception of the interests and self-help of those in need of care and disabled persons at the federal level as well as independent experts are to be involved. You can propose to which topics of expert standards are to be developed. The contract for the development or updating and the introduction of expert standards shall be carried out by a decision of the Contracting Parties. If such decisions are not taken, each Contracting Party and the Federal Ministry of Health may, in agreement with the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, call upon the arbitration body under § 113b. A decision of the Court of Arbitration that an expert standard has been established in accordance with the Rules of Procedure referred to in paragraph 2 shall replace the introductory decision of the Contracting Parties. (2) The Contracting Parties shall provide the methodical and care professional Quality of the procedure for the development and updating of expert standards and the transparency of the procedure. The requirements for the development of expert standards must be laid down in a procedural order. In the Rules of Procedure, the procedure is based on a recognised methodological basis, in particular the scientific foundation and independence, the sequence of steps of the development, the technical coordination, the practice test and the model-based To establish the implementation of an expert standard and the transparency of the procedure. The Rules of Procedure are to be approved by the Federal Ministry of Health, in consultation with the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth. If agreement is not reached on a Rules of Procedure until 30 September 2008, it will be established by the Federal Ministry of Health in consultation with the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth. (3) The Expert standards are to be published in the Federal Gazette. They are directly binding for all care funds and their associations as well as for the approved care facilities. The contracting parties support the introduction of the expert standards into practice. (4) The costs for the development and updating of expert standards are administrative costs, which are borne by the Association of the Covenant of the Care Insurance Funds. Private insurance companies carrying out private maintenance compulsory insurance shall participate in a proportion of 10 per cent of the expenditure as set out in the first sentence. The share of financing that is attributable to private insurance companies can be provided by the Association of Private Health Insurance (private insurance). V. are made directly to the Association of the Association of Nurses of the Care Board. Unofficial table of contents

§ 113b Arbitration Board Quality Assurance

(1) The Contracting Parties shall, in accordance with Section 113, establish a Quality Assurance Unit jointly until 30 September 2008. This shall be decided in the cases assigned to it under this Act. The decision of the Court of Arbitration shall be the legal route to the Social Courts. A preliminary proceedings shall not take place; the action against the decision of the arbitrator shall have no suspensive effect. (2) The arbitration body shall consist of representatives of the top association Confederation of the caregivers and of the associations of the institutions of the Care facilities at the federal level in the same number as well as an impartial chairman and two other non-partisan members. The non-partisan members and their alternates shall be appointed jointly by the Contracting Parties. If an agreement is not reached, the non-partisan members and their representatives shall be up to 31. The President of the Federal Social Court (Bundessozialgericht) appointed in October 2008. The arbitrator shall also include a representative of the working group of the local social assistance institutions and a representative of the local community leaders; they shall be credited to the number of representatives of the top association of the caregivers ' association. The arbitration body may also be a representative of the Association of Private Health Insurance e. V., which is also credited to the number of representatives of the top association of the Association of Nursing Care Funds. A representative of the nursing profession's associations may include the arbitral body on the basis of the number of representatives of the associations of the institutions of the carer's institutions. To the extent that the participating organisations do not appoint members until 30 September 2008, the arbitration body shall be constituted by the three non-partisan members appointed by the President of the Federal Social Court. (3) The Contracting Parties pursuant to § 113 agree on 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 members of the arbitration board and the management, the Procedures, the collection and the level of fees and the distribution of costs. If the Rules of Procedure do not come into effect until 30 September 2008, the Federal Ministry of Health shall determine its content. Decisions of the arbitral body shall be taken by the majority of its members within three months; moreover, Section 76 (3) shall apply accordingly. (4) The Federal Ministry of Health shall be responsible for legal supervision of the arbitral body. It may transfer the legal supervision in whole or in part as well as permanently or temporarily to the Federal Insurance Office. Unofficial table of contents

Section 114 Quality checks

(1) In order to carry out a quality check, the national associations of the care insurance companies grant the medical service of the health insurance company, the audit service of the Association of Private Health Insurance (BfB). V. to the extent of 10 per cent of the test orders obtained in one year or to the experts appointed by them to a test order. The test order contains information on the type of test, the subject matter of the test and the scope of the test. The test is carried out as a control test, an examination of the test or a repeat test. The care facilities have to enable the examinations to be carried out properly. From 1 January 2014, full-patient care facilities shall be obliged to inform the regional associations of the care funds immediately after a regulatory examination, such as medical, medical and dental care, as well as the The supply of medicinal products in the facilities is regulated. In particular, they shall indicate:

1.

the conclusion and content of cooperation agreements or the integration of the facility in medical networks;

2.

the conclusion of agreements with pharmacies.

Major changes regarding the medical, medical and dental care as well as the supply of medicines are to be reported to the regional associations of the care insurance funds within four weeks. (2) The regional associations of the care insurance companies shall arrange for examination by the Medical Service of the Health Insurance, the examination service of the medical insurance company, at least once until 31 December 2010 in approved care facilities and from 2011 on a regular basis with a distance of not more than one year. Association of private health insurance e. V. or by experts ordered by them (regulatory examination). It is necessary to check whether the quality requirements of this book and the contractual agreements concluded on this basis have been fulfilled. In particular, the regulatory examination records essential aspects of the state of care and the effectiveness of the care and care measures (result quality). It can also extend to the process, the implementation and the evaluation of the service provision (process quality) as well as the immediate framework conditions of the service provision (structural quality). The regulatory examination refers to the quality of general care services, medical treatment care, social care, including the additional care and activation within the meaning of § 87b, the provision of accommodation and services. Catering (§ 87), the additional services (§ 88) and the services of the home nursing care provided in accordance with § 37 of the Fifth Book. It may also cover the settlement of the above-mentioned benefits. It is also to be examined whether the care needs of the patients in need of care comply with the recommendations of the Commission for Hospital Hygiene and Infection Prevention in accordance with § 23 (1) of the Infection Protection Act. (3) The state associations of the care insurance companies have in the framework of (§ 117) before a regulatory examination, in particular, to ask whether quality requirements in accordance with this book and the contractual agreements concluded on the basis of this book are to be carried out in accordance with the rules of law. Agreements in an examination of the rules under secret law competent supervisory authority or in an audit procedure carried out under national law. For this purpose, it is also possible to conclude agreements at the national level between the regional associations of the care insurance funds and the supervisory authorities responsible for legal provisions, as well as the supervisory authorities responsible for further testing procedures. In order to avoid duplication of tests, the national associations of the caregivers have to reduce the scope of the regulatory examination in an appropriate manner, if:

1.

the tests are not longer than nine months,

2.

the results of the tests are equivalent to the results of a regulatory examination in accordance with the criteria of the maintenance professional;

3.

the publication of the services provided by the care institutions and their quality, in particular as regards the outcome and quality of life, in accordance with Article 115 (1a).

The care facility may require that a reduction in the duty to be checked be waiver. (4) The state associations of the caregivers shall provide results on the quality of the process and of the structure from an examination carried out by the caregiver or by the nurse. As a result, it is necessary to reduce the scope of the regulatory audit in an appropriate manner. The prerequisite is that the test results submitted should be carried out in accordance with a procedure for measuring and evaluating the quality of care by independent experts or testing institutions, according to a procedure recognised by the national associations of the nursing care institutions, in accordance with the procedures laid down by the Contracting Parties have been carried out in accordance with Section 113 (1) sentence 4 Nos. 2 and 3, the examination shall not be longer than one year and the results of the examination shall be published in accordance with Section 115 (1a). An examination of the quality of the results by the medical service of the health insurance or the examination service of the association of private health insurance e. V. is always to be carried out. (5) In the case of starter tests, the test order usually goes beyond the respective test lass; it comprises a complete test with a focus on the quality of the results. If, in the context of an occasion, rule or repetition examination, there are factually substantiated references to non-professional care in the case of those in need of care, to which the examination does not extend, the patients in need of care shall be subject to the following conditions: to include data protection provisions in the audit. The test shall be carried out as a whole as an examination. In the context of a prior rule or approval procedure, a repeat examination may be initiated by the national associations of the caregivers at the expense of the caregivers, in order to verify that the established quality defects are have been removed by the measures ordered pursuant to section 115 (2). On request and at the expense of the caregivers, a repeat examination must be carried out by the regional associations of the caregivers, if essential aspects of the care quality are concerned and without a prompt examination of the care facility. are threatening unreasonable disadvantages. Costs within the meaning of sentences 4 and 5 are only additional expenses incurred in the case of the repeat examination, but not administrative or maintenance costs, which would also have been incurred without a repeat examination. Flat-rate or average values cannot be applied.

Footnote

§ 114 para. 1 idF d. G v. 28.5.2008 I 874: Nordrhein-Westfalen-Deviation by Section 19 (3) Living and Partial Hay Act (WTG NW) v. 18.11.2008 GV NRW 2008, 738 mWv 1.1.2009 (cf. BGBl I 2008, 2984) Unofficial table of contents

§ 114a Implementation of the quality checks

(1) The Medical Service of the Health Insurance, the audit service of the Association of Private Health Insurance e. V. and the experts appointed by the regional associations of the nursing staff are entitled and obliged, in the context of their examination contract in accordance with § 114, in each case to verify on the spot whether the approved care facilities are the performance and Fulfill quality requirements according to this book. Examinations in stationary care facilities are to be carried out in principle unannounced. Quality checks in ambulatory care facilities must be announced the day before. The medical service of the health insurance, the audit service of the association of private health insurance e. V. and the experts appointed by the regional associations of the care insurance companies consult the care facilities in matters of quality assurance in the framework of the quality checks. Section 112 (3) applies accordingly. (2) Both in the case of partial and full-time nursing care, the Medical Service of the Health Insurance, the audit service of the Association of Private Health Insurance e. V. and the experts appointed by the regional associations of the nursing funds shall each have the right to enter the land and rooms used for the nursing home at any time for the purposes of quality assurance, where examinations and visits are carried out there , to contact persons in need of care, their dependants, persons with legal representation and carers, as well as to consult the employees and the advocacy of the interests of the residents. Night-time examinations and inspections are only permitted if and to the extent that the aim of quality assurance at other times of the day cannot be achieved. To the extent that spaces are subject to the right of residence of the inhabitants of the home, they may only be entered without their consent, insofar as this is necessary for the prevention of threats to public security and public order; the fundamental right of the The inviolability of the apartment (Article 13 (1) of the Basic Law) is restricted to this extent. In the case of outpatient care, the medical service of the health insurance company, the audit service of the Association of Private Health Insurance e. V. and the experts appointed by the regional associations of the nursing staff are entitled to check the quality of the services provided by the nursing service, with the consent of the person in need of care, also in his home. The medical service of the health insurance and the audit service of the association of private health insurance e. V., the supervisory authority responsible under secret legislation is to take part in exams in so far as this does not delay the examination. (3) The examinations also include the appearance of the health and nursing condition of the People in need of care. In order to do this, it is possible to interview patients who are in need of care, as well as employees of the care facilities, carers and relatives, as well as members of the secret interests of the residents ' interests. In the assessment of the quality of care, the care documentation, the receipt of the care requirements and the interviews of the employees of the care facilities, as well as of the nursing staff, their relatives and the persons responsible for representation are To take appropriate account of persons. Participation in inconspicuations and interviews is voluntary; the rejection shall not lead to disadvantages. Inspection of care documentations, inconspicuations of persons in need of care and interviews of persons in accordance with the second sentence, as well as the related collection, processing and use of personal data by persons in need of care for the purposes of (3a) The consent referred to in paragraph 2 or 3 shall be given in a document or other appropriate manner for permanent reproduction in written form. the person of the declaring person and the conclusion of the declaration by the replica of the name signature or otherwise (text form). If the person in need of care is incapable of consent, the consent of a person entitled to do so must be obtained. (4) At the request, representatives of the care funds or their associations, the competent social assistance provider and the association of the persons concerned shall be required to obtain the consent. private health insurance e. V. shall be involved in the tests referred to in paragraphs 1 to 3. The institution of the care institution may require that an association of which it is a member (carrier association) be involved in the examination referred to in paragraphs 1 to 3. The exception is a participation in the first sentence or in the second sentence, insofar as it is likely to delay the conduct of an audit. Independent of their own audit powers pursuant to paragraphs 1 to 3, the Medical Service of the Health Insurance, the audit service of the Association of Private Health Insurance e. V. and the experts appointed by the national associations of the nursing staff each have the power to participate in verifications of approved care institutions, provided that they are subject to the supervision of the competent supervisory authority in accordance with the provisions of domestic law. be carried out in accordance with the provisions of secret law. In this case, you have to limit your participation in the examination of the care facility in the area of quality assurance in accordance with this book. (5) The examination service of the Association of Private Health Insurance is below the test service. V. the audit rate referred to in Article 114 (1), first sentence, of the Federal Republic of Germany, shall involve the private insurance companies carrying out private maintenance compulsory insurance, up to an amount of 10% of the costs. the quality checks of the outpatient and inpatient care facilities. The Federal Insurance Office shall, at the end of each year, ensure compliance with the audit rate or the amount of the excess or overrun and the level of the average cost of audits by means of an estimate after hearing the association of the private health insurance e. V. and the top association of the Confederation of Nursing Funds, and the number of examinations carried out annually and, if the audit rate is underwritten, the share of the financing of the private insurance companies; the financing share is the result of the multiplication of the average cost with the difference between the number of the average cost of the test service of the association of private health insurance e. V. audits carried out and the test rate referred to in Article 114 (1) sentence 1. The share of the financing, which is attributable to private insurance companies, is provided by the Association of Private Health Insurance (private insurance). V. is to be transferred annually directly to the Federal Insurance Office for the benefit of the compensation fund of the nursing care insurance (§ 65). The association of private health insurance e. V. the Federal Insurance Office shall not have to comply with the payment request if it proves within four weeks of the payment request that the underwriting of the audit quota is not to be represented by him or his audit service. (5a) The Association of the Covenant of Nurses has agreed to the 31. October 2011 with the association of private health insurance e. V. Further information on the cooperation in the performance of quality audits by the audit service of the Association of Private Health Insurance (BV). V., in particular on the measurement of the test quota, selection procedures for the care facilities and measures of quality assurance to be tested, and for the uniform publication of results of the quality checks by the Association of Private Health insurance e. V. (6) The medical services of the health insurance and the audit service of the association of private health insurance e. V. report to the Medical Service of the Association of the Federal Government of the Health Insurance Fund as of 30 June 2011, thereafter at intervals of three years, on the experience gained with the application of the advisory and auditing requirements according to this book, on the results of the study their quality tests and their findings on the status and development of the quality of care and quality assurance. They ensure the comparability of the data obtained with the participation of the Medical Service of the top association of the health insurance companies. The Medical Service of the Federal Association of Health Insurance Funds is responsible for the reports of the medical services of the health insurance company, the audit service of the Association of Private Health Insurance (Association of Private Health Insurance) e. V. and his own findings and experience on the development of the quality of care and quality assurance in a report together, and within half a year they submit the report to the Confederation of Nurses ' Association, the Federal Ministry of Education and Research (BMBF). Health, the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth as well as the Federal Ministry of Labour and Social Affairs and the ministries responsible for the Länder. (7) The Association of the Covenant of Nursing decides with the participation of the Federal Ministry of Labour and Social Affairs. Medical service of the top association of the health insurance companies and of the Audit service of the association of private health insurance e. V. Guidelines on the examination of the services provided in care facilities and their quality according to § 114. He has the Bundesarbeitsgemeinschaft der Freien Wohlfahrtspflege, the federal associations of private old-and nursing homes, the associations of private outpatient services, the federal associations of nursing professions, the Federal Association of Health Care, the Association of private health insurance e. V., the Bundesarbeitsgemeinschaft der überlocalbearer der Sozialhilfe, the municipal top associations at the federal level, as well as the relevant organizations for the perception of the interests and self-help of the dependants and disabled People to participate. They shall be provided with the information required for this purpose. an appropriate period before the decision shall be given an opportunity to comment; the opinions shall be included in the decision. The guidelines are to be adapted regularly to the medical-care-related progress. They are subject to the approval of the Federal Ministry of Health. Complaints from the Federal Ministry of Health must be remedied within the time limit set by the Federal Ministry of Health. The quality inspection guidelines are for the medical service of the health insurance and the audit service of the association of private health insurance e. V. mandatory. Unofficial table of contents

Section 115 Results of quality checks

(1) The medical services of the health insurance, the audit service of the association of private health insurance e. V. as well as the experts appointed by the regional associations of the nursing staff for quality checks have the result of each quality check as well as the data and information obtained from the national associations of the care insurance companies and the in the context of their competence and in the case of home care, the competent authorities responsible for social assistance and the supervisory authorities responsible for their domestic care, for the purpose of carrying out their legal duties, and of the care facility concerned. The same applies to the results of quality checks carried out by independent experts or test institutions in accordance with § 114 (4) and a regulatory examination by the medical service of the health insurance in part replace. The regional associations of the caregivers are empowered and obliged, upon request, to transmit the data and information which have become known to them in accordance with the first sentence or in the second sentence, together with the consent of the institution of the caregivers ' association, to its association of carriers, in so far as their knowledge of the hearing or an opinion of the care institution is required for a communication pursuant to paragraph 2. The auditors and the recipients of the data shall be obliged to secrecy vis-à-vis third parties, except in the case of the data and information required to publish the results of quality checks referred to in paragraph 1a. (1a) National associations of caregivers ensure that the services provided by care institutions and their quality, in particular with regard to the quality of the results and the quality of life, are understandable to those in need of care and to their relatives, Clearly and comparably both on the Internet and in other suitable form free of charge will be published. Here are the results of the quality tests of the medical service of the health insurance and of the audit service of the association of private health insurance e. V., as well as equivalent test results according to § 114 (3) and (4); they may be obtained by information obtained in other examination procedures which are provided by the services provided by care facilities and their quality, in particular with regard to: Quality of life and quality of life, are complemented. In the case of exams in accordance with § 114 (5), the test results of all persons in need of care included in the examination form the basis for the evaluation and presentation of the quality. Personal data and personal data are to be anonymized. The results of repeat tests shall be taken into account in a timely manner. In the case of the presentation of the quality, reference should be made to the type of examination as an occasion, rule or repetition test. The date of the last examination by the medical service of the health insurance or by the examination service of the association of private health insurance e. V., a classification of the test result according to an evaluation system as well as a summary of the test results are to be suspended in a clearly visible place in each care facility. The criteria of the publication, including the evaluation system, are provided by the Association of the Covenant of Nurses, the associations of the institutions of the care institutions at the federal level, the Federal Working Group of the Local Sponsors. Social assistance and the Federal Association of Local Government Associations until 30 September 2008, with the participation of the Medical Service of the Association of the Federal Government of the Health Insurance Funds. The relevant organizations for the perception of the interests and self-help of the dependent and disabled people, independent consumer organisations at the federal level as well as the association of private health insurance e. V. and the associations of nursing professions at the federal level are to be involved at an early stage. They shall be given the opportunity to comment within a reasonable time before the decision has been sent to them, and the opinions shall be included in the decision. The agreements on the criteria for publication, including the evaluation system, must be adapted to the progress made in the field of medical care. If a consensual agreement is not reached within six months from the written request of a agreement partner to negotiations, any agreement partner may call the arbitration body in accordance with § 113b. The deadline is no longer applicable if the top association of the caregivers and the majority of the associations of the institutions of the care institutions at the federal level, after consulting all agreement partners, call the arbitration board by mutual agreement. The arbitration board is to make a decision within three months. Existing agreements shall continue until the conclusion of a new agreement. (1b) The regional associations of the nursing staff shall ensure that, as from 1 January 2014, the information referred to in Article 114 (1) on the regulations concerning medical, medical and medical care and dental care as well as for the supply of medicinal products in fully stationary facilities for those in need of care and their relatives, comprehensible, clear and comparable, both on the Internet and in other suitable forms, free of charge shall be made available. The care facilities are obliged to apply the information in accordance with the first sentence in a clearly visible place in the care facility. (2) As far as quality defects are found during an examination according to this book, the regional associations of the Care funds, after hearing the institution of the caring institution and the participating carrier association, with the participation of the competent institution of social assistance, of the measures to be taken, shall inform the institution of the institution of the establishment of such measures; and shall at the same time set a reasonable time limit for the removal of the the deficiencies noted. If the deficiencies noted in the first sentence are not remedied within the time limit, the regional associations of the caregivers may jointly terminate the supply contract in accordance with Section 74 (1), in serious cases according to § 74 (2). Section 73 (2) shall apply in accordance with. (3) The care institution shall keep its legal or contractual obligations, in particular its obligations to provide quality-appropriate service provision from the supply contract (§ 72) in whole or in part. , the maintenance allowances agreed in accordance with the Eighth Chapter shall be reduced accordingly for the duration of the breach of duty. The amount of the amount of the reduction shall be sought between the Contracting Parties in accordance with Section 85 (2). If an agreement is not reached, the arbitral body shall decide, at the request of one of the parties, in accordance with Section 76 in the appointment of the Chairman and the two other non-partisan members. The decision under sentence 3 is the right to the social courts; a preliminary procedure does not take place, the action has suspensive effect. The amount of reduction agreed or fixed shall be reimbursed by the carer up to the amount of its own share to the patients in need of care and, furthermore, to the care funds; to the extent that the nursing allowance is a subordinated In fact, the amount of the material has been transferred to the other service provider, the amount of the reduction is to be repaid. The amount of the reduction may not be refinanced through the remuneration or charges in accordance with the Eighth Chapter. Claims for damages of the affected persons in accordance with other regulations remain unaffected; § 66 of the Fifth Book applies accordingly. (4) In the event of a determination of serious, short-term incorrectable defects in the stationary care, the Care funds are obliged to provide the affected home residents with another suitable care facility on their application, which will seamlessly take care of care, care and care. In the case of social assistance recipients, the competent institution of social assistance shall be involved. (5) The medical service of the sickness insurance institution or the audit service of the Association of Private Health Insurance (BfB). If there are serious deficiencies in the outpatient care, the responsible nursing staff can take care of the nursing service on the recommendation of the medical service of the health insurance or the examination service of the Association of Private Health Insurance (BV). V. the further care of the person in need of care for the time being provisionally undersigned; § 73 (2) shall apply accordingly. In this case, the care fund must provide the person in need of care with another suitable care service, which takes care of the care seamlessly; in doing so, the right to vote of the person in need of care according to § 2 para. 2 must be observed as far as possible. (6) In the cases referred to in paragraphs 4 and 5, the institution of the carer shall be liable to the patients in need of care and to their expenses for the costs of the mediation of another outpatient or inpatient care. Care facility, insofar as it has to represent the deficiencies in the appropriate application of Section 276 of the Civil Code. Paragraph 3, sentence 7 shall remain unaffected. Unofficial table of contents

Section 116 Cost arrangements

(1) The test costs for effectiveness and performance audits in accordance with § 79 shall be taken into account as an expense in the next possible remuneration agreement in accordance with the Eighth Chapter; they may also be distributed over several remuneration periods. (2) The costs of the arbitration decision in accordance with Section 115 (3) sentence 3 shall be borne by the institution of the carer, in so far as the arbitral body arranges a reduction in remuneration; otherwise, the institution shall be jointly responsible for the costs of the parties to the award of the award. . If the arbitration body sets a lower reduction amount than required by the cost carriers, the parties have to pay the costs of the proceedings proportionally. (3) The Federal Government is authorized to do so by means of a legal regulation with the consent of the Federal Council to regulate the charges for carrying out economic performance audits. Minimum and maximum rates may also be laid down in the Regulation, taking into account the legitimate interests of the auditors (§ 79) and the care facilities required to pay the fees. Unofficial table of contents

Section 117 Cooperation with supervisory authorities in accordance with secret law

(1) The regional associations of the caregivers as well as the medical service of the health insurance and the audit service of the Association of Private Health Insurance e. V. shall cooperate closely with the supervisory authorities responsible for legal provisions in the authorisation and verification of care facilities in order to carry out their mutual duties in accordance with this book and in accordance with the provisions of the law on secret services in particular by

1.

regular mutual information and advice,

2.

Termination arrangements for a joint or labour-intensive review of care facilities and

3.

Agreement on the measures necessary in individual cases

shall be effectively coordinated. It is necessary to ensure that double checks are avoided as far as possible. In order to carry out these tasks, the national associations of the care insurance companies as well as the medical service and the audit service of the Association of Private Health Insurance are responsible for the fulfilment of these tasks. V. is obliged to participate in the working groups according to the rules of law and to participate in corresponding agreements. (2) The regional associations of the caregivers as well as the medical service and the audit service of the association of private health insurance e. V. may agree with the supervisory authorities or the supreme state authorities a model project which aims to achieve a coordinated approach to the quality of care facilities according to the rules of law of this book and according to legal regulations. The guidelines pursuant to Section 114a (7) and the provisions of Section 115 (1a) sentence 6 of the Federal Republic of Germany may deviate from these guidelines for the purposes and duration of the pilot project. The responsibility of the caregivers and their associations for the content provision, protection and examination of the quality of care, supply and care according to this book can be carried out by means of cooperation with the regulations according to the provisions of the law. (3) In order to achieve the close cooperation, the national associations of the care insurance companies and the medical service of the health insurance and of the health insurance companies are responsible for the implementation of the Audit service of the association of private health insurance e. V. is entitled, upon request, to the supervisory authority competent in accordance with the provisions of secret law and to the data accessible to them in accordance with this book on the care facilities, in particular on the number and type of care places and on the inform persons (occupancy), of the personnel and of the material, and of the benefits and allowances of the care facilities. Personal data are to be anonymized prior to the data transfer. (4) findings from the examination of care facilities are from the medical service of the health insurance, the audit service of the association of private health insurance e. V. or any other experts or bodies carrying out quality audits carried out in accordance with this book, without delay, to communicate to the supervisory authority competent in accordance with the rules of law, insofar as they are responsible for the preparation and implementation of: prudential supervision measures are required in accordance with the regulatory requirements. Section 115 (1) sentence 1 and 2 remains unaffected by this. (5) The care insurance funds and their associations as well as the medical service of the health insurance and the audit service of the Association of Private Health Insurance e. V., they shall bear the costs incurred by cooperation with supervisory authorities competent in accordance with the rules of the secret service. Participation in the costs of the supervisory authorities in charge of legal regulations or of any other bodies or bodies involved in the supervisory authority responsible for secret legislation is inadmissible. (6) By means of arrangements of the If they are eligible for remuneration within the meaning of Article 82 (1), the nearest possible maintenance agreement shall be taken into account in accordance with the provisions of Article 82 (1) of the Directive. The objection or the action of a contracting party or a party pursuant to Section 85 (2) against the order shall have no suspensive effect. Unofficial table of contents

Section 118 Participation of representations of interest, regulation

(1) In the case of development or modification

1.

the guidelines laid down in § 17 (1), § 18b, 45a (2) sentence 3, § 45b (1) sentence 4 and § 114a (7) of the Confederation of Nursing Care Funds as well as

2.

the agreements of the self-management partners in accordance with Section 113 (1), § 113a (1) and (115) (1a)

In accordance with the provisions of the Regulation referred to in paragraph 2, the organisations responsible at the federal level shall provide advice on the perception of the interests and self-help of dependent and disabled persons in accordance with the provisions of the Regulation. The right to be asked for an opinion also includes the right to be present in the case of decision-making. If the written concerns of these organizations are not followed, the reasons for this shall be communicated to them in writing. (2) The Federal Ministry of Health shall be authorized, by means of a regulation with the consent of the Federal Council Determine the details for

1.

the conditions for recognition of the organisations at the federal level relevant to the exercise of the interests and self-help of those in need of care and for the disabled, in particular with regard to the requirements for the form of organisation and the Disclosure of financing, and

2.

the procedure of participation.

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§ 119 Contracts with nursing homes outside the scope of the Living and Care Contracts Act

For the contract between the institution of an approved stationary care facility, to which the living and care contract law does not apply, and the resident in need of care, the provisions relating to the contracts shall apply after the residential and The law on care contracts accordingly. Unofficial table of contents

§ 120 Care contract for home care

(1) In the case of home care, the approved care service shall also take over the obligation, not later than the beginning of the first care use, to the person in need of care, in accordance with the nature and severity of his care needs, in accordance with the conditions laid down by him. Benefits accepted, cared for and provided for in the home (care contract). In the event of any substantial change in the condition of the person in need of care, the care service must inform the responsible carer immediately. (2) The nursing service shall immediately have a copy of the care service after the competent care fund has been requested. of the care contract. The nursing contract can be terminated by the person in need of care at any time without due notice. (3) In the nursing contract, at least the type, content and scope of the services, including those agreed with the cost carriers in accordance with § 89, are Remuneration for each service or service complex separately to be described. The nursing service must inform the person in need of care in writing about the expected costs before the conclusion of the contract and in the event of any substantial change. (4) The nursing service's entitlement to remuneration of his nursing and nursing staff and domestic services shall be directly directed against the competent care fund. To the extent that the services provided by the person in need of care exceed, in accordance with the provisions of the first sentence, the maximum amount of the benefits laid down by the caregivers and payable by the caregivers, the nursing service shall be entitled to benefit the person in need of care for the Do not charge any additional services that have been requested than the remuneration agreed in accordance with § 89.

Twelfth chapter
Fine

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Section 121 Bußmonetary

(1) Administrative offences are those who are intentional or reckless

1.

the obligation to conclude or maintain the private care insurance contract in accordance with § 23 (1) sentence 1 and 2 or § 23 (4) or the obligation to maintain the private care insurance contract in accordance with § 22 para. 1 sentence 2 shall not be complied with,

2.

Contrary to § 50 (1) sentence 1, § 51 para. 1 sentence 1 and 2, § 51 para. 3 or contrary to Article 42 (4) sentence 1 or 2 of the care insurance act, a notification is not reimbursed, not correct, not fully or not reimbursed in good time,

3.

Contrary to § 50 (3) sentence 1 no. 1, no information is provided, not correct, not in full or in good time, or in violation of § 50 (3) sentence 1 no. 2, does not notify a change, not correct, not complete or not in good time,

4.

does not submit the necessary documents, in full or in time, in accordance with the second sentence of Article 50 (3),

5.

Contrary to Article 42 (1), third sentence, of the Care Insurance Act, the scope of its private insurance contract does not or does not fit in due time,

6.

with the payment of six monthly premiums for private nursing care insurance,

7.

Contrary to Section 128 (1) sentence 4, the data referred to therein shall not be transmitted, not correct, in full or in a timely manner.

(2) The administrative offence may be punishable by a fine of up to two thousand five hundred euros. (3) The Federal Insurance Office shall be the Federal Insurance Office for the offences committed by private insurance undertakings in accordance with the provisions of paragraph 1 (2) and (7). Managing authority within the meaning of Section 36 (1) (1) of the Code of Administrative Offences. Unofficial table of contents

Section 122 Transitional arrangements

(1) § 45b is to be applied only from 1 April 2002 with the exception of the third sentence of paragraph 2; paragraph 2 sentence 3 shall apply from 1 January 2003. (2) The top associations of the caregivers have the version in force in accordance with Section 45b (1) sentence 4 as from 1 July 2008. , with the participation of the Medical Service of the top associations of the health insurance companies, the Association of Private Health Insurance (private health insurance). V., to decide on the federal level and the relevant organizations for the perception of the interests and self-help of people in need of care and the disabled at the federal level, and to the Federal Ministry for Economic Cooperation and Development (BMWB) To be submitted for approval by 31 May 2008. § 17 (2) shall apply. (3) For persons who are entitled to a residential group surcharge in accordance with § 38a in the version in force until 31 December 2014, this benefit shall be further provided if the person concerned is entitled to a residential group surcharge in accordance with section 38a. Conditions have not changed. Unofficial table of contents

Section 123 Transitional arrangements: Improved nursing care for persons with significantly reduced everyday competence

(1) insured persons who fulfil the conditions laid down in § 45a on account of their substantially reduced daily competence shall, in addition to the services provided for in § 45b, have until the entry into force of a law which provides for the granting of benefits under a new law. (2) insured persons without a nursing level shall have the right to receive care in accordance with the following calendar month.

1.

Care allowance according to § 37 in the amount of 123 euros or

2.

Nursing services in accordance with § 36 of up to 231 euros or

3.

Combination benefits from points 1 and 2 (§ 38)

as well as claims in accordance with § § 38a, 39, 40, 41, 42 and 45e. The right to part-inpatient care for insured persons without a nursing level comprises a total value of up to 231 euros per calendar month. (3) For nursing staff in the nursing school I, the care allowance according to § 37 will increase by 72 euros to 316 euros and the Nursing care benefits according to § 36 as well as § 41 by 221 Euro up to 689 Euro. (4) For those in need of nursing level II, the care allowance according to § 37 is increased by 87 Euro to 545 Euro and the nursing care benefits according to § 36 as well as § 41 by 154 Euro up to 1 298 Euro. Unofficial table of contents

Section 124 Transitional arrangements: Häusliche servicing

(1) In need of nursing care grades I to III as well as insured persons who fulfil the conditions of § 45a due to their substantially reduced daily life competence, have until the entry into force of a law which provides for the granting of benefits under a new law In accordance with § § 36 and 123, the concept of nursing care and an appropriate assessment procedure regulates domestic care. (2) In addition to basic care and domestic care, domestic care services are provided as a service. Nursing care measures provided. They include support and other assistance in the home environment of the person in need of care or his/her family, and in particular include the following:

1.

Support activities in the home environment serving the purpose of communicating and maintaining social contacts,

2.

Support in the design of domestic everyday life, in particular support for the development and maintenance of a daily structure, for the implementation of needs-oriented occupations and for the observance of a day-and-night rhythm that is appropriate for the needs.

Domestic care can also be provided by several persons in need of care or insured persons with a significantly reduced daily competence as a joint domestic care in the home environment of one or a participant or his/her family as a material benefit (3) The right to home care requires that basic care and domestic care be ensured on a case-by-case basis. (4) The seventh, the eighth chapter and the Eleventh Chapter shall be applied accordingly. Unofficial table of contents

§ 125 Model projects for the testing of services of home care by care services

(1) In the years 2013 and 2014, the top association of the caregivers can use the compensation fund of the nursing care insurance scheme with up to 5 million euros in model projects to test the benefits of domestic care in accordance with § 124 Care services agree. As care services, services can become agreement partners, which in particular provide permanent home care and domestic care for dementia patients in need of care. (2) The model projects are to be geared towards the Effects of the use of care services on nursing care comprehensively with regard to quality, cost-effectiveness, content of the services provided and acceptance of the care in need of care and are to be examined for at least three years. temporary ones. A scientific monitoring and evaluation shall be provided for the pilot projects. To the extent that personal data are required within the framework of the model projects, they can be collected, processed and used with the consent of the person in need of care. The top association of the nursing funds determines the objectives, duration, content and implementation of the model projects. The model projects are to be agreed with the Federal Ministry of Health. (3) The provisions of this book for care services should be applied to the services participating in the model. Instead of the responsible nursing staff, they can have a suitably qualified, technically suitable and reliable force with practical professional experience in the learned occupation of two years within the last eight years as responsible Use force; § 71 (3) sentence 4 shall apply accordingly. The admission of the participating care services to the supply remains valid for up to two years after the end of the model program.

Thirteenth chapter
Support for private nursing care

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Section 126 Beneficiaries

Persons insured under the third chapter in the social or private nursing care insurance (persons entitled to the allowance) have, in the case of a private care supplementary insurance based on their name, under the conditions laid down in § 127 (2) shall be entitled to a care allowance allowance. Excluded from this are persons who are the 18. Have not yet completed their life year, as well as persons who already receive benefits under § 123 before the end of the private care supplementary insurance scheme or as persons in need of care according to the fourth chapter or equivalent contract benefits of the private Maintenance-compulsory insurance-related or related. Unofficial table of contents

Section 127 nursing care allowance; eligibility conditions

(1) The person entitled to the right of payment shall be entitled to at least one contribution of EUR 10 per month in the respective contribution year for the benefit of a supplementary private care insurance scheme which is based on its name and eligible under paragraph 2, and shall be entitled to a Supplement to the amount of 5 Euro per month. The allowance shall not be taken into account for the minimum contribution referred to in the first sentence. The allowance is only granted for one insurance contract each month for each person entitled to the allowance. The minimum contribution and the supplement are to be used for the eligible tariff. (2) A private maintenance supplementary insurance which is eligible under this Chapter shall be provided when the insurance undertaking is responsible for this purpose.

1.

the calculation of life insurance in accordance with Article 12 (1) (1) and (2) of the Insurance Supervision Act (Insurance Supervision Act),

2.

all persons referred to in § 126 shall be entitled to insurance,

3.

the ordinary right of dismissal and a risk assessment and the agreement of risk surcharges and exclusions of benefits,

4.

if there is a need for care within the meaning of § 14, a contractual claim for payment of cash benefits for each of the care levels listed in § 15, in the case of at least 600 euros for the nursing care levels referred to in § 15 (1) sentence 1, point 3 , as well as in the case of substantially reduced everyday competence as defined in § 45a, a right to payment of cash benefits is provided; the cash benefits provided for in the course of this procedure may be provided at the time of the Conclusion of the contract shall not exceed the applicable amount of the performance of this book, a However, dynamisation up to the level of the general inflation rate is permitted; other benefits may not be provided for the eligible tariff,

5.

in the determination of the insurance policy and the determination of the level of care, the result of the procedure for determining the need for care in accordance with § 18 and the findings on the existence of considerably reduced everyday competence in accordance with § 45a; in the case of insured persons of private maintenance compulsory insurance, the corresponding findings of the private insurance undertaking must be taken as a basis,

6.

the waiting period is limited to a maximum of five years,

7.

an policyholder who is in need of assistance within the meaning of the second or twelfth book, or who would be in need of assistance solely by paying the contribution, is entitled to the contract without the maintenance of the insurance cover for a period of time for at least three years, or to terminate the contract retroactively at the time of entry within three months of the entry of the need for assistance; in the event of a rest period, that period shall begin with the end of the Dormant status, if assistance is still available,

8.

the level of the administrative and final costs which have been taken into account are limited; the further details of this will be laid down in the legal regulation according to § 130.

The association of private health insurance e. V. is to be given the right to define, for this purpose, uniform contract patterns which are to be used by insurance undertakings as part of the general insurance conditions of eligible maintenance supplementary insurance. The order referred to in the second sentence shall include the power to compensate insurance undertakings which offer supplementary private care insurance supplementary insurance for the purpose of offsetting any surplus; § 111 (1), first and second sentences, and (2) shall apply accordingly. The professional supervision of the association of private health insurance e. The Federal Ministry of Health shall be responsible for the tasks listed in sentences 2 and 3. (3) The entitlement to the allowance shall be established by the end of the calendar year for which the contributions to a private care supplementary insurance pursuant to § 127 (1) have been made (contribution year). Unofficial table of contents

§ 128 Procedure; liability of the insurance undertaking

(1) The allowance in accordance with § 127 paragraph 1 shall be granted on request. With the conclusion of the contract, the person entitled to be entitled shall authorize the insurance company to apply for an eligible private care supplementary insurance scheme to apply for the supplement for each year of contribution. Where a supplement or an insurance number has not yet been awarded to the person entitled to pay in accordance with section 147 of the sixth book, it shall at the same time authorise its insurance undertaking to provide a supplement to the central body. apply. The insurance undertaking shall be obliged to provide the central body with an officially prescribed data record by means of an officially designated data transmission for the purpose of determining entitlement to payment of the allowance at the same time as the application in the The period from 1 January to 31 March of the calendar year following the contribution year shall be submitted to:

1.

the application data,

2.

the amount of contributions paid to the supplementary private care supplementary insurance,

3.

the contract data,

4.

the insurance number referred to in § 147 of the sixth book, the allowance number of the person entitled to the right to be awarded, or a request for the award of a grant number,

5.

further information required for the payment of the allowance;

6.

confirmation that the applicant is a person entitled to the right of access within the meaning of section 126, and

7.

the confirmation that the respective insurance contract satisfies the requirements of § 127 (2).

The person entitled to the right of access shall be obliged to inform the insurance undertaking without delay of any change in the situation which leads to a removal of the claim. If the contribution year for which the insurance company has already applied for an allowance has not been granted, the insurance undertaking has to cancel this application record. (2) The payment of the allowance shall be effected by means of a central point of the German Pension Insurance Association; the further details, in particular the amount of the administrative expenses, will be provided by the administrative agreement between the Federal Ministry of Health and the German Pension Fund (Deutsche Rentenversicherung Bund) , The supplement shall be paid to the insurance undertaking in the case of the conditions under which the contract relates to the supplementary private insurance cover for which the supplement has been applied for. If, for a person entitled to it, the allowance for more than one private care supplementary insurance contract is applied for, the allowance for the respective month shall be granted only for the contract for which the application first comes to the central office has been received. In so far as the competent institution of the pension insurance has not issued an insurance number, the central body shall issue an allowance number to fulfil the tasks assigned to it. In the event of an application as referred to in the third sentence of paragraph 1, the central body shall inform the insurance undertaking of the allowance number, from where it shall be forwarded to the applicant. The central body shall determine, on the basis of the information available to it, whether a claim is entitled to an allowance and shall arrange to be paid to the insurance undertaking for the benefit of the person entitled to pay. Subject to sentence 9, a separate notice of grant shall not be taken. The insurance undertaking shall, without delay, credit the allowances received to the beneficiary contract. The allowance shall be fixed only at the specific request of the person entitled to the right of access. The application shall be sent by the applicant to the insurance undertaking in writing within one year from the date of dispatch of the information referred to in paragraph 3 by the insurance undertaking. The insurance undertaking shall forward the application of the central body to the fixing. The request shall be accompanied by an opinion and the documents necessary for the fixing of the opinion. The central body shall also communicate the fixing to the insurance undertaking. If the central body recognizes subsequently that the claim for payment has not passed or has fallen away, it shall recover unduly credited or disbursed allowances and this shall be the result of a data record for the insurance undertaking. (3) If the central body comes to the conclusion that there is no claim for allowance or has passed, it shall inform the insurance undertaking accordingly. The insurance company shall be liable within one month of receipt of the relevant data record. (4) The insurance undertaking shall be liable in the event of the payment of an allowance to the person in question for the fact that the insurance undertaking in accordance with § 127 (5) The Federal Ministry of Health is responsible for the payment of carers ' allowances, as well as the administrative costs incurred by the central body. The administrative costs also include the corresponding costs for the development of the technical and organisational infrastructure. The total administrative costs shall be reimbursed at the end of each contribution year, with the Federal Government's personnel and property costs being applied accordingly. Starting in 2014, monthly charges will be paid. To the extent that the Federal Insurance Office exercises the supervision of the central office, the Federal Ministry of Health shall be subject to the second sentence of Article 94 (2) of the Fourth Book. Unofficial table of contents

§ 129 Waiting period for eligible nursing-supplementary insurance

Insofar as a waiting period is agreed upon in the contract for a private care supplementary insurance that is eligible pursuant to section 127 (2), this may not exceed five years by way of derogation from § 197 (1) of the Insurance Contracts Act. Unofficial table of contents

Section 130 Regulation empowerment

The Federal Ministry of Health is authorized, in agreement with the Federal Ministry of Finance and the Federal Ministry of Labour and Social Affairs, to enact regulations without the consent of the Federal Council, the approximate rules on

1.

the central body in accordance with Section 128 (2) and its tasks,

2.

the procedure for the identification, fixing, payment, repayment and recovery of the allowance;

3.

exchange of data between insurance undertakings and the central body in accordance with Article 128 (1) and (2)

4.

limiting the amount of the administrative and final costs to be taken into account in eligible maintenance supplementary insurance.

Fourteenth chapter
Formation of a care pension fund

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Section 131 nursing care fund

In the social care insurance scheme, a special fund is established under the name "Social Care Insurance Fund". Unofficial table of contents

Section 132 Purpose of the Pre-Sorge Fund

The special fund is used to stabilize the contribution development in the long term in social care insurance. In accordance with § 136, it may only be used to finance the performance expenses of social care insurance. Unofficial table of contents

Section 133 Legal form

The special fund is not legally capable. It can act, sue and be sued under its name in the legal trade. The general place of jurisdiction for the special assets is Frankfurt am Main. Unofficial table of contents

Section 134 Administration and installation of funds

(1) The administration and the facility of the funds of the special assets shall be transferred to the Deutsche Bundesbank. In accordance with Section 20, second sentence, of the Act on the Deutsche Bundesbank, the Bundesbank will not be reimbursed for the administration of the special assets and its funds. (2) The funds infused with the special assets, including the proceeds, are under to apply the rules of application of the federal pension fund to normal market conditions in accordance with the applicable rules. In doing so, the share of special assets in shares or equity funds will be reduced from 2035 over a period of not more than ten years. The Federal Ministry of Health is represented in the investment committee according to § 4a of the investment guidelines of the German Federal Government's Supply Fund. Unofficial table of contents

Section 135 Feed of funds

(1) The Federal Insurance Office (Bundesversicherungsamt) is responsible for the special assets on a monthly basis. of the compensation fund an amount corresponding to one twelfth of 0.1 per cent of the contributor receipts of the social care insurance of the previous year. (2) The feeder referred to in paragraph 1 shall be for the first time on 20 February 2015 and ends with the payment for December 2033. Unofficial table of contents

Section 136 Use of special assets

As from 2035, the special fund may be used to ensure the stability of the social care insurance premium if, without the provision of funds to the compensation fund, it would be necessary to raise a contribution rate which does not apply to is based on a general dynamisation of performance improvements. The upper limit of the annual appropriations to be paid to the compensation fund, at the request of the Federal Insurance Office, is 20. Part of the real value of the assets of the special assets as at 31 December 2034. In the absence of a call in one year, the appropriations for this year may be obtained in the following years if, without a corresponding supply of funds to the compensation fund, a contribution rate increase would be required which would not be available for the purpose of: is based on performance improvements that go beyond general dynamisation of performance. Unofficial table of contents

Section 137 Property separation

The assets are to be kept separate from the remaining property of the social care insurance as well as from its rights and liabilities. Unofficial table of contents

Section 138 Annual accounts

The Deutsche Bundesbank submits an annual report to the Federal Ministry of Health on the management of the funds of the special assets. It shall identify the stock of special assets, including claims and liabilities, as well as revenue and expenditure. Unofficial table of contents

§ 139 Resolution

The special assets shall be deemed to be dissolved after the payment of their assets.