Key Benefits:
Designation of the Minister for Health, Welfare and Sport of 26 June 2012, under Article 7 of the Health Organisation Act, on the transfer of geriatric rehabilitation care from the AWBZ to the Zorginsurance Act
The Minister for Health, Welfare and Sport,
Having regard to Article 7 of the Health Organisation Act ;
After giving written notice of 13 May 2011 to the First and Second Chamber of the States-General referred to in Article 8 of the Health Organisation Act (Chamber pieces II 2010/11, 30 597, nr. 184);
Having regard to the report of a written consultation with the Standing Committee on Health, Welfare and Sport of the Second Chamber of the States-General of 22 June 2011 (Kamerpieces II 2010/11, 30 597, nr. 200);
Decision:
For the purposes of this designation:
a. Law: Health Organisation Act ;
b. Health authority: Dutch Healthcare Authority, named in Article 3 of the Act ;
c. Occupational medicine specialist: doctor who is registered as a nursing doctor or medicine specialist by the household doctor and the Nursing Home Registration Committee;
ed. Geriatric rehabilitation care: to provide rehabilitation care, such as a specialist in the age of medicine;
e. dbc: diagnosis-treatment combination;
f. Zzp: Care weight package;
g. Designation of nhcs: Designation of normative housing components in rates intramural AWBZ of 12 July 2011 (Stcrt. 2011, 13319), as amended by the Designation amending the designation of normative housing components in rates intramural AWBZ of 8 August 2011 (Stcrt. 2011, 16189);
h. nhc: normative housing component within the meaning of the Designation of Nhcs ;
i. AWBZ: General Law Specific Health Costs ;
j. existing healthcare provider: Healthcare provider providing geriatric rehabilitation care and having concluded production arrangements with a care office before 1 January 2012.
This designation shall apply to geriatric rehabilitation care.
The care authority shall adopt rules or policy rules in due time before 1 January 2013 for the purpose of this designation. It shall also set out in good time before 1 January 2013 the limits set out in the Articles 9 and 10 of this designation.
The care authority shall introduce a funding system for geriatric rehabilitation care as from 2013, using the performance descriptions based on dbc care products. It uses as a starting point the currently existing performance descriptions for recovery-oriented treatment with nursing and care (zzp VV9a) and AWBZ rehabilitation in day care (H801).
1 The care authority performs with effect from 2013 for the performance, intended Article 4 , maximum rates in accordance with Article 50, first paragraph, introductory wording and point (c) of the Act .
2 The care authority processes the capital charges completely in the maximum rates. It shall include the capital charges associated with the existing performance descriptions, mentioned in: Article 4 , as a starting point, with the following, that she counts with the full nhc in terms of zzp VV9a.
The healthcare authority shall implement the new financing system in a macro-budgetary neutral position. The amount of this amount is € 817 million (price level 2012)
1 The care authority shall determine the amount of compensation per existing health care provider in respect of the 2013 statement of the year of its own motion. This amount is the positive or negative difference between the total amount that an existing health care provider in 2013 based on the new funding system intended Article 4 , for provided care, has been or would have been able to bring legally into account, in relation to the amount that could have been legally charged by that bidder in 2013 if the funding system for AWBZ care was still in place has been.
2 If the care authority determines a positive settlement amount for a healthcare provider, it shall set a closing rate per relevant health insurer in proportion to the share of the health insurance provider concerned in the turnover of that provider.
3 If the health care authority determines a negative clearing amount for a healthcare provider, it shall, with the application of Article 56b of the Act , a settlement amount per relevant health insurer, in proportion to the share of the health insurance provider concerned in the turnover of that provider.
The healthcare authority provides for the capital burden of existing health care providers, subject to compliance with the Designation of Nhcs , in a transitional regime, in which:
a. The capital charge on the basis of the full nhcs is accounted for in the maximum rates of the dbc care products specified in Article 4 ;
(b) the difference in yield resulting from the application of the policy rules of the care authority to the effect of the provisions of (a) and the yield which would have been generated by applying the policy rules for the implementation of the provisions of the Article 7 of the Designation of Nhc , after the end of the year, the acceptable cost AWBZ of the relevant healthcare provider shall be settled by means of the post-allocation procedure.
1 The healthcare authority proposes geriatric rehabilitation care covered by health insurance as intended Article 1 (d) of the Zorginsurance Act claim, all health care providers jointly automatically establish a macrofrontier for the year 2013, which is an upper limit as intended for the purpose of Article 50, second paragraph, introductory wording and point (c) of the Act .
2 The care authority shall set the macroboundary referred to in paragraph 1 and the individual limits, Article 10 , fixed on the basis of the amount of care available to the highest level for 2013, which is € 730 million (price level 2012).
1 The care authority shall establish an individual limit of its own motion per individual health care provider for the year 2013, which is an upper limit as defined in Article 50, second paragraph, introductory wording and point (c) of the Act . In doing so, it shall take account of the macroboundary as follows:
a. If the care providers together do not exceed the macroboundary, the individual limit for a healthcare provider shall be equal to the turnover realised by that provider in 2013;
b. if the care providers together exceed the macroboundary, the individual limit for a provider is equal to the percentage share of that provider ' s turnover in the total turnover of all health care providers jointly multiplied by the amount that the care authority has established as a macro border.
2 To the turnover realised in 2013 is part of the amount of netting established for a healthcare provider on the basis of Article 7 .
3 To the turnover achieved in 2013 by a healthcare provider are not counted amounts arising from the application of the policy rules of the care authority to the effect of Designation on transitional relief of capital expense general and academic hospitals of 22 June 2010 (Stcrt. 2010, 10255) and the Designation of 26 September 2011 on capital charges transition model performance finance specialist medical speciality care 2012 (Stcrt. 2011, 19621).
4 To the turnover of a healthcare provider are not counted as the nacalculation amounts arising out of the application of the policy rules of the care authority to effect Article 8 .
The care authority maintains the macroboundary through enforcement of individual boundaries, intended Article 10, first paragraph .
1 If all care providers together have not exceeded the macro limit, the care authority shall, of its own motion, establish that for each healthcare provider, the individual limit shall be equal to the turnover achieved by that provider in 2013.
2 The care authority shall make a determination as referred to in the first paragraph not after I have informed it in writing by 1 December 2014 that the amount, mentioned in Article 9, second paragraph , it's not crossed.
1 If all care providers together exceed the macro limit, the care authority shall automatically give the individual health care providers a designation in the sense of Article 76, second paragraph, of the Act , until the transfer to the ZorgInsurance Fund of an amount fixed by the care authority.
2 To be carried out individually, the amount to be determined by the care authority shall be equal to the percentage share of that provider's turnover in total turnover in the year 2013 of all providers combined, multiplied by the percentage share of each healthcare provider's turnover. the amount, referred to in the third paragraph, which the care authority is required to provide as a basis for enforcement.
3 The care authority shall issue a designation as referred to in the first paragraph, not after I have informed her by 1 December 2014, that the amount, mentioned in Article 9, second paragraph , has been exceeded, indicating the amount that the healthcare authority should take as a basis for maintaining the macro border.
The Care Authority will send me a substantiated, qualitative analysis of the (possible) impact of the introduction of the new funding system intended to be implemented by 1 September 2013. Section 2 , and the functioning of the transitional regime, intended in Section 3 .
This designation shall be communicated by means of the explanatory memorandum in the Official Journal.
TheMinister
of Public Health, Welfare and Sport,E.I. Schippers
