Key Benefits:
Designation of the State Secretary for Health, Welfare and Sport of 31 October 2008, No DLZ/SFI-2890287, pursuant to Article 7 of the Health Organisation Act, on introduction performance funding in residential long-term care on the basis of care-weight packages
The Secretary of State for Health, Welfare and Sport,
Having regard to Article 7 of the Health Organisation Act ;
After written notice of 22 September 2008 to the First and Second Chamber of the States-General (Kamerpieces II, 2008-2009, 26 631, no. 273);
Having regard to my contribution from the written report of 27 October 2008, document DLZ-CSF-U-2882839,
Decision:
For the purposes of this designation:
a. Law: The Health Organisation Act ;
b. Health authority: Dutch Zorgauthority;
c. inpatient care provider: Institution based on the Health care institutions Act has been admitted for the function stay, in combination with the functions personal care, nursing, supportive guidance, enchanting guidance, counseling or treatment as defined in the AWBZ Healthcare Claims Decision ;
ed. extramural health care provider: Institution based on the Health care institutions Act has been admitted for one or more of the functions personal care, nursing, supportive guidance, enacting guidance, counseling or treatment as defined in the AWBZ Healthcare Claims Decision ;
e. MFC: on the basis of the Health institutions permitted institutions as Multifunction Centres (MFCs), which provide collaborative care with residence and treatment in the interface of disability care and children/and youth psychiatry;
f. KIB: Clinics for Intensive Treatment in Mental Health Care;
g. Budget request: Tariff request by an intra-or outpatient care provider or care office based on the provision of, or under, Section 4.4 of the Act fixing the acceptable costs in any year;
h. Budgeting: the negotiation between an intra-or outpatient care provider and care office prior to the budget request, the submission to the care authority of that budget request and the decision-making of the care authority at that request;
i. capacity management: a change from 1 January 2009 from the following Health care institutions Act Authorised capacity of an in-patient healthcare provider actually being put into service after 31 December 2008;
j. Old pelting parameters: the usual parameters for the year 2008 for the funding in the year 2009 of an inpatient care provider related to beds and places;
k. production commitments: local arrangements between an intra-or extramural health care provider and a care office in relation to inpatient or outpatient production;
l. Budget Base: the financial total of a healthcare provider which determines the care authority on the basis of the production arrangements submitted by the care provider and care office in terms of the old contripation parameters taking into account labour costs, material costs, inpatient care benefits other than night nursing, night care and sessions of paramedical care, palliative terminal care, care-heavy duty rates, care of custom, application of the hardship clause as included in the till 31 December 2003 applicable policy rule watchlists and resistant policies for 2009, by means of a separate decision, was granted to cover the care heavy of the categories of clients, energy and maintenance costs as they arise from the policy rule small-scale living and remunitations that are result from the application of the policy rule heralding normative budgeting;
m. ZZP: a care balance package consisting of a complete package of inpatient care that is consistent with the client's characteristics and the type of care required by that client;
n. ZZP indication: the indication established by the care authority on the basis of the number of ZZPs agreed by the care provider and care office and the corresponding rates and the allowances agreed by the care provider and care office arising from the policy rule ZZP performance, residence component for unincorporated partner, temporary stay, absence day, CVA, observation, MFCs, KIB's, epilepsy, where that task is based on the indication data of new clients or reindications, on the basis of: updated care heavyweights of existing clients with processing of the results of the Monitoring by the Centre for Indication of Indication on the basis of maintenance packages and adjustments decision, and on the outcome of the expert team of the Consultation and Expertise Centre if and where applicable;
o. relocation amount: the difference between the budget base and the declaration of the ZZP. This reallocation amount is set by the care authority only once in 2009 on the basis of budget requests in the but throngs 2009. Capacity reductions in 2009 shall not be taken into account in the calculation of the reallocation amount;
P. acceptable costs 2009: the budget-based plus or minus the reallocation amount to be made on the basis of the deleveraging/build-up or measurement scheme plus the other budget components (capital charges and outpatient care) to be provided by the care authority in a policy rule;
q. High rate: the rate used to cover the difference between the ZZPs declared by the care provider and the care services provided by the care authority for that healthcare provider's 2009 acceptable costs;
r. Run-off The reallocation trajectory if the ZZP task exceeds the budget basis;
s. build up: the reallocation journey if the ZZP task exceeds the budget basis;
t. Tailor-made scheme: by the care authority as part of introducing ZZPs for intramural AWBZ care to be established for intramural health care providers whose reallocation of the health care authority is more than 13% of their health care. the budget basis.
u. Construction scheme: a reallocation scheme for inpatient care providers, to be established by the care authority in the context of the introduction of ZZPs for intramural AWBZ, whose higher than the budget base is the ZZP task established by the care authority.
This designation applies to care which is caused by the General Law Specific Health Costs Entitlement exists.
In order to implement this Decision, the Care Authority shall lay down rules and policy rules.
The health authority shall:
a. With effect from 1 January 2009 for the Article 2 provided care provided by inpatient care providers as intended in Article 1, introductory wording and point c , which were approved at the end of 2008 pursuant to the Law authorising healthcare providers and which have concluded production arrangements with a care office for 2008, in which:
1. the performance descriptions shall be based on care balance packages, further identifying as ZZPs, with the exception of the performance descriptions for KIB, child and youth psychiatry, observation, MFCs, temporary residence and absence;
2. to charge the intramural health care provider for those performance descriptions for the care provided; and
3. the transition from the financial system in 2008 to the funding scheme provided for in the introductory words and points (1) and (2) of this Article, has been carried out by means of a gradual reallocation of the financial system.
(b) define performance descriptions for each ZZPs;
With effect from 1 January 2009 for ZZP's fixed rates as referred to in Article 3 (2) of the Treaty. Article 57, fourth paragraph, point (a) of the Act .
With effect from 1 January 2010 for the ZZPs, sets the limits for the ranges of the bands concerned. Article 57, fourth paragraph, point (b) of the Act . The range has a range between eight-ninety and one hundred per cent of the amount to be determined by the care authority, which may be charged at most for the relevant ZZPs;
e. shall establish by inpatient care provider as referred to in (a) a charge rate, by which any discrepancies between the acceptable cost of any year and the actual filling of that budget with ZZP rates shall be offset.
The Care Authority shall apply the performance descriptions and ZZP rates, as specified in: Article 3 , the budget available for the production arrangements under the old contrivation parameters, above which the extra resources for the quality care will be € 246 million for the V&V and € 42 million for disability care.
1 The care authority requires intramural health care providers and health care firms together, according to specification determined by the care authority, and at the same time, with production arrangements made between them in old contripleated parameters with refer to the year 2009, to indicate how those production arrangements are denominated in ZZP-terms.
2 The budget base that the inpatient care providers meet with their health care office is based on old parameters in 2009.
3 The healthcare authority proposes in the March 2009 budget by inpatient care provider, who is the Article 2 Such care shall provide a reallocation amount.
4 The relocation amount established pursuant to the previous paragraph shall apply to the relevant inpatient care provider for the entire heraldate period.
1 If the adjustment of the amount of the reallocation referred to in the previous article leads to the situation of a reduction in the inpatient care provider, the following construction steps shall apply:
a. For the year 2009, a uniform starting percentage of two per cent of the budget base of the relevant inpatient care provider shall apply;
b. For the year 2010, a uniform starting percentage of four per cent of the budget base of the relevant inpatient care provider shall apply;
c. for the year 2011, in view of the requirement of (d), a uniform rate of exit of at least seven percent of the budget base of the relevant inpatient care provider;
d. for the year 2011 and next, the care authority may, on the basis of special conditions to be given by it, apply a customsscheme to the inpatient care provider who has to build up more than 13% of its budget base.
e. The care provider and the care office may agree to a higher rate for run-off by means of a joint request to the care authority.
2 The percentages referred to in the preceding paragraph shall be cumulative.
3 The actual deleveraging referred to in paragraph 1 shall not exceed the relocation amount established for the relevant inpatient care provider.
4 The care authority processes the rate of exit of two percent in 2009 with throughput in 2010 of its own motion in the acceptable cost of health care institutions.
5 The care authority processes the nominal amounts resulting from the reallocation of individual intramural health care providers in accordance with the designation on the basis of Article 7 of the Act to the Care Authority on Contract Space for the year 2009.
1 The care authority totalisates the nominal amounts available in a single year from the reallocation reduction of the individual inpatient care providers.
2 The amounts referred to in the first paragraph shall be supplemented by 0,25% of the one-per cent margin arrangement of the contract space.
3 If the determination of the reallocation amount, intended Article 5 , leading to the situation of institution-building for the inpatient care provider, the amounts referred to in paragraph 1 shall be used by the care authority in accordance with a distribution standard developed by that authority for the purpose of building up to that institution health care providers.
4 For the year 2011 and next, the care authority may, on the basis of special conditions to be given by the care authority on the inpatient care provider that needs to build up more than 13% with respect to its budget base, will be able to establish a measure of Apply.
5 The allocation of the funds available for the construction shall be carried out in accordance with the designation on the basis of Article 7 of the Act to the Care Authority on Contract Space for the year 2009.
1 The introduction of the care credit rate as of 1 January 2009 and the steps taken in the reallocation will apply to each of the nursing and Care, Mental Health and Disability Sectors sectors, subject to the condition that, if The care authority's investigation into the opinion of the care authority shows that:
a. The ZZPs and ZZP rates for the Mental Health Sector are not sufficiently stable to base the reallocation process on it, the (pace of) reallocation pathway in that sector can be reconsidered;
b. In the disability care sector, the herallocation step as referred to in Article 6, first paragraph, introductory wording and point (c) , in the year 2011 is not feasible, the (pace of the) herallocation pathway in that sector can be reconsidered.
2 The Health Care Authority informs me in good time about the results of the investigations referred to in the previous paragraph, and proposes a revised reallocation project. I will make the further choice on the review of a reallocation journey to the care authority by letter, from which I send a copy to both Chambers of the States-General.
The care authority:
a. With effect from 2009, proposes design performance descriptions for intra-and outpatient day spending in the disability sector;
b. As from 2009, lays down harmonised draft tariffs as referred to in the Directive in respect of the tariffs in 2008 Article 57, fourth paragraph, point (a) of the Act , for the performance descriptions referred to in point (a), the day-to-payment rates;
c. whether or not to jointly provide extramural health care providers and care offices, according to specification established by the Care Authority, and at the same time with production agreements made between them with regard to the year 2009, how they would have sound, if the performance descriptions and charges referred to in point (a) (b) and (b) of this Regulation, respectively, would have been applicable. The latter information is further identified as outpatient day-spending arrangements.
2 The care authority shall, as from 2010:
(a) performance descriptions for intra-and outpatient day spending in the disability sector;
b. Rates fixed as specified in Article 57, fourth paragraph, point (a) of the Health Organisation Act , for the performance descriptions referred to in point (a).
Within the nursing and care sector, the care authority harmonises the so-called out-of-office days on the death of the insured person, taking into account the following:
a. The care authority shall establish, as from 2009, a performance description for the out-of-office day in relation to the death of a patient;
For that performance description, the care authority shall establish a fixed rate of interest for that performance as of 2009. Article 57, fourth paragraph, point (a) of the Act ;
c. The rate to be determined by the care authority shall not exceed the amount to be charged with and without treatment for the performance description ZZP-VV-1;
d. the performance may be charged for no more than 13 non-member days, starting on the first day of those days from the day following the day of death of the patient.
The care authority shall establish, as from 2009, a rate of temporary stay or stay with a healthcare provider, with care and support being funded on the basis of the outpatient policy rules. A temporary stay or stay is where an insured person is dependent on a stay for one, two or three times a week. The indication is set in functions and classes.
The care authority shall establish a performance description for the purpose of determining extreme care gravity of individual disabled persons with heavy mental, physical or sensory impairment, to be delivered by an inpatient care provider. The performance description provides for the deployment of the Centre Indication Committee and the Centre for Consultation and Expertise for determining the necessary care heaviness. The care authority determines individual component extreme care for disabled disabled care with a fixed rate as intended by the care authority individually. Article 57, fourth paragraph, point (a) of the Act .
1 The introduction of a funding system on the basis of ZZPs and ZZP rates does not apply to inpatient care providers as referred to in Article 4 (1) of the EC Treaty. Article 1, introductory wording and point c , providing care for children and youth in the Mental Health Service sector.
2 The care authority is investigating an appropriate manner of funding from the client groups referred to in the previous paragraph, and I am informed of the results of that investigation in good time and makes a proposal to me. My decision on the introduction of another method of financing will be made known by letter to the care authority, a copy of which I send to the two Chambers of the States-General.
The care authority provides by means of an individual component, in the funding of:
a. Special costs for residents of Jewish Care homes dealing with the processing of the consequences of experiences in the Second World War and
b. expenses relating to processing the effects of the war on residents of Indian/Molucate care homes.
The care authority shall establish a storage charge for customers with a diagnosis of CVA at the rate of the care balance package 9 for the nursing and care sector. In addition to the present working method, this surcharge, in the form of a fixed tariff as referred to in Article 3 (2), is Article 57, fourth paragraph, point (a) of the Act , apply during the first eight weeks from the first day of stay with the care provider, from the rehabilitation care for these particular clients.
The care authority shall adjust the performance description ZZP-VG-7 for residence of highly behavioural impaired persons so that it can only apply to healthcare providers who have an authorisation in accordance with Article 5 of the Law authorising health care institutions for the places of residence of that category of disabled persons. If the healthcare provider is not in possession of this admission will not be funded on the indiced VG-7, but on VG-6.
In addition to the payment scheme, the care authority shall take the following measures in addition to the payment scheme for the following categories of in-patient care providers, which are authorised in particular for an expert function:
a. For the basis of Article 5 of the Law authorising health care institutions Authorised institutions such as Multifunction Centres (MFCs), which provide a cooperative relationship with residence and treatment for the interface of disability care and child/youth psychiatry, shall establish adequate funding for the care authority;
b. For institutions specializing in the observation of clients with the basis of disability, the care authority shall define appropriate performance descriptions and rates;
c. for intensive treatment Clinics (KIB's 75 sites) in the Mental Health Sector, the care authority for future funding of the care in these institutions is investigating the differences between the current health care and the funding and the reason for the opposition;
d. for care establishments which act as a specialised centre in the care of clients with mental or physical disability with epilepsy, the care authority shall establish adequate funding.
In setting policy rules, the health authority is based on the principle that the introduction of the care capital should be carried out in a budgetary neutral sector. The budgetary framework shall be supplemented and cancelled both on the budget available for the production arrangements in the existing contriation parameters and on the budget available for the production arrangements in ZZPs.
This designation shall enter into force immediately and shall be published in the Official Journal.
TheState Secretary
of Public Health, Welfare and Sport,M. Bussemaker
