New eligible maximum amounts for federal officials - secure receipt of the aid by changing the state aid regulation
On September 23, 2011, representatives of the large naturopathic associations met the Head of Unit Mr. Ditmar Lümmen in Berlin at the invitation of the Federal Ministry of the Interior (BMI). Due to the Federal Administrative Court ruling (AZ: 2C 61.08) dated November 12, 2009, there was a need for clarification regarding the granting of grants for alternative practitioner treatments. After the aid for alternative practitioner services in Saarland was canceled without replacement, it was clear that we urgently needed to talk to the responsible ministry in Berlin. When asked by the BMI, it became clear that the cost development of alternative practitioners is being monitored.
Open discussion in the Federal Ministry
The colleagues of the Advisory and Fees Committee Siegfried Kämper, Franz Dieter Schmidt, Karl-Fritz König and Frank Haseloff held the talks in the Federal Ministry of the Interior (BMI). It became clear that both the federal government and some federal states had to note with great concern that the costs for alternative practitioner treatment were significantly higher than in previous years. In order to improve and continue to ensure the budgetary justifiability and cost-effectiveness of the eligibility of expenses for services provided by naturopaths, there was an open discussion between all those involved.
New reimbursement table The new reimbursement table submitted by the BMI was discussed. Some eligible amounts are now lower than before but very close to the so-called GOÄ threshold. The basic prerequisite for maintaining eligibility for the BMI was that for comparable services, the alternative practitioner receives less fees than a doctor. This does not contradict the Federal Administrative Court's ruling that the aid should be re-regulated and that only complained that the previous reference to a directory from 1985 can no longer be legal. According to this judgment, the appropriate amount is the amount that is granted to a doctor for a comparable service and that was defined in a binding manner in the GOÄ. However, this amount does not have to be reimbursed in this amount because the cost structure and training between doctor and alternative practitioner can be assessed differently.
The Federal Administrative Court has thus approved a certain “scope” downwards. It is also undisputed that it is at the discretion of the federal and state governments to grant subsidies for treatments to a medical practitioner or not. In addition to the profitability requirement, special attention was paid to the concerns of alternative practitioners when creating the new table. In principle, alternative practitioner services are respected as a valuable contribution to health, but the Federal Administrative Court ruling had to be implemented.
From October 1, 2011, the federal government will grant aid to its sector up to the amounts listed in the new performance table. The Confederation has made an indefinite commitment to the maximum eligible amounts specified in the Appendix (see below). Of course, it is up to each naturopath to decide what fee he agrees with his patient. Aid from the federal government is only granted to the extent of the new table.
Aid secured Mr Lümmen currently sees the aid secured for us. We naturopaths were able to convey that we not only offer high-quality health services, but also make a contribution to reducing costs.
Conclusion If you look at the new table, one can speak of an improvement overall compared to the old aid scheme. There are also drawbacks and these are of course uncomfortable, but far less painful than a complete cancellation of the allowance. It should not be overlooked that the undesirable increase in costs for the state treasury has resulted in a need for action. Since civil servants do not always cover supplementary insurance according to the previous benefit commitment, the GOÄ threshold is well advised anyway, so that medical practitioners should be calculated in such a way that a possible deductible is not too high.
In the long term, the amounts mentioned relieve households of the previous practice and, above all, ensure that the aid is received where it is still granted and will continue to exist. The fact that many amounts are still significantly higher than up to a year ago is a real cause for joy and helps a little beyond the fact that small discounts were unavoidable for some amounts (e.g. the injection figures).
This is illustrated by a few examples: Fee 1:
Examination € 12.30 - € 20.50. Remunerated with € 12.30 until 2010, now € 12.50 is eligible (bhfg).
In-depth advice € 16.40 - € 22.00. Until 2010 € 16.40, now € 18.50 bhfg.
Advice € 8.20 - € 20.50. Up to 2010 € 8.20, now € 9.00 bhfg.
Neurological examination € 5.20 - € 26.00. Up to 2010 € 5.20, now € 21.00 bhfg.
Acupuncture € 10.30 - € 26.00. Up to 2010 € 10.30, now € 23.00 bhfg.
Neural therapy € 7.70 - € 26.00. Previously € 7.70, now € 11.00 bhfg.
Drawn Chiropractic € 15.40 - € 19.00. Previously € 15.40, now € 17.00 bhfg. (and the elimination of the limit of 3 x per treatment case, but can only be calculated once per treatment day.)
While these examples show that some improvements have been made, a few “bitter pills” should not be withheld:
Injection SC up to € 5.20. Until 2010 bhfg. 5.20 €, now 4.50 € bhfg.
Injection i.m. Up to 2010 € 5.20, now € 4.50 train station. Fee 25.3:
IV injection up to € 7.70. Up to 2010 € 7.70, now € 6.00 bhfg. Fee 25.4:
Wheal treatment € 7.20 - € 13.00. Up to 2010 € 7.20, now € 7.00 bhfg.
Chiropractic € 10.50 - € 18.00. Up to 2010 € 4.96 (= GOÄ threshold), now € 4.00.
The BMI was keen to also leave the GOÄ model. thus these values can be seen without the GOÄ limits, which leads to further improvement / simplifications!
Homeopathy Unfortunately, especially in paragraph 2 and homeopathy, the application of the GOÄ threshold of EUR 120.65 (compared to the amount of EUR 15.40), based on the BVerwG judgment, caused such enormous costs that it was about this number was very bad. There were always problems with this number and very different interpretations.
The BMI has now decided:
Medical exam 15.40 - 41.00 EUR. Previously 15.40 EUR, now 35.00 EUR, but only once a year and max. 3 x / 6 months.
Positive conclusion: It should not be forgotten that every civil servant also has additional private insurance, which, depending on his status, is supposed to reimburse 30% to 50% of the bill. Nothing has changed in the benefit commitments and reimbursement amounts of the private health insurers, so that the different billing models have resulted in considerable patient deductibles. So far, these have been difficult to convey if the invoice amount was significantly higher than in the past. For this reason alone, we have been cautious at the beginning of the year. With the new amounts, the possible deductible is very limited and reasonable, in many cases (depending on the tariff and private health insurance) not even available at all.
Association of German Alternative Practitioners (BDH)
Association of German Naturopaths. (FDH)
Free Association of German Naturopaths. (FVDH)
Union of German Naturopaths (UDH)
Association of German Alternative Practitioners (VDH)