New civil servant aid for alternative practitioner treatment

New maximum eligible amounts for federal officials - guaranteed receipt of the aid by amending the State aid rules

10/10/2011

On 23 September 2011, representatives of the major non-medical practitioner associations met with head of department Mr. Ditmar Lümmen at the invitation of the Federal Ministry of the Interior (BMI) in Berlin. Due to the decision of the Federal Administrative Court (AZ: 2C 61.08) of 12 November 2009, there was a need for clarification regarding the granting of aid for non-medical practitioner treatments. After the subsidy for non-medical practitioner services in Saarland was canceled without replacement, it was clear that we urgently needed to seek an interview with the responsible ministry in Berlin. Upon request from the BMI it became clear that the cost development of alternative practitioners is under observation.

Open conversation in the Federal Ministry
The colleagues of the expert and fee committee Siegfried Kämper, Franz Dieter Schmidt, Karl Fritz king and Frank Haseloff led the discussions in the Federal Ministry of the Interior (BMI). It became clear that both the federal government and some countries had to realize with great concern that far more costs were incurred for alternative health care treatment than in the years before. In order to improve and maintain the budgetary viability and cost-effectiveness of the eligibility for medical expenses, there was an open discussion between all participants.

New refund table
The new reimbursement table presented by the BMI was discussed. Some eligible amounts are now lower than before but very close to the so-called GOÄ threshold. The basic condition for obtaining the eligibility for the BMI was that with comparable services the alternative practitioner receives less fee than a doctor. Nor does that contradict the decision of the Bundesverwaltungsgericht, which states that the aid should be redrafted and merely alleged that the previous reference to a 1985 inventory can no longer be lawful. According to this judgment, the amount that is given to a doctor for a comparable benefit and defined in the GOÄ as appropriate is considered appropriate. However, this amount does not have to be reimbursed in this amount because the cost structure and training between doctor and alternative practitioner are to be valued differently.

Thus, the Federal Administrative Court has approved a certain "downside" downwards. It is also undisputed that it is at the discretion of the federal government and the federal states for its officials to grant subsidies for treatments with a health practitioner or not. In the preparation of the new table, in addition to the economic efficiency requirement, the interests of the non-medical practitioner were taken into account in a special way. In principle, non-medical practitioner services are respected as a valuable contribution to health, but the Federal Administrative Court judgment had to be implemented.

From the first October 2011, the federal government will grant aid for its area up to the amounts listed under the new benefit table. The Confederation has made an undertaking for an indefinite period of time in respect of the maximum eligible amounts set out in the Annex (see below). Naturally, it remains up to now to each alternative practitioner how high he agreed with his patient. Aid from the Confederation will only be granted within the scope of the new table.

Aid secured
Mr. Lümmen currently sees the subsidy secured for us. We naturopaths were able to convey that we not only offer high quality health services, but also contribute to cost containment.

Conclusion
If one looks at the new table, one can speak of an improvement on the old aid scheme as a whole. There are also some drawbacks and these are obviously uncomfortable, but far less painful than a complete loss of aid. It should not be overlooked that the cost increase undesirable for the public purse has led to a need for action. Since civil servants and supplementary insurance under the current benefit plan have by no means always covered the GOÄ threshold, any non-medical practitioner is well advised to settle accounts in such a way that a possible excess is not too high.

Behilfe Officials Alternative Medicine Treatments

The above amounts will relieve households of their long-term practice and, above all, ensure the receipt of aid where it is still granted and will continue to exist. Nevertheless, the fact that many sums are significantly higher than a year ago is a real cause for happiness and helps a little over the fact that for some amounts (eg the injection rates) small discounts were unavoidable.

Some examples are intended to illustrate this:
Fee 1:
Examination 12,30 € - 20,50 €. Remunerated by 2010 with € 12.30, now € 12.50 are eligible (bhfg).

Fee 4:
Detailed advice 16,40 € - 22,00 €. Until 2010 16,40 €, now 18,50 € bhfg.

Fee 5:
Advice 8,20 € - 20,50 €. By 2010 € 8.20, now € 9.00 bhfg.

Fee 17.1:
Neurological examination 5.20 € - 26.00 €. Until 2010 5.20 €, now 21.00 € bhfg.

Fee 21.1:
Acupuncture 10,30 € - 26,00 €. 10,30 € until 2010, now 23,00 € bhfg.

Fee 25.6:
Neural therapy 7,70 € - 26,00 €. So far 7,70 €, now 11,00 € bhfg.

Fee 34.2:
Gez. Chiropractic 15,40 € - 19,00 €. So far 15,40 €, now 17,00 € bhfg. (and elimination of the limit of 3 x per treatment case, but only 1 x per treatment day calculable.)

While these examples show that some improvements have taken place, a few "bitter pills" should not be withheld:

Fee 25.1:
Injection s.c. to 5.20 €. By 2010, bhfg. 5.20 €, now 4.50 € bhfg.

Fee 25.2:
Injection i.m. to 5.20 €. By 2010 5.20 €, now 4.50 € bhfg. Fee 25.3:
Injection i.v. to 7,70 €. 7,70 € until 2010, now 6,00 € bhfg. Fee 25.4:
Wheal treatment 7,20 € - 13,00 €. 7,20 € until 2010, now 7,00 € bhfg.

Fee 34.1:
Chiropractic 10.50 € - 18.00 €. Until 2010 4.96 € (= GOÄchwellenwert), now 4.00 €.

The BMI was keen to leave the GOÄ-leaning. thus these values ​​can be seen without the GOÄ limits, which leads to further improvement / simplifications!

homeopathy
Unfortunately, the application of the GOÄ threshold of EUR 120.65 (compared to the amount of EUR 15.40), in line with the BVerwG ruling, has caused such enormous costs for paragraph 2 and homeopathy Digit very bad. This number has always had problems and very different interpretations.

Now the BMI has decided:
Fee 2:
Sick exam 15,40 - 41,00 EUR. So far 15,40 EUR, now 35,00 EUR, but only 1 x jw Appointment max. 3 x / 6 months.

Positive summary:
It should not be forgotten that every civil servant also has private supplementary insurance, which, depending on his status, should reimburse between 30% and 50% of the bill. The benefits and reimbursement amounts of the private funds have not changed, so that the various accounting models and not inconsiderable deductibles of patients have arisen. These were previously difficult to convey, if the invoice amount was significantly higher than in the past. For this reason alone, we advised caution at the beginning of the year. With the new amounts, the possible excess is very limited and quite reasonable, in many cases (depending on tariff and PKV), even not available.

Association of German Non-medical Practitioner e.V. (BDH)
Fachverband Deutscher Heilpraktiker eV. (FDH)
Free Association of German Naturopaths eV. (FVDH)
Union of German Naturopaths e.V. (UDH)
Association of German Naturopaths e.V. (VDH)