Collective wages for home nursing must be calculable

BSG: Nursing services have to pay tariff and explain their costs
Kassel (jur). Outpatient care services must also be able to take into account collective wages paid in the home care sector. If the collective wages are actually paid, health insurance companies can not refuse higher rates of remuneration with the argument that a wage increase is uneconomical and income stability is jeopardized, the Federal Social Court (BSG) ruled in Kassel on 23 June 2016 (Ref .: B 3 KR 26 / 15 R and B 3 KR 25/15 R).

However, in order for nursing organizations to be able to agree on higher reimbursement for wage increases, they must first disclose the operating and cost structure of "a representative number of institutions". It must be examined whether an underfunding of care services leads to a threat to medical care.

Picture: Kzenon - fotolia

Unlike in long-term outpatient care, where long-term care insurance covers the costs, temporary health care is the responsibility of temporary health care. Health insurances and nursing associations have to agree on the compensation rates for the care provided, such as dressing changes or the administration of insulin syringes. If they can not agree, an arbitrator must make an arbitration award and settle the dispute.

Basically, the health insurance funds by law, the "contribution stability" true. The care allowance must therefore not be too high, "unless the necessary medical care can not be guaranteed even after exhaustion of economic reserves".

However, according to the German Protestant Association for Retirement Work and Care (DEVAP) and the Association of Catholic Elderly Aid in Germany (VKAD), home health care has been underfunded for years. Despite wage increases for the nursing staff, the remuneration for home care had not been sufficiently adjusted. The health insurance companies justify this with the reference to the contribution stability to be maintained. The collective wage increases were also not "economic".

In the two cases negotiated by the BSG, there were two arbitral awards in the dispute, which set the care allowance in Hesse for commercial outpatient care services in 2010 and in the field of voluntary welfare in 2009. The compensation rates were considered too low in one case by the nursing associations and in the other case by the health insurances too high, so that now the SPAs should review them. Since then, all subsequent arbitral awards have been suspended until today.

The 3rd BSG Senate reversed both rulings and ruled that health insurance companies and nursing associations must now negotiate the compensation rates and, if necessary, obtain a new award. There is a lack of concrete evidence that justifies the determination of the rates in the arbitral awards, complained the BSG.

However, the Kassel judges gave the health insurance funds and the representatives of the nursing service industry some legal basis along the way.

If the providers of outpatient care services also want to receive higher compensation from the health insurance funds because of wage increases, they have to prove concretely that the collective wage actually benefits the employees. A general reference to increased collective bargaining wages is not enough.

"Rather, an operating and cost structure must be presented and in place for a representative number of entities justifying such an increase," said the SPA. Here, the nursing service providers would have to provide appropriate information, otherwise no higher remuneration could be required by the health insurance companies. The nursing services would ultimately have to prove that they have no economic reserves and the medical care of the insured is at risk.

Conversely, the health insurance companies should not refuse to pay higher rates of remuneration simply by pointing to the stability of contributions and the requirement of cost-effectiveness, the BSG ruled. Tariff wage increases are not "uneconomic", so they can justify higher rates of remuneration. fle / mwo