For the reimbursement of additional personnel costs for necessary 1:1 individual support by the funding body (especially autism-related illnesses) Summary and practical tip

On 25.06.2015 (case no. L 7 SO 1447/11), the State Social Court of Baden-Württemberg issued a landmark decision on the reimbursement of additional costs for necessary individual 1:1 care for people with autism, which is likely to set the tone for a large number of cases with individual care needs. The ruling, which is explained in great detail, comes to the conclusion that reimbursement of additional costs for individual care in an integration assistance facility is generally excluded if the facility, as the service provider, has not previously concluded a corresponding service and fee agreement (LV) with the cost bearer. If and to the extent that the specific care requirements exceed the staffing ratio stipulated in the existing agreement (usually 4:1 or 3:1), the facility must conclude an individual service agreement with the funding body in accordance with Section 75 (4) SGB XII. However, if it has not done so, reimbursement of additional costs is always excluded. According to the court, the facility would then run the "risk that, given the very undifferentiated description of the type of service, beneficiaries with high care needs would also be admitted without being reimbursed accordingly".

Summary and practical tip

As a result, the court considers that in the case of such special needs, which go far beyond the needs typified in the service agreements, the only way forward is via an individual agreement with the cost bearer in accordance with Section 75 (4) SGB XII. If this route is not followed, additional costs incurred by the facility in the past will not be reimbursed by the funding body. As a consequence of this ultimately clear decision by the State Social Court, facilities must be advised to always carefully check whether individual one-to-one care will be necessary before admitting residents or pupils and, if necessary, to negotiate and conclude an individual agreement with the cost bearer in accordance with Section 75 (4) SGB XII before admission. For persons already admitted with a 1:1 care requirement, such individual agreements must now be concluded with the funding body, if this has not already been done.