What changes does the IPReG bring, especially for outpatient intensive care services? 1. what are the most important key points of the IPReG for service providers?

The Intensive Care and Rehabilitation Reinforcement Act (IPReG) came into force on October 29, 2020 and has now been in force for well over half a year. It is probably one of the most controversial legislative projects at the moment and has been met with criticism, particularly from those affected.

Is it possible to draw a first interim balance of this law in connection with outpatient intensive care services or is this "music of the future", the effects of which will only become apparent for outpatient intensive care in the coming years?

1. what are the most important key points of the IPReG for service providers?

  • Uniform and joint negotiation of the health insurance funds

  • Coexistence of home nursing and outpatient intensive care

  • Intensive care can be provided in assisted living facilities - including those in which integration assistance services are provided

  • Framework recommendations still to be negotiated are to regulate personnel requirements for nursing care, structural requirements for residential units, principles of economic efficiency, principles of cooperation and principles of remuneration

  • The Federal Joint Committee regulates the details regarding the requirements for the particularly high demand for medical treatment care, the cooperation between the medical and non-medical service providers involved in medical and nursing care, the prescription of services and the qualifications of the contract doctors who may prescribe the services

  • Incentives under benefit law for outpatient intensive care in full inpatient care facilities: In addition to care-related expenses, including expenses for care and expenses for medical treatment care services, the investment costs necessary for operation and the fees for accommodation are also included (which does not apply to outpatient residential groups/shared accommodation)

2. entitlement of the insured person to outpatient intensive care in accordance with § 37c SGB V

With the new Section 37c SGB V, the law already grants insured persons an entitlement to outpatient intensive care. This requires a prescription from a contract doctor who is specially qualified. In addition, the potential for reducing ventilation time through to weaning and the measures required for implementation must be documented with every prescription for out-of-hospital intensive care, particularly for insured persons who are ventilated, and efforts must be made to implement this.

The details regarding the prescription of services and the procedure for recording the documentation of the weaning goal, as well as the requirements for the special qualifications of doctors and the particularly high need for medical treatment care, will be determined by the Federal Joint Committee by October 31, 2021, according to the law. For the first time, a distinction is to be made between children and adolescents up to the age of 18, young adults in whom a clinical picture of childhood and adolescence persists or a typical clinical picture of childhood and adolescence occurs for the first time, and adults.

The details regarding the special care contracts required for the provision of intensive care are also still unclear and do not result directly from the regulation in Section 132l SGB V. These ambiguities are to be eliminated by 2022 through unified framework recommendations.

3. conclusion of care contracts in accordance with Section 132l SGB V for intensive care services not yet possible

According to the legislator's vision, the National Association of Health Insurance Funds and the associations of providers of full inpatient care facilities, the umbrella organizations responsible for representing the interests of service providers, are to agree on joint framework recommendations on the content of care contracts at federal level.

A period of two years after the law comes into force is envisaged for this (almost a year has now passed). After this period, a further year will be available for the implementation of the recommendations. It will therefore be some time before the first supply contracts can be concluded in accordance with Section 132l SGB V, as the content of the framework recommendations must first be agreed.

If the framework recommendations are not agreed in whole or in part, there is even the possibility of appealing to the arbitrator, which could make the possibility of concluding supply contracts for the provision of intensive care even more remote. Until then, the contracts in accordance with Section 132a (4) SGB V will continue to apply until they are replaced by the contracts in accordance with Section 132l SGB V.

4 In addition to content of care contracts, framework recommendations should also regulate personnel requirements for nursing care

The current framework recommendations are therefore to be replaced by the framework recommendations to be renegotiated and, among other things, regulate the personnel requirements for nursing care. What these personnel requirements or structural requirements for residential units should look like from a performance law perspective is still open, so that it is currently difficult for service providers to prepare for this.

5. currently only isolated uniform and joint negotiations between the health insurance funds

The uniform and joint negotiation of contracts and remuneration with the health insurance funds will also only be applied in the future, once the framework recommendations have been unified. Although many health insurance funds are already preparing for this unified negotiation, there are also local health insurance funds, for example, that are holding on to their sovereignty for as long as they can.

6 Conclusion

The consequences of the performance law incentives for the provision of non-clinical intensive care in fully inpatient facilities standardized in Section 37c (3) SGB V, with which the legislator has opened up the trend towards inpatient facilities - for which, among other things, the respective home care regulations may also have to be observed - are therefore not yet having a concrete effect.

This is because the details have been delegated to the Federal Joint Committee or the National Association of Health Insurance Funds and the associations of providers of full inpatient care facilities and the leading organizations at federal level responsible for representing the interests of service providers and the leading organizations at federal level responsible for representing the interests of care services. The statutory provisions of the IPReG are therefore ultimately "empty shells" that still need to be fleshed out.

Status: 05.03.2021

Date: 5. Mar 2021