The consultation on the proposed 2023/25 NHS Payment Scheme is now open in England

17

Jan 2023

On December 23, 2022, NHS England published a preliminary 2023/25 NHS Payment Scheme and launched a consultation. The deadline for comments submission is January 27, 2023.

NHS Payment Scheme (NHSPS) will replace the National Tariff Payment System from April 1, 2023. The NHSPS will be set for two years. The key proposed changes are presented below.

As in the previous year, the leading payment mechanism to cover almost all secondary care activity will be an aligned payment and incentives (API) approach. These will apply to contracts between a commissioner and an NHS provider with an expected annual activity value above £0.5 million. API payments will include two parts: the fixed and variable components (“elements”):

  • The fixed component should be set between the commissioner and provider to cover funding for an agreed level of acute activity, maternity, mental health, community and ambulance services, expected quality achievement (Best Practice Tariff, BPT, and Commissioning for Quality and Innovation, CQUIN), implementation costs of MedTech Funding Mandate (but not the products itself), and some other activities;
  • The variable component will include actually provided elective activity paid using HRG (Healthcare Resource Groups, the term used for DRGs in England) tariffs. The more elective activity is delivered, the more funding the provider receives. The variable component is also used to reflect actual attainment for elective activity BPTs and CQUIN metrics.

The other three payment mechanisms will be the following:

  • Low volume activity (LVA) block payments will cover secondary care from NHS providers under contracts with the expected value of the annual activity of £0.5 million or less;
  • Activity-based payment using HRG tariffs will apply to services delivered by non-NHS providers;
  • The local agreement will apply to activities not covered by another payment mechanism.

There will be two types of HRG tariffs published in Annex A NHS Payment Scheme workbook 2023/24 (Annex A will be updated and reissued for 2024/25):

  • Unit prices must be used for the variable component of API and the activity-based payments to non-NHS providers;
  • Guide prices can be used as benchmarks and to support local payment arrangements.

Best Practice Tariffs (BPTs) will be divided into two payment categories: “annual” (included in the fixed component of API) and “elective activity” (payment using the BPT tariffs for actually provided activity).

As in the previous year, all High Cost device categories will be excluded from the basic payment mechanism. No changes are proposed for MedTech Funding Mandate (MTFM). The cost of MTFM products is still excluded from API fixed and variable components. However, the fixed component of API should include the implementation costs of MTFM (as in the previous year).

See the full details here.

This news is just one of about 300 market access news collected by our team in the subscription services "HTA Alerts" and "Reimbursement Alerts" every two weeks from more than 80 organizations. Access our paid subscription services to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). First EU issues of both newsletters are available for download free-of-charge.

Not ready for a subscription service? Subscribe to our free-of-charge newsletter delivered every second week to get updates about key reimbursement developments in Europe (10-12 news every two weeks).

The latest related news

27

Jan 2023

On January 09, 2023, the National Institute for Health and Disability Insurance (INAMI-RIZIV) published 2023 tariffs for the “low variability care” (APR-DRG) system. APR-DRG logic for 2023 is not published as of January 27, so no information about its changes or new DRGs is available.

Read more

26

Jan 2023

The updated German Uniform Evaluation Standard (EBM) catalog came into force on January 1, 2023. The EBM catalog (Einheitlicher Bewertungsmaßstab) regulates the reimbursement of services in the public outpatient sector in Germany and is updated once a quarter (four times a year). Among other changes, a new code for "zanadio" health app for follow-up and evaluation was introduced in the catalog.

Read more

25

Jan 2023

On December 31, 2022, the Decree defining the reimbursement of medical telemonitoring activities via the new framework was published in the Official Journal of the French Republic. The Decree determines the methods of evaluation of digital solutions, registration for reimbursement, modification of the registration conditions, removal and invoicing of medical telemonitoring activities, as well as the conditions for setting the reimbursement packages.

Read more

24

Jan 2023

In December 2022, NHS England launched a consultation on the preliminary 2023/25 NHS Payment Scheme, which is set for two years and will replace the National Tariff Payment System from April 2023. Two new cardiovascular categories (antibacterial envelope, mitral valve repair and replacement devices) are proposed for inclusion in the 2023/24 High Cost Device List (will be updated and reissued for 2024/25). The deadline for comments submission is January 27, 2023.

Read more

23

Jan 2023

On December 26, 2022, three more health apps were introduced in the Directory of digital health applications (DiGAs) at the Federal Office for Drugs and Medical Devices (BfArM) and thus became reimbursable. These apps can be prescribed by physicians and psychotherapists and will be reimbursed by sickness funds.

Read more