Reimbursement

At the beginning of September 2021, the Government of the Russian Federation released the preliminary version of the Program of State Guarantees for the period of 2022-2024. Major changes concerned the High-End Medical Care (HEMC) list I, where two new procedures in the cardiovascular and neurovascular field were added. The HEMC list II was expanded with the procedures in the field of radiotherapy, neurology, and neurosurgery, surgical procedures. The final version is expected at the beginning of 2022.

On August 30, 2021, the Decision Forum for "New Methods" made a positive coverage decision for two methods: Transurethral Microwave Thermotherapy (TUMT) for benign prostatic hyperplasia treatment and organ donation using normothermic regional perfusion in patients with severe brain injury and who died of cardiac and respiratory arrest when life-prolonging treatment is discontinued.

On August 16, 2021, the preliminary version of OPS 2022 was published. Numerous content updates and new procedure codes concern chapters 5 “Operations” and 8 “Non-operative therapeutic measures”. Also, minor changes were made in chapters 1, “Diagnostic measures” and 3, “Diagnostic imaging”.New codes were introduced in the peripheral vascular, cardiovascular, nephrology and urology, endoscopy, gastroenterology, otorhinolaryngology, interventional radiology, orthopedics, pulmonary and airways, and other fields of care.

Certain medical devices are financed within the DRG tariff but require explicit review to ensure that they are safe and effective. This mechanism is called “intra-DRG” (intra-GHS) coverage. On August 5, 2021, the new version of the intra-DRG list was published by the French Ministry of Solidarity and Health. No new devices were added to the list compared to the version of November 2020.

On August 11, 2021, the Dutch Healthcare Institute (ZIN) published the assessment of Oncotype DX®. The assessment was conducted to confirm whether the test complies with the criteria of "science and practice" to determine if it can be reimbursed under the basic health insurance package. In conclusion, the test can be reimbursed under the basic health insurance package.

On July 30, 2021, the final version of the French DRG manual was published on the website of the Technical Agency for Information on Hospitalizations (ATIH). No new DRGs or other changes compared to the preliminary version published in March 2021 have been introduced.

In late July 2021, NHS England opened a call for applications to the High Cost Device List (HCDL) changes for the 2022/23 National Tariff Payment System. The completed application form should be submitted via email by September 30, 2021. HCDL is an add-on reimbursement for medical devices and in-vitro diagnostic tests, so the amount is paid in addition to the payment for regular care.

On July 30, 2021, the Swiss Federal Statistics Office (UFS) published the 2022 version of the procedure code (CHOP) nomenclature in the German language. The newly introduced codes concern various technology groups, such as cardiovascular, gastrointestinal, neurology, interventional radiology, orthopedics, gynecology, and others.

In July 2021, the Austrian Institute for Health Technology Assessment (AIHTA) published six new decision support documents and one update to a previous decision support document. The assessed topics included percutaneous left ventricular assist devices, liposuction for surgical therapy of lipoedema, triphasic biomaterial for augmentation of the osteoporotic femoral neck, endoscopic plication therapy in patients with gastroesophageal reflux disease (GERD), allogenic bone screw Shark Screw® in patients with hallux valgus or scaphoid fractures/pseudarthroses, and surgical interventions for the treatment of benign prostatic hyperplasia. The updated decision support document concerned implantable bulking agents for fecal incontinence.

On July 1, 2021, the updated Framework Contract that defines the social health insurance benefit package in Romania entered into force. The Framework Contract defines the SHI benefits package, the conditions for providing services and payments. The updated Framework Contract will be valid for the years 2021-2022.

In July 2021, the Clinical Coding and Schedule Development (CCSD) working group, which develops and maintains procedural and diagnostics nomenclature for private payers in England, has published Bulletins 0178 and 0075 with changes to be implemented not later than November 01, 2021. No new procedure codes were introduced. Two new diagnostic codes were introduced.

In early July 2021, two 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 health insurers. In total, nineteen health apps are now available at the DiGA Directory.