Reimbursement

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.

The revised EBM (German Uniform Evaluation Standard) catalog came into force on July 1, 2021. Three biomarker tests in breast cancer, a number of services related to cryopreservation of egg and sperm cells in young cancer patients, new services dedicated to prenatal testing of the fetal rhesus factor, services concerning the delivery of brachytherapy in prostate cancer were introduced.

On June 30, 2021, the Swiss Federal Council announced that the TARDOC outpatient tariff structure, presented by the association of insurers curafutura and the Swiss Medical Association (FMH), cannot be approved at this point. The Federal Council found the TARDOC tariff structure to have many drawbacks. Curafutura released an announcement in which they state that they will continue working on the TARDOC tariff structure and will try to implement as many changes as possible, according to the FOPH recommendations. This means that the TARDOC tariff structure is not likely to be implemented before January 2023.

On July 7, 2021, the Federal Joint Committee (G-BA) has launched an online database of method evaluations for conceptually new diagnostic and treatment methods (§135 SGB V), diagnostic and treatment methods in hospital settings (§137c SGB V) and within the framework of co-funded studies (§137e SGB V).