Reimbursement

On December 22, 2020, the Swiss Federal Office of Public Health announced the changes that will occur to the Services Ordinance (KLV/OPre). The changes concern the general part of the Services Ordinance (KLV/OPre), and all four of its Annexes, which define the coverage of services (List of explicitly evaluated services, List of Medical Aids and Equipment, List of Analyses, List of Medications with Tariff). The updates will enter into force on January 1, 2021. Updates concern among others bariatric surgery, Autologous Chondrocyte Transplantation, ultrasound focused therapy for neurological indications.

The Austrian Institute for Health Technology Assessment (AIHTA) completed the research project “Framework for reimbursement decisions of digital health technologies (mHealth) and its (retrospective) application on selected examples”. The report was published in the middle of December 2020.

In November 2020, the General Directorate of Basic Package of National Health System and Pharmacy Services published the Resolution on the agreement of the Commission of Benefits, Insurance, And Financing in relation to the proton therapy technique. The key points of the agreement include the recommendation for the creation of an interdisciplinary committee in each autonomous community to evaluate each specific case of proton therapy and therapeutic indications.

In late November 2020, the Norwegian Directorate of e-Health released an updated version of the National Laboratory code (NLK) system and associated tariffs that will be implemented not later than January 01, 2021. A total of 25 new codes were added in this version of NLK, 201 codes have been changed, and eight codes were inactivated. Six new codes for SARS-related coronavirus antigen and six new codes for SARS-CoV-2 antigen have been established.

In early December 2020, the Swedish National Board of Health and Welfare announced significant changes in the Swedish Classification of Health Care Measures (KVÅ) structure related to vascular surgery procedure codes. New Chapter V, “Operations on the aorta, peripheral vessels and lymphatic system,” will be introduced from January 2021, gathering all vascular surgical procedures previously located in several subchapters.

In early December 2020, one more reimbursable health app was introduced on the Directory of digital health applications (DiGAs) at the Federal Office for Drugs and Medical Devices (BfArM). These applications can be prescribed by physicians and psychotherapists and will be reimbursed by health insurers.

In November 2020, the Clinical Coding and Schedule Development (CCSD) group, which develops and maintains procedural and diagnostics nomenclature for private payers in England, has published Bulletins 0173 and 0070 with changes to be implemented not later than February 01, 2021. Three new procedure codes were introduced, related to robotic laparoscopy in gynecology, brachytherapy in prostate tumor, and autologous bone marrow aspirate concentrate (BMAC) for osteochondral defects of the knee. Also, four codes for diagnostic tests were added.

On November 3, 2020, the Dutch Healthcare Authority (NZa) published the critical features of the first release of the DRG package for the 2022 (RZ22a). Sixteen new procedure codes and three new DRG groups will be implemented.

In late November 2020, the Danish Health Authority has published DRG tariffs, as well as psychiatric and rehabilitation rates for 2021.

On November 5, 2020, the Dutch Healthcare Authority (NZa) published the third release of the DRG package for the 2021 (RZ21c) to implement reimbursement for extra beds in intensive care and added the pathway for new optional add-on services (using fast-track decision-making).

On November 18, 2020, the 2020/21 National Tariff Payment System was published and came into effect in England. The publication has been delayed due to the NHS response to the COVID-19 pandemic.

In November 2020, the new intra-DRG was published on the website of the French Ministry of Solidarity and Health. A new chapter was added for urogenital implants - “Implantable devices for the treatment of female stress urinary incontinence.”