Reimbursement

The revised EBM (German Uniform Evaluation Standard) catalog came into force on July 1, 2020. MTRC has compiled the selection of the most significant changes.

In March 2020, the Dutch Healthcare Institute advised the Ministry of Health, Welfare, and Sport to simplify the reimbursement to diabetes care aids. In accordance with this advice, the Real-Time Continuous Glucose Monitoring (RT-CGM) and ketone test strips will no longer fall under specialist medical care (MSZ) but will be covered by medical aid care (HMZ). The new scheme is intended to take effect on 1 January 2021.

In March 2020, the Dutch Healthcare Institute advised the Ministry of Health, Welfare, and Sport to simplify the reimbursement to diabetes care aids. In accordance with this advice, the Real-Time Continuous Glucose Monitoring (RT-CGM) and ketone test strips will no longer fall under specialist medical care (MSZ) but will be covered by medical aid care (HMZ). The new scheme is intended to take effect on 1 January 2021.

The Corona warning app, developed on behalf of the German government, has been available for download in the Google and Apple stores since June 16, 2020. It is intended to help identify and break infection chains at an early stage. Users of the app receive a notification if they have been for a long time in the vicinity of a person who was later found to be infected with the coronavirus.

New material codes and related conditions of reimbursement for an isolated iliac bifurcation endoprosthesis were added to the List of reimbursable devices of the Belgian National Institute for Health and Disability Insurance (INAMI-RIZIV) in June 2020.

The French High Authority for Health (HAS) regularly publishes new decisions about add-on reimbursement for medical devices. The decisions made in June 2020 concern various types of devices, including total lumbar disc prostheses, arthroscopic meniscal repair system, vagus nerve stimulation system, and medical aids. A total of 10 decisions were made.

On 9 May 2020, the Reimbursement Commission made changes to the SUT regarding response to the COVID-19 pandemic and introduced codes for IVD tests for Covid-19 (SARS-CoV-2) reverse transcriptase PCR and detection of Covid-19 antigen, IgG, IgM.

The reimbursement for PCR tests for the detection of SARS-CoV-2 will be reduced from €59.00 to €39.40 per test starting from July 1, 2020, and the billing of the examination will be limited to five times in the case of treatment. This decision was made by the extended evaluation committee on June 10, 2020.

On May 27, 2020, the Federal Council adopted the modification of the Insurance Law (KVG/LAMal) on the reimbursement of medical aids and equipment. In the future, health insurers will have to bear the costs of the medical material regardless of whether it is used directly by the insured person, by a non-professional person, or by the nursing staff.

The French High Authority for Health (HAS) regularly publishes new decisions about add-on reimbursement for medical devices. The decisions made in May 2020 concern various types of devices, including cardiovascular devices (self-expanding intracranial stents, TAVI), CT navigation kit for CT-guided percutaneous interventions and medical aids. A total of 8 decisions were made.

The application portal for inclusion in the directory of digital health apps (DiGA) at the Federal Office for Drugs and Medical Devices (BfArM) has been online since May 27, 2020. The application, which can be submitted only electronically, is the first step for the respective health app to be reimbursed in the future as part of regular care.

In April 2020, the Belgian National Institute for Health and Disability Insurance (INAMI-RIZIV) introduced four new nomenclature codes for stereotactic radiotherapy (Belgian Monitor of April 27, 2020). Physicians also must register data on provided stereotactic radiotherapy series in the specific module of Cancer Registry Foundation.