Reimbursement

On August 10, 2023, the Clinical Coding and Schedule Development (CCSD) working group, which develops and maintains procedural and diagnostics nomenclatures for private payers in England, published Bulletins 191 and 087 with changes to be implemented no later than October 6, 2023. Five new procedure codes (concerning urogynecology, robotic surgery, and neuromodulation) and six new codes for in-vitro diagnostics were introduced.

The Essential Levels of Care defines outpatient specialist care and prosthetic care guaranteed to the Italian population. Although the LEA document was brought in 2017, the national tariffs for outpatient specialist and prosthetic care were approved in April 2023. The tariffs for the 2017 LEA catalog (to be in use from January 2024) were updated with the Decree of the Ministry of Health published in the Official Gazette on 4 August 2023

On July 25, 2023, the final version of the DRG manual for 2023 was published. Introduced changes relate to the MDC14, coding of gender in patients under three months of age, and performance of acts inconsistent with the declared sex in transsexual patients.

On July 31, 2023, the National Committee for the evaluation of medical devices and health technologies (CNEDiMTS) at the French National Authority for Health (HAS) published the first positive opinion on the “Early coverage of digital medical devices” (PECAN) framework. The positive opinion is provided to CUREETY TECHCARE medical telemonitoring solution, which is used for medical telemonitoring of adult cancer patients under systemic treatment and/or treated with radiotherapy.

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in July 2023. Sixteen recommendations were published in relation to the registration, modification of registration conditions, and renewal of registration for devices in the List of reimbursable products and services (LPPR). Opinions concern neuromodulation and surgical devices, as well as medical aids.

On July 17, 2022, the Austrian Institute for HTA (AIHTA) published four decision support documents, which provide recommendations regarding the inclusion of new medical interventions in the catalog of individual medical services of the performance-oriented hospital financing (Leistungsorientierten Krankenanstaltenfinanzierung, LKF) model, as well as three updates to previous decision support documents.

On July 07, 2023, the Ministry of Health and Prevention announced the implementation of the transitional period for innovative technologies following the experiment under Article 51 of the Social Security Financing Act.

In July 2023, the National Institute for Health and Disability Insurance (INAMI-RIZIV) significantly updated the process to obtain reimbursement for health apps. More stakeholders, including the industry, can now submit an application to INAMI-RIZIV for temporary or permanent reimbursement. The new process will come into force on October 1, 2023.

At the end of June 2023, the French National Authority for Health (HAS) published a new document with the goal of improving professional practices: Digital medical devices for professional use – Guide on choosing digital medical devices for professional use.

In late June 2023, the National Institute for Health and Disability Insurance (INAMI-RIZIV) decided to extend reimbursement for molecular biology tests by next-generation sequencing (NGS) for one year until June 30, 2024. NGS in oncology and hemato-oncology are temporarily reimbursed as a pilot under a specific agreement (Convention) with INAMI-RIZIV from 2019.

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in June 2023. Twenty-eight recommendations were published in relation to the registration, modification of registration conditions, and renewal of registration for devices in the List of reimbursable products and services (LPPR). Opinions concern cardiovascular and peripheral vascular, endocrine, ENT, orthopedic, spinal, and surgical devices, as well as medical aids.

On July 3, 2023, the document "Changes and innovations in the 2024 LKF model" (Änderungen und Neuerungen in den LKF-Modellen 2024) was published. The document summarizes the most significant changes and innovations in the LKF model for inpatient and outpatient care. The newly added procedure codes mainly concern endoscopic procedures, orthopedics, peripheral vascular, and pulmonary and airways fields.