Collective wages for home nursing care must be calculable

Collective wages for home nursing care must be calculable

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BSG: Nursing services have to pay the tariff and explain their costs
Kassel (jur). Outpatient care services must also be able to factor in the wages paid in home nursing. If the wages are actually paid, health insurance companies cannot refuse higher remuneration rates with the argument that an increase in wages is uneconomical and the stability of contributions is jeopardized, the Federal Social Court (BSG) in Kassel on June 23, 2016 (ref .: B 3 KR 26 / 15 R and B 3 KR 25/15 R).

So that nursing associations can agree on a higher remuneration due to wage increases, they must first disclose the operating and cost structure of "a representative number of institutions". It had to be checked whether underfunding of nursing services would endanger medical care.

In contrast to long-term outpatient care, where long-term care insurance pays for the costs, the health insurers are responsible for temporary home care. According to the law, health insurance funds and nursing associations have to agree on the remuneration rates for the care provided, such as changing the association or giving insulin injections. If they cannot agree, an arbitrator must make an arbitration award and thus settle the dispute.

Basically, according to the law, the health insurance companies must maintain "premium stability". The care allowance must therefore not be too high, "unless the necessary medical care cannot be guaranteed even after the economic reserves have been exhausted".

According to the German Evangelical Association for Elderly Work and Care (DEVAP) and the Association for Catholic Elderly Care in Germany (VKAD), however, home nursing has been underfunded for years. Despite tariff increases for nursing staff, the remuneration for home nursing was not sufficiently adjusted. The health insurance companies justify this by referring to the contribution stability to be maintained. The wage increases are also not "economical".

In the two cases negotiated by the BSG, two arbitration awards were in dispute, which determined the care allowance in Hessen for commercial outpatient care services in 2010 and in the area of ​​free welfare care in 2009. The compensation rates were considered too low by the nursing associations in one case and too high by the health insurance companies, so that the BSG should now check them. Since then, all subsequent awards have been suspended.

The 3rd BSG Senate overturned both awards and decided that health insurance funds and nursing associations would have to renegotiate the remuneration rates and, if necessary, obtain a new award. The BSG complained that there was no concrete evidence to justify the setting of the remuneration rates in the arbitral awards.

However, the Kassel judges gave the health insurance companies and the representatives of the nursing sector some legal foundations along the way.

If the providers of outpatient care services also want to receive higher reimbursements from the health insurance companies because of wage increases, they have to provide concrete evidence that the wages actually benefit the employees. A general reference to higher wages is not enough.

"Rather, an operating and cost structure of a representative number of facilities must be set out and available that justifies such an increase," says the BSG. Here, the nursing service providers would have to provide the relevant information, otherwise no higher remuneration could be requested from the health insurance companies. Ultimately, the nursing services would have to prove that they have no economic reserves and that medical care for the insured is at risk.

Conversely, the health insurance companies should not refuse higher remuneration rates simply by referring to the stability of premiums and the need for economy, the BSG judged. Collective wage increases are not "uneconomical" so that they can justify higher remuneration rates. fle / mwo

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