Federal Care Rate Ordinance

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Basic data
Title: Ordinance regulating hospital care rates
Short title: Federal Care Rate Ordinance
Abbreviation: BPflV
Type: Federal Ordinance
Scope: Federal Republic of Germany
Issued on the basis of: §§ 16, 17 KHG
Legal matter: Special administrative law , social law
References : 2126-9-13-2
Issued on: September 26, 1994
( BGBl. I p. 2750 )
Entry into force on: January 1, 1995
Last change by: Art. 3 VO of July 13, 2020
( Federal Law Gazette I p. 1692, 1693 )
Effective date of the
last change: 		May 26, 2020
(Art. 5 of July 13, 2020)
Please note the note on the applicable legal version.

The Federal Care Rate Ordinance (BPflV) is a legal ordinance that regulates the remuneration for inpatient and semi-inpatient care services in hospitals in Germany. The Federal Care Rate Ordinance was introduced with the reorganization of the care rate law in 1994 ( Federal Law Gazette 1994 I p. 2750). To distinguish it from the first Federal Care Rate Ordinance of April 25, 1973 ( BGBl. 1973 I p. 333), which came into force on January 1, 1974, this newer ordinance is also referred to as the 1995 Federal Care Rate Ordinance .

history

With the new Federal Care Rate Ordinance 1995, new forms of remuneration were introduced, in which the care rates were no longer based on the cost recovery principle applicable until December 31, 1992. Rather, case flat rates for certain treatment cases , special fees for certain operations and an individual budget for the hospital were introduced. The budget had to be settled using departmental and basic care rates. With the Stabilization Act of April 29, 1996 and other laws, the budget cap was continued.

Until the mandatory introduction of the Diagnosis Related Groups (DRG) by the case flat rate law of April 22, 2002 and the case flat rate ordinance, the Federal Care Rate Ordinance (BPflV) regulated the details of the costs eligible for care allowance for the remuneration of hospitals. With the nationwide introduction of the diagnosis-related case groups (DRG) from 2004, the BPflV only applies in a few hospitals that are not yet included in the DRG system. These include psychiatric and psychosomatic hospitals that receive remuneration for full and part-time inpatient services through the same daily care rates.

scope of application

According to the BPflV, the full inpatient and partial inpatient services of the hospitals are reimbursed, which are not included in the reimbursement system of the diagnosis-related case groups (DRG) according to § 17b para. 1 sentence 1 second half sentence of the Hospital Financing Act (KHG). Police hospitals and prison hospitals as well as those sponsored by statutory accident insurance are excluded from the Federal Care Act . University clinics, hospitals that are managed outside of Section 67 AO , and supply hospitals (cf. these and others in Section 5 KHG ) are also subject to this.

Hospital services

Section 2 BPflV describes the hospital services concerned as follows:

(1) Hospital services according to Section 1, Paragraph 1 are, in particular, medical treatment, nursing care, supply of medicines, therapeutic aids and aids that are necessary for hospital care, as well as accommodation and meals; they include general hospital services and optional services. The hospital services do not include the services of the attending physicians (Section 18 of the Hospital Remuneration Act) or the midwives and maternity care staff.
(2) General hospital services are those hospital services that are necessary for the medically appropriate and adequate care of the patient, taking into account the efficiency of the hospital in individual cases, depending on the type and severity of the illness. Under these conditions this also includes
  • 1. the measures carried out during the hospital stay for the early detection of diseases within the meaning of the fifth book of the Social Security Code ,
  • 2. the services of third parties arranged by the hospital,
  • 3. the inclusion of a person accompanying the patient, which is necessary for medical reasons,
Dialysis is not a hospital service .

Payment for hospital services

The remuneration system according to Section 17d of the Hospital Financing Act (KHG) will be introduced for the hospitals for the years 2013 to 2016 with no budget impact. From January 1, 2015, the application of the remuneration system is mandatory for all hospitals.

Structure of the Federal Care Rate Ordinance

First section: General regulations

  • § 1 Scope
  • § 2 hospital services

Section two: payment for hospital services

  • § 3 Agreement on a total amount for the years 2013 to 2016
  • § 4 Agreement on a revenue budget for the years 2017 to 2021
  • § 5 Agreement of surcharges and discounts
  • § 6 Agreement on other fees

Third section: Types of charges and billing

  • § 7 Fees for general hospital services
  • § 8 Calculation of the fees

Fourth section: Agreement procedure

  • Section 9 Agreement at the federal level
  • § 10 Agreement at state level
  • § 11 Agreement for the individual hospital
  • § 12 Preliminary Agreement
  • § 13 Arbitration Board
  • § 14 approval
  • § 15 Duration

Fifth section: other regulations

  • § 16 Separately calculable medical and other services
  • § 17 Responsibility of the health insurance companies at state level
  • § 18 Transitional Provisions
  • Annex: List of fees and budget determination (AEB-Psych)
  • Appendix 1 to the list of services and calculations: Bed-managing departments
  • Appendix 2 to the list of services and calculations: footnotes
  • Appendix 3 to the list of services and calculations: Separate ID card for foreign patients according to Section 3, Paragraph 4

Former structure of the Federal Care Rate Ordinance

Structure of the Federal Care Rate Ordinance in 2006:

  • First section: General regulations (§§ 1, 2)
  • Second section: Basics of remuneration assessment (§§ 3–9)
  • Third section: Types of charges and billing (§§ 10-14)
  • Fourth section: care rate procedure (§§ 15-21)
  • Fifth section: Other regulations (§§ 22–26)
  • Annexes 1 and 2

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