Remedy Guidelines
| Basic data | |
|---|---|
| Title: | Guideline of the Federal Joint Committee on the prescription of therapeutic products in statutory health care |
| Short title: | Remedies Directive |
| Abbreviation: | HeilM-RL |
| Type: | Guideline of the G-BA |
| Scope: | Federal Republic of Germany |
| Issued on the basis of: | Section 92 (1) sentence 2 no. 6 SGB V |
| Legal matter: | Social law , statutory health insurance |
| Original version from: | February 26, 2002, BAnz . No. 121 (p. 14 873) of July 4, 2002 |
| Entry into force on: | August 1, 2002 |
| Last revision from: | September 21, 2017, BAnz AT November 23 , 2017 B1 |
| Effective date of the last change: |
01/01/2018 |
| Please note the note on the applicable legal version. | |
In Germany, the prescription of therapeutic products within the framework of contract medical care is regulated by a therapeutic product directive. In Austria, the relevant regulations are contained in the Reimbursement Code (EKO) issued by the Main Association of Austrian Social Insurance Institutions .
Medicines are part of the benefits in kind provided by the German statutory health insurance as part of health treatment ( Section 32 SGB V). They are to be differentiated from the medicaments and bandages ( § 31 SGB V) as well as the aids ( § 33 SGB V).
The first remedy directive was from the then Federal committees of doctors or dentists and health insurers, today the Federal Joint Committee (G-BA) on the legal basis of § 92 para. 1 sentence 2 no. 6 SGB V adopted. According to the established case law of the Federal Social Court , the directive, like all directives of the G-BA, has a normative character as a subordinate legal norm, i.e. In other words, it describes the individual types and the scope of the remedies to be prescribed by the contract doctors with binding effect on the contract doctors, the insured and the health insurance companies.
The legal character of the directives raises questions about their constitutionality. The Federal Constitutional Court expressly left the compatibility with the Basic Law open in a decision of December 6, 2005.
The Therapeutic Products Directive regulates the supply of the insured with medicinal products by the medicinal product providers, such as physiotherapists , occupational therapists , speech therapists and podiatrists . Above all, however, it regulates which types of remedies may be prescribed, to what extent and for which indications.
A revised version of a new guideline came into force on July 1, 2004. Since then, diagnosis groups have been named instead of individual diagnoses . The prescription now takes place after a diagnosis has been assigned to a diagnosis group and the remedy is selected after the key symptoms and therapy goal have been determined. In the remedies catalog, each key symptom (related to the diagnosis group) is assigned the remedies that can be prescribed and the maximum amount of prescription (total amount of prescription as a rule).
The current guideline has been in effect since January 1, 2018 in the version amended by the resolution of September 21, 2017.
Individual evidence
- ↑ Federal Social Court, judgment of March 20, 1996, 6 RKa 62/94; November 29, 2006, B 6 KA 7/06 R, margin number 15
- ↑ BVerfG, decision of the First Senate of December 6, 2005 - 1 BvR 347/98 - BVerfGE 115, 25 .
- ^ Online catalog of medicines
- ↑ Information archive of the Federal Joint Committee: [1] (PDF; 202 kB)
Web links
- Information archive of the Federal Joint Committee: Guideline on the prescription of therapeutic products in statutory health care (framework guideline) (PDF; 219 kB)
