Homecare company
In Germany, homecare companies are sales organizations which, according to medical prescriptions, provide medical devices such as auxiliary materials and bandages, accessories for artificial nutrition or respiratory therapy in the home; according to the principle outpatient before stationary and the legal requirements according to § 31 and § 33 SGB V . Companies that are approved as contractual partners by the statutory health insurance are considered to be service providers within the meaning of the Social Security Code and bill the respective health insurance company directly.
The supply by such companies takes place according to the legal requirements of § 126 SGB V with trained specialists who have certain training qualifications and medical knowledge. It consists of product-specific services and is therefore not to be confused with the activities performed by outpatient care services . The product supply and the associated services such as advice and instructions form a combination product that cannot be unbundled. Accompanying costs incurred in individual cases such as additional payments, co-payments and products that are not reimbursed by the health insurance company must be paid for on your own account.
Homecare companies are not providers of home health care according to § 37 SGB V and not providers of long-term care insurance within the meaning of SGB XI .
financing
Homecare companies finance themselves through product sales. Various providers have concluded selective contracts with health insurers and supply the insured with certain products. For this, the company receives the contractually regulated remuneration from the respective fund. If products are purchased from a provider who is not a contractual partner of the cash register, it is not obliged to assume the costs.
legal framework
The insured person's entitlement to the provision of aids, bandages and enteral nutrition to his health insurance company is regulated in § 31 and § 33 SGB V. These laws include not only the entitlement to the actual products under certain conditions, but also to the necessary repair and replacement, training in the use of the products, maintenance and technical controls. Section 139 SGB V also defines requirements for the quality of supply and products. Since the GKV Competition Enhancement Act (GKV-WSG, 2007) came into force , the company as a service provider has had to be entitled to care under Section 127 SGB V (contract) with the respective health insurance company.
The premise for the enumerated supply measures of the insured person is that the service provider fulfills and proves the requirements for a sufficient, appropriate and functional production, delivery and adjustment of the aids according to § 126 SGB V. According to the GKV-OrgWG (Law for the Further Development of Organizational Structures, 2009), this can be done through the prequalification of the service provider, i.e. the certified proof of qualification according to technical and personal suitability criteria for competent, efficient and reliable care. This proof of suitability takes place within the framework of a prequalification procedure by so-called prequalification bodies. By following the above criteria, the service provider - as a contractual partner of the health fund - fulfills the requirements for the care of the insured. The insured person, in turn, can freely choose between the contractual partners of his health insurance company.
Typical homecare coverage areas
Homecare companies supply the necessary tools and materials in particular for the following areas:
- Enteral and parenteral nutrition ( artificial nutrition )
- Infusion therapies
- Ostomy and incontinence care
- Wound treatment
- Pressure ulcer prophylaxis
- Tracheostomy and laryngectomy care
- Long-term oxygen therapy
- Home ventilation
- Compression therapy
- Rehabilitation aids that, among other things, support the patient's mobility
Activities of homecare companies
Employees of homecare companies work together with doctors, relatives, outpatient care services or inpatient care facilities. They accompany patients in connection with a medically prescribed therapy after discharge from the hospital at home and advise on the selection and use of the individually suitable products. If certain medical devices are used for which instruction is required by law, this must be carried out by a suitably qualified employee.
Certain therapy procedures that were started in the hospital must be continued in the home. To ensure this, the hospital engages an appropriate homecare company before discharge. Company employees contact the general practitioner, organize the necessary aids and materials and deliver them to the patient's home or to their care facility. Therapy measures are coordinated in consultation with the doctor, patient, relatives and nursing staff. The patient is instructed in the handling of the products used and thus in self-help. This enables him to cope with everyday life again as soon as possible with his changed situation. If he is not able to do this himself, the relatives or caregivers are trained. With regular care, homecare companies support the prevention of further illnesses in the chronically ill and reduce medical and hospital treatments. Homecare service providers are on call for product-related emergencies.
literature
- Christine von Reibnitz (Ed.): Homecare. Hans Huber Verlag, 2nd edition, Heidelberg 2009, ISBN 978-3-456-84639-2 .
Web links
Individual evidence
- ^ Christine von Reibnitz (Ed.): Homecare, Hans Huber Verlag, 2nd edition, Heidelberg 2009.
- ↑ National Association of Statutory Health Insurance Funds, prequalification
