Cooperation agreement
According to Section 119b (1) SGB V, contract dentists have been able to conclude cooperation agreements with inpatient care facilities individually or jointly since April 1, 2014 . The basis is a framework agreement on the cooperative and coordinated dental and nursing care of those in need of inpatient care between the National Association of Statutory Health Insurance Dentists and the National Association of Health Insurance Funds .
Goal setting
The agreement is intended to ensure dental care in inpatient care facilities that takes into account the special needs of insured persons in need of care. In particular, this requires regular care for those in need of care and close cooperation between the parties to the cooperation agreement. Regular care and all dental and nursing measures provided or recommended in the agreement are only carried out if the resident or his legal representative agrees. The right to a free choice of doctor remains unaffected.
For those in need of care, good dental and oral health improves the overall quality of life and helps prevent life-threatening diseases. It makes eating and speaking easier and thus also promotes social participation.
The Association of Statutory Health Insurance Dentists establishes that the contract dentist is entitled to bill the services in accordance with Section 87 (2) of the Social Code Book V on the basis of the cooperation agreement he has concluded with the care facility .
Quality and supply goals
The quality and supply goals are in particular:
- Maintaining and improving oral health including oral and prosthetic hygiene standards and thus improving oral health-related quality of life (including freedom from pain, eating, speaking, social participation )
- Avoid early detection and treatment of diseases of the tooth, mouth and jaw area
- Regular check- ups and bonus examinations
- Timely treatment that takes into account the living conditions of the person in need of care or working towards such treatment
- Reduction of the complaint-oriented use, avoidance of patient transports and hospital stays for medical reasons
- Strengthening the cooperation and improvement of the exchange of information between the professional groups involved in the care and medical and dental care of the residents, the residents / legal representatives and their relatives.
Duties of the collaborating dentist
In the event that a person in need of care is admitted to the care facility, the first examination should take place within eight weeks. An in- depth examination to determine tooth, mouth and jaw diseases should take place up to twice a year , during which the need for dental treatment, the condition of the teeth , oral mucosa and prostheses will be assessed, followed by suggestions for measures to maintain and improve them oral health. The detailed examination also serves to confirm the dental examination with regard to the increase in the fixed subsidy for dentures according to Section 55 (1) SGB V (bonus booklet).
Up to twice a year, the nursing staff should be instructed (possibly practical) in carrying out the tasks incumbent on them by means of insured-related suggestions for measures to maintain and improve oral health, as well as information on special features of dental care and the care and handling of dentures. This also includes organizational information and consultations , which should be based on needs, for example on the clinical picture of xerostomia or a referral for further clarification or treatment. In the care facility itself, only those measures are carried out that can be professionally performed according to the specific circumstances and the rules of dental art .
Eligible
Eligible are those in need of care in inpatient care facilities who have signed the cooperation contract between the care facility and the cooperating dentist and who belong to one of the following care levels:
- Care level 0 - people with dementia, mentally, mentally and physically disabled people with significantly reduced everyday skills can claim care allowance and certain benefits to cover a need for general supervision and care, even if the time required for care level I has not yet been met
- Care level I - considerable need for care, ie average need for help at least 90 minutes per day. The basic care must take more than 45 minutes a day
- Care level II - severe need for care, ie average need for help at least 180 minutes per day with a need for basic care of more than 120 minutes a day
- Care level III - most severe need for care, ie average need for help at least 300 minutes per day. The part of the basic care must be more than 240 minutes a day and there must also be regular basic care at night (between 10 p.m. and 6 a.m.).
| Full inpatient in homes | Care level 0 | Care level I | Care level II | Care level III |
|
|---|---|---|---|---|---|
| 2011 | - | 283.266 | 299,404 | 151,952 | 734.622 |
| 2013 | 11,583 | 291.193 | 302.636 | 157.164 | 762.576 |
Care facilities
People in need of care who are accommodated in a care facility in accordance with Section 71 (2) SGB XI can join the cooperation agreement . These are self-employed institutions in which people in need of care:
- are cared for under the constant responsibility of a trained nurse ,
- can be accommodated and fed all day (full inpatient) or during the day or night (partial inpatient).
There are 12,354 nursing homes in Germany, including 10,706 with full inpatient long-term care (as of 2011). Of the 2.5 million people in need of care, 743,000 receive full inpatient care. Based on the 12th coordinated population projection by the federal and state statistical offices , the number of people in need of care in Germany could rise to around 3.4 million people by 2030.
criticism
The National Association of Statutory Health Insurance Dentists and the German Dental Association criticize the fact that the measures proposed in the law do not have an effect on all those in need of care, but only on those who live in inpatient facilities. On the other hand, the care entitlement of those in need of care remains limited to the statutory catalog of benefits (BEMA); the Nursing Reorientation Act does not include entry into dental prevention management with additional preventive services . Preventive services that respond to the special needs of people in need of care and people with disabilities are urgently needed.
See also
Web links
- Care Reorientation Act Brochure from the Federal Ministry of Health
Individual evidence
- ↑ a b c Agreement according to Section 119b (2) SGB V on requirements for cooperative and coordinated dental and nursing care for insured persons in need of care in inpatient care facilities (framework agreement for cooperative and coordinated dental and nursing care for inpatient care recipients). (PDF, 44 kB) In: aok-gesundheitpartner.de. Retrieved June 2, 2014 .
- ↑ a b Care statistics 2011. (PDF, 1.4 MB) Care as part of the German long-term care insurance results. In: Destatis. Federal Statistical Office, p. 9, Table 1.1 , accessed on June 2, 2014 .
- ^ Nursing statistics 2013 , Destatis, page 9, table 1.1. Retrieved November 26, 2015.
- ↑ Care facilities. In: Destatis. Federal Statistical Office, accessed on June 2, 2014 .
- ↑ Forecast of the number of people in need of care in Germany by 2030. In: Statista. Retrieved June 2, 2014 .
- ↑ Germany's population by 2060 (PDF, 987 kB) 12th Coordinated Population Forecast. In: Destatis. Federal Statistical Office, accessed on June 2, 2014 .
- ↑ Care for people in need of care and people with disabilities. In: kzbv.de. National Association of Statutory Health Insurance Dentists, accessed on June 2, 2014 .
