State Committee of Doctors and Health Insurance Companies
The physicians 'associations or the dentists' associations in each case form with the national associations of the health insurance and the substitute funds for the range of each state a National Committee of the Diagnosis and Treatment , and a National Committee of dentists and health insurance . The legal basis is § 90 SGB V.
The replacement funds can transfer this task to a working group formed by the replacement funds in the district of the Association of Statutory Health Insurance Physicians, for example a regional association of replacement funds or an individual replacement fund.
occupation
The state committees consist of an impartial chairman, two other impartial members, nine representatives of the doctors , three representatives of the local health insurance funds , three representatives of the substitute health insurance funds, one representative each of the company health insurance funds and the guild health insurance funds as well as a joint representative of the agricultural health insurance fund and Knappschaft-Bahn-See . The (dental) medical associations and the regional associations as well as the substitute funds should agree on the chairman and the two other impartial members as well as their deputies. If an agreement cannot be reached, they are appointed by the highest administrative authority in the state responsible for social insurance, usually the state health ministry in consultation with the (dental) medical associations, the state associations of health insurance companies and the substitute funds.
If a regional association of a certain type of insurance company does not exist in the area of a regional committee and this reduces the number of representatives of the health insurance companies, the number of doctors is reduced accordingly. The representatives of the doctors and their deputies are appointed by the associations of statutory health insurance physicians, the representatives of the health insurance funds and their deputies are appointed by the regional associations of the health insurance funds and the substitute funds.
The members of the state committees carry out their office as honorary posts. You are not bound by instructions. The participating health insurance associations on the one hand and the associations of the health insurance funds and the substitute funds on the other hand each bear half the costs of the state committees.
tasks
The tasks of the state committee are
- Advice on the requirements plan in accordance with requirements planning in accordance with Section 99 of the Social Code Book V.
- Determination of an over- or undersupply according to § 103 SGB V and resulting from the latter
- Resolution of admission restrictions for doctors.
The § 103 SGB V, which governs the arrangement of licensing restrictions, effective from 1 April 2007 enactment of the competition law to strengthen in SHI (SHI Competition Enhancement Act) is no longer for dentists so expressly in paragraph 8 of § 103 SGB V Accordingly, the dentists have been removed from the requirements planning regulations for the excess and undersupply of SGB V. However, the requirements planning as such is still calculated and determined by the state committee.
Legal supervision
The supreme administrative authorities of the federal states responsible for social security are responsible for the supervision of the state committees according to § 87 SGB IV. Sections 88 and 89 of Book Four of the Social Security Code apply accordingly. The supervisory authority can object to the decisions in the event of a legal violation within two months of submission.
