State Arbitration Office

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State arbitration courts are under the care of persons insured in the German statutory health insurance with medical and dental services dental services at the country level in each of the Statutory Health Insurance Physicians (KV) and the dentists' association (KZV) and the regional health insurance funds and the national associations of health insurance as well as the dental technician -Guild and the health insurance companies. There are therefore three regional arbitration offices in each federal state:

  • The State Arbitration Office for statutory medical care
  • The state arbitration office for contract dental care
  • The regional arbitration office for dental technology supplies

Purpose of arbitration

Pursuant to Section 83 SGB ​​V, the associations of statutory health insurance physicians and statutory health insurance providers conclude general contracts with the state associations of the health insurance funds and the substitute health insurance funds responsible for their district on the provision of contractual medical or contractual dental care for members residing in their district, including, in particular with regard to the total remuneration for all services provided . The arbitration system serves the purpose of bindingly stipulating the content of the contract if no agreement has been reached on the total income. This also applies if a contracting party terminates a contract.

The guild associations of dental technicians, the state associations of the health insurance companies and the substitute funds also form a state arbitration office. (§ 89 para. 8 SGB V) This constitutes for the respective KZV area dental laboratories maximum prices of the nationwide service specifications tight (BEL II).

If no new contract is concluded by the end of a contract, the arbitration office must determine its content within three months. This requires a majority decision. The provisions of the previous contract continue to apply for the time being until the arbitration office has decided. If the Arbitration Board does not reach an arbitration award by the end of the period, the supervisory authority can set a three-month period within which the Arbitration Board must determine the content of the contract. If that also fails, the supervisory authority sets the content of the contract bindingly instead of the arbitration office.

Jurisdiction

The state arbitration office is responsible for contracts at state level. Federal arbitration offices have been set up for contracts at federal level .

composition

The regional arbitration offices are composed in equal parts of representatives from the regional associations of the statutory health insurance funds and the KV or the KZV as well as an impartial chairman and two other impartial members. The associations of statutory health insurance physicians, the regional associations of the health insurance funds and the substitute funds should agree on the chairman and the two other impartial members as well as their deputies. In this case, the term of office is four years. If there is no agreement, the lot decides. In this case, the term of office is one year. The members of the arbitration office carry out their office as an honorary office. You are not bound by instructions. When deciding on a contract that does not affect all types of funds, only representatives of the types of funds concerned participate in the arbitration office. (§ 89 Abs. 2, SGB V)

The regional arbitration office issues rules of procedure, according to which each party can call in experts.

Legal supervision

The legal supervision of the state arbitration offices is carried out by the respective supervisory ministry, usually the health ministry of the respective federal state. The decisions of the arbitration boards on the overall contracts must be submitted to the supervisory authority. The supervisory authority can object to the decisions in the event of a legal violation within two months of submission.

legal action

The parties involved can file a complaint with the social court against the decision of the regional arbitration office, also against a possible objection to the decision by the supervisory authority. An action against the determination of the arbitration office has no suspensive effect. ( § 89 SGB ​​V)