Announcements
The statutory health insurance physician , K. d. ö. R., Berlin - on the one hand - and the GKV-Spitzenverband (National Federation), K. d. ö. R., Berlin - on the other hand - agree the following
from April 1, 1995
1. The following changes have been made to the agreement on forms for statutory health care:
1.1. Number 2.56 is changed as follows:
2.56 Sample 56: Application for reimbursement of rehabilitation sports / functional training (as of: 7.2011)
The table of contents changes accordingly .
2. The following changes will be made to the explanations of the forms:
2.1. Sample 56: Application for reimbursement of costs for rehabilitation sports / functional training
The text is replaced by the following:
1st form
Rehabilitation sport and functional training cannot be prescribed at the same time on one form. The form is usually available from health insurance companies, sports clubs / self-help groups or the contracted doctor. At the request of the insured, the contract doctor should comment on the need for rehabilitation sport or functional training.
2. Approval
Before starting rehabilitation sport or functional training obtain the approval of the health insurance company by the insured person. The health insurance company sends the approved application back to the insured person.
3. Notes for the contracted doctor and patients
3.1. Rehabilitation sport
Rehabilitation sport is used to cope with illness, to strengthen personal responsibility and to facilitate social integration. This supplementary service to rehabilitation thus supplements the medical treatment at the place of residence in meaningful way. However, it does not replace the supply of therapeutic products that may be required, e.g. B. Movement exercises, physiotherapy. The health insurance companies finance rehabilitation sport in recognized, qualified groups and clubs with which, as rule, there are corresponding contractual agreements on the implementation and financing of rehabilitation sport. The exercise groups are under the expert guidance of exercise leaders. The rehabilitation sport should u. a. serve to provide the patient with help for self-help with the aim of strengthening the responsibility of the disabled person or person at risk of disability for his or her health, as well as motivating and enabling him to carry out movement training independently and responsibly in the long term >
3. Announcements The statutory health insurance physician , K. d. ö. R., Berlin - on the one hand - and the GKV-Spitzenverband (National Federation), K. d. ö. R., Berlin - on the other hand - agree the following from April 1, 1995 1. The following changes have been made to the agreement on forms for statutory health care: 1.1. Number 2.56 is changed as follows: 2.56 Sample 56: Application for reimbursement of rehabilitation sports / functional training (as of: 7.2011) The table of contents changes accordingly . 2. The following changes will be made to the explanations of the forms: 2.1. Sample 56: Application for reimbursement of costs for rehabilitation sports / functional training The text is replaced by the following: 1st form Rehabilitation sport and functional training cannot be prescribed at the same time on one form. The form is usually available from health insurance companies, sports clubs / self-help groups or the contracted doctor. At the request of the insured, the contract doctor should comment on the need for rehabilitation sport or functional training. 2. Approval Before starting rehabilitation sport or functional training obtain the approval of the health insurance company by the insured person. The health insurance company sends the approved application back to the insured person. 3. Notes for the contracted doctor and patients 3.1. Rehabilitation sport Rehabilitation sport is used to cope with illness, to strengthen personal responsibility and to facilitate social integration. This supplementary service to rehabilitation thus supplements the medical treatment at the place of residence in meaningful way. However, it does not replace the supply of therapeutic products that may be required, e.g. B. Movement exercises, physiotherapy. The health insurance companies finance rehabilitation sport in recognized, qualified groups and clubs with which, as rule, there are corresponding contractual agreements on the implementation and financing of rehabilitation sport. The exercise groups are under the expert guidance of exercise leaders. The rehabilitation sport should u. a. serve to provide the patient with help for self-help with the aim of strengthening the responsibility of the disabled person or person at risk of disability for his or her health, as well as motivating and enabling him to carry out movement training independently and responsibly in the long term > 3.2 Functional training Functional training serves to cope with illness, to strengthen personal responsibility and to facilitate social integration. In particular, functional training can be indicated in the case of illnesses or functional restrictions of the supporting and locomotive organs. This supplementary service to rehabilitation thus supplements the medical treatment at the place of residence in meaningful way. However, it does not replace the supply of therapeutic products that may be required, e.g. B. Movement exercises, physiotherapy. The health insurance companies finance functional training in recognized, qualified groups, with whom there are usually contractual agreements on the implementation and financing of functional training. The exercise groups are under the expert guidance of physiotherapists / physiotherapists and / or occupational therapists with special experience and special training in the field of rheumatic diseases / osteoporosis including water aerobics and respiratory gymnastics and with knowledge and experience in psychological and educational leadership. They must be able to assess the performance and the exercises to be coordinated for the individual patient. The functional training should u. a. serve to provide the patient with help for self-help with the aim of strengthening the responsibility of the disabled person or person at risk of disability for his or her health, as well as motivating him and enabling him to undertake long-term independent and responsible movement training i. S. to carry out an appropriate exercise program. The following statements are largely based on the framework agreement on rehabilitation sport and functional training of January 1, 20112 concluded at the level of the Federal Working Group for Rehabilitation. a. for the implementation of the rehabilitation sport or functional training. 4. Aim, purpose and content of the rehabilitation sport or the functional training Rehabilitation sport Rehabilitation sport is an option for people with disabilities and those at risk of disability3 in order to integrate them into society and working life as long as possible. Rehabilitation sport has holistic effect on disabled people and those at risk of disability who have the necessary mobility as well as physical and psychological resilience for exercises in the group using the means of sport and sports-oriented games.2 Functional training
Functional training serves to cope with illness, to strengthen personal responsibility and to facilitate social integration. In particular, functional training can be indicated in the case of illnesses or functional restrictions of the supporting and locomotive organs. This supplementary service to rehabilitation thus supplements the medical treatment at the place of residence in meaningful way. However, it does not replace the supply of therapeutic products that may be required, e.g. B. Movement exercises, physiotherapy.
The health insurance companies finance functional training in recognized, qualified groups, with whom there are usually contractual agreements on the implementation and financing of functional training. The exercise groups are under the expert guidance of physiotherapists / physiotherapists and / or occupational therapists with special experience and special training in the field of rheumatic diseases / osteoporosis including water aerobics and respiratory gymnastics and with knowledge and experience in psychological and educational leadership. They must be able to assess the performance and the exercises to be coordinated for the individual patient. The functional training should u. a. serve to provide the patient with help for self-help with the aim of strengthening the responsibility of the disabled person or person at risk of disability for his or her health, as well as motivating him and enabling him to undertake long-term independent and responsible movement training i. S. to carry out an appropriate exercise program.
The following statements are largely based on the framework agreement on rehabilitation sport and functional training of January 1, 20112 concluded at the level of the Federal Working Group for Rehabilitation. a. for the implementation of the rehabilitation sport or functional training.
4. Aim, purpose and content of the rehabilitation sport or the functional training
Rehabilitation sport
Rehabilitation sport is an option for people with disabilities and those at risk of disability3 in order to integrate them into society and working life as long as possible. Rehabilitation sport has holistic effect on disabled people and those at risk of disability who have the necessary mobility as well as physical and psychological resilience for exercises in the group using the means of sport and sports-oriented games.The aim of rehabilitation sport is to strengthen stamina and strength, improve coordination and flexibility, strengthen the self-confidence, especially of disabled women and girls or those at risk of disability, and offer help for self-help. The aim of helping people to help themselves is to activate self-help potential, to strengthen the responsibility of the disabled or at risk of disability for their health, as well as to motivate and enable them to carry out exercise training independently and responsibly in the long term.
Rehabilitation sport includes exercises that are carried out in the group as part of regularly held exercise events. Joint practice in fixed groups is prerequisite for promoting group dynamic effects, supporting the exchange of experiences between those affected and thus strengthening the self-help character of the performance. Measures that serve to behave appropriately for the illness / disability and to cope with psychosocial consequences of illness (e.g. relaxation exercises), as well as practicing the use of technical aids, can also be part of rehabilitation sport. The individual measures must be tailored to the needs of the participants.
Rehabilitation sport can also include special exercises for disabled women and girls who are at risk of disability, whose self-confidence is restricted as result of the disability or impending disability and for whom self-confidence can be strengthened as part of rehabilitation sport.
The health insurance companies finance rehabilitation sport as long as the disabled or at risk of disability depends on the professional performance of the instructor (s) during the exercise event in order to achieve the above. Achieve goals.
The health insurance companies have in the above. Framework agreement on the following reference values for the duration of performance, which can also be deviated from on the basis of individual testing according to the requirements of the individual case:
1. 50 training units in period of 18 months (Guide values)
2.The aim of rehabilitation sport is to strengthen stamina and strength, improve coordination and flexibility, strengthen the self-confidence, especially of disabled women and girls or those at risk of disability, and offer help for self-help. The aim of helping people to help themselves is to activate self-help potential, to strengthen the responsibility of the disabled or at risk of disability for their health, as well as to motivate and enable them to carry out exercise training independently and responsibly in the long term.
Rehabilitation sport includes exercises that are carried out in the group as part of regularly held exercise events. Joint practice in fixed groups is prerequisite for promoting group dynamic effects, supporting the exchange of experiences between those affected and thus strengthening the self-help character of the performance. Measures that serve to behave appropriately for the illness / disability and to cope with psychosocial consequences of illness (e.g. relaxation exercises), as well as practicing the use of technical aids, can also be part of rehabilitation sport. The individual measures must be tailored to the needs of the participants.
Rehabilitation sport can also include special exercises for disabled women and girls who are at risk of disability, whose self-confidence is restricted as result of the disability or impending disability and for whom self-confidence can be strengthened as part of rehabilitation sport.
The health insurance companies finance rehabilitation sport as long as the disabled or at risk of disability depends on the professional performance of the instructor (s) during the exercise event in order to achieve the above. Achieve goals.
The health insurance companies have in the above. Framework agreement on the following reference values for the duration of performance, which can also be deviated from on the basis of individual testing according to the requirements of the individual case:
1. 50 training units in period of 18 months (Guide values)
2.120 exercise units within period of 36 months (guideline values) in the case of:
● bronchial asthma
● blindness, acquired in the last 12 months before application
● chronic obstructive pulmonary disease (COPD)
● renal failure requiring dialysis (terminal kidney failure)
● double amputation of limbs (arm / arm, leg / leg, arm / leg)
● Epilepsy, therapy-resistant
● Glass bones (osteogenesis imperfecta)
● Infantile cerebral palsy
● Marfan's syndrome
● Bechterew's disease (spondylitis ankylosans)
● Parkinson's disease
● Cystic fibrosis (cystic fibrosis)
● Multiple sclerosis
● Muscular dystrophy
● Organic brain damage caused by:
- infection (consequences of inflammatory diseases of the CNS)
- traumatic brain injury
- tumors
- vascular insult (consequences of cerebrovascular disease)
● polyneuropathy
● transverse Cutting paralysis
● severe paralysis (paraparesis, paraplegia, tetraparesis, tetraplegia)
3. For exercises to strengthen the self-confidence of disabled women and girls at risk of disability, the health insurance funds finance 28 exercise units (guide value ).
4. In the case of chronic heart disease, the health insurances finance
- 90 exercise units within period of 24 months (guide values), for children and adolescents with heart disease
- 120 exercise units within 24 months (reference values).
Further regulations for rehabilitation sports in cardiac groups are possible with maximum load limit of <1.4 watts / kg body weight (evidence not older than 6 months) as result of heart disease or cardiac Ischemia criteria.
The scope of work is 45 exercise units within 12 months (guidelines). In the case of other indications, it must be checked in each individual case whether the services are necessary, suitable and economical.
After repeated acute treatment, rehabilitation sport in cardiac groups can be considered again.
A longer duration of performance is possible in rehabilitation sport (apart from Section 4) after individual assessment, if the services are necessary, suitable and are economical. This is particularly the case if, with cognitive or psychological impairments, the long-term implementation of the exercise program on one's own responsibility is not or not yet possible. This also applies to rehabilitation sports in cardiac groups.
Rehabilitation sports primarily include gymnastics (including water aerobics), athletics, swimming and movement games, as well as bowling for blind people and archery for people in wheelchairs.120 exercise units within period of 36 months (guideline values) in the case of:
● bronchial asthma
● blindness, acquired in the last 12 months before application
● chronic obstructive pulmonary disease (COPD)
● renal failure requiring dialysis (terminal kidney failure)
● double amputation of limbs (arm / arm, leg / leg, arm / leg)
● Epilepsy, therapy-resistant
● Glass bones (osteogenesis imperfecta)
● Infantile cerebral palsy
● Marfan's syndrome
● Bechterew's disease (spondylitis ankylosans)
● Parkinson's disease
● Cystic fibrosis (cystic fibrosis)
● Multiple sclerosis
● Muscular dystrophy
● Organic brain damage caused by:
- infection (consequences of inflammatory diseases of the CNS)
- traumatic brain injury
- tumors
- vascular insult (consequences of cerebrovascular disease)
● polyneuropathy
● transverse Cutting paralysis
● severe paralysis (paraparesis, paraplegia, tetraparesis, tetraplegia)
3. For exercises to strengthen the self-confidence of disabled women and girls at risk of disability, the health insurance funds finance 28 exercise units (guide value ).
4. In the case of chronic heart disease, the health insurances finance
- 90 exercise units within period of 24 months (guide values), for children and adolescents with heart disease
- 120 exercise units within 24 months (reference values).
Further regulations for rehabilitation sports in cardiac groups are possible with maximum load limit of <1.4 watts / kg body weight (evidence not older than 6 months) as result of heart disease or cardiac Ischemia criteria.
The scope of work is 45 exercise units within 12 months (guidelines). In the case of other indications, it must be checked in each individual case whether the services are necessary, suitable and economical.
After repeated acute treatment, rehabilitation sport in cardiac groups can be considered again.
A longer duration of performance is possible in rehabilitation sport (apart from Section 4) after individual assessment, if the services are necessary, suitable and are economical. This is particularly the case if, with cognitive or psychological impairments, the long-term implementation of the exercise program on one's own responsibility is not or not yet possible. This also applies to rehabilitation sports in cardiac groups.
Rehabilitation sports primarily include gymnastics (including water aerobics), athletics, swimming and movement games, as well as bowling for blind people and archery for people in wheelchairs.Measures that include exercises on technical equipment that are used to build muscle or to increase endurance (e.g. sequence training equipment, equipment with rope pull technology, weight bench, arm / leg press, treadmill, rowing machine, cross trainer) are excluded. An exception is training on bicycle ergometers in heart groups.
There are special rehabilitation sports groups, for example. B. for coronary patients (heart groups, constant medical supervision is guaranteed in these groups), cancer patients, etc.
If exercises are required to strengthen the self-confidence of disabled women or girls who are at risk of disability, this is required in addition to the specification of the additionally tick the recommended rehabilitation sport.
The health insurances as well as the associations of rehabilitation sports provide information about the existing local offers.
Functional training
Functional training is possible for disabled people and people at risk of disability4 to integrate them into society and working life as long as possible. Functional training works specifically with the means of physiotherapy and / or occupational therapy specifically on special physical structures (muscles, joints, etc.) of the disabled or at risk of disability, who have the necessary mobility as well as physical and psychological resilience for movement therapy exercises in the group , a. Functional training is essentially organ-oriented. The aim of functional training is to maintain and improve functions as well as delaying the loss of function of individual organ systems / body parts, relieving pain, improving movement, helping people cope with illness and helping people to help themselves. The aim of helping people to help themselves is to activate self-help potential, to strengthen the responsibility of the disabled or at risk of disability for their health, as well as to motivate them and enable them to carry out long-term, independent and responsible movement training in the sense of an appropriate exercise program.
Functional training includes exercise therapy exercises that are carried out in groups (up to maximum of 15 participants) as part of regular exercise events. Joint practice in fixed groups is prerequisite for promoting group dynamic effects, supporting the exchange of experiences between those affected and thus strengthening the self-help character of the performance. In addition to movement therapy exercises, joint protection measures and practicing the use of technical aids and everyday objects can be part of functional training.Measures that include exercises on technical equipment that are used to build muscle or to increase endurance (e.g. sequence training equipment, equipment with rope pull technology, weight bench, arm / leg press, treadmill, rowing machine, cross trainer) are excluded. An exception is training on bicycle ergometers in heart groups.
There are special rehabilitation sports groups, for example. B. for coronary patients (heart groups, constant medical supervision is guaranteed in these groups), cancer patients, etc.
If exercises are required to strengthen the self-confidence of disabled women or girls who are at risk of disability, this is required in addition to the specification of the additionally tick the recommended rehabilitation sport.
The health insurances as well as the associations of rehabilitation sports provide information about the existing local offers.
Functional training
Functional training is possible for disabled people and people at risk of disability4 to integrate them into society and working life as long as possible. Functional training works specifically with the means of physiotherapy and / or occupational therapy specifically on special physical structures (muscles, joints, etc.) of the disabled or at risk of disability, who have the necessary mobility as well as physical and psychological resilience for movement therapy exercises in the group , a. Functional training is essentially organ-oriented. The aim of functional training is to maintain and improve functions as well as delaying the loss of function of individual organ systems / body parts, relieving pain, improving movement, helping people cope with illness and helping people to help themselves. The aim of helping people to help themselves is to activate self-help potential, to strengthen the responsibility of the disabled or at risk of disability for their health, as well as to motivate them and enable them to carry out long-term, independent and responsible movement training in the sense of an appropriate exercise program.
Functional training includes exercise therapy exercises that are carried out in groups (up to maximum of 15 participants) as part of regular exercise events. Joint practice in fixed groups is prerequisite for promoting group dynamic effects, supporting the exchange of experiences between those affected and thus strengthening the self-help character of the performance. In addition to movement therapy exercises, joint protection measures and practicing the use of technical aids and everyday objects can be part of functional training.
The health insurance companies finance functional training as long as the disabled person or person at risk of disability is dependent on the professional performance of the therapist during the training event in order to achieve the above. Achieving goals.
The health insurances have in the above. Framework agreement on the following reference values for the duration of benefits, from which deviations can also be made on the basis of individual testing according to the requirements of the individual case:
1. 12 months (reference value)
2. 24 months (reference value) only for the following chronic diseases / disabilities with severe impairment of mobility / mobility:
● Fibromyalgia syndromes
● Collagenoses
● Ankylosing spondylitis
● Osteoporosis
● Psoriatic arthritis
● Rheumatoid arthritis
● Severe polyarthroses
A longer duration of performance is possible with functional training after individual examination, if the performance is necessary, suitable and economical. This is particularly the case if, in the case of cognitive or psychological impairments, the long-term implementation of the exercise program on one's own responsibility is not or not yet possible.
Functional training types are in particular
● dry gymnastics,
● Water aerobics.
The health insurance companies and self-help organizations, e.g. Rheumatism League, information.
2.3. Samples 57 and 58 are deleted.
2.4. The note "Sample 59 unoccupied " is changed to:
"Sample 57 to 59 unoccupied ".
The table of contents changes accordingly.
3. This agreement comes into force on July 1, 2011.
3.1 For sample 56, the reference date regulation applies to July 1, 2011.
National Association of Statutory Health Insurance Physicians, K. d. ö. R., Berlin
GKV-Spitzenverband, K. d. ö. R., Berlin
Berlin, June 1, 2011
2 The framework agreement on rehabilitation sport and functional training from January 1, 2011 is on the Internet on the homepage of the Federal Working Group for Rehabilitation (BAR) can be found at: http://www.bar-frankfurt.de.
3 These groups of people belong to iSd Framework agreement also includes chronically ill people for whom an impairment in life in society has not yet occurred but is to be expected.
4 These groups of people include i. The framework agreement also includes chronically ill people for whom an impairment in life in society has not yet occurred but is to be expected.
The health insurance companies finance functional training as long as the disabled person or person at risk of disability is dependent on the professional performance of the therapist during the training event in order to achieve the above. Achieving goals.
The health insurances have in the above. Framework agreement on the following reference values for the duration of benefits, from which deviations can also be made on the basis of individual testing according to the requirements of the individual case:
1. 12 months (reference value)
2. 24 months (reference value) only for the following chronic diseases / disabilities with severe impairment of mobility / mobility:
● Fibromyalgia syndromes
● Collagenoses
● Ankylosing spondylitis
● Osteoporosis
● Psoriatic arthritis
● Rheumatoid arthritis
● Severe polyarthroses
A longer duration of performance is possible with functional training after individual examination, if the performance is necessary, suitable and economical. This is particularly the case if, in the case of cognitive or psychological impairments, the long-term implementation of the exercise program on one's own responsibility is not or not yet possible.
Functional training types are in particular
● dry gymnastics,
● Water aerobics.
The health insurance companies and self-help organizations, e.g. Rheumatism League, information.
2.3. Samples 57 and 58 are deleted.
2.4. The note "Sample 59 unoccupied " is changed to:
"Sample 57 to 59 unoccupied ".
The table of contents changes accordingly.
3. This agreement comes into force on July 1, 2011.
3.1 For sample 56, the reference date regulation applies to July 1, 2011.
National Association of Statutory Health Insurance Physicians, K. d. ö. R., Berlin
GKV-Spitzenverband, K. d. ö. R., Berlin
Berlin, June 1, 2011
2 The framework agreement on rehabilitation sport and functional training from January 1, 2011 is on the Internet on the homepage of the Federal Working Group for Rehabilitation (BAR) can be found at: http://www.bar-frankfurt.de.
3 These groups of people belong to iSd Framework agreement also includes chronically ill people for whom an impairment in life in society has not yet occurred but is to be expected.
4 These groups of people include i. The framework agreement also includes chronically ill people for whom an impairment in life in society has not yet occurred but is to be expected.
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