45. Amendment to the agreement on forms for statutory health care from April 1, 1995 (Annex 2 BMV-Ä)

Announcements

The National Association of Statutory Health Insurance Physicians , Kdö.R., Berlin - on the one hand - and the GKV-Spitzenverband (National Association of Health Insurance Funds), Kdö.R., Berlin - on the other hand - agree the following:

Article 1

45. Change to the agreement on forms for statutory health care from April 1, 1995 (Annex 2 BMV-Ä)

Changes to the form agreement

1. Number 2.26 changes as follows:

" 2.26 sample 26: Ordinance on sociotherapy according to § 37 SGB V (as of 10.2017) "

2. Number 2.28 changes as follows:

" 2.28 Sample 28: Ordinance for referral for indication for sociotherapy according to § 37a SGB V up to maximum of 5 therapy units (as of: 10.2017) “1

Article 2

Changes to the explanations of the form

1 . The form explanations for sample 26 change as follows:

" Sample 26: Ordinance on sociotherapy in accordance with Section 37a SGB V

Die The following doctors may prescribe sociotherapy:

● Specialists in neurology,

● Specialists in neurology,

● Specialists in psychosomatic medicine and psychotherapy,

● Specialists in psychiatry and psychotherapy.

● Specialists in child and adolescent psychiatry and psychotherapy (in therapeutically justified cases in the transition phase from the age of 18 to the age of 21)

● Psychological Psychotherapists

● Child and adolescent psychotherapists (in therapeutically justified cases in the transition phase from the age of 18 to the age of 21)

The guidelines of the Federal Joint Committee on the regulation of sociotherapy in contract medical care (Sociotherapy Guideline / ST-RL) must be observed.

The form has two copies:

● the original is the copy for the health insurance company ,

● the 1st copy is for the sociotherapeutic service provider and

● the 2nd copy remains with the doctor.

The completed form must be submitted to the health insurance company for approval together with the sociotherapeutic care plan.

Announcements

The National Association of Statutory Health Insurance Physicians , Kdö.R., Berlin - on the one hand - and the GKV-Spitzenverband (National Association of Health Insurance Funds), Kdö.R., Berlin - on the other hand - agree the following:

Article 1

45. Change to the agreement on forms for statutory health care from April 1, 1995 (Annex 2 BMV-Ä)

Changes to the form agreement

1. Number 2.26 changes as follows:

" 2.26 sample 26: Ordinance on sociotherapy according to § 37 SGB V (as of 10.2017) "

2. Number 2.28 changes as follows:

" 2.28 Sample 28: Ordinance for referral for indication for sociotherapy according to § 37a SGB V up to maximum of 5 therapy units (as of: 10.2017) “1

Article 2

Changes to the explanations of the form

1 . The form explanations for sample 26 change as follows:

" Sample 26: Ordinance on sociotherapy in accordance with Section 37a SGB V

Die The following doctors may prescribe sociotherapy:

● Specialists in neurology,

● Specialists in neurology,

● Specialists in psychosomatic medicine and psychotherapy,

● Specialists in psychiatry and psychotherapy.

● Specialists in child and adolescent psychiatry and psychotherapy (in therapeutically justified cases in the transition phase from the age of 18 to the age of 21)

● Psychological Psychotherapists

● Child and adolescent psychotherapists (in therapeutically justified cases in the transition phase from the age of 18 to the age of 21)

The guidelines of the Federal Joint Committee on the regulation of sociotherapy in contract medical care (Sociotherapy Guideline / ST-RL) must be observed.

The form has two copies:

● the original is the copy for the health insurance company ,

● the 1st copy is for the sociotherapeutic service provider and

● the 2nd copy remains with the doctor.

The completed form must be submitted to the health insurance company for approval together with the sociotherapeutic care plan.This must be done no later than the 3rd working day after the ordinance has been issued. Until the decision on the approval, the health insurance company will cover the costs of the prescribed services and the services provided by the sociotherapeutic service provider.

When filling in the fields, please note the following:

Diagnosis (ICD-10 code)

The therapy-relevant diagnosis is to be entered here in encrypted form as ICD-10 GM code.

Severity (according to GAF SCALE)

In addition to specifying the therapy-relevant ICD-10 GM code, Sociotherapy the ability disorder is always decisive. The impaired ability is shown using the GAF SCALE and comprises two defined areas in the ST-RL:

a) Section 2, paragraphs 2, 3 and 4 of the Sociotherapy Guideline - GAF -SCALE: Orientation value 40 (maximum ≤ 50)

For the severe mental illnesses mentioned here, especially those of the schizophrenic type, the prescription of sociotherapy is possible, provided that the impairment of the Skills with level on the GAF-SCALA at most between 40 and 50 is available.

b) Section 2, paragraph 5 of the Sociotherapy Directive - GAF-SCALA with value ≤ 40

The prescription of sociotherapy is also possible for all severe mental illnesses with diagnoses from the entire range F00 to F99, provided that the impairment of skills is not more than 40 plus one of the in Section 5 of the Sociotherapy Directive has been met Examples of these criteria are that the patient has relevant co-morbidities (psychiatric or somatic) or has severely restricted ability to walk (see also).

The disease has existed since (if known )

If it is known since when the illness has existed, the corresponding date must be entered here in the format DDMMYY (e.g. 09.08.17).

Type and severity of the ability disorder

At this point there is information in key words about the ability disorder, which corresponds to the GAF value given below.

Example:

GAF value is 43, ability disorders are: drive, endurance and resilience of the patient are disturbed; he is unable to structure his actions; His planning thinking and acting as well as his relation to reality are limited.This must be done no later than the 3rd working day after the ordinance has been issued. Until the decision on the approval, the health insurance company will cover the costs of the prescribed services and the services provided by the sociotherapeutic service provider.

When filling in the fields, please note the following:

Diagnosis (ICD-10 code)

The therapy-relevant diagnosis is to be entered here in encrypted form as ICD-10 GM code.

Severity (according to GAF SCALE)

In addition to specifying the therapy-relevant ICD-10 GM code, Sociotherapy the ability disorder is always decisive. The impaired ability is shown using the GAF SCALE and comprises two defined areas in the ST-RL:

a) Section 2, paragraphs 2, 3 and 4 of the Sociotherapy Guideline - GAF -SCALE: Orientation value 40 (maximum ≤ 50)

For the severe mental illnesses mentioned here, especially those of the schizophrenic type, the prescription of sociotherapy is possible, provided that the impairment of the Skills with level on the GAF-SCALA at most between 40 and 50 is available.

b) Section 2, paragraph 5 of the Sociotherapy Directive - GAF-SCALA with value ≤ 40

The prescription of sociotherapy is also possible for all severe mental illnesses with diagnoses from the entire range F00 to F99, provided that the impairment of skills is not more than 40 plus one of the in Section 5 of the Sociotherapy Directive has been met Examples of these criteria are that the patient has relevant co-morbidities (psychiatric or somatic) or has severely restricted ability to walk (see also).

The disease has existed since (if known )

If it is known since when the illness has existed, the corresponding date must be entered here in the format DDMMYY (e.g. 09.08.17).

Type and severity of the ability disorder

At this point there is information in key words about the ability disorder, which corresponds to the GAF value given below.

Example:

GAF value is 43, ability disorders are: drive, endurance and resilience of the patient are disturbed; he is unable to structure his actions; His planning thinking and acting as well as his relation to reality are limited.

Type and extent of co-morbidities / other restrictions

If sociotherapy for diseases from the area F00 up to F99 is prescribed that are not already mentioned in § 2 paragraphs 2, 3 and 4 of the Sociotherapy Directive and there is an impairment of activity with GAF value ≤ 40 (see also), additional information on existing co-morbidities is provided here or other restrictions. Co-morbidities can be both psychiatric (e.g. personality disorder) and somatic (e.g. chronic pain disorder).

Information provided by the insured person

In addition to the address data, the information on the type of accommodation must be given here. Here, the health insurance companies check whether the insured person e.g. lives in facility (e.g. assisted living) which, due to its structure, already provides the content of sociotherapeutic measures.

Details of the next of kin

The contact details of close relative (e.g. parent, spouse or adult child) are entered here to enable the service provider to consult and coordinate with the relatives if necessary.

Information about the supervisor

If legal supervisor has been appointed, corresponding cross must be ticked and the contact details must be entered; In addition, if known, the care matters taken over by the legal supervisor should be named.

Expected number of therapy units / before Expected duration of therapy

If it is possible to estimate the total number of therapy units required or the duration of the complete therapy, the fields must be completed accordingly.

Requested number of therapy units

The number of currently requested sociotherapy units must be entered here. A prescription can be issued for maximum of 30 therapy units.

Services already performed

Is the prescribing doctor / psychotherapist aware that Services of sociotherapy (therapy units) have already been carried out in the context of the present case of illness and within the last 3 years, this must be indicated in this field.

prognosis

With the prescription of sociotherapy, a. The aim is to enable the insured person to make use of specialist medical or psychotherapeutic services. At this point, it is predicted that the insured person will be able to do so with the number of prescribed therapy units.

Type and extent of co-morbidities / other restrictions

If sociotherapy for diseases from the area F00 up to F99 is prescribed that are not already mentioned in § 2 paragraphs 2, 3 and 4 of the Sociotherapy Directive and there is an impairment of activity with GAF value ≤ 40 (see also), additional information on existing co-morbidities is provided here or other restrictions. Co-morbidities can be both psychiatric (e.g. personality disorder) and somatic (e.g. chronic pain disorder).

Information provided by the insured person

In addition to the address data, the information on the type of accommodation must be given here. Here, the health insurance companies check whether the insured person e.g. lives in facility (e.g. assisted living) which, due to its structure, already provides the content of sociotherapeutic measures.

Details of the next of kin

The contact details of close relative (e.g. parent, spouse or adult child) are entered here to enable the service provider to consult and coordinate with the relatives if necessary.

Information about the supervisor

If legal supervisor has been appointed, corresponding cross must be ticked and the contact details must be entered; In addition, if known, the care matters taken over by the legal supervisor should be named.

Expected number of therapy units / before Expected duration of therapy

If it is possible to estimate the total number of therapy units required or the duration of the complete therapy, the fields must be completed accordingly.

Requested number of therapy units

The number of currently requested sociotherapy units must be entered here. A prescription can be issued for maximum of 30 therapy units.

Services already performed

Is the prescribing doctor / psychotherapist aware that Services of sociotherapy (therapy units) have already been carried out in the context of the present case of illness and within the last 3 years, this must be indicated in this field.

prognosis

With the prescription of sociotherapy, a. The aim is to enable the insured person to make use of specialist medical or psychotherapeutic services. At this point, it is predicted that the insured person will be able to do so with the number of prescribed therapy units.

Hospital treatment (will be avoided / will be shortened / cannot be carried out)

Since sociotherapy can only be prescribed if hospital treatment is avoided or can be shortened or if this is necessary but not feasible, the relevant information must be ticked here. "

2. The form explanations for sample 27 change as follows:

" Sample 27: Sociotherapeutic care plan acc. § 37 SGB V

The sociotherapeutic care plan is the result of coordination process between the prescribing doctor, sociotherapeutic service provider and patient. The care plan is the basis of the therapy. The course and goals of the therapy are discussed by all parties at regular intervals and the plan is adjusted if necessary.

The sociotherapeutic care plan must be submitted to the health insurance company for approval together with the completed form, sample 26 . This must be done no later than the 3rd working day after the ordinance has been issued. Until the decision on approval is made, the health insurance company bears the costs of the prescribed services and services provided by the sociotherapeutic service provider.

The guidelines of the Federal Joint Committee on the regulation of sociotherapy in contract medical care (sociotherapy Directive / ST-RL) must be observed.

The form has two copies:

● the original is the Copy for the health insurance company,

● the 1st copy is for the sociotherapeutic service provider and

● the 2nd copy remains at the doctor's.

When filling in the fields, please note the following:

IC of the service provider

Enter the institution code of the sociotherapeutic service provider here.

Therapy goals (define short and long-term goals)

The sociothera The therapeutic care plan is created in consultation between the treating contract doctor / psychotherapist, the sociotherapeutic service provider and the patient and should be signed by everyone. It contains the therapy goals, which are divided into near and long-term goals. Short-term goals are, for example, increasing resilience or preventing hospitalization. A long-term goal is, for example, to regain the ability to work.

Prescribed and recommended measures, the use of which must be coordinated

Here are to name the measures that should enable the patient to achieve the therapeutic goals listed under 2. A maximum of 9 measures can be entered here.

Hospital treatment (will be avoided / will be shortened / cannot be carried out)

Since sociotherapy can only be prescribed if hospital treatment is avoided or can be shortened or if this is necessary but not feasible, the relevant information must be ticked here. "

2. The form explanations for sample 27 change as follows:

" Sample 27: Sociotherapeutic care plan acc. § 37 SGB V

The sociotherapeutic care plan is the result of coordination process between the prescribing doctor, sociotherapeutic service provider and patient. The care plan is the basis of the therapy. The course and goals of the therapy are discussed by all parties at regular intervals and the plan is adjusted if necessary.

The sociotherapeutic care plan must be submitted to the health insurance company for approval together with the completed form, sample 26 . This must be done no later than the 3rd working day after the ordinance has been issued. Until the decision on approval is made, the health insurance company bears the costs of the prescribed services and services provided by the sociotherapeutic service provider.

The guidelines of the Federal Joint Committee on the regulation of sociotherapy in contract medical care (sociotherapy Directive / ST-RL) must be observed.

The form has two copies:

● the original is the Copy for the health insurance company,

● the 1st copy is for the sociotherapeutic service provider and

● the 2nd copy remains at the doctor's.

When filling in the fields, please note the following:

IC of the service provider

Enter the institution code of the sociotherapeutic service provider here.

Therapy goals (define short and long-term goals)

The sociothera The therapeutic care plan is created in consultation between the treating contract doctor / psychotherapist, the sociotherapeutic service provider and the patient and should be signed by everyone. It contains the therapy goals, which are divided into near and long-term goals. Short-term goals are, for example, increasing resilience or preventing hospitalization. A long-term goal is, for example, to regain the ability to work.

Prescribed and recommended measures, the use of which must be coordinated

Here are to name the measures that should enable the patient to achieve the therapeutic goals listed under 2. A maximum of 9 measures can be entered here.Examples of such measures are the use of psychiatric consultation hours, other contract medical therapies, occupational therapy or psychotherapy.

Implementation of sociotherapeutic measures

Here the information on the type of measures is provided with information on the frequency per week / month and the period. Examples of these measures are practical exercises to increase motivation, resilience and endurance; Analysis of the patient's domestic, professional and social situation as well as strengthening the awareness of the disease. ”

3. The form explanations for sample 28 change as follows:

" Sample 28: Ordinance for referral for the indication for sociotherapy according to § 37a SGB V with maximum of 5 therapy units 2

Doctors other than those authorized in accordance with the Sociotherapy Directive (Section 4, Paragraphs 2 and 3) can refer the patient to specialist doctor authorized to prescribe or Psychotherapists refer if they have reasonable suspicion that this patient has an indication for sociotherapy. If the prescribing doctor is of the opinion that the patient is not able to make use of the referral independently, sociotherapeutic service provider can be called in with the prescription on model 28.

The guidelines of the Federal Joint Committee on the regulation of sociotherapy in statutory health care (sociotherapy guidelines / ST-RL) must be observed.

The form has two copies:

● the original is the copy for the health insurance company,

● the 1st copy is given to the sociotherapeutic service provider,

● the 2nd copy remains with the doctor.

When filling The following information must be observed in the fields:

Diagnosis (ICD-10 code)

Here is the (suspicious ) Enter the diagnosis encrypted as ICD-10-GM code.

Illness It has existed since (if known)

If it is known since when the illness has existed, the corresponding date is shown here in the format DDMMYY (e.g. B. 09.08.17).

Hospital treatment (will be avoided / will be shortened / cannot be carried out)

Because sociotherapy can only be prescribed if hospital treatment can be avoided or shortened or if this is necessary but not feasible, the relevant information must be ticked here.

Declaration by the doctor

The aim of the prescription is that the patient receives medical orExamples of such measures are the use of psychiatric consultation hours, other contract medical therapies, occupational therapy or psychotherapy.

Implementation of sociotherapeutic measures

Here the information on the type of measures is provided with information on the frequency per week / month and the period. Examples of these measures are practical exercises to increase motivation, resilience and endurance; Analysis of the patient's domestic, professional and social situation as well as strengthening the awareness of the disease. ”

3. The form explanations for sample 28 change as follows:

" Sample 28: Ordinance for referral for the indication for sociotherapy according to § 37a SGB V with maximum of 5 therapy units 2

Doctors other than those authorized in accordance with the Sociotherapy Directive (Section 4, Paragraphs 2 and 3) can refer the patient to specialist doctor authorized to prescribe or Psychotherapists refer if they have reasonable suspicion that this patient has an indication for sociotherapy. If the prescribing doctor is of the opinion that the patient is not able to make use of the referral independently, sociotherapeutic service provider can be called in with the prescription on model 28.

The guidelines of the Federal Joint Committee on the regulation of sociotherapy in statutory health care (sociotherapy guidelines / ST-RL) must be observed.

The form has two copies:

● the original is the copy for the health insurance company,

● the 1st copy is given to the sociotherapeutic service provider,

● the 2nd copy remains with the doctor.

When filling The following information must be observed in the fields:

Diagnosis (ICD-10 code)

Here is the (suspicious ) Enter the diagnosis encrypted as ICD-10-GM code.

Illness It has existed since (if known)

If it is known since when the illness has existed, the corresponding date is shown here in the format DDMMYY (e.g. B. 09.08.17).

Hospital treatment (will be avoided / will be shortened / cannot be carried out)

Because sociotherapy can only be prescribed if hospital treatment can be avoided or shortened or if this is necessary but not feasible, the relevant information must be ticked here.

Declaration by the doctor

The aim of the prescription is that the patient receives medical orcan make use of psychotherapeutic and prescribed services independently. To achieve this, sociotherapeutic service provider is called in. The name and address of the sociotherapist are given on the form. To achieve this goal, the sociotherapeutic service provider has maximum of 5 therapy units available. These will be counted towards the total contingent of sociotherapy if it comes to prescribing sociotherapy according to § 2 of the sociotherapy guidelines.

The following fields are from Sociotherapeutic service provider to be completed

IC of the service provider

Enter the institution code of the sociotherapeutic service provider here.

Billing of the sociotherapeutic service provider

To support the use of the referral, the sociotherapeutic service provider has maximum of 5 treatment units available. The data and the description of the measures must be entered in this field. These treatment units are counted towards the total contingent of sociotherapy.

Ordinances on sample 28 do not require the approval of the patient's health insurance. If, despite sociotherapeutic support, the patient does not visit the specialist or the specialist does not prescribe further sociotherapy, the treatment units provided can still be billed. Billing takes place on sample 28.

Comments on billing

The account details of the sociotherapeutic service provider are entered here. "

Article 3

Entry into force

The changes take effect on October 1st, 2017. Old samples 26 and 28 lose their validity.

Berlin, July 24th, 2017

National Association of Statutory Health Insurance Physicians, Kdö.R., Berlin

GKV-Spitzenverband, Kdö.R., Berlin

1 The table of contents changes accordingly.

2 The table of contents changes accordingly.