With three long-term care strengthening laws, the help for those in need of care and their relatives will be significantly improved in this election period.
With the First Care Strengthening Act (PSG I), support for those in need of care and their families has been noticeably expanded. In addition, a long-term care provision fund was set up in order to maintain intergenerational equity in the financing of long-term care insurance.
With the Second Care Strengthening Act (PSG II), a new definition of the need for long-term care and a new assessment procedure will be introduced from January 1, 2017. For the first time, all those in need of care have equal access to the benefits of long-term care insurance – regardless of whether they suffer from physical limitations or are suffering from dementia. This is accompanied by a new assessment procedure that determines the degree of independence and, on this basis, determines five levels of care. Anyone who is already in need of care receives protection of confidence. Overall, the benefits of the social long-term care insurance will increase by 20 percent in this election period.
These changes enable those in need of care and their families to tailor the benefits of long-term care insurance much better to their particular situation. This strengthens the situation so that the help that is needed reaches those in need of care and their relatives quickly Third Care Strengthening Act (PSG III) care advice in the municipalities. This means that those in need of care and their relatives receive advice from a single source. In addition, controls are tightened to better protect those in need of care, their families and the caregivers from fraudulent care services.
The most important regulations of the PSG III
Securing the supply
The federal states are responsible for maintaining an efficient, sufficiently numerous and economical care infrastructure. To do this, they can set up committees to deal with supply issues. With the PSG III, the long-term care insurance funds are now to be obliged to participate in committees that deal with regional issues or cross-sectoral care. In the future, the long-term care insurance funds will have to include the recommendations of the committees relating to the improvement of the care situation in contract negotiations. This can be necessary, for example, to avoid undersupply in outpatient care if, for example, the provision of these services by a nursing service would have to be discontinued due to inefficiency.
Advice
Advice for people in need of care and their relatives on site should be improved. Municipalities are to be given the right to initiate care support centers for a period of five years with the PSG III. In addition, in future they should be able to redeem advice vouchers from the insured for care advice. In addition to their own advisory tasks in the area of care assistance, assistance for the elderly and integration assistance, they should also be able to advise those in need of care who receive care allowance, if they so wish. In addition, pilot projects for advising people in need of care and their relatives by municipal advice centers in up to 60 districts or urban districts are planned for a period of five years. The federal states decide on the applications from municipalities that want to participate in these model projects. Those in need of care and their relatives should receive advice from a single source on all services that they can claim, such as assistance with care, integration assistance or care for the elderly.
Offers for support in everyday life
The PSG III creates the opportunity for municipalities to get involved in measures to set up and expand the offers for support in everyday life, also in the form of human or material resources. These offers of support in everyday life are not only aimed at those in need of care, but also at their relatives, who are relieved by this. In addition, countries that have almost completely drawn down the funds due to them should also be able to use the funds that have not been used by other countries. The aim is to make full use of the long-term care insurance contribution of up to 25 million euros for the development of such offers.
Implementation of the new definition of the need for care in the law on assistance with care
Even after the introduction of the new definition of the need for care in SGB XI and after the significant improvement in the benefits of long-term care insurance, there may be a need for care that goes beyond this. In the event of financial need, this is covered by help for care within the framework of social assistance and the social compensation law. As in SGB XI, the new definition of the need for long-term care is to be introduced in the right to care assistance under the Twelfth Social Code (SGB XII) and in the Federal Supply Act (BVG) to ensure that the financially needy are adequately cared for if they need care.
Regulation of the interface problem between long-term care insurance and integration assistance
With the introduction of the new definition of the need for long-term care in the SGB XI, an extension was made in the area of benefit law: now the nursing care measures are also part of the benefit area of long-term care insurance. This leads to questions of demarcation between the benefits of integration assistance and the benefits of long-term care insurance or help for long-term care. The PSG III is therefore intended to provide clarity: It is therefore regulated that the care services are generally given priority over the services of integration assistance in the home environment, unless the fulfillment of the tasks of integration assistance is the focus of the service provision.
Outside the home environment, on the other hand, the benefits of integration assistance take precedence over the benefits of care. The draft thus contains clear delimitation regulations at the interfaces between long-term care insurance and integration assistance, which also avoid shifting costs between the two systems.
Measures to prevent billing fraud in nursing
Statutory health insurance is given a systematic right to audit: Even nursing services that only provide home nursing services on behalf of the health insurance companies should in future be regularly included in the quality and billing audits by the medical service of the health insurance company (MDK).
In addition, existing quality assurance instruments in the area of long-term care insurance are to be further developed: people who only receive home nursing care are to be included in the random samples for the MDK examinations of nursing services. In home care, the nursing staff’s documentation obligations will be adapted to the obligations that already apply in outpatient care for the elderly. Billing checks should also be carried out by the long-term care insurance funds independently of the quality checks of the MDK if there are indications of incorrect billing behavior.
These rules already apply to care services that are active in outpatient care for the elderly. They may be checked unannounced in the event of suspicion, and their accounts must be checked regularly by the MDK.
In addition, the care self-government in the federal states should be legally obliged to lay down in the state framework agreements, in particular, requirements for contracts through which more effective action can be taken against providers who have already become suspicious. This is to ensure that criminal nursing services, for example, cannot simply obtain a new license under a new name or through straw men.
The care self-administration is also obliged to develop clear quality standards for outpatient living groups.