Orthopedic technicians demand structure for the provision of insoles

The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) has updated the "Insoles" product group in the list of medical aids. The German Association of Orthopedic Technicians (BIV-OT) demands that the current state of the art be reflected in the list of medical aids.

The umbrella organization of statutory health insurance funds (GKV-Spitzenverband) has updated the "Insoles" product group in the list of medical aids and published the revised version in the Federal Gazette. Federal Guild Association for Orthopedic Technology (BIV-OT) criticizes that the state of the art cannot be reflected in the list of aids without a "fixed amount logic" structurally preventing the further development of care.

The state of the art is represented by the "Compendium – Quality Standard in the Foot and Shoe Sector" of the German Society for Interprofessional Assistive Technology Supply (DGIHV) The standard is authoritative. It was developed by recognized experts, recommended by the relevant medical and technical associations and professional societies, and implemented in the initial, advanced, and continuing training of healthcare professionals. It structures the path from medical indication to technical solution and creates a uniform logic for physicians, healthcare providers, payers, and the medical review board.

Restructure product group

The BIV-OT had together with the Top association for orthopedic shoe technology (SpiOST) proposed restructuring the product group along this standard to adequately reflect the state of the art and also in the interest of reducing bureaucracy and implementing the Joint Federal Committee's directive on medical aids for electronic prescriptions. The National Association of Statutory Health Insurance Funds rejected this, citing fixed reimbursement issues and legal uncertainties.

"From our perspective, a fixed reimbursement logic must not lead to the permanent disregard of the state of the art. The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) justified its decision not to consider a new structure in accordance with DGIHV quality standards by stating that the organizational structure of the deposit product group constitutes the framework for the formation of fixed reimbursement groups and the setting of fixed reimbursement amounts for deposits. A change to this structure would therefore necessitate a change to the currently applicable fixed reimbursement amounts," stated the BIT-OV. 

enable a practical solution

In compliance with current legal regulations and in accordance with the Federal Social Court's ruling of April 7, 2022, a legally sound redesign and collection of fixed amounts and fixed amount group systems is not currently possible. Further review and adjustment of the product group structure can take place as soon as legally sound regulations exist. The BIV-OT is now advocating for this, together with the Ministry of Health, the SpiOST, the GKV-Spitzenverband and with the involvement of the DGIHV, to clarify the "point of state of the art, systematization of the care pathway and fixed amounts" and to enable a practical solution.

Source: BIT-OV

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