Monitoring Limits in Prescribing Incontinence Aids is Essential
The amendment to the Public Health Insurance Act, which came into effect in December 2019, brought many changes in the reimbursement of medical aids through prescriptions. The methodology for determining the degree of incontinence has changed, and it is now also possible to combine aids according to the individual needs of the patient. We summarize other novelties related to limits issues in the following text.
Watch out for Two Limits
When prescribing aids, it is essential to monitor two limits – quantity and financial. In practice, this means that if the insurance company is to cover the cost of the aids for the patient, either in full or partially, both limits must be observed. For instance, if the aids for a given period are insufficient for the patient, they must cover the additional cost out of pocket even if the financial limit has not been reached yet.
What Does the Quantity Limit Mean?
The maximum number of incontinence aids that a doctor can prescribe to a single patient is 150 pieces per month, or 30 for non-absorbent underpads. Therefore, it is necessary to monitor the quantity of aids in the packaging. Information about the different types of incontinence aids and the number of pieces per package can be found in the prescription cards of individual manufacturers. The option to prescribe aids for up to 3 months remains unchanged with the amendment.
What About the Financial Limit and Co-payment?
A reimbursement limit from the insurance company has been set for different degrees of incontinence. The contributions for each degree are as follows:
- Degree I incontinence: 450 CZK per month
- Degree II incontinence: 900 CZK per month
- Degree III incontinence: 1700 CZK per month
The amendment also introduces a mandatory co-payment by the patient, which is calculated from the total cost of the prescription. The co-payment is 15% for Degree I and 5% for Degree II. Patients with the most severe issues (Degree III incontinence) do not need to contribute, moreover, they can also be prescribed non-absorbent underpads up to 220 CZK per month with a 25% co-payment. Thus, a doctor can issue prescriptions for a larger number of units than before. For example, in the case of Degree I incontinence, where the insurance limit is 450 CZK per month and the co-payment is 15%, the patient is entitled to aids worth 529 CZK.
Conclusion
The amendment to the Public Health Insurance Act has brought significant changes. More patients can now access incontinence aids, and the ability to combine them is an advantage. The fixed co-payment allows for more units per package to be prescribed. On the other hand, prescription restrictions and the validity length of the prescription remain unchanged.
(mraf)
Sources:
1. Krhut J., Zachoval R. Information material on prescribing medical devices for urine collection and drainage. Czech Urological Society ČLS JEP, November 18, 2019. Available at: www.cus.cz/pro-odborniky/o-spolecnosti/dulezite-informace/informacni-material-k-preskripci-zdravotnickych-prostredku-pro-sber-a-vyprazdnovani-moci
2. New rules in the Public Health Insurance Act. Seni.cz. Available at: www.prolekare.cz/media/uhradova_regulace_zdravotnickych_prostredku_predepisovanych_lekari_na_poukaz.pdf
3. Methodology for reporting reimbursements for medical devices in selected reimbursement groups − updated version release. SÚKL, November 25, 2019. Available at: www.sukl.cz/sukl/metodika-ohlasovani-uhrad-zdravotnickych-prostredku-u
4. Categorization and reimbursement regulation of medical devices covered by prescription. National Information System of Medical Devices. Available at: www.niszp.cz/kategorizace-uhradova-regulace-zdravotnickych-prostredku-hrazenych-na-poukaz
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