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23-11-2023

New changes: extended time for accessing rehabilitation services

Recently, changes in the way medical rehabilitation is provided have made it difficult for patients to know where, when and who to contact for rehabilitation services. The Health Insurance Funds bring attention to the changes in timelines and other important changes.

Duration of referral and time of arrival for rehabilitation 

When the patient is referred for rehabilitation by a family doctor or treating physician to a Physical Medicine and Rehabilitation (PMR) consultation, it is necessary to register for the consultation within 60 days. However, this period is not the timeframe for seeing the PMR physician, but only for registering within 2 months.    

What’s New? In September 2023, some of the requirements for prescribing and providing medical rehabilitation services changed. One of the most important changes is that the patient must arrive at the rehabilitation facility no later than 2 months after signing the referral for rehabilitation services. If the patient needs rehabilitation later based on medical symptoms, the specific date of arrival is set and registered by the physician. For example, if an injury requires waiting for a fracture to heal, etc.

Outpatient or inpatient primary rehabilitation  

Primary rehabilitation is provided during outpatient or inpatient treatment.

On an outpatient basis, the PMR physician assesses the patient’s complaints, clinical condition, impairment of biopsychosocial functions, recommends primary outpatient rehabilitation services as needed, and decides whether a second consultation is necessary. During one episode of primary rehabilitation treatment, between 5 and 25 procedures may be provided, covered by the Compulsory Health Insurance Fund. At least 10 of these must be carried out individually. It is recommended that the prescribed procedures are carried out in the same institution where the PMR physician was consulted.        

During hospital treatment, the patient’s biopsychosocial functions are also assessed and primary rehabilitation is provided as needed. In the inpatient department, this consists only of individual rehabilitation procedures, the number of which depends on the patient’s functional status and the length of treatment in the specialised unit.

When is the primary rehabilitation not prescribed?

Occasionally, patients may be referred to rehabilitation services without primary rehabilitation - to prepare for primary (therapeutic) or permanent prosthesis, for supportive rehabilitation, for day surgery services, or at the reasonable discretion of the PMR physician (reasons to be documented in the medical records).  

The patient can only postpone the rehabilitation treatment on his/her own for justified reasons (other illness, death of a relative, etc.). If the patient is unable to start rehabilitation on time due to personal circumstances (business trip, exams, etc.), he/she has to sign a form that he/she refuses to undergo rehabilitation for the time being, and if necessary, he/she can be re-consulted by the PMR physician and the need for rehabilitation will be reassessed later.   

If the impairment in biopsychosocial functions persists after primary rehabilitation, but further improvement is expected, and the PMR physician decides that more rehabilitation services are needed, inpatient or outpatient rehabilitation may be prescribed. It should be noted that further rehabilitation is not available in all cases and is at the discretion of the PMR physician. 

Inpatient rehabilitation and its termination 

Inpatient rehabilitation is only prescribed after inpatient treatment, except in certain cases. For example, inpatient rehabilitation may be prescribed for children or adults without hospitalisation when day surgery services have been provided; supportive rehabilitation is prescribed; the patient’s condition has changed to the point where rehabilitation services can be provided after inpatient treatment in a nursing and supportive care hospital, etc. 

What’s New? Inpatient rehabilitation can be prescribed after day inpatient treatment where chemotherapy or radiotherapy for cancer has been provided. 

If the patient is transferred from the facility where he/she received rehabilitation to another facility or unit providing inpatient treatment due to an unexpected illness, the patient’s return to rehabilitation shall be coordinated by the attending physician. If the duration of inpatient treatment exceeds 20 days but there is a continuing need for rehabilitation, the patient’s condition must be assessed by a PMR physician before the patient returns to rehabilitation.

If rehabilitation is terminated due to unforeseen circumstances, rehabilitation may be continued in the same institution at a later date, provided that at least 30 % of the duration remains, but no later than 1 month after the date of termination of rehabilitation services.   

When is rehabilitation needs to be immediate? 

Rehabilitation treatment must be given as soon as the diseases and health disorders that are the main causes of death or disability are diagnosed. This is a priority inpatient rehabilitation for which “green corridors” have been created for patients with serious illnesses after hospitalisation, where timely access to rehabilitation services is crucial. Priority rehabilitation is given to patients after heart attack, stroke, trauma, after surgery for certain oncological diseases or endoprosthetic surgery, and to patients with particularly serious health conditions who need tertiary inpatient rehabilitation, as well as to children who need secondary or tertiary inpatient rehabilitation.

What’s New? The patient must arrive at the priority inpatient rehabilitation facility within the time specified by the PMR. If the patient is unable to arrive on time for objective reasons, the patient shall arrange the next arrival time independently, but not later than 2 months after the referral for rehabilitation services has been issued.    

When there are no available dates for rehabilitation 

If the patient is prioritised for inpatient rehabilitation after hospital treatment, the referring doctor informs the patient about the facilities providing rehabilitation services of the appropriate profile, and the person in charge of the referring facility coordinates the date of the patient’s arrival with the administration of the facility chosen by the patient. 

If there are no vacancies at the medical facility of the patient’s choice during the rehabilitation start period specified in the PMR physician’s consultation, he/she is registered at the medical facility with the nearest available date.  

Information of Panevėžys Territorial Health Insurance Fund 

(Freepic photo)

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