The procedure for payment for rehabilitation services has been changed
The National Health Insurance Fund under the Ministry of Health (NHIF) reports that the provision of medical rehabilitation services in accordance with the planned funds (quotas) has been declined. The contractual amount for rehabilitation services is provided only to the institutions providing these services and not to the sending institutions. There have also been payment innovations that will allow patients to access some rehabilitation services more quickly.
As of January 1, when concluding new contracts with medical institutions, territorial health insurance funds no longer provide for contractual amounts for referrals for medical rehabilitation and sanatorium anti-relapse services.
This change aims to reduce the administrative burden on healthcare institutions. In addition, the patient's access to rehabilitation services will not depend on the contractual amount of the sending institution and its ability to manage it.
“Referrals for rehabilitation services must be issued in the same way as for all other services. This means that the family or the treating doctor decides on the rehabilitation of the patient only according to the medical indications and the recommendations of the physical medicine and rehabilitation doctor. The doctor no longer needs to take into account the funds for rehabilitation planned for referrals, but it is recommended to take into account the possibilities of rehabilitation institutions to accept the patient,” says Tatjana Golubajeva, Deputy Director of NHIF.
Also from 1 January of this year, the procedure for payment for medical rehabilitation services has been changed. A completely new - priority - group of inpatient rehabilitation services has been singled out, providing for a separate payment for the services provided to patients.
“This group includes patients after acute diseases that impair biosocial functions, such as after a heart attack, stroke, trauma, after endoprosthesis, as well as children and patients with extremely serious medical conditions who need level III rehabilitation. We hope that the singling out of the new group will ensure better access to inpatient medical rehabilitation services for those patients who most need to receive these services at the right time”, states Ms. Golubajeva.
A separate contractual amount is provided for the payment of priority inpatient services, with additional plans to pay for non-contractual services from the Compulsory Health Insurance Fund (CHIF) on a monthly basis.
“In order to restore patients' biopsychosocial functions and improve their health, patients do not always need inpatient services. In order for as many patients as possible to receive the rehabilitation services they need, treatment facilities are encouraged to provide outpatient services as close as possible to patients. If these or psychosocial medical rehabilitation services are provided in excess of what is provided for in the contract, they will be paid for as a matter of priority at the end of the year, according to the possibilities of the CHIF, ”emphasizes the Deputy Director of NHIF.
It is important to know that the doctor referring the patient for rehabilitation must explain what rehabilitation services he or she needs. And the patient has the right to choose the rehabilitation institution himself/herself. It is convenient to find all Lithuanian medical institutions and the services they provide on the website of the health insurance funds.
The Health Insurance Fund reminds that rehabilitation facilities are not intended for recreation but for treatment. Thus, rehabilitation is given not when the time is convenient for the patient, but when treatment is really needed.
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Last updated: 28-03-2022
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