Care Reinforcement Act II

Background

Following the service changes and improvements in the care sector introduced by the Care Reinforcement Act I on 1 January 2015, the Second Act on Reinforcing Care Provision and Amending other Regulations (Care Reinforcement Act II) has now come into force as of 1 January 2016.

Both Acts raise the contributions for nursing care insurance in two steps, so from 2017 there will be nearly five billion euros a year additionally available on a permanent basis for new and improved care services. Care insurance benefits are to be expanded by around 20% as a result.

Key points of the Act

The Care Reinforcement Act II contains new features which will gradually come into force – i.e. some in 2016 and some in the following years. In summary, the main ones are:

• In future, a patient’s bodily, mental and physical limitations will be recorded as part of a new assessment procedure and included in the classification into one of the care levels (of which there will be five from 1 January 2017). The degree of independent activity is measured in six different activity areas, each weighted on a differentiated basis, and combined into an overall evaluation (known as the New Assessment).
• The existing framework agreements on care provision in Germany’s federal states (Section 75 Social Security Code XI) are to be adapted by the self-governing counterparts to the aforementioned new concept of care needs.
• Care home operators, social welfare agencies and care insurance funds must review the personnel structure and personnel ratio in the homes before the introduction of the new care levels and adjust them (to the actual requirements). By 30 September 2016, new care rates must be agreed for the care homes; by 2020 there is to be a scientifically validated procedure in place for measuring staffing requirements in care homes.
• From 2018 at the latest, a new quality review and transparency system will be established: the existing arbitration board for quality assurance (Section 113b Social Security Code XI) will be converted into an independent Quality Committee (consisting of a maximum of ten representatives each from the care providers and the funding agencies). The main task of the Quality Committee is to develop a successor model to the current care rating system (“care quality benchmark”) and in doing so take into account in particular indicators for measuring quality of outcomes in the care homes. This new procedure for quality review is to be developed by 31 December 2017 for inpatient care, and by 31 December 2018 for outpatient care.
• Insured persons who live in fully/partially inpatient care homes will in future have an individual entitlement to additional care offerings and measures for additional activation. The care homes must conclude corresponding agreements with the care insurance funds and hire additional carers.
• According to the intention of the legislator, the principle of rehab before care should be reinforced, since rehabilitation services can prevent or delay the need for care. Therefore the medical services are obliged to apply a nationally uniform, structured procedure for rehab recommendations.

Summary & outlook

The Care Reinforcement Acts put care insurance as a whole on a new footing, with the focus being on improving care provision for patients. However, the effects of the statutory measures will be tangible throughout the care sector.

For example, not only the social insurance agencies but also the care homes will have to adapt to the various new features of the Care Reinforcement Act II. The guidelines on reviewing and adapting personnel structures in care homes are intended to reinforce the professional fundamentals of care work, for example, and promote the development of new concepts in care homes. Also with a view to the individual legal right of inpatients to additional – possibly innovative – care services, the care homes will be given new opportunities for service offerings and for hiring additional carers (funded by nursing care insurance).

Regarding the individual measures set out in the Care Reinforcement Act II but not yet specified (especially the procedure for measuring staffing requirements and the new mechanisms for quality reviews in care homes), it will be interesting to see how these are implemented from the perspective of all those involved. With regard to the reorganisation of quality reviews and the equal staffing of the Quality Committee, it is likely that the care providers’ associations will no longer be able to veto or delay the further development of quality and transparency standards.