Healthcare services under the KOSM pilot from 1 September 2022: On 30 August, the new order of the President of the National Health Fund on the pilot programme for hospital treatment - KOSM comprehensive services came into force.
- Multiple sclerosis (MS) affects 45-50 000 people in Poland. For almost two years, a pilot of the Comprehensive Care for Patients with MS (KOSM) has been implemented
- A new order of the President of the National Health Fund concerning the piloting of KOSM from 1 September until the end of next year has appeared in the Database of the National Health Fund's own acts
- The new Ordinance on the Hospital Treatment Pilot Programme - Comprehensive Benefits KOSM contains a number of changes from previous programmes and the rules under which the pilot can be run in the new iteration. The act took effect on 30 August
Extended KOSM pilot. On what terms?
The Ordinance of the President of the National Health Fund on the pilot programme in the field of hospital treatment - comprehensive services KOSM specifies:
1) Aim of the pilot programme: to explore the possibility of improving the therapeutic outcomes of patients diagnosed with multiple sclerosis (MS), including: reducing the occurrence of relapses and the appearance of new demyelinating lesions, and reversing existing lesions in the nervous system, by changing the way in which services are organised and extending comprehensive care to recipients with an ICD-10 G35 diagnosis.
(2) period of implementation of the pilot programme: healthcare services under the pilot programme may be provided no earlier than 1 September 2022 and no later than 31 December 2023
3) the scope and type of healthcare services covered by the pilot scheme;
4) in cases arising from the purpose of the pilot programme, the population living in the specific territorial area covered by the pilot programme;
5) the conditions for the organisation of healthcare services and the conditions for their provision, including medical personnel and medical equipment and apparatus;
6) the method of accounting for healthcare services;
7) the way in which the healthcare provider is selected by the beneficiary, taking into account the rules for the provision of healthcare services on the basis of a referral and the maintenance of a waiting list for the provision of services, or the way in which the healthcare provider covers a given population with healthcare services;
8) the implementer of the pilot programme or the procedure for its selection;
9) indicators for the implementation of the pilot programme;
10) how the indicators for the implementation of the pilot programme will be measured;
11) how the results of the pilot programme will be evaluated;
12) the entity obliged to finance the pilot programme.
The Ordinance also sets out the rules necessary for the reporting and billing of benefits, the model contract for the provision of benefits that are the subject of this regulation, the model application for the conclusion of contracts for the pilot programme in question, and the model report.
Dropping the condition for health assessment
On the basis of the regulation, the director of the provincial branch of the National Health Fund will be obliged to act in order to conclude contracts for the provision of services under the pilot programme.
In addition, the accessibility of comprehensive care for multiple sclerosis (MS) patients is being increased through changes to the programme's patient eligibility criteria and the terms and conditions of service organisation and delivery.
The change is to increase accessibility to treatment under the programme by extending their eligibility criteria - the condition on the patient's health assessment, which includes a group with a moderate degree of disability, i.e. between 4.0 and 6.5 points on the EDSS scale, has been dropped.
The conditions of the organisation of services and the conditions of their implementation have also been relaxed by, among other things, reducing the number of beneficiaries with diagnosed multiple sclerosis (MS) under the care of one coordination centre, which covers min. 300 patients (was: from 500 to 1,200 patients).
Clinical psychologist instead of neuropsychologist
With regard to the required personnel - in place of neuropsychologist, the entry: clinical psychologist has been introduced - this change j is to facilitate the verification of the correctness of the submitted documents, because according to the Regulation of the Minister of Health of 13 June 2017 on specialisations in fields applicable to health care, the specialisation "neuropsychologist" is not listed.
The procedure for the urodynamic examination as mandatory for the billing of the first consultation has also been abolished. Valuations of the billing products of comprehensive specialised care for patients with MS have been aligned with current valuations for inpatient treatment, outpatient specialised care, inpatient rehabilitation and psychiatric and addiction care.
The entire project is available HERE.
Source: rynekzdrowia.pl