Pharmacies and other service providers can be contract partners of health insurance funds in the field of medical aids and must fulfill certain requirements, so-called suitability criteria. The basis for this is the Fifth Social Code with Section 126, which also requires them to undergo certain prequalification procedures so that their suitability to provide medical aids can be proven for contracts with the health insurance funds. These procedures have been in place since the beginning of 2011.
In 2022, there will be made some changes which will also affect pharmacies. Enteral nutrition, consisting of sip and tube feed nutrition, has been newly included in the catalog of criteria for prequalification; existing prequalifications are excluded. Pharmacies that are re-prequalified must tick the supply area 03F15 R, otherwise there is no risk of reimbursement by the health insurance funds.
A lack of prequalification does not generally mean that the supply of SHI patients is excluded: from January 2022, if health insurance funds conclude contracts with insured persons for sip feeds and tube feeds, the service providers concluding the contracts, such as pharmacies, are also legally obliged to show prequalification in this area. However, if in some cases no contract has been concluded between the SHI patient and the SHI fund, it is still the case that service providers do not have to be qualified.
For employed pharmaceutical technical assistants (PTA), too, it has recently been stipulated that the professional qualification must cover the areas of care. Prerequisites are a professional license and three years of relevant professional experience. A criteria catalog provides information about the professional management as PTA of the individual care area, such as in stoma care. PTAs have professional responsibility and are also authorized to give professional instructions, but not necessarily disciplinary instructions. The PTA does not generally have to be on site, but must always be available throughout in the event of problems.
For the supply area of ostomy, the professional management must provide proof of further training, which identifies the supply area 29A with „ostomy aids“. These verifications always apply to all employees when advising and dispensing stoma products. However, the deadlines for completing these continuing education courses have been postponed due to the Corona pandemic and, as a result, are subject to review with deadline extensions – beginning in January 2024 for managers and January 2025 for employees, respectively.
Source: www.apotheke-adhoc.de