Diederik Schrijvershof is representing a large mental healthcare provider claiming cost-covering reimbursement of acute mental healthcare. Maverick Advocaten’s team is assisting the mental healthcare provider regarding both the actual costs for 2020 (final budget) and the estimated cost for 2021 (provisional budget). The provider objected to the NZa's decision for 2021. In both cases the aim is to arrive at a budget that does justice to the actual costs involved in the Acute Psychiatry Generic Module (GMAP) for the mental healthcare provider.
Since 2020, acute mental healthcare has been purchased jointly in 28 different acute mental healthcare regions. Acute mental healthcare is reimbursed on the basis of availability. Care providers must therefore make agreements with insurers on what constitutes appropriate acute mental healthcare in accordance with the Acute Psychiatry Generic Module in the acute mental healthcare region for which they are responsible. The NZa then issues decisions on the basis of which providers can claim acute mental healthcare from the health insurer. In 2020, Maverick Advocaten successfully helped seven mental healthcare providers obtain a cost-covering decision from the NZa. A team of Maverick Advocaten did the same in 2021. Diederik Schrijvershof and Ramesh Kaushik successfully represented mental healthcare provider Arkin in proceedings before the Dutch Trade and Industry Appeals Tribunal (CBb). According to the CBb, the NZa had set too low a budget for acute mental healthcare in 2020.
Maverick Advocaten helps healthcare providers on a daily basis to obtain cost-covering rates in the healthcare sector or to challenge inadequate turnover ceilings. Maverick has also successfully brough legal actions on behalf of healthcare providers in the procurement of, among other things, GP care, acute mental healthcare (see here and here), forensic care, youth care, SGLVG (Serious Behavioural Problems and Mild Intellectual Disability) care, long-term care (also on appeal) and care under the Social Support Act (see also here), and against excessive market power of health insurers.
More information on the duty of care, the healthcare procurement duty and their enforcement can be found in this blog. More information on the rights of healthcare providers in healthcare sale and the ways in which their trade associations can support them in that regard can be found at www.zorgcontractering.com.