Diederik Schrijvershof and Ramesh Kaushik have successfully represented Arkin in proceedings before the Dutch Trade and Industry Appeals Tribunal (the “Tribunal”). The proceedings were instituted to obtain cost-covering reimbursement of acute mental healthcare. The Tribunal set aside the decision of the NZa (Dutch Healthcare Authority) that served as the basis for the 2020 acute mental healthcare budget for the Amsterdam region. The Tribunal found that the NZa had set the acute mental healthcare budget for this region too low.
Since 2020, acute mental healthcare has been purchased on an annual basis per acute mental healthcare region. Acute mental healthcare is reimbursed on the basis of availability. Healthcare providers and insurers make regional agreements on what constitutes appropriate acute mental healthcare in accordance with the Acute Psychiatry Generic Module (GMAP). The NZa issues orders per acute mental healthcare region, on the basis of which healthcare providers can claim acute mental healthcare from the insurer. Arkin is the budget holder for the Amsterdam acute mental healthcare region. Arkin argued on appeal, among other things, that the acute mental healthcare budget adopted by the NZa is incomplete and does not cover the costs. The budget is wrongly based exclusively on a calculation model of Zorgverzekeraars Nederland (the Association of Dutch Health Insurers (the “ZN calculation model”).
The Tribunal found in favour of Arkin. The NZa had not established whether the acute mental healthcare budget for the Amsterdam region covered the costs. In that regard the ruling clarifies the NZa’s role in setting the rates under the Wet marktordening gezondheidszorg (Healthcare (Market Regulation) Act). Those rates must meet the cost-coverage requirement, meaning that the rates must cover the reasonable healthcare costs. According to the Tribunal, the NZa has no discretionary leeway with regard to cost coverage. The Tribunal also found that the 2020 acute mental healthcare budget for the Amsterdam region was based on a budget proposal by Zilveren Kruis that used the ZN calculation model. The ZN calculation model in fact resulted in a predetermined budget ceiling for each acute healthcare region in the Netherlands (including the Amsterdam region). According to the Tribunal, that is not in keeping with the manner in which an acute healthcare budget must be calculated under the NZa Acute Mental Healthcare Policy Rules. The Tribunal issued a press release on the ruling. Various media have also reported on the Tribunal’s ruling: see here, here and here.
Maverick Advocaten represents healthcare providers on a daily basis in proceedings to obtain better healthcare rates. It has previously successfully helped several acute healthcare providers obtain a cost-coverage ruling from the NZa for 2020. Maverick Advocaten has also been successful in (preliminary relief) proceedings on behalf of healthcare providers relating to the procurement of, among other things, youth care, forensic care, SGLVG (Serious Behavioural Problems and Mild Intellectual Disability) care and (also on appeal) long-term healthcare. Maverick Advocaten has furthermore successfully challenged excessive purchasing power of health insurers.
More information on the rights of healthcare providers in healthcare sales and on how their trade associations can support them in that respect can be found at www.zorgcontractering.com.