AOK Nordost plans the binding coordinated and structured cooperation of fully stationary care facilities with general practitioners who already provide services to the insured persons of the care facility within the framework of a cooperation agreement in accordance with Section 119b SGB V. The aim of the contract is to provide participating insured persons in need of care with binding, close-meshed and high-quality, needs-based medical and nursing care. For this purpose, contracts according to Section 140a SGB V in conjunction with Section 92b SGB XI are concluded with providers of full-inpatient care facilities that go beyond the services provided for in accordance with Section 119b SGB V.
This is an authorisation procedure within the meaning of recital (4) of the EU Directive (2014/24/EC) of 26.02.2014 on public procurement. Any suitable interested party can become a contractual partner. Subject to uniform suitability requirements and taking into account the cost-effectiveness requirement (§§ 4 para. 4, 12, 70 SGB V), all suitable full-stationary care facilities are offered the conclusion of a contract in accordance with Section 140a SGB V in conjunction with § 92b SGB XI, as long as the objectives of the contract are still met at the time the contract is concluded can be achieved.
AOK Nordost publishes the approval procedure for special care for insured persons in fully inpatient care facilities for the period from April 1, 2022 to March 31, 2026, which are approved in accordance with Section 71 (2) SGB XI. The care of participating, usually multi-morbid, insured persons in need of care should represent binding, close-knit and high-quality, needs-based medical and nursing care within the framework of this contract.
For this purpose, binding regular attendance of the cooperating family doctor, extended family doctor call services and weekend talks to agree on individual emergency plans for participating insured persons with foreseeable acute situations that are emerging are defined.
In order to implement more effective care processes, the nursing care providers (contractually bound full-stationary care facilities) establish a coordinated and binding cooperation with the cooperating family doctor in accordance with this contract. This is done, among other things, through regular case conferences and doctor-patient contacts accompanied by the care facilities, coordinated and binding contacts, and the appointment of a permanent contact person in the fully inpatient care facility for the cooperating family doctor.
Nursing service providers must develop a concept for the interfaces of medical and nursing care that reflects the distribution of tasks, responsibilities and coordination processes.
Care providers must ensure that nursing staff complete the training offered by the payers under this contract.
The training includes identifying drug-associated diseases and risks based on symptoms of policyholders in need of care and reducing and/or avoiding them as far as possible, and creating the basis for targeted communication with everyone involved in care.
The nursing care providers provide care to the insured and are responsible for involving the cooperating family doctors (according to point III.1.3 d).
Nursing and medical care providers must meet personal and technical requirements as well as quality requirements, which are described in the application form (including forms).
Compensation is calculated at a flat rate per quarter.
The open procedure form is only used because there is no form for admission procedures. Contracts for which no selection decision is made among suitable applicants are not subject to public procurement law. Submission to public procurement regulations is not associated with the use of this form.