Before a new diagnostic and treatment method can be offered and reimbursed in the outpatient sector, two important steps need to be completed first.
First, the G-BA needs to assess the method and determine that it
- offers a benefit for patients,
- is medically needed, and
- is economical.
Then, the evaluation committee of physicians and SHI funds needs to agree on the amount of reimbursement and add the method to the EBM.
Only then can the method be offered by physicians and will be reimbursed by the SHI funds. This is referred to as a “reservation for allowance” (German: Erlaubnisvorbehalt).
These steps have been completed now for the following three new methods, which can be offered from 1 October 2021 onwards:
- Newborn screening for SMA and sickle cell disease
- One-time hepatitis B and C screening included in 3-yearly check-up available for people aged > 35 years
- Group psychotherapy within primary care setting without prior approval from SHI funds