832.10

CH-TG

§ 41 Krankenversicherungsverordnung (TG KVV) - Bedarfserfassungssysteme

Pflegefinanzierung - Ambulante Pflege sowie Hauswirtschaft und Betreuung

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§ 41 TG KVV · Bedarfserfassungssysteme

1. Die Leistungserbringer verwenden für die Bedarfsabklärung der ambulanten Langzeitpflege das Bedarfsabklärungssystem interRAI HC Schweiz oder ein vergleichbares, von unabhängiger Seite validiertes Bedarfserfassungssystem. Ausgenommen sind Leistungen der isolierten Wundbehandlung, der Wochenbettbetreuung, der Stillberatung sowie die in separaten Tarifverträgen abschliessend bezeichneten speziellen Leistungen der Ligen.

2. Für die Leistungserfassung im Tagesheim und in bewilligten Tages- und Nachtstrukturen im Pflegeheim ist ein vereinfachtes Bedarfsabklärungssystem zu verwenden. Die Restfinanzierung gemäss Art. 25a Abs. 5 KVG ist geschuldet, wenn das Bedarfsabklärungssystem RAI D/N oder weitere, von unabhängiger Seite validierte Bedarfsabklärungssysteme verwendet werden.

← § 40 TG KVV Krankenversicherungsverordnung (TG KVV) - Inhalt § 42 TG KVV →

Gerichtsentscheide zu dieser Bestimmung (9)

TVR.2005.Nr.31 · tg (Art. 41 Abs. 1 Satz 1 KVG)

Cost Coverage for Non-Cantonal Hospitalizations and Cantonal Physician Approval

Cited to explain the principle of the insured person's freedom to choose a service provider anywhere in Switzerland.

TVR.2005.Nr.31 · tg (Art. 41 Abs. 1 Satz 3 KVG)

Cost Coverage for Non-Cantonal Hospitalizations and Cantonal Physician Approval

Cited to explain the general rule regarding the maximum cost coverage based on the resident canton's tariffs, which serves as context for the exception in Art. 41 Abs. 3 KVG.

TVR.2005.Nr.31 · tg (Art. 41 Abs. 2 KVG)

Cost Coverage for Non-Cantonal Hospitalizations and Cantonal Physician Approval

Cited to define the conditions under which costs must be covered according to out-of-canton tariffs due to medical necessity relative to the hospital list.

TVR.2005.Nr.31 · tg (Art. 41 Abs. 3 KVG)

Cost Coverage for Non-Cantonal Hospitalizations and Cantonal Physician Approval

This provision is the substantive legal basis underpinning the claim for the canton to cover the difference in costs for medically necessary hospitalization outside the canton, and it is central to the dispute regarding the second operation.

TVR.2004.Nr.40 · tg (Art. 41 Abs. 3 KVG)

Insured Person v. Canton of Residence regarding Out-of-Canton Hospitalization Coverage for Morbus Behçet

This article governs the cost assumption for extra-cantonal hospitalisation, which is the core issue decided upon in point 2 of the dispositive.

TVR.2003.Nr.31 · tg (Art. 41 Abs. 3 KVG)

Jurisdictional Challenge in Health Insurance Reimbursement Claim

This provision concerns the substantive claim (Tariff difference for out-of-canton outpatient treatment) whose procedural route was the central issue of the decision.

TVR.2004.Nr.39 · tg (Art. 41 Abs. 3 KVG)

Cost Reimbursement for Out-of-Canton Treatment and Principle of Economy

Cited in point 1 of the summary regarding the retention of the right to cost reimbursement even without prior cost approval.

TVR.2004.Nr.39 · tg (Art. 41 Abs. 3 KVG)

Cost Reimbursement for Out-of-Canton Treatment and Principle of Economy

Cited in the summary regarding the right to cost reimbursement for out-of-canton treatment, which was affirmed despite the lack of prior approval.

TVR.2000.Nr.38 · tg (Art. 41 Abs. 3 KVG)

Jurisdiction Over Federal Health Insurance Cost Reimbursements and Cantonal Procedural Rules

This article establishes the basis for the right to reimbursement for extra-cantonal hospitalization costs which was the subject of the dispute.