Facts
The self-employed nurse A. submitted a collective invoice to the municipality B. for residual costs of outpatient psychiatric care from April to June 2014 in the amount of 129.15 Swiss francs. The municipality rejected the reimbursement, as A. had not used the prescribed, validated needs assessment system "Resident Assessment Instrument - Home Care (RAI-HC)".
The Administrative Court of the Canton of Thurgau dismissed the appeal filed against this. A. then filed a public law appeal with the Federal Supreme Court.
Considerations
The Federal Supreme Court states that the Federal Council must regulate the procedure for determining the need for nursing services according to federal law. The Federal Department of the Interior (EDI) has stipulated in the Ordinance on Benefits in Compulsory Health Insurance (KLV) that the needs assessment must be based on uniform criteria and the expected time required must be specified.
The Canton of Thurgau has determined in its Ordinance on the Cantonal Health Insurance Act (KVV/TG) that the validated "RAI Homecare" system must be used for the needs assessment. This system meets…