Facts
A.A., born in 1948, is mandatorily insured for nursing care with Arcosana AG. Since the onset of paraplegia, she has been cared for at home by her husband B.A. and by the home care organization C. since December 2015. B.A. was employed as a caring relative by X. GmbH as of 1 January 2017. However, Arcosana AG rejected the remuneration of the measures of examination and treatment provided by B.A., as he does not have the appropriate training.Considerations
The Federal Supreme Court confirms the decision of the lower court. According to the case law, family members employed by a home care organization can provide basic nursing services within the meaning of Art. 7 para. 2 lit. c no. 1 HIBO at the expense of the mandatory health insurance (OKP), even if they do not have nursing training. However, for measures of examination and treatment pursuant to Art. 7 para. 2 lit. b HIBO, appropriate training is required.
The Federal Supreme Court states that neither the law nor the ordinances define the minimum professional requirements that employees of home care organizations must meet in order for their services to be reimbursed by the OKP. For basic nursing measures,…