Percutane hartklep implantatie bij congenitale en ... - KCE

20 Percutaneous Heart Valves KCE Reports 95
The OI/CCI advises on the proposition and transfers its advice for approval to the
“Insurance Committee”. The proposition contains a proposition of a convention with
scientific societies, physicians or hospitals. It determines the conditions for
reimbursement:
• the target group and the criteria of inclusion of the patients are defined
• an evaluation period is scheduled
• norms aimed for the implantation centres/physicians are set
• the number of implants or patients is (can be) limited
• the feedback between the physicians and the system is compulsory in
order to be reimbursed
• the reimbursement and the evaluation are specified
• the evaluation method is described
• the reimbursement procedure is clearly defined. Mostly, the “College
of physician-directors” (CGD/CMD) is charged with the examination of
the individuals file.
Before the end of the agreed period of evaluation, the peer review group competent in
the domain at stake should present a report based on the collected data and the
scientific literature on behalf of the TRI/CTI and the CGD/CMD. The report also
contains a proposition for a permanent reimbursement regulation.
This proposition is then transmitted with the advice of the CGD/CMD to the TRI/CTI,
who works out, in case of a favourable evaluation, the proposition into a full
reimbursement regulation. It transmits its proposition to the OI/CCI.
The OI/CCI advises on the proposition and submits its advice to the “Insurance
Committee” for approval.
Figure 2.4: Current procedure for reimbursement of implants (Art. 35, §3,
cat. 5 medical nomenclature)