Diederik Schrijvershof, Leah Peeters and Annabel Kingma have successfully challenged in court the long-term care procurement policy of the CZ care administration office on behalf of seven mental healthcare providers. The seven care providers (Emergis, Parnassia Groep, GGZ WNB, GGzE, GGz Breburg, GGZ Oost Brabant and Mondriaan) were forced to apply to the court in July 2023 because they disagreed with the CZ care administration office’s mental healthcare procurement plans. The CZ care administration office expressly refused to comply with their substantiated objections. The care procurement policy was designed so that applying to the court was the only option available to the care providers.
The CZ care administration office intended to fund clients with a long-term care indication who live in sheltered accommodation at a mental healthcare provider only in the form of bundled payment (whereby residential care, mental healthcare treatment and general medical care are all funded under the Wet langdurige zorg (Long-Term Care Act). Previously, modular funding was possible (residential care being covered under the Long-Term Care Act and mental healthcare treatment and general medical care under the Zorgverzekeringswet (Healthcare Insurance Act)). For providers of sheltered accommodation, the abrupt switch would mean that, in order to protect their clients’ freedom of choice of a treatment provider, they would have to enter into subcontracts with numerous primary care providers in the short term, which would create a significant administrative burden. CZ furthermore introduced a 20% discount on the Residential 1 and 2 care profiles as from 1 January 2024. That would lead to unrealistic and non-cost-effective rates.
The Court of The Hague ruled in favour of the mental healthcare organisations in preliminary relief proceedings. The court cancelled the proposed bundled payment and the proposed reduction of the rates. With regard to the switch to bundled payment, the court found that CZ was exceeding the limits of its own freedom of policy. The mental healthcare providers are therefore free to choose a modular funding model until 1 January 2025. The court also found the discount to be disproportionate and considered it insufficiently plausible that it would effectively contribute towards stimulating the deployment of care, counselling and support in the home environment.
Maverick Advocaten assists healthcare providers on a daily basis to achieve cost-covering healthcare rates or to challenge inadequate turnover and other caps. It is litigating, for instance, on behalf of providers of forensic mental healthcare against the NZa 2023 Mental Healthcare and Forensic Care Rates Decision. Maverick Advocaten is also litigating on behalf of the De Bevlogen Huisartsen foundation and 129 individual GPs against the NZa Tariff Decision on GP Care 2023. Previously, Maverick Advocaten achieved successes in preliminary relief proceedings for healthcare providers in the procurement of, among other things, GP care, acute mental healthcare (see here and here), forensic care, youth care, SGLVG (Serious Behavioural Problems and Mild Intellectual Disability) care, long-term care (also on appeal) and care under the Social Support Act (see also here). Maverick Advocaten also challenges excessive market power of health insurers: see also here.
More information on the healthcare procurement duty/duty of care and its enforcement is provided in this blog, this blog and this interview in Zorgvisie. More information on the rights of healthcare providers in healthcare sales and the possibilities for their industry associations to support them in this regard can be found at www.zorgcontractering.com
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