Filenews 14 January 2022
The home general nursing services joined the GHS in December 2020, offering the opportunity to specific groups of beneficiaries to receive specialized health care services at home.
Access to these services is made upon referral by the Staff or the Specialist Doctor and concerns beneficiaries who have been registered by the PD as "bowed". In other words, in cases where a beneficiary, due to serious health problems, cannot move from the place where he/she is located, there is the possibility that the nursing health care services are provided at home.
Therefore, when the beneficiary secures the relevant referral from the Personal or Specialist doctor, he/she has the right to choose from the list of providers participating in the GHS, the one who wishes to offer him/her the services he/she needs at home. The beneficiary must then arrange an appointment with the nurse of his/her choice.
The GHS covers a specific maximum number of sessions for home general nursing services per beneficiary, per year.
More specifically:
All patients (children and adults) have the right to receive up to 12 visits per year, which are covered by the System. In exceptional cases where the attending physician and the nurse consider that the patient needs more visits, then they have the possibility to request a larger number of visits. That request shall be assessed by the Agency, provided that all necessary information and relevant documentation are provided.
Each new year, the beneficiary has the possibility of receiving up to 12 visits, if of course the conditions for which the GHS compensates the home nursing services are met.
CONSUMABLES
The medical devices or consumables needed by each beneficiary for his/her health care at home are prescribed by the attending physician. They may be obtained according to the type either from hospital pharmacies (or from hospital warehouses) or from private pharmacies. Products supplied by private pharmacies shall bear the words 'IF' in their description.
In cases where the beneficiary or another relative does not have the ability to receive the necessary consumables himself and in case there is a relevant authorization, the System enables the nurse to obtain them on behalf of the beneficiary. In this case, the nurse should obtain the appropriate authorization from the beneficiary. The nurse should provide the pharmacy with personal information of the beneficiary such as identity card number and date of birth.
FREQUENTLY ASKED QUESTIONS
Can a beneficiary receive services outside the GHS from a nurse who is contracted with the System?
In cases where the beneficiary does not own or does not submit a referral with services reimbursed by the GHS, then the nurse has the ability to provide his services, which however will not be compensated by the System. However, it must inform the beneficiary from the beginning that he/she will receive services outside the System. The same applies in cases where the beneficiary has exhausted the maximum number of visits to which he is entitled, as defined by the Agency.
Can beneficiaries receive services over the weekend?
The Health Insurance Organisation does not specify the working days/hours of each provider. In such cases, however, the provider must comply with the regulations issued by the Agency in relation to the total duration of service provision in order to ensure the provision of quality healthcare services to the beneficiaries.
Can a beneficiary who is hospitalized in a hospital not contracted with the OSA receive services from a nurse contracted with the GHS?
If this is a patient who is hospitalized in a hospital not contracted with the HIO and who does not have a referral for the provision of Nursing Health Care services, then the Nurse can continue to offer his services outside the GHS framework, with the cost to be borne by the beneficiary.
In case of provision of services during the hospitalization of a beneficiary in a hospital contracted with the GHS, these services are reimbursed in accordance with the DRG coding system in which they are included.
