draft regulation KOSM. It alleviates the circumstances, increases accessibility

  • A Draft New Ordinance from the President of the National Health Fund on a Pilot Hospital Treatment Program Has Been Published – Comprehensive KOSM Services
  • The regulation increases the availability of comprehensive care for patients suffering from multiple sclerosis (MS) through changes to the criteria for qualifying patients for the program and the conditions for the organization of health services
  • Service providers have until July 20 to submit comments

Project ordered in case of KOSM. What is changing?

The ongoing KOSM pilot program will end on July 31. It will continue under slightly different terms.

The new regulation determines, inter alia, the rules necessary for the notification and settlement of the benefits, the model of the contract for the regulation of services, the model of the application for the conclusion of contracts for the implementation of the relevant pilot program as well as the model of the report.

Pursuant to the decision, the director of the provincial department of the National Health Fund is obliged to undertake activities aimed at concluding contracts for services within the framework of the pilot.

In addition, the regulation increases the availability of comprehensive care for patients suffering from multiple sclerosis (MS) through changes in the criteria for qualifying patients for the program and the conditions for the organization of health services and the conditions for their implementation.

The change consists of increasing patients’ availability for treatment under the program by expanding their eligibility criteria – the condition relating to the assessment of a patient’s health, including a group with moderate degrees of disability, was waivedie from 4.0 to 6.5 points on the EDSS scale.

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Relaxed conditions for the provision and execution of benefits

The conditions for the organization of care services and the conditions for their implementation have also been relaxed, e.g. by:

  • The reduction in the number of beneficiaries diagnosed with multiple sclerosis (MS) covered by one coordination center includes min. 400 patients (from: 500 to 1,200 patients).
  • As for the necessary staff – instead of a neuropsychologist, the following entry was entered: clinical psychologist; This change will facilitate the verification of the correctness of the documents submitted, because according to the Ordinance of the Minister of Health of June 13, 2017 on specialization in fields applicable to health care, there is no specialization called “neuropsychologist” .
  • At the completion of the first consultation, the urodynamic examination has been abolished as mandatory.
  • · The valuation of settlement products for integrated specialist care for a patient with MS has been adjusted to current valuations in the field of hospital treatment, outpatient specialist care, therapeutic rehabilitation as well as psychiatric care and addiction care.

The above activities have been undertaken in the context of the implementation of Objective 2 of the Strategy National Health Fund 2019-2023 – Improving the quality and availability of healthcare services.

The National Health Fund headquarters is waiting in time for opinions and comments on the draft regulation in question until July 20, 2022, until 4 p.m. (the date of receipt by the Fund’s registered office is counted), which may only be sent in electronic form to the email address: pilotaze@nfz.gov.pl, in accordance with the editable Excel version.

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KOSM Pilot Objectives

Let us remind you that the aim of the pilot project is to investigate the possibility of improving the effects of therapy in patients diagnosed with multiple sclerosis (MS), including: reducing the occurrence of relapses and the onset of new demyelinating lesions, and restoring the pre-existing changes in the nervous system by changing the organization of services, in particular by:

Diagnostics, including verification of multiple sclerosis (MS) diagnosis, verification of relapse diagnosis, monitoring magnetic resonance imaging (MRI) of the brain or spinal cord without contrast or with contrast
Therapy according to clinical indications:
a) in patients with symptoms of significant spasticity – ensure access to treatment with a baclofen pump,
b) in patients with neurogenic bladder symptoms – ensuring access to the drug program B.73.- Treatment of neurogenic detrusor overactivity ICD-10N31
Outpatient specialist care (access to specialist doctors)
Comprehensive therapeutic rehabilitation
Care in the field of psychology and psychiatry
Collaboration with a doctor and nurse from primary health care (POZ).

Download the text of the draft regulation below.

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