[The content-analysis of normative legal regulation of medical social rehabilitation of children with infantile cerebral paralysis in the Russian Federation].

The infantile cerebral paralysis is a significant medical social problem and economic burden for family, health care system and state economy in general since such children require organization of accessible environment and life-long rehabilitation maintenance. The purpose of the study is content-analysis of normative legal regulation of medical social rehabilitation of children with infantile cerebral paralysis in the Russian Federation. The analysis of main normative legal documents established that medical social rehabilitation is implemented in concordance with norms of international legislation and is regulated by provisions of Federal laws and other normative legal acts of the Russian Federation and its subjects. It was established that despite noticeable progress the legislation in this area has a number of significant shortcomings that adversely affect accessibility for children with cerebral palsy of high-quality and effective services of comprehensive medical social rehabilitation and requires improvement.

[Social rights claims for malignant melanoma patients : Providing patient information in German dermatological practices]. / Sozialrechtliche Ansprüche beim malignen Melanom : Aufklärung von Patienten in deutschen dermatologischen Praxen.

BACKGROUND: Treatment of patients with malignant melanoma includes informing the patients about their rights regarding social/disability benefits. In particular, every patient has the right to rehabilitation treatment according to SGB V and IX (SGB: Sozialgesetzbuch; Social Security Code) and to an examination regarding the classification of the disability. OBJECTIVES: The present study examines the extent to which patients with invasive malignant melanoma are informed after initial diagnosis about their social rights to medical rehabilitation measures and the classification of disability. MATERIALS AND METHODS: In the course of a survey in 2014, n = 1800 German dermatological practices were contacted and provided a standardized questionnaire on several care-relevant questions, including the aforementioned ones. RESULTS: Evaluable questionnaires were submitted by n = 424 practices. In all, 52% of dermatologists stated that they regularly provided information on the right to rehabilitation, 15% sometimes, 41% rarely or never. Furthermore, 44% of dermatologists regularly, 17% sometimes and 38% rarely or never informed their patients about the classification of disability. Relevant differences were found in regional comparisons. CONCLUSIONS: Practicing dermatologists seem to transfer the information requirement to the clinics involved in the treatment. It would be beneficial if the information were also provided again by the dermatologists in private practice. In view of the known limited capacity to receive new information from patients with newly diagnosed melanoma, repeated counselling appears to be more patient-friendly.

Definition of Domiciliary Care. Final rule.

The Department of Veterans Affairs (VA) adopts as final, with no changes, a proposed rule amending the definition of domiciliary care to encompass VA's Mental Health Residential Rehabilitation Treatment Program (MH RRTP). This rule aligns regulations with VA's administrative decision in 2005 to designate MH RRTP as a type of domiciliary care. We also proposed clarifying that domiciliary care provides temporary, not permanent, residence to affected veterans. We provided a 60-day comment period on this proposed rule and received 4 comments, all of which were generally supportive of the proposed changes. We make no changes based on public comments and adopt the proposed rule as final.

[Reorientation of Medical Procedures Covered by Statutory Accident Insurance]. / Neuausrichtung der Heilverfahren der Gesetzlichen Unfallversicherung.

As of 01/01/2014, the German Statutory Accident Insurance (DGUV) has reorganized inpatient medical procedures. The central element of reorientation is the reorganization of the catalogue of types of accidents and type of medical procedures of hospitalized injured patients in 3 care stages. In addition, the reorientation also concentrates on hospitals with the highest performance and the best qualification and also focuses on severe and most severe injuries.This reorientation is also based on the White Paper of the German Society for Trauma Surgery (DGU), especially on the Trauma Network DGU. The new regulations will be implemented by the state associations of the German Statutory Accident Insurance.The hierarchy of care depends on established admission criteria and the severity of injury. This structuring also refers to special competence in the field of rehabilitation and will lead to the strengthening of multidisciplinary rehabilitation management and workplace-related modules of the healthcare. Overall, the accident insurance institution will place increased demands on their network partners.

Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2018. Final rule.

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2018 as required by the statute. As required by section 1886(j)(5) of the Social Security Act (the Act), this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2018. This final rule also revises the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes that are used to determine presumptive compliance under the "60 percent rule," removes the 25 percent payment penalty for inpatient rehabilitation facility patient assessment instrument (IRF-PAI) late transmissions, removes the voluntary swallowing status item (Item 27) from the IRF-PAI, summarizes comments regarding the criteria used to classify facilities for payment under the IRF PPS, provides for a subregulatory process for certain annual updates to the presumptive methodology diagnosis code lists, adopts the use of height/weight items on the IRF-PAI to determine patient body mass index (BMI) greater than 50 for cases of single-joint replacement under the presumptive methodology, and revises and updates measures and reporting requirements under the IRF quality reporting program (QRP).

[Comparison of medical rehabilitation in various European countries and the impact of European law on rehabilitation practice in Germany]. / Medizinische Rehabilitation im europäischen Vergleich und Auswirkungen des europäischen Rechts auf die deutsche Rehabilitation.

Medical rehabilitation practice differs substantially among European countries. In most countries, rehabilitation is predominantly carried out on an outpatient basis. It is funded by health care, and rehabilitation facilities are not very specialized in terms of specific indications. In contrast, medical rehabilitation in Germany is mostly carried out on an in-patient basis as a contained 3­week treatment. European law and European policies merely have an indirect impact on rehabilitation practice in Germany. In this article, the advantages and disadvantages of the various forms of rehabilitation services are discussed.

[Current legal and jurisdictional questions from the perspective of the German Federal Association for Geriatrics : Practical report]. / Aktuelle rechtliche und rechtspolitische Fragestellungen aus Sicht des Bundesverbands Geriatrie : Praxisbericht.

The article discusses the questions of the arbitration bodies according to § 111b SGB V (Volume V of the Social Insurance Code) in the individual federal states from the perspective of geriatric rehabilitation hospitals. The content of the agreement of reimbursement between a rehabilitation hospital and health insurance will be targeted as well as the question whether the entire content of the agreements of reimbursement can be negotiated at the arbitration body. In addition, the authors describe the consequences of the jurisprudence of the Federal Social Court on § 301 I. S. 1 no. 8 SGB V and the reaction of the lawgiver. Furthermore the authors describe the effects of the jurisprudence of the Federal Social Court regarding the minimum age associated with complex geriatric treatment (OPS 8-550).

Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis.

BACKGROUND: Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization's (WHO) Guidelines on health related rehabilitation. METHODS: An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley's approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. RESULTS: Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and 'institutionalizing' programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability. CONCLUSIONS: Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.

Between ideals and reality in home-based rehabilitation.

SETTING AND OBJECTIVE: The growing elderly population and the rising number of people with chronic diseases indicate an increasing need for rehabilitation. Norwegian municipalities are required by law to offer rehabilitation. The aim of this study was to investigate how rehabilitation work is perceived and carried out by first-line service providers compared with the guidelines issued by Norway's health authorities. DESIGN AND SUBJECTS: In this action research project, qualitative data were collected through 24 individual interviews and seven group interviews with employees--service providers and managers--in the home-based service of two boroughs in Oslo, Norway. The data were analysed using a systematic text-condensation method. RESULTS: The results show that rehabilitation receives little attention in the boroughs and that patients are seldom rehabilitated at home. There is disagreement among professional staff as to what rehabilitation is and should be. The purchaser-provider organization, high speed of service delivery, and scarcity of resources are reported to hamper rehabilitation work. CONCLUSION AND IMPLICATIONS: A discrepancy exists between the high level of ambitious goals of Norwegian health authorities and the possibilities that practitioners have to achieve them. This situation results in healthcare staff being squeezed by the increasing expectations and demands of the population and the promises and statutory rights coming from politicians and administrators. For the employees in the municipalities to place rehabilitation on the agenda, it is a requirement that authorities understand the clinical aspect of rehabilitation and provide the municipalities with adequate framework conditions for successful rehabilitation work. KEY POINTS: Home-based rehabilitation is documented to be effective, and access to rehabilitation has been established in Norwegian law. The purchaser-provider organization, high rate of speed, and a scarcity of resources in home-based services hamper rehabilitation work. Healthcare providers find themselves squeezed between the health authorities' overarching guidelines and requirements and the possibilities of achieving them. Rehabilitation must be placed on the agenda on the condition that authorities understand the clinical aspect of rehabilitation.

Final Priority--Training of Interpreters for Individuals Who Are Deaf or Hard of Hearing and Individuals Who Are Deaf-Blind Program. Final priority.

The Assistant Secretary for Special Education and Rehabilitative Services announces a final priority under the Training of Interpreters for Individuals Who Are Deaf or Hard of Hearing and Individuals Who Are Deaf-Blind Program. The Assistant Secretary may use this priority for competitions in fiscal year 2016 and later years. We take this action to provide training and technical assistance to better prepare novice interpreters to become highly qualified, nationally certified sign language interpreters.

Automobile or Other Conveyance and Adaptive Equipment Certificate of Eligibility for Veterans or Members of the Armed Forces With Amyotrophic Lateral Sclerosis Connected to Military Service. Final rule.

The Department of Veterans Affairs (VA) published an Interim Final Rule on February 25, 2015, to amend its adjudication regulations to provide a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment for all veterans with service-connected amyotrophic lateral sclerosis (ALS) and servicemembers serving on active duty with ALS. The amendment authorized automatic issuance of a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment to all veterans with service-connected ALS and members of the Armed Forces serving on active duty with ALS. The intent of this final rule is to confirm the amendment made by the interim final rule without change.

[The federal participation law : New requirements for needs assessment with special emphasis on medical rehabilitation services]. / Das Bundesteilhabegesetz : Neue Anforderungen an die Bedarfsermittlung und -feststellung mit besonderem Fokus auf medizinische Rehabilitationsleistungen.

The federal participation law (Bundesteilhabegesetz - BTHG) is one of the largest efforts in the last 15 years to reform the legal participation rights of people with disabilities. In particular, a number of enhancements are planned in the overall benefits law in Part 1 of Book IX in the Social Code (Sozialgesetzbuch - SGB), which applies to all rehabilitation carriers including general provisions and standards for needs assessment. This paper deals with the implications of these provisions and interacting standards, based on the draft bill of April 2016.The discussion takes place against the background of the regulatory objectives formulated in the ministerial draft itself, jurisprudential expertise on the effects of the current legal norms of the SGB IX as well as relevant professional political developments and statements by various stakeholders.The analysis shows a clear political commitment to increase the requirements for needs assessment in the overall law of the SGB IX and to express these more effectively. The draft bill seeks not only to modify procedures subsequent to the application for rehabilitation benefits, but also to precisely set out provisions on instruments for needs assessment in a new § 13. Common principles for these instruments of needs assessment should increase the cooperation, coordination and convergence among rehabilitation carriers.Nevertheless, with regard to the proposed regulatory texts, there is doubt that the objectives set by the draft bill itself will be achieved. For example, the required common principles for needs assessment are to be agreed upon based on the existing special legislation for the different rehabilitation carriers, without the SGB IX setting its own binding standards or framework principles. In addition, it lacks clear legal guidelines for the professional practice to make use of the bio-psycho-social model of the WHO and the ICF in the process of needs assessment. As a consequence the ICF cannot serve as a legally standardized reference point.

Realizing the Potential of Rehabilitative Care for People with Complex Health Conditions: The Time Is Now.

In today's demographic landscape, with its aging population and increasing number of individuals who are living with multiple chronic conditions and comorbidities, the healthcare system is tasked with responding to the needs of medically complex individuals. However, the pressures arising from this emerging demographic are felt not only within the acute care sector at the point of medical crisis but along the entire continuum of the healthcare system. Rehabilitative care plays a key role in that continuum by providing the process through which individuals are engaged in interventions to address their functional (both cognitive and physical) and psychosocial care goals to help them carry on with the business of living.

Final Priority and Definitions; Demonstration and Training Program: Career Pathways for Individuals With Disabilities. Final priority and definitions.

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority designed to demonstrate promising practices in the use of career pathways to improve employment outcomes for individuals with disabilities. Specifically, this priority will establish model demonstration projects that engage State vocational rehabilitation (VR) agencies in partnerships with other entities to develop and use career pathways to help individuals with disabilities eligible for VR services, including youth with disabilities, acquire necessary marketable skills and recognized postsecondary credentials. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2015 and later years.

Final Priority; Rehabilitation Training: Vocational Rehabilitation Technical Assistance Center--Youth With Disabilities. Final priority.

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Rehabilitation Training program. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2015 and later years. This priority is designed to ensure that professionals working in State vocational rehabilitation (VR) agencies receive the technical assistance (TA) they need to provide youth with disabilities with services and supports that lead to postsecondary education and competitive integrated employment.

Final Priority. Rehabilitation Training: Vocational Rehabilitation Workforce Innovation Technical Assistance Center. Final priority.

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Rehabilitation Training program. The Assistant Secretary may use this priority for competitions in fiscal year 2015 and later years. We take this action to provide training and technical assistance to State vocational rehabilitation agencies to improve services under the State Vocational Rehabilitation Services program and State Supported Employment Services program for individuals with disabilities, including those with the most significant disabilities, and to implement changes to the Rehabilitation Act of 1973, as amended by the Workforce Innovation and Opportunity Act (WIOA), signed into law on July 22, 2014.

Final Priority and Definitions--Rehabilitation Training: Vocational Rehabilitation Technical Assistance Center-Target Communities. Final priority and definitions.

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority and definitions under the Rehabilitation Training program to fund a cooperative agreement to develop and support a Vocational Rehabilitation Technical Assistance Center for Targeted Communities (VRTAC-TC). The Assistant Secretary may use the priority and definitions for competitions in fiscal year (FY) 2015 and later years. We take this action to focus Federal financial assistance on an identified national need. We intend the VRTAC-TC to improve the capacity of State vocational rehabilitation (VR) agencies and their partners to increase participation levels for individuals with disabilities from low-income communities and to equip these individuals with the skills and competencies needed to obtain high-quality competitive integrated employment.

Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2016. Final rule.

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2016 as required by the statute. As required by section 1886(j)(5) of the Act, this rule includes the classification and weighting factors for the IRF PPS's case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2016. This final rule also finalizes policy changes, including the adoption of an IRF-specific market basket that reflects the cost structures of only IRF providers, a 1-year phase-in of the revised wage index changes, a 3-year phase-out of the rural adjustment for certain IRFs, and revisions and updates to the quality reporting program (QRP).

[Data protection in rehabilitation research]. / Datenschutz in der Rehabilitationsforschung.

Data protection is regulated by legislation and has to be adhered to by scientists, too. This overview shows where aspects of data protection have to be considered in rehabilitation research. Important legal sources are the code of social law X, the German Federal Data Protection Act and the data protection acts of the German states. Specific recommendations about patient information sheet and written informed consent are given for research based on interviews with study participants. Furthermore, operations such as collecting, processing, using, storing, publishing and archiving of personal data are explained, taking into account the requirements of data protection. A practical example (URL: www.thieme-connect.de/ejournals/toc/rehabilitation) shows how to separate personal data and research data using the services of an external data custodian.

Final priority. Rehabilitation Training: Job-Driven Vocational Rehabilitation Technical Assistance Center. Final priority.

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Rehabilitation Training program to establish a Job-Driven Vocational Rehabilitation Technical Assistance Center (JDVRTAC). The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. We take this action to focus on training in an area of national need. Specifically, this priority responds to the Presidential Memorandum to Federal agencies directing them to take action to address job-driven training for the Nation's workers. The JDVRTAC will provide technical assistance (TA) to State vocational rehabilitation (VR) agencies to help them develop for individuals with disabilities training and employment opportunities that meet the needs of today's employers.