Victory in federal court

Werder Viganò has won an important victory for people with disabilities. A health insurance company took the view that, due to the stay in a home for the disabled and the factual overlap of outpatient care services with cantonal disability assistance services, the obligation to pay for outpatient care services under the KVG did not apply.

‍

The Federal Supreme Court has now clarified that services provided by a licensed Spitex organization in accordance with Art. 7 para. 2 KLV to persons in need of care in an inpatient facility that is not a recognized nursing home (Art. 39 para. 3 KVG) are not to be remunerated in accordance with the nursing home tariff in accordance with Art. 7a para. 3 KLV, but in accordance with the tariff for outpatient service providers in accordance with Art. 7a para. 1 KLV. This also applies to so-called ln-House care, i.e. care services provided by the home's own Spitex organization.

‍

It also stated that the legal opinion of the health insurance company amounted to excluding people in homes for the disabled from health insurance benefits. This violates "the prohibition of discrimination enshrined in Art. 8 para. 2 of the Federal Constitution and in Art. 1 para. 1 and Art. 3 of the Convention on the Rights of Persons with Disabilities of December 13, 2006 (SR 0.109)".

‍

The case was supervised by Gregori Werder. The judgment of the Federal Supreme Court 9C_169/2023 of May 29, 2024 is available here and is intended for publication.