How long should the start-up funding last?

The benefits of social long-term care insurance for residential groups

The service catalog of the social long-term care insurance looks with the Residential group surcharge an additional benefit for people in need of care in residential groups with outpatient care. In addition, with the Start-up funding a one-off funding amount, provided that the requirements for the group living allowance are met.

The legal basis for the group surcharge is § 38a SGB XI, the legal basis for the start-up financing for the establishment of outpatient care groups is § 45e SGB XI.

Residential group surcharge

The Residential group surcharge will, provided that all eligibility requirements are met, for the period from January 2017 in the amount of monthly 214.00 euros done. Payment is made monthly in advance, which means that the group living allowance has the same due date as the care allowance. The payment is always made at the end of the month for the following month.

If you are only entitled to the residential group surcharge for a part of the month, the full benefit amount will still be granted. It is therefore carried out for part-months in which z. B. a hospital stay, or moving into or moving out of the residential group takes place in the course of a month, no proportional reduction.

For the period up to December 2016, the group surcharge is 205.00 euros per month.

Eligibility requirements for the group supplement

The residential group surcharge can be granted if the residential group consists of at least three residents and a maximum of twelve residents. At least three of the residents must be in need of care; d. H. that one of the care levels 1 to 5 must have been confirmed. In addition, at least three people must receive outpatient care benefit (care allowance, care benefit in kind, combined benefit, relief amount or offers for everyday support) from the living group members.

Certain requirements are placed on the shared apartment of the residential group. The kitchen and the sanitary area must be used by all residents either alone or together. This also applies to a possibly existing lounge. In addition, each apartment must have its own lockable access - from outside, from a stairwell or from an anteroom.

The living group members must jointly commission a person who provides general organizational, supervisory, administrative or community life-promoting activities or housekeeping support. These tasks or support must go beyond the usual services that are usually provided in home care. In the case of domestic support, it is necessary that the person in need of care is included. It is not required that the jointly authorized person is present around the clock, although a mere on-call duty is not sufficient.

Another prerequisite for the granting of the residential group surcharge is that there is an outpatient form of care. This means that there is no entitlement to the residential group surcharge if a provider of a residential group or a third party offers or guarantees services that correspond to the scope of the respective framework contract for full inpatient care.

Day and night care entitlement with group living surcharge

If a person in need of care who receives a living group supplement wishes to take advantage of day or night care (semi-stationary care), special conditions are attached to this. A claim only exists if care in the residential group with outpatient care is not sufficiently ensured without day or night care. The Medical Service of the Health Insurance (MDK) must check and confirm this in each individual case.

However, confirmation by the MDK is not required if the person in need of care has made use of the group surcharge according to the law applicable until December 31, 2016 and day or night care. In this case, the vested rights regulation of § 141 SGB XI applies, which makes the separate proof by the MDK available.

Start-up funding

In order to promote the establishment of outpatient care groups, a one-off redesign of a shared apartment can be made for barrier-free and age-appropriate Start-up funding be done. The start-up funding is up to 2,500.00 euros and is limited to a maximum of 10,000.00 euros per residential group.

Eligibility requirements for start-up funding

Start-up financing can be provided when a new residential group is set up, whereby at least three people in need of care must be involved in the start-up. Start-up financing cannot be granted if the residential group already exists.

In contrast to the measures to improve the living environment, for which the long-term care insurance funds can grant an amount of up to EUR 4,000.00, the amount of the start-up financing does not necessarily have to be used to improve the current care situation of the person in need of care. Rather, the funding amount is provided for the barrier-free and age-appropriate redesign of the apartment. Nevertheless, renovation measures are also eligible, which can be considered as "classic" measures to improve the living environment.

The reimbursement of the costs as part of the start-up financing can only take place if the eligibility requirements are met. However, the renovation can already begin before the residential group has been re-established and the residential group members have moved into the residential group.

In order to be entitled to start-up financing, the entitlement to benefits for measures to improve the living environment does not have to be exhausted in advance.

The total costs of the start-up financing - up to the maximum benefit amount - are borne proportionally by the long-term care insurance funds involved if there are more than four eligible people in need of care. The respective share is calculated by dividing the total costs by the number of people in need of care living in the residential group.

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