The Care Performance Model: questions & answers

The Care Performance Model determines the reimbursements paid for mental healthcare and forensic care. We define mental healthcare as:

• general basic mental healthcare,
• specialist mental healthcare, and
• long-term mental healthcare.

The Care Performance Model does not apply to youth mental healthcare or mental healthcare provided by a nurse practitioner in your doctor’s surgery. The Care Performance Model sets out how the healthcare professional is to charge for your treatment. It also stipulates how invoices are to be paid. The Care Performance Model is not about which type of care you receive or how.

There is nothing you need to do. Your healthcare professional will keep a record of every part of your treatment as required by the care performance model. He will safely send invoices to you, or directly to us, on a regular basis.

Your treatment will consist of a number of different components. For example, appointments with a healthcare professional or admission to a clinic for a number of days and nights. In the Care Performance Model, these separate components are called ‘performances’ and specified on the invoices submitted to us by either the healthcare professional or you. We will reimburse the cost of the care provided on the basis of these invoices.

It is important for you to know which care you are paying for, so the invoices you receive will show which performances your treatment involved.

See Mijn HollandZorg for information about the costs of performances that you or your healthcare professionals are claiming from us and that we will reimburse to you. In 2022, the information provided will include the date on which and who you had a consultation with and how long it lasted.

There are different types of performance:

• Consultations. These are the (physical or online) appointments you have with your healthcare professional,
• Group consultations. These are appointments in which you talk to your healthcare professional as part of a group of other patients,
• Admission days. We define an admission day as one day and night in a clinic

Sometimes, a consultation will require extras. For example, an interpreter or travel time because your healthcare professional visited you in your home. These performances are called ‘additional charges’. Where applicable, they will be added on to the cost of the consultation or admission day. There are several ‘other performances’ too. For example, a ‘consultation meeting’ that a healthcare professional has with other professionals in his/her own practice.

When the care performance model is introduced, the same performances will apply for both basic mental healthcare and specialist mental healthcare. Basic mental healthcare will continue to exist, but the way in which it is specified when processing claims will change. A care label will be used in claims to identify performances for basic mental healthcare. This will ensure that healthcare professionals, patients and healthcare insurers are still able to recognise basic mental healthcare. We will continue to apply the distinction between basic mental healthcare and specialist mental healthcare in our policy conditions in 2022 too. One reason for this: different conditions will apply when establishing who is permitted to be the control practitioner.

When your treatment starts, it will not be clear what your treatment will involve or how long it will last. This is why you will not usually know how much your treatment is going to cost in advance. However, you will know how much each treatment component will cost. Your healthcare professional will charge a certain rate for each separate treatment component (the performances). Your healthcare professional will inform you of these rates in advance.

If you are 18 or older, mental healthcare treatment will usually be reimbursed under your public healthcare insurance. Read more about this on our reimbursements pages.

If you are being treated by a non-contracted care provider, you may have to pay for part of your treatment yourself (depending on your policy). See our website for information about the reimbursement provided per performance in this situation. If you want to be sure that the cost of your treatment will be reimbursed in full, always opt for a contracted care provider.

Your excess will be calculated per calendar year with effect from 2022. This means that 2022 is a calendar year and 2023 is a new calendar year. Your healthcare professional will calculate whether or not you will have to pay an excess. In the Care Performance Model, treatment consists of a number of separate components: so-called performances. For example, one appointment with the healthcare professional is one separate performance. The healthcare insurer will include the performances provided in 2022 in its calculation of your excess for 2022. The care performances provided in 2023 will count towards the excess calculation for 2023.

Example

Suppose that you have 8 appointments with a psychologist in 2022. You then have 2 appointments with a psychologist in 2023. The 8 appointments in 2022 will count towards your excess in 2022. The 2 appointments in 2023 will count towards your excess in 2023.

As a patient, you may notice changes to your excess under the new funding system if your treatment starts before 31 December 2021 and continues into 2022. For more information about your excess, see this factsheet.

Under the Care Performance Model, you will need to get our permission for a number of types of performance before treatment starts. The permission requirements applicable are set out in our policy conditions and also in the reimbursements page for special mental healthcare. No permission requirements apply for basic mental healthcare.

When a patient fails to attend an appointment he/she has with a healthcare professional, we call this a 'no-show'. No care is provided in the event of a ‘no-show’. Because of this, the care performance model does not include a performance/rate for this situation and nothing will be reimbursed under the healthcare insurance either. However, it may be the policy of your healthcare professional to charge a fixed amount to any patient who fails to attend an appointment. The healthcare professional must notify patients of this policy in advance.

We have not set any limits on the number of performances or consultations permitted in our policy conditions. However, we will make agreements with healthcare professionals about volume management and the appropriate use of care.