The day care agreement

A day care centre is paid its forfait only for a user the health insurer has agreed to. The agreement is asked with a request of its own, csj-in, and its Annexe 14; the end of care is declared with a csj-out. Both follow the same steps as the rest home’s requests: see Agreements (eAgreement).

The requests are listed under eHealth → eAgreement → eAgreement Light, with the filters Day care centre — admission, Day care centre — end of care and Day care renewal due.

Prerequisites

  • The user’s stay is a CSJ stay, started, under the centre’s own INAMI number.

  • The Katz evaluation is validated and gives a CSJ category: F, Fp, Fd or D. A scale that meets none of them asks nothing of the insurer — no forfait is due.

  • The evaluation was completed and signed by a nurse or a physician, as recorded on their employee file.

  • For a D: the date of the diagnostic assessment and the specialist who made it are on the evaluation.

Send the admission request

Starting the stay prepares the admission request. Send it within 14 days of the admission: a late request takes effect on the day it is filed, not on the admission.

  1. Open the request, from the user’s file or from the eAgreement list.

  2. Click Generate prefilled Annexe 14: the official form is filled in with the centre and its approval, the insurer, the user, the day and hour they came in, the category asked for, and first request or renewal.

  3. Click Sign Annexe 14 to sign it in the app — or print it, have it signed on paper and load the signed version under Annexe 2.

  4. Send the request.

Before it leaves, the request is checked: a category D without its diagnostic assessment, an evaluator who is not a nurse or a physician, or a scale with no day care category each stop the sending and say what to correct.

The insurer’s answer

The insurer answers on paper, with an Annexe 15 (grant) or an Annexe 16 (refusal). Record its decision on the request, as for any agreement. See Following up an agreement.

  • Granted: the request records the category granted — F, Fp, Fd or D — and the agreement start.

  • Silent for 15 days: the request is approved, recorded as a tacit agreement. A decision that arrives later replaces it.

  • Refused: no forfait is due on the days the refusal covers, until a new request is granted. The month still bills the user’s day price.

A day care agreement belongs to the insurer that received it: when the user changes insurer, a new request is needed.

Renew the agreement every year

A day care agreement runs for one year from its start, unless the insurer wrote another end. Covered Until on the request gives that last day.

  • From 30 days before that date, a banner on the agreement says A day care agreement is renewed every year, with the date, and an activity Renew the day care agreement (Annexe 14) is scheduled for whoever made the request.

  • The Billing dashboard counts the Day care agreements to renew on the day care card, in red once one is overdue.

To renew it:

  1. Click Prepare the renewal on the agreement: it opens a new admission request for the same user, marked as a renewal. It is created only once.

  2. Generate and sign its Annexe 14, which now says « renewal », with a current Katz scale.

  3. Send it before the end date.

The 14-day rule of the first request does not apply to a renewal.

Warning

A forfait billed past the end of the agreement is flagged before the eFact sending: a warning while a renewal awaits the insurer, a blocking problem when none was sent. Prepare the renewal and send it, or hold these days until it is granted.

Declare the end of care

When the user stops coming — the stay ends, or the user dies — WideCare prepares the end-of-care request, csj-out.

  1. Open it, and click Generate the end-of-care notification: the centre’s own notice says who, since when, until when, and why.

  2. Send the request. No signature is expected: the eHealth certificate stands for it.

An end of care closes the agreement. A user who comes back later is admitted again with a new request.

A respite in the rest home

In a house that also runs a rest home, a short stay in a bed between two periods at the day care is a respite: the agreement runs on, nothing is notified on the way out, and no new request is filed on the way back while the agreement still covers the user. See Admitting a day care user.

What’s next