The INAMI dependency allowance¶

The dependency allowance is the daily amount covered by the health insurance fund for a resident’s care. It depends on their degree of dependency, measured by the Katz assessment, and it is sent to the insurer (OA) via electronic billing (eFact).

This page explains the full chain: Katz assessment → category → billed amount.

From the Katz assessment to the category¶

The Katz assessment rates 6 criteria (washing, dressing, transfer and mobility, going to the toilet, continence, eating) from 1 (independent) to 4 (fully dependent). From these ratings, Resthome computes a dependency category, which is declared to the health insurance fund:

How the amount is calculated¶

The allowance billed for a resident follows a simple rule:

Allowance = the daily allowance rate (the same for all categories) × the number of billable days of presence

• The days of presence are counted over the INAMI intervention period (from admission to the end of intervention), minus absences. This period can be shorter than the accommodation (admission mid-month, departure, death, end of intervention before the room is vacated).

• An absence (hospitalization, holidays) reduces the number of days, according to the noon rule (Brussels time).

• The rate applied is the one in force on the date of billing; it is indexed over time (see below).

Clinical category and billed category¶

Two concepts coexist here, and it is important not to confuse them:

• The clinical category — your latest validated Katz assessment; it reflects the actual dependency and is used for care.

• The billed category — the one that appears on the invoice sent to the health insurance fund.

They can differ. The health insurance fund reimburses the category it approved in the agreement (eAgreement), not necessarily your latest assessment. In practice:

• If an OA agreement is in force → we bill the category of that agreement.

• If a category change is requested but the agreement is still pending with the health insurance fund → Resthome keeps the previous category for billing.

• Otherwise → we bill the clinical category.

Worsening of dependency¶

If a resident’s condition deteriorates, enter a new Katz assessment with an aggravation reason. Resthome prepares the update of the care agreement (Annexe 10), with the reason carried over automatically and the clinician’s signature. The new category only becomes billed once the health insurance fund’s agreement is obtained (see above).

Configuring the allowance rates¶

The rates are configured in the MR/MRS → Configuration → INAMI Rates app: one rate per Katz category, with a validity period. Resthome automatically applies the rate in force on the billing date. For the annual indexation, you add a new rate line (new start date) and close the old one. The same screen also manages the accommodation rate (charged to the resident).

Key points¶

• The daily allowance is the same amount for all categories (including O); the category is used to declare the correct profile to the health insurance fund (OA agreement).

• The billed allowance = daily rate × days of presence (INAMI intervention period, minus absences).

• We bill the category agreed with the health insurance fund (agreement), not necessarily the latest clinical assessment.

• Allowance = health insurance fund, accommodation = resident, over the same period.

Further reading¶

• The Katz assessment

• Electronic billing (eFact) · eFact rejections

• Agreements (eAgreement)

• Absences and hospitalizations

• FAQ · Glossary