To be entitled to a reimbursement from the National Health Fund (CNS) or the competent public sector fund, acts of psychomotor rehabilitation and relaxation performed by a psychomotor therapist must be prescribed by a doctor and authorised by the CNS, after a favourable opinion of the Medical Board of the Social Security (CMSS).
Conditions of coverage
Treatment prescription is made by means of a prior medical prescription.
The insured person receives a medical prescription for psychomotor care from their attending/prescribing physician. The insured person may then present this prescription to a psychomotor therapist of their choice in Luxembourg.
During the first consultation with the patient, the psychomotor therapist establishes a treatment plan, which will be included in the assessment report. This report must be presented to the doctor who issued the medical prescription, as he must give his written consent in the form of a treatment prescription, with which the insured person can start treatment after prior authorisation from the CMSS. The assessment report is mandatory in order for the treatment to be authorised.
Prior authorisation by the Medical Board of the Social Security (CMSS)
Psychomotor rehabilitation and relaxation care must be previously authorised by the CMSS before the treatment is provided. However, the assessment reports provided for in the nomenclature are exempt from prior authorisation.
However, treatment may be started fifteen days after an assessment report has been sent to the attending physician and, where applicable, to the CNS, if there is no response or return notice from the CMSS in a timely manner.
The treatment once begun, ceases to be covered by health insurance as soon as the assessment report is cancelled by the attending physician or as soon as the CMSS’s decision to refuse authorisation of the treatment is acquired. However, treatment costs already incurred before the authorisation/refusal is obtained will be covered by the CNS.
For psychomotor rehabilitation treatments, the CMSS initial agreement can only be made on the basis of the first psychomotor examination and assessment report before treatment (Y11). In the case of a long-term treatment, the CMSS may require an intermediate assessment report (Y12).
Beginning of treatment
Unless specified otherwise by the doctor on the psychomotor care medical prescription, the prescribed treatment must be started within six months of the prescription’s issue date. In the event of waiting periods exceeding six months, certified by the healthcare provider, this provision shall not apply.
The insured person receives a prescription from their attending physician for a first visit to a psychomotor therapist of their choice.
The insured person visits the psychomotor therapist with the medical prescription. The latter carries out an initial examination and draws up an assessment report containing a treatment plan.
The insured person presents the report to the attending doctor. The doctor must give his prior consent to the report by issuing a treatment prescription, with which the insured person will be able to report again to his psychomotor therapist in order to start treatment after a certificate of coverage has been issued.
In general, the psychomotor therapist forwards the request for prior authorisation to the competent department of the CNS with the supporting documents (medical prescription of the prescribing doctor, assessment report of the psychomotor therapist). The CNS verifies whether the administrative conditions are met. If the conditions are fulfilled, the request is forwarded by the CNS to the CMSS.
Following a favourable opinion of the CMSS, the CNS issues a certificate of coverage and sends it to the psychomotor therapist or the insured person, if the latter initiated the request for prior authorisation.
Compensation for lost fees and extraordinary circumstances
If the insured person failed to keep an appointment or was away from home at the time they were supposed to receive the treatment, and if the insured person failed to notify the therapist at least during the day before the appointment, the therapist is entitled to a compensation for lost fees.
This compensation, as well as potential travel costs incurred, are not covered by health insurance.
When the psychomotor therapist sets an appointment at the insured's express request on a specific day after 7 p.m. or on a Saturday, Sunday or statutory holiday, the former is entitled to receive compensation for extraordinary circumstances, provided that the appointment falls outside the normal working days or working hours announced by the healthcare provider and that the appointment has been honoured by the latter.
The psychomotor therapist is not entitled to a compensation for services provided in the event of an emergency. The same applies if the services are required at the appointed times and dates due to the insured's state of health.
The benefits provided for above are not covered by health insurance. They are invoiced, where applicable, with the services on the same invoice.
Travel expenses for psychomotor therapists are covered, provided that:
- the doctor indicates on the prescription that the insured person is unable to leave their home for medical reasons;
- the journey takes place on Luxembourg territory. Journeys beyond the borders cannot be covered.
The travel expenses include the travel allowance as well as the travel costs per kilometre driven.
The travel costs per kilometre driven can only be invoiced if the journey took place outside of the locality where the psychomotor therapist has established their practice or within the locality, if the journey exceeds one kilometre. However, the incurred travel costs cannot exceed the costs corresponding to the distance actually travelled.
Travel expenses incurred because of the following treatments are excluded from coverage:
- in a hospital setting,
- in nursing homes,
- in centres for the disabled,
- in cure and functional rehabilitation centres.