【News】Ministry of Health, Labour and Welfare to announce an explanation of the insurance points for the technical fee regarding the treatment of rare neuromuscular disease patients using HAL® 〜Worlds’ first determination of an insurance reimbursement price for treatment with Robots〜

On the evening of April 25, 2016, the Ministry of Health, Labour and Welfare’s (“MHLW”), Health Insurance Bureau, Medical Economics Division announced its explanation regarding the technical fee for the treatment of rare neuromuscular disease patients using HAL® for Medical Use (Lower Limb Type) (Acquired medical device manufacture and distribution approval in November 25, 2015) as set forth below. This is the first public medical insurance reimbursement price for treatment with robots established in the world.

【Technical fee regarding the usage of HAL®】
The following is a summary translation of a selection from documents released by MHLW.
―――――――――――――――――
(Question 31) When conducting section number「J118-4」Ambulatory Exercise Treatment (using a robot suit), there is a need to take into account the patient’s weight, thigh and leg length, hip width, etc., in order to determine the appropriate wearing conditions for a patient who will be wearing the robot for the first time. How will the technical fee for this process be calculated?
(Answer) For the determination of appropriate wearing conditions for a first-time user, the technical fee is calculated based on section number「J129」Treatment Brace Orthopedic Cast「2」Prosthesis Molding (for quadruple amputees) for each limb
―――――――――――――――――

Medical fee points possible for claim after each treatment session using HAL® (reimbursement price) can be calculated as set forth below. It has been confirmed with the MHLW, Health Insurance Bureau (April 25, 2016).
(Note: The stated fees include fees for all necessary treatments in relation to the treatment using HAL®)

(1)Maximum points that can be claimed for the first treatment session is 8,510 points (JPY 85,100).
(2)Maximum points that can be claimed for each of the 2nd to 9th treatment sessions is 6,880 points (JPY 68,600).
(3)Maximum points that can be claimed for each treatment session onwards is 4,960 points (JPY 49,600).
(4)As long as the effect of each treatment can be confirmed, points can be claimed per treatment indefinitely.

Reference 1: Insurance reimbursement price for treatment using HAL® in Germany
In Germany, paraplegic patients, such as patients with spinal cord injuries, have been treated for the improvement of physical function since 2013. An application to the German Statutory Accident Insurance (“DGUV”) was approved, and the entire treatment cost of EUR 500 (approximately JPY 65,000) for each session of functional improvement treatment is covered by public workers’ compensation insurance.

Reference 2: Copayment price for rare neuromuscular disease patients
The medical expense grant for specified diseases has a predetermined maximum copayment limit (monthly) based on income, so the monthly copayment for even the highest earning households will be less than JPY 30,000.

Reference 3: Diagnosis Procedure Combination / Per-Diem Payment System (DPC/PDPS)
The MHLW released a notice on March 18, 2016 that states that when section number「J118-4」Ambulatory Exercise Treatment (using a robot suit) is conducted, all hospital charges for that day are excluded from the DPC/PDPS bundled payment system.