ARTICLE 1 – DEFINITIONS
In the current Terms and Conditions, the following definitions will apply:
Healthcare institution: a legal entity that provides healthcare within the field of mental health and addiction care.
Client: a natural entity who turns or has turned to a healthcare institution in order to receive or is already receiving healthcare.When reference is made to ‘client’, ‘patient’ can also be understood: the natural person to whom care is provided by the Healthcare Provider.
Agreement: the treatment or counselling agreement.
Healthcare provider: the professional working for the healthcare institution who has personal contact with the client in the context of the treatment or counselling.
Healthcare or healthcare provision: treatment or counselling, whether or not in combination with in-house stay (in this integral version, the term healthcare or healthcare provision is used when the legal provision applies to both treatment and counselling. If only treatment is mentioned, this provision does not apply to counselling. The same applies vice versa).
Counselling: activities aimed at promoting self-reliance and participation on the side of the client so that they can remain in their own living environment for as long as possible. Counselling is also understood to include support. This is subject to the Dutch Social Support Act (Wet Maatschappelijke Ondersteuning or WMO 2015).
Treatment: treatments in the field of medicine provided by a healthcare provider that practices a medical profession or business to which the Dutch Medical Treatment Agreement Act (Wet op de Geneeskundige Behandelingsovereenkomst or WGBO) applies.
Practice: the Healthcare Provider’s treatment area, including waiting room, counter or other areas used by the client as part of the treatment.
Caregiver(s): family, partners, friends or other loved ones of the client.
Representative: the legal representative of the client, as referred to in the Dutch Civil Code (Burgerlijk Wetboek or BW). The representative enters into the client’s rights and obligations under these general terms and conditions to the extent that the client is incapacitated and to the extent that the representative is authorized to do so in accordance with the law or by personal written authorization by the client.
Healthcare plan: a plan prepared in consultation with the client, which addresses the client’s general data and image, limitations, abilities and desires, goals, action plan, evaluation and reporting.
The healthcare plan is also understood to include the treatment or counselling plan.
Dossier: The healthcare provider has the obligation to maintain a dossier regarding the client’s healthcare. He enters the data regarding the client’s health, the actions and declarations into the dossier and he saves the data that is required for quality healthcare. This is also understood to include the patient dossier or healthcare dossier.
Quality standards: guidelines, healthcare modules and healthcare standards pertaining to the entire healthcare process and stipulating what is ‘quality healthcare’.
Indication decision: any insured person wanting to be eligible for healthcare in accordance with the Dutch Long-term Care Act (Wet Langdurige Zorg or Wlz) must submit an application with the Centre for Healthcare Indication (Centrum Indicatiestelling Zorg or CIZ). In its indication decision, the CIZ determines whether someone may use the WIz.
Incident: an event during the healthcare process that resulted, could have resulted, or could (still) result in harm to the client, a fellow resident or employee of the facility.
Decision: the decision establishing whether and, if so, according to what nature, extent and duration a healthcare recipient qualifies for a care claim under the Wmo 2015. This decision is made by the Municipal Executive (College van Burgemeester en Wethouders or ‘B en W’).
ARTICLE 2 – APPLICABILITY
1. The current General Terms and Conditions will apply to the agreement made between the client and the healthcare institution, regarding:
a. treatment, whether or not with residential care
b. counselling, whether or not with residential care.
2. The General Terms and Conditions will apply to both outpatient healthcare and to residential healthcare and are applied as much as possible, regardless of how the healthcare is funded.
3. The General Terms and Conditions will also apply to the treatment of clients who are committed in accordance with the Dutch Act on Special Admissions to Psychiatric Hospitals (Wet bijzondere opnemingen in psychiatrische ziekenhuizen or BOPZ), insofar as they do not contravene that Act.
4. The General Terms and Conditions will not apply if admission or healthcare is imposed pursuant to a judicial order or if admission or healthcare is initiated in compliance with the conditions or imposed by a criminal court or prosecutor.
5. The parties cannot deviate from these General Terms and Conditions unless explicitly agreed in an individual case and the deviation is not detrimental to the client. Such deviations must be confirmed in writing.
ARTICLE 3 – ALTERATION
The current General Terms and Conditions may only be amended in consultation between the Dutch Association of Mental Health Care (Geestelijke Gezondheidszorg or GGZ) on one side and the Dutch Consumer Association (Consumentenbond) and the National Platform Ggz (Landelijk Platform GGz) on the other.
ARTICLE 4 – CLOSE RELATIVE(S)
1. The healthcare institution will have regulations in place with regard to close relatives, based on the current model regulations for close relatives.
2. If they wish, clients may have themselves be assisted by someone of their choice to help make an informed choice regarding their healthcare.
ARTICLE 5 – CLEAR INFORMATION
The client has the right to all information that is required to be able to make properly informed choices regarding healthcare. All information provided to the client must be at an appropriate level for client, in terms of its content, its form and its timing. The healthcare provider must check with the client whether they have understood the information and if any questions remain.
ARTICLE 6 – HEALTHCARE-SPECIFIC INFORMATION
1. Prior to the conclusion of the agreement, the healthcare provider and the client will mutually determine which care suits the client best and exchange information relevant to that care. They will discuss, in any case:
a. the right to free choice of healthcare provider within the possibilities of the healthcare institution
b. the diagnosis – if applicable – and what it means to have that diagnosis; a clear description of the relevant day-care and healthcare options, the goal, the chances of success and any possible risks and side-effects (such as pain, discomfort or social consequences) partly based on previous experiences of the client
c. the name of the responsible healthcare provider and those of other healthcare providers involved
d. the experience of the healthcare providers involved
e. other aspects, such as the waiting period and the costs or additional costs
2. If the client has explicitly indicated that they do not wish to receive information about the treatment, the provision of information may be omitted.
3. In addition to the provisions of paragraph 1, information about the treatment may be omitted only in exceptional cases in which providing it would expressly and negatively affect the client.
ARTICLE 7 – GENERAL INFORMATION
1. The healthcare provider will make information available to the client, tailored to their needs and capabilities. The healthcare provider will provide information regarding:
a. the healthcare institution and the course of the healthcare process, such as the intake, the preparation of a any healthcare plan, the healthcare itself, and setting up arrangements related to the client’s specific situation
b. payment for charges for additional services, excess (eigen risico) and potentially healthcare that is not covered by insurance
c. the relevant client and family organisations
d. the client council and the family council
e. the complaints and disputes regulations
f. the confidential advisor for clients and patients and, if present, the confidential advisor for families
g. the consequences of incapacitation of will occurring during the healthcare process
h. the house rules
i. the institution’s dealings with next-of-kin
j. accessibility of the organisation in case of emergency situations
k. the privacy regulations, the privacy statement, the use of personal data for research and regarding privacy measures
l. the policy on ethical and life-philosophical issues including declarations of will, declarations of self-commitment, non-resuscitation and euthanasia
m. the quality statement containing the concrete agreements in case of a healthcare collaboration.
ARTICLE 8 – CONCLUSION OF THE AGREEMENT
1. The agreement between the client and the healthcare institution will only be concluded if:
a. the client or their representative has expressed their wish to enter into the agreement, and
b. the healthcare institution reasonably believes that the client’s request for help can be met based on the facilities available at the healthcare institution, and
c. a referral required for funding or an indication decision has been issued or by a municipal decision.
ARTICLE 9 – SETTING UP THE HEALTHCARE PLAN
1. The healthcare provider, in accordance with professional standards, will set up a proposal for a healthcare plan to the client based on the consultation between the healthcare provider and the client.
2. The healthcare provider will offer the client support during the consultations about the healthcare plan.
3. The healthcare provider will start providing healthcare after the client or their legal representative has agreed to the healthcare plan or the preliminary healthcare plan.
4. In acute situations, where there is no time to seek consent because immediate treatment is necessary to prevent serious harm to the client, the provisions of the preceding paragraphs of this article may be deviated from. This will be substantiated, with reasons, in the dossier. In that case, consultation between the healthcare provider and the client will take place as soon as possible after said deviation.
5. If the client or the healthcare provider deems it necessary to deviate from the healthcare plan, mutual consultation will take place.
The healthcare plan will stipulate at least the following:
a. the healthcare-related goals set for a specific period of time, based on the client’s wishes, abilities and limitations, taking into account any decision given by the municipality
b. the way in which the healthcare provider and the client will try to achieve those set goals
c. who will be responsible for the different parts of the healthcare and how coordination will take place between several healthcare providers, and whom the client can hold accountable for this coordination
d. the way in which the client wishes to organise their life and the support the client will receive from the healthcare provider in that regard
e. the frequency with which and the circumstances under which the healthcare plan will be reviewed and updated with the client. In the event that the municipality gives a new decision, an evaluation of the counselling plan will take place regardless.
ARTICLE 10 – DOSSIER
1. In addition to the healthcare plan and the topics stipulated by law and regulations, the dossier will contain the following:
a. in consultation with the client, which next of kin will be involved in or informed about the healthcare and the way in which this will take place and, if so desired, which persons will not be involved
b. the client’s wishes and preferences, including contraindications for healthcare interventions
c. the progress (including reports, results, ROM results, GAF scores, et cetera) of the healthcare
d. any incidents and emergencies insofar as these have consequences for the healthcare or the client’s state of health.
2. The dossier will remain at client’s disposal during the healthcare process; the client will always have the right to inspect it and may obtain a copy.
ARTICLE 11 – SECOND OPINION DURING TREATMENT
The healthcare institution will provide all reasonable cooperation to a second opinion requested by client and will discuss the results of the second opinion at client’s request, even if client has requested it without cooperation from the healthcare institution.
ARTICLE 12 – PRIVACY DURING HEALTHCARE
The healthcare institution will maintain a set of privacy regulations.
ARTICLE 13 – HEALTHCARE QUALITY
The rules of conduct of the various professional groups, quality standards, standards derived from modern science and practice, as well as generally accepted principles, will form the standard of quality healthcare provision. Deviation from protocols and guidelines must be justified, explained to the client and recorded in the dossier by the healthcare institution.
ARTICLE 14 – ACCESSIBILITY OF ROOMS
All rooms that are of interest to the client must be adequately accessible.
ARTICLE 15 – INCIDENTS
1. Following an incident that has or may have noticeable consequences for the client, the healthcare institution will inform the client and/or the client’s representative as soon as possible regarding:
a. the nature and the cause of the incident
b. whether any measures have been taken to prevent similar incidents from occurring in the future, and if so, which ones.
2. If an incident affects the client’s health condition, the healthcare institution will discuss with the client and/or the client’s representative the healthcare alternatives available to address the situation and will make agreements regarding the start of the chosen type of healthcare and its follow-up.
ARTICLE 16 – HEALTHCARE ON APPOINTMENT
1. If the healthcare takes place at a time agreed on beforehand, the healthcare institution will ensure that it is clear to the client when and at what time said healthcare will take place.
2. The healthcare institution will take into account the client’s wishes, preferences and limitations as much as possible when scheduling appointments.
3. If the client or healthcare provider cannot keep an appointment made, the appointment must be cancelled no later than 24 hours in advance, unless there is a compelling reason.
4. The client will be informed of any additional waiting time if the agreed time is deviated from.
ARTICLE 17 – ONE CLIENT – MULTIPLE HEALTHCARE PROVIDERS
The healthcare institution will act in accordance with the agreements derived from the drawn up quality statement while dividing tasks and responsibilities.
ARTICLE 18 – GOOD CLIENT BEHAVIOUR
1. Each client will identify themselves at the request of the healthcare institution prior to the conclusion of the agreement with a legally recognised and valid proof of identity and will submit the details of their health insurance company, the indication decision or court/ municipality decision. If the client is unable to provide such proof of identity and/or insurance details or the decision when requested, the healthcare institution will be entitled not to start the execution of the agreement until the client has presented the necessary details, unless immediate treatment is necessary.
2. Prior to the start of the healthcare trajectory, the client will provide the name and contact details of a contact person, preferably his representative, at the request of the healthcare institution.
3. The client will abide by the house rules and will refrain to the best of their ability from behaviour that poses a risk to the safety of people in the healthcare facility.
4. The client will adhere to (fire) safety instructions and measures of the healthcare institution.
5. If the healthcare is provided in the client’s home, the client will provide all necessary cooperation to enable the healthcare institution to provide healthcare in accordance with regulations on working conditions.
6. The client must take due care themselves to prevent damage to or loss of their property.
ARTICLE 19 – INFORMATION OBLIGATIONS
1. To the best of their knowledge, the client will provide the healthcare institution, including in response to its questions, with the information and cooperation it reasonably needs to carry out the agreement, including information about any living will or crisis card.
2. When intermediate changes occur in the client’s situation that may lead to changes in (the extent of) the healthcare to be provided, the client will be obliged to inform the institution as soon as possible.
3. Clients who are on a waiting list with the healthcare institution and have their healthcare provided by another institution during the waiting period, will report this to the former healthcare institution as soon as they have agreed with the other institution that the healthcare will be provided there.
ARTICLE 20 – PAYMENT
1. The client will owe the healthcare institution the agreed price for the agreed healthcare and services insofar as it is not paid directly by the health insurance company, the healthcare administration office or the municipality.
2. If funding of the healthcare is uncertain, for example due to the lack of health insurance, referral, indication decision or court/municipality decision, no healthcare will be provided except if medically required. In case of reasonable doubt as to whether or not funding will be obtained, the healthcare institution and client will consult with each other.
3. For the previously agreed (additional) costs of healthcare and services to be charged by the healthcare institution, it will send a clear and itemised invoice to the client, stating a payment term of 30 days.
4. The healthcare institution will send a payment reminder after the payment deadline has passed and will give the client the opportunity to still pay within 14 days of receiving the reminder.
5. If payment still has not been received after the expiry of the second payment term, the healthcare institution will be entitled to charge interest and extrajudicial collection costs as from the expiry of the first payment term. The interest rate will be equal to the legal interest rate.
ARTICLE 21 – ACCESS TO OWN LOCKER OR ACCOMMODATION
1. Healthcare providers will not have access to the client’s locker or accommodation without the client’s consent, unless reasonably necessary in cases of:
a. general safety, including potentially unacceptable hygiene conditions
b. or in case of reasonable suspicion of criminal offences, including possession of prohibited substances and/or objects
c. or in the interest of the execution of the healthcare plan.
2. Unless it would impede a criminal investigation, the client will be informed of the entry into the locker or accommodation in advance and given a chance to tidy up the locker or accommodation themselves. In any case, the client or their representative or contact person/authorised representative will be given the opportunity to be present when the locker or accommodation are entered into.
ARTICLE 22 – ACCOMMODATION
1. The healthcare institution will offer the client the most suitable accommodation for the provision of the healthcare. If multiple accommodations qualify, the healthcare institution will leave the choice to the client.
2. The healthcare institution may assign another accommodation if the evaluation of the healthcare plan requires it, or if practical circumstances urgently demand it.
3. The client must cooperate in case of any relocation, insofar as it can reasonably be required of them.
4. The client may request a different accommodation room, stating reasons. The healthcare institution shall honour this request unless it has compelling reasons that prevent it from doing so. Any denial of the request will be stated with reasons.
5. The stay will end in case of termination of the agreement, in accordance with article 27 applies.
6. The client must maintain the accommodation as a ‘good housekeeper’ to the extent that they are capable of doing so.
The following will apply specifically to the accommodation:
a. the client may use the accommodation exclusively for their own occupancy, other purposes are not permitted, unless authorised by the institution
b. a security deposit may be required
c. the healthcare institution may establish rules regarding the access to and stay of third parties in the accommodation
d. if a key is provided to the client as part of the counselling, the client will receive at least one key, unless there are compelling reasons to deviate from this; it must be returned at the end of the stay
e. if sub d applies, a joint decision will be made as to who may also have a key and under what conditions this/these person(s) may or can enter the accommodation
f. client is responsible for keeping the accommodation room clean daily, unless it has been agreed with the care institution that it will take care of keeping the room clean itself
g. in case the client will provide furniture for the accommodation, the healthcare institution may give instructions in this respect for safety and efficiency reasons
h. a contribution may be charged to client for the purpose of maintenance and additional services. The client will receive an itemised invoice for this purpose
i. the client must apply for a private liability insurance and is advised to take out a property insurance for these household effects. The healthcare institution will remind the client of their responsibility and, if necessary, will assist in taking out the insurances.
ARTICLE 23 – TEMPORARY ABSENCE
1. During the client’s absence, their accommodation will remain available unless the absence exceeds the period the institution has agreed upon with the funder in case funding during temporary absence applies. This is subject to the policy regulations of the Dutch Healthcare Authority (Nederlandse Zorgautoriteit or NZa), or the agreements made with the municipality.
2. If the period of absence exceeds the period agreed upon by the institution for funding in the event of temporary absence, the healthcare contract will expire by operation of law, unless other arrangements are made in this respect.
3. When the agreement comes into force, the healthcare institution will inform the client of the period referred to in the first paragraph. If this period is changed, it will inform the client as soon as possible.
4. When the period referred to in the first paragraph expires, the healthcare institution will be entitled to vacate the client’s accommodation. If possible, the healthcare institution will inform the client or their next-of-kin or representative about this in advance. The healthcare institution will provide, at the client’s expense, appropriate storage of the client’s belongings present in the accommodation.
ARTICLE 24 – LEAVE OF ABSENCE
Only in case of treatment-related considerations, as set out in the treatment plan, may a client be denied a leave of absence from the institution.
ARTICLE 25 – NOURISHMENT – WISHES AND BELIEFS OF CLIENT
In case of a stay that includes meals, the institution will provide a medically required diet. Additionally, the client’s wishes and philosophical beliefs are taken into account as much as possible.
ARTICLE 26 – HOUSE RULES
1. The healthcare institution maintains house rules, for example based on the House Rules regulations model of GGZ Nederland.
2. Any agreements that deviate from said regulations will be recorded in the client’s dossier.
ARTICLE 27 – TERMINATION OF THE AGREEMENT
1. The agreement will terminate:
a. in case of a transfer to another healthcare institution
b. in case of approval by both parties
c. following unilateral, unambiguous termination of the agreement by the client
d. following unilateral termination by the healthcare institution in compliance with the provisions in Article 30
e. in case of death of the client
f. on the end date stated in the indication decision
g. when the period of validity of the decision on which the agreement is based expires.
2. If the agreement included the provision of independent accommodation under a rental agreement, the agreement will end no later than one calendar month after the moment of termination of the agreement in accordance with the first paragraph of this article.
ARTICLE 28 – NEW COURT OR MUNICIPAL DECISION
1. If care is provided on the basis of a court or municipal decision and the validity period of said decision expires in the near future and the need for healthcare continues to exist, the healthcare institution will be of assistance in applying for a new decision.
2. If the nature and scope of the client’s need for care develops to such an extent that the institution is no longer able to provide responsible care (this may also be understood to mean ‘good care’) within the limits of the nature and scope of the healthcare entitlement specified in the court order, the institution will support the client in applying for a new order.
ARTICLE 29 – CLIENT’S POSSESSIONS
In the situation described in Article 27 paragraph 1 under a through f, the healthcare provider will be entitled to vacate the room after the client’s departure. The healthcare provider will have a best-efforts obligation to make arrangements with the client to collect the goods that have been left behind. If the client does not respond, the contact person will be contacted for the collection of the goods.
ARTICLE 30 – TERMINATION OF THE AGREEMENT BY THE HEALTHCARE INSTITUTION
1. The healthcare institution will be entitled to terminate the agreement if:
a. the funding, referral, indication or applicable court or municipal decision for the healthcare becomes absent or void; however, the healthcare institution will not do so if the institution believes that stopping the healthcare at that time is irresponsible because it is necessary healthcare
b. the client repeatedly does not or cannot fulfil his responsibilities under the agreement, has been repeatedly addressed about this but does not change their behaviour, and this has led to such a situation that the continuation of the agreement can no longer reasonably be required of the healthcare institution
c. the client commits such serious criminal offences that clearly affect the relationship with the healthcare providers or fellow clients that the continuation of the agreement can no longer be reasonably required of the healthcare institution
d. serious tension with the healthcare providers arises due to actions of the client’s relatives, seriously hampering the continuation of quality healthcare (be it with or without in-house stay)
e. if the client’s healthcare needs change to such an extent that the healthcare institution can no longer be required to provide the healthcare as agreed and recorded in the care plan.
2. Upon termination of the agreement, the healthcare institution will observe a reasonable term as well as such due diligence regarding after-care as may reasonably be expected from the institution.
ARTICLE 31 – AFTER-CARE
1. Upon termination of the agreement, the healthcare institution and the client will make every effort to timely arrange the preconditions required for discharge and/or after-care in mutual consultation if continuity of the healthcare is required. The healthcare institution will notify the following persons of the discharge before the actual departure:
a. the client’s contact person or representative
b. the healthcare providers involved, either within or outside of the healthcare institution.
2. If the agreement includes in-house stay, the healthcare institution will be of assistance in finding possible accommodation and – if necessary – arranging social benefits for the client.
ARTICLE 32 – DEATH
1. In case the client dies during their stay in the healthcare institution, the institution will inform the contact person and/or representative of their demise without delay.
2. In case the client has not designated a contact person or representative, or if this person does not take adequate steps, the healthcare institution will act according to an established policy for final care, in which the healthcare institution will take the deceased’s life philosophy – insofar as this is known – into account as much as possible.
3. The healthcare institution will provide after-care to the client’s next of kin if they wish, within the legal possibilities.
4. The healthcare provider will be entitled to vacate the client’s room in case of the client’s demise. The institution will have a best-efforts obligation to make arrangements with the client’s contact person to collect their belongings.
ARTICLE 33 – COMPLAINTS REGULATIONS
1. The healthcare provider has a legally based and sufficiently publicised arrangement in place for the reception and handling of complaints and will handle complaints in accordance with this complaints procedure.
2. In the context of and subject to the scope of the Dutch Healthcare Quality, Complaints and Disputes Act (Wet kwaliteit, klachten en geschillen zorg or Wkkgz), the healthcare provider will appoint one or more persons to be considered capable to offer advice to a complainant at their request with regard to the submission of a complaint and will assist in formulating the complaint and investigating the possibilities of reaching a solution for the complaint.
ARTICLE 34 – DISPUTES COMMITTEE FOR THE DUTCH LONG-TERM HEALTHCARE ACT (WET LANGDURIGE ZORG OR WLZ) AND HEALTHCARE INSURANCE ACT (ZORGVERZEKERINGSWET OR ZVW (SCOPE WKKGZ)
1. In the context of healthcare as defined in the Dutch Healthcare Insurance Act (ZVW) or Long-Term Healthcare Act (WLZ), the client may, in addition to the other existing possibilities, submit a dispute to a dispute settlement organisation in accordance with the Healthcare Quality, Complaints and Disputes Act (Wkkgz) if the treatment of the complaint does not sufficiently resolve the client’s or the institution’s discontent, if the complaints procedure has not been adequately complied with or if the client cannot reasonably be required to submit their complaint to the healthcare provider under the given circumstances about the conduct of the healthcare provider in the context of the provision of care.
2. The disputes committee may award compensation for personal or property damage not exceeding €25,000.