m (תיקון קישורים שבורים)
m (שימוש בתבנית טלפון)
 
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{{עצם העניין}}{{סוג ערך|זכות}}
 
{{עצם העניין}}{{סוג ערך|זכות}}
{{תקציר}}
+
{{תקציר |תוכן=
 
{{דגשים  
 
{{דגשים  
| מידע = The health plans are responsible for providing paramedical treatments for children
+
| מידע = Children with medical or developmental disabilities are entitled to paramedical treatments through their HMO as part of [[The Healthcare Basket]]
| חשוב = Children who receive [[Paramedical Treatments as Part of Special Education|paramedical treatments as part of special education]] do not lose eligibility to receive them from their health plan as well
+
| חשוב = Children who receive [[Paramedical Treatments as Part of Special Education]] may also be entitled to treatments that are part of the healthcare basket
| פיצוי = The health plans are required to provide a reimbursement for diagnostic and treatment services that were purchased privately in all cases in which the waiting time at the health plan was longer than that which has been established by the Ministry of Health
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| פיצוי = The health plans are required to provide reimbursement for services that were paidd for privately in cases in where the waiting time for [[Developmental Medical Diagnosis for Children (Child Development Services)|diagnostic]] and treatment services at the health plan was longer than the amount established by the Ministry of Health
| ממשל = For more information, see [http://www.health.gov.il/hozer/MR19_2013.pdf Medical Administration Circular 19/2013]  
+
| ממשל = For more information on services included in child development services, see the [http://call.health.gov.il/infocenter/index?page=content&id=EL7317 "Kol Habriut website] and the [https://www.health.gov.il/Subjects/KidsAndMatures/child_development/Pages/child-development-rights.aspx Ministry of Health website].
 +
}}
 
}}
 
}}
{{תקציר/סיום}}
 
 
{{טפסים
 
{{טפסים
 
|
 
|
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| [[Children with Special Needs]]
 
| [[Children with Special Needs]]
 
| [[Child and Adolescent Health]]
 
| [[Child and Adolescent Health]]
 +
| [[Paramedical Treatments as Part of Special Education]]
 +
| [[Developmental Medical Diagnosis for Children (Child Development Services)]]
 
| [[The Healthcare Basket]]
 
| [[The Healthcare Basket]]
| [[Paramedical Treatments as Part of Special Education]]
+
 
 
}}
 
}}
 
{{עצם העניין/סיום}}
 
{{עצם העניין/סיום}}
*According to [[:he:חוק ביטוח בריאות ממלכתי|The National Health Insurance Law]], the state is responsible for providing paramedical treatments (child development services) to children who require them due to developmental or medical problems.
+
According to [[:he:חוק ביטוח בריאות ממלכתי|The National Health Insurance Law]], the state is responsible for providing paramedical treatments (child development services) to children who require them due to developmental or medical problems.
* Children are entitled to receive the treatment from the health plan in which they are enrolled, in accordance with a professional staff diagnosis.<br />
+
* Children are entitled to receive the treatment from the health plan in which they are enrolled, in accordance with a professional staff diagnosis.
'''Diagnoses:'''
+
* The types of paramedical treatments included in the [[The Healthcare Basket|healthcare basket]] are: Physical therapy, occupational therapy, speech therapy, psychological (see expanded explanation on the [https://www.health.gov.il/Subjects/KidsAndMatures/child_development/professionals/Pages/psyc.aspx Ministry of Health website]) and psychosocial therapy, and social work.
* A psychological diagnosis will be provided for children whom the treatment team has decided require it.
 
* Following initial diagnosis, up to 2 diagnoses may be conducted during the 6 years of eligibility.
 
* A repeat diagnosis will not generally be conducted within one year of the previous diagnosis, although each case is examined on an individual basis.<br /> 
 
'''Treatments:'''
 
* The types of paramedical treatments included in the [[The Healthcare Basket|healthcare basket]] are: Physical therapy, occupational therapy, speech therapy, psychological and psychosocial therapy, and social work.
 
 
* The treatments are provided by a multidisciplinary professional staff, including: medical specialists in pediatric neurology or pediatrics with experience in the field of child development; psychologists; physical therapists; social workers; communications clinicians; and occupational therapists.
 
* The treatments are provided by a multidisciplinary professional staff, including: medical specialists in pediatric neurology or pediatrics with experience in the field of child development; psychologists; physical therapists; social workers; communications clinicians; and occupational therapists.
* Each treatment session performed by a healthcare professional should be one hour long, and never less than 45 minutes. Treatments may also include instruction and guidance for parents.
+
* The health funds have expanded, through supplementary insurance, the entitlements established by the [[:he:חוק ביטוח בריאות ממלכתי|law]] (detailed in this page). For further information about the arrangements in each fund, see the [http://call.health.gov.il/infocenter/index?page=content&id=EL7317 Kol HaBriut website].
  
== Who is Eligible and for Which Treatments? ==  
+
== Who is Eligible? ==  
 
* Children up to age 9 are eligible for diagnosis and treatment by a multidisciplinary professional staff.
 
* Children up to age 9 are eligible for diagnosis and treatment by a multidisciplinary professional staff.
 
* Children diagnosed as having a [[Somatic Developmental Disorder|somatic developmental disability]] are entitled to unlimited paramedical treatments until age 18 according to need.
 
* Children diagnosed as having a [[Somatic Developmental Disorder|somatic developmental disability]] are entitled to unlimited paramedical treatments until age 18 according to need.
 +
* Children on the autism spectrum are entitled to [[Paramedical Treatments for Children with Autism|paramedical treatments]] from the age of diagnosis until 18.
 
* Children up to age 6 are entitled to treatment for [[Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD)]].
 
* Children up to age 6 are entitled to treatment for [[Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD)]].
* Children between the ages of 4 and 9 who do not suffer from a [[Somatic Developmental Disorder|somatic developmental disorder]] or complex disability, may undergo diagnosis by a qualified medical professional, even if they are not in a facility or department which is recognized by the Ministry of Health.
+
===Diagnosis===
 
* Children who do not suffer from a somatic developmental disability, but who do suffer from a complex developmental problem (children with a disorder/disability in more than one field of child development) will be diagnosed and treated at a facility or department recognized by the Ministry of Health.
 
* Children who do not suffer from a somatic developmental disability, but who do suffer from a complex developmental problem (children with a disorder/disability in more than one field of child development) will be diagnosed and treated at a facility or department recognized by the Ministry of Health.
* Children requiring treatment in a field of child development due to other medical problems that are not developmental (such as recovery from a specific type of surgery or medical care after an accident) will receive it according to the medical necessity of these services, regardless of eligibility for the developmental services basket.
+
*Children up to age 4 who have a suspected developmental delay should be referred to a clinic recognized for child development and the diagnosis should be made in the clinic or by outside professionals that the child was referred to.
* For more information regarding different children's populations, see the "More Information" section below.
+
* Children between the ages of 4 and 9 who do not suffer from a [[Somatic Developmental Disorder]] or complex disability, may undergo diagnosis by a qualified medical professional, even if they are not in a facility or department which is recognized by the Ministry of Health.
 
+
* For more information regarding different children's populations, see the [[Paramedical Treatments for Children (Child Development Services)#More Information|More Information]] section below.
== Number of Treatments for Which Children are Eligible ==
+
=== Number of Treatments for Which Children are Eligible ===
* Children not suffering from a somatic developmental disorder are entitled to the following number of treatments:
+
*Children suffering from a [[Somatic Developmental Disorder]] are en.titled to treatments, without limitation, based on medical need
 +
* Children that do not suffer a somatic developmental disorder and who are not on the [[Autism|autistic spectrum]] are entitled to the following number of treatments:
 
** For children '''ages 0 to 3''': An unlimited number of treatments are provided according to need and based on the professional opinion of the health plan's medical specialist.
 
** For children '''ages 0 to 3''': An unlimited number of treatments are provided according to need and based on the professional opinion of the health plan's medical specialist.
 
** For children '''ages 3 to 6''': Up to 27 treatments per year per paramedical profession (with the total number of treatments not to exceed 54) are provided according to need and based on the professional opinion of the health plan's medical specialist.
 
** For children '''ages 3 to 6''': Up to 27 treatments per year per paramedical profession (with the total number of treatments not to exceed 54) are provided according to need and based on the professional opinion of the health plan's medical specialist.
 
** For children '''ages 6 to 9''': Up to 9 treatments per year per paramedical profession (with the total number of treatments not to exceed 18) are provided according to need and based on the professional opinion of the health plan's medical specialist.
 
** For children '''ages 6 to 9''': Up to 9 treatments per year per paramedical profession (with the total number of treatments not to exceed 18) are provided according to need and based on the professional opinion of the health plan's medical specialist.
** Children receiving a diagnosis before age 6 are, in the first year of treatment (for the issue that was diagnosed), entitled to the number of treatments to which they were entitled on the day of the diagnosis.  
+
** Children diagnosed before age 6 are, in the first year of treatment, entitled to the number of treatments to which they were entitled on the day of the diagnosis.   Meaning that in the first year the child is entitled to the number of treatments that a 3-6 year old receives.  
** Children with a somatic developmental disability are entitled to unlimited treatments according to need.
+
*The number of treatments given to children who do not have a somatic developmental disability is based on individual need, overall goals, and the objectives set by the professional staff in accordance with that which has been established by a qualified medical or healthcare professional.
** The number of treatments given to children who do not have a somatic developmental disability is based on individual need, overall goals, and the objectives set by the professional staff in accordance with that which has been established by a qualified medical or healthcare professional.
+
*Children requiring treatment in a field of child development due to other medical problems that are not developmental (such as recovery from a specific type of surgery or medical care after an accident) will receive services according to medical necessity, regardless of eligibility for the developmental services basket.
* '''Through the supplementary health insurance policies, the health plans have expanded upon the number of treatments established in the [[:he:חוק ביטוח בריאות ממלכתי|law]]. Those with supplementary health insurance should check the arrangements specific to their plan and level.'''
+
* For further information about additional treatments provided through the supplemental plans of the health funds, see [http://call.health.gov.il/infocenter/index?page=content&id=EL7317 Ministry of Health website].
<!--== Who is Eligible? ==--> <!--מי זכאי-->
+
 
 
== How to Claim It? == <!--תהליך מימוש הזכות-->
 
== How to Claim It? == <!--תהליך מימוש הזכות-->
* Diagnostic and treatment services are only provided with health plan approval provided by a medical specialist in pediatric neurology or pediatrics with experience in the field of child development. The attending pediatric physician may provided a referral for diagnosis.
+
* First, a diagnosis will be made for the children who according to the opinion of the treating staff, require it. For more information, see [[Developmental Medical Diagnosis for Children (Child Development Services)]].
* Diagnostic services are provided at a child development center or developmental treatment department recognized by the Ministry of Health. [http://www.health.gov.il/Subjects/KidsAndMatures/child_development/Pages/child_development_complex.aspx Click here] for a listing of recognized child development facilities.
+
* The child will be referred for treatment based on to the results of the diagnosis.
 +
* Diagnostic and treatment services are only provided with health plan approval provided by a medical specialist in pediatric neurology or pediatrics with experience in the field of child development. (The attending pediatric physician may provide a referral for diagnosis).
 
* The health plans must provide the healthcare services themselves or through service providers.
 
* The health plans must provide the healthcare services themselves or through service providers.
* Parent may choose an attending medical profession from among the service providers with whom their health plan has arrangements. If the health plan is connected to more than one service provider, the health plan will established the arrangements regarding the extent of personal choice.
+
* Parents may choose an attending medical professional from among the service providers with whom their health plan has arrangements. If the health plan is connected to more than one service provider, the health plan will established the arrangements regarding the extent of personal choice.
 
* '''Treatments must be provided within a reasonable amount of time and within a reasonable distance from the patient's residence.'''   
 
* '''Treatments must be provided within a reasonable amount of time and within a reasonable distance from the patient's residence.'''   
* '''Stopping treatment''' - Treatment may only be stopped before the full number of treatments established in the healthcare services basket have been used up according to a professional opinion.  
+
* Each treatment session performed by a healthcare professional should be one hour long, and never less than 45 minutes. Treatments may also include instruction and guidance for parents.
 
+
* '''Stopping treatment''' - Treatment may be stopped before the full number of treatments established in the healthcare services basket are used used up, only if done with professional discretion.  
 
===Wait Times for Diagnosis and Treatment===
 
===Wait Times for Diagnosis and Treatment===
* The waiting time for treatment after diagnosis is established according to a professional medical opinion.
+
* The maximum waiting time for diagnosing and starting treatment should not exceed 3 months from the time of referral.
* The maximum waiting time for diagnosis and beginning treatment (from the initial health plan request) may be no more than 3 months.
+
*The wait between necessary appointments for treatment for the child should not be more than one month.
* Priority for diagnosis and treatment in the first year following their referral is given to:
+
*In the event of delay in diagnosis and treatment beyond the 3 months from the referral, you can contact one of the [https://www.health.gov.il/Subjects/KidsAndMatures/child_development/Pages/child_development_complex.aspx child development units recognized by the Ministry of Health] (even if the unit is not connected by arrangement with the health fund and the health fund has not referred the child to that unit).
** Children with a developmental disorder requiring immediate therapeutic intervention.
+
* In these cases, the family is entitled to reimbursement of the payments for treatment or diagnosis, up to the [https://www.health.gov.il/Subjects/KidsAndMatures/child_development/Documents/child-development-rate.pdf Ministry of Health rates], provided that the number of treatments did not exceed the number of treatments to which they are entitled.
** [[:he:עולים|Immigrant]] children with a developmental disorder who are waiting during their first year after aliyah for developmental diagnosis so they can claim their National Insurance and special education benefits.
+
* The refund will be provided by the health fund.
** Premature infants born at a birth weight of less than 1500 grams and before week 32 of pregnancy (their wait time may not exceed 2 months from the date of the request).
+
*'''Priority for diagnosis and treatment in the first year following their referral is given to children in the following cases:'''
* '''Parents are entitled to a reimbursement from their health plan for all private services paid for in cases where the waiting time exceeded the maximum wait time''' - Parents of children forced to wait longer than the maximum wait time may pay for diagnostic and treatment services from private developmental service providers meeting Ministry of Health requirements, and '''the health plans are required to reimburse for these expenses up to the [http://www.health.gov.il/Subjects/KidsAndMatures/child_development/Documents/child-development-rate.pdf amounts established by the Ministry of Health]''', as long as the number of treatments did not exceed the number of treatments to which they were entitled.
+
** Children with a developmental disorder requiring immediate therapeutic intervention. (For details, see [http://www.health.gov.il/hozer/mr28_2000.pdf Medical Administration Circular 28/2000 of 06.08.2000 regarding early referral to the Child Development Institute of children at risk of developmental disabilities]).
* Children not diagnosed within the maximum wait time are entitled to utilize the right to reimbursement regarding both diagnostic services and treatment services in any field, according to what has been established by the diagnosis.
+
** [[New Immigrants (Olim)]] children with a developmental disorder during their first year after aliyah.
* Children diagnosed within the maximum wait time, but for whom treatment according to the diagnosis was not provided according to the established wait times are entitled to utilize the right to reimbursement regarding the treatment services that they did not receive within the reasonable period of time.
+
** Premature infants born at a birth weight of less than 1500 grams and before week 32 of pregnancy (their wait time may not exceed one month from the date of the request). For further details, see [[Early Referral to Child Development Services for Premature Infants]].
* Policyholders entitled to a reimbursement may choose between continuing to receive reimbursements for the service and receiving the service through the health plan.
 
* Policyholders are also eligible for a reimbursement if they were given an appointment within the permitted wait time, but the wait time between the appointments for that service was more than a month.
 
  
 
== Payment for Services ==
 
== Payment for Services ==
 
* Treatment by a multidisciplinary professional staff is provided in exchange for a co-payment from the policyholder.
 
* Treatment by a multidisciplinary professional staff is provided in exchange for a co-payment from the policyholder.
* The co-payment for a child between ages 3 and 9 who does not suffer from a somatic developmental disorder for services in the field of child development is established in Section 6 of the second addendum to the National Health Insurance Law, and is updated every year according to the increase in the healthcare cost index (as of 07.2013, this amount was 28 NIS).
+
* The co-payment for a child between ages 3 and 9 who does not suffer from a somatic developmental disorder for services in the field of child development is established in Section 6 of the second addendum to the National Health Insurance Law, and is updated every year according to the increase in the healthcare cost index.
 
* Additional treatments provided through supplementary insurance also require a co-payment which varies by health plan. Supplementary insurance policyholders should check their arrangements according to their plan and level.
 
* Additional treatments provided through supplementary insurance also require a co-payment which varies by health plan. Supplementary insurance policyholders should check their arrangements according to their plan and level.
 +
* For updated information on the rates of co-payment, see the [http://call.health.gov.il/infocenter/index?page=content&id=EL7317 Ministry of Health website] and the [https://www.health.gov.il/Subjects/Finance/Taarifon/Pages/PriceList.aspx Ministry of Health price list].
  
 
===Exemptions from Co-Payments===
 
===Exemptions from Co-Payments===
 
* Children up to age 3.
 
* Children up to age 3.
* Children diagnosed as having a somatic developmental disability (if they receive the treatments through the health plan).
+
* Children diagnosed as having a [[Somatic Developmental Disorder]] (if they receive the treatments through the health plan).
 
* Health plan policyholders entitled to [[:he:גמלת הבטחת הכנסה (השלמת הכנסה)|income support (an income supplement)]] (as of 01.08.2005).
 
* Health plan policyholders entitled to [[:he:גמלת הבטחת הכנסה (השלמת הכנסה)|income support (an income supplement)]] (as of 01.08.2005).
  
 
==More Information==
 
==More Information==
 
===Premature Infants, Babies and Children at Risk for Developmental Disorders===
 
===Premature Infants, Babies and Children at Risk for Developmental Disorders===
* Special newborn care units must refer any newborn weighing less than 1500 grams for a developmental examination and assessment at a recognized facility for child development and rehabilitation, and the wait time may not exceed 2 months from the date of the request. For more information, see: [[:he:הפניה מוקדמת של פגים למכון להתפתחות הילד|Early Referral of Premature Infants to a Child Development Center]].
+
* Special newborn care units must refer any newborn weighing less than 1500 grams for a developmental examination and assessment at a recognized facility for child development and rehabilitation, and the wait time may not exceed 2 weeks from the date of the request. For more information, see: [[Early Referral to Child Development Services for Premature Infants]].
 
* Additionally, there is a list of cases for which the Ministry of Health recommends early referral of newborns, infants and children at risk for developmental disorders to child development centers. For more information, see: [http://www.health.gov.il/hozer/mr28_2000.pdf Medical Administration Circular 28/2000 from 06.08.2000] - early referral of children at risk for developmental disorders to child development centers.
 
* Additionally, there is a list of cases for which the Ministry of Health recommends early referral of newborns, infants and children at risk for developmental disorders to child development centers. For more information, see: [http://www.health.gov.il/hozer/mr28_2000.pdf Medical Administration Circular 28/2000 from 06.08.2000] - early referral of children at risk for developmental disorders to child development centers.
  
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* The treating professional at the health plan receives the child's [[:he:תכנית לימודים אישית (תל"א)|personalized curriculum (TALA)]] established by the education system, which includes the type and number of paramedical treatments a child receives at school.
 
* The treating professional at the health plan receives the child's [[:he:תכנית לימודים אישית (תל"א)|personalized curriculum (TALA)]] established by the education system, which includes the type and number of paramedical treatments a child receives at school.
 
* When making professional decisions, the treating professional at the health plan may take into account the fact that a child receives treatments at school.
 
* When making professional decisions, the treating professional at the health plan may take into account the fact that a child receives treatments at school.
 +
*Until the educational plan is put in place, the kupat cholim can not stop providing, or change the existing treatments the child is receiving.
 
* When making professional decisions, the treating professional at the health plan may take into account the fact that a child is not receiving necessary treatments at school.
 
* When making professional decisions, the treating professional at the health plan may take into account the fact that a child is not receiving necessary treatments at school.
  
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* The basket of services for children under the age of 3 who have [[Somatic Developmental Disorder|somatic disorders]] is generally provided in the framework of [[Rehabilitative Daycare Centers|rehabilitative daycare]] in accordance with each child's specific needs.
 
* The basket of services for children under the age of 3 who have [[Somatic Developmental Disorder|somatic disorders]] is generally provided in the framework of [[Rehabilitative Daycare Centers|rehabilitative daycare]] in accordance with each child's specific needs.
 
* Children of this age who are not in rehabilitative daycare are entitled to receive the services through their health plan.
 
* Children of this age who are not in rehabilitative daycare are entitled to receive the services through their health plan.
* From age 3 and up, the services are provided through the health plan.
+
* From age 3 and up, the services are provided through the health plan to which they are members of.
 
:* There is no annual or other form of restriction or limitation placed on the number of treatment sessions children are entitled to through this framework.
 
:* There is no annual or other form of restriction or limitation placed on the number of treatment sessions children are entitled to through this framework.
 
:* The number of treatment sessions and their frequency should be in accordance with each child's specific needs, according to the decision of the health plan's treating professional (this is generally up to 3 treatments per week total in all fields of treatment).
 
:* The number of treatment sessions and their frequency should be in accordance with each child's specific needs, according to the decision of the health plan's treating professional (this is generally up to 3 treatments per week total in all fields of treatment).
 
* Parents of children with somatic disorders are exempt from co-payments for treatments provided through the health plan.
 
* Parents of children with somatic disorders are exempt from co-payments for treatments provided through the health plan.
  
=== Children with ADD/ADHD ===
+
=== Additional Populations ===
* See: [[:he:אבחונים וטיפולים לילדים עם הפרעות קשב וריכוז|Diagnoses and Treatments for Children with ADD/ADHD]]
+
*Children with ADHD:
 
+
**[[Evaluations in the Kupat Cholim for Children with ADD/ADHD]]
=== Children with Autism ===
+
**[[ADHD Treatment in the Kupat Cholim (Health Fund)]]
* See: [[Paramedical Treatments for Children with Autism]]
+
* [[Paramedical Treatments for Children with Autism]]
 
+
* [[Communication Therapy Services for Children with Hearing Impairment]]
=== Children with Hearing Impairment ===
+
* [[:he:טיפולים לילדים עם הפרעה בשטף הדיבור (גמגום)|Children with speech disorder (stuttering)]]
* See: [[Communication Therapy Services for Children with Hearing Impairment]]
 
  
 
== Please Note == <!--חשוב לדעת-->
 
== Please Note == <!--חשוב לדעת-->
 
* '''Those for whom a health plan has refused to provide paramedical services may contact the [[:he:נציבות קבילות הציבור לחוק ביטוח בריאות ממלכתי|National Health Insurance Law Ombudsman]] at the Ministry of Health.'''
 
* '''Those for whom a health plan has refused to provide paramedical services may contact the [[:he:נציבות קבילות הציבור לחוק ביטוח בריאות ממלכתי|National Health Insurance Law Ombudsman]] at the Ministry of Health.'''
* Parents wishing to submit a claim against their health plan may do so through the regional labor court in their area of residence.
+
* The health funds are obligated to maintain continuity in the provision of services in the area of child development, even in the event of changes in the agreements or arrangements of the health fund with the service provider. For more information, see [[Maintaining Continuity of Care (Principle of Treatment Continuity)]].
 +
* Parents wishing to submit a claim against their health plan may do so through the regional labor courts in their area of residence.
  
 
== Court Rulings == <!--פסקי דין-->
 
== Court Rulings == <!--פסקי דין-->
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== Aid Organizations == <!--ארגוני סיוע-->
 
== Aid Organizations == <!--ארגוני סיוע-->
* For a comprehensive categorized listing of healthcare organizations offering assistance and support, [[People with Disabilities/Aid Organizations|click here]].
+
* [[:he:העמותה הישראלית להתפתחות הילד ושיקומו|The Israeli Association for Child Development and Rehabilitation]]
 +
* For a comprehensive categorized listing of healthcare organizations offering assistance and support for people with special needs and their families, [[People with Disabilities/Aid Organizations|click here]].
 +
*[[Health and Illness/Aid Organizations|Click here for a general list of organizations that provide assistance for medical related issues]]
  
 
== Government Agencies == <!--גורמי ממשל-->
 
== Government Agencies == <!--גורמי ממשל-->
 +
* [[:he:משרד הבריאות|The Ministry of Health]]
 +
**[https://www.health.gov.il/PniyotHazibur/Pages/CallCenter.aspx Kol Habriut] - The Ministry of Health's call center {{טלפון|*5400}}
 +
*[[:he:נציבות קבילות הציבור לחוק ביטוח בריאות ממלכתי|The Ombudsman under the National Health Insurance Law]]
 
* The Health Plans - (Kupot Cholim)
 
* The Health Plans - (Kupot Cholim)
* [[:he:המוסד לביטוח לאומי|The National Insurance Institute]]
 
* [[:he:משרד הבריאות|The Ministry of Health]]
 
  
 
== Laws and Regulations == <!--חקיקה ונהלים-->
 
== Laws and Regulations == <!--חקיקה ונהלים-->
 
* [[:he:חוק ביטוח בריאות ממלכתי|The National Health Insurance Law]]
 
* [[:he:חוק ביטוח בריאות ממלכתי|The National Health Insurance Law]]
 
* [[:he:חוק מעונות יום שיקומיים|The Rehabilitative Day Care Law]]  
 
* [[:he:חוק מעונות יום שיקומיים|The Rehabilitative Day Care Law]]  
 +
* [https://www.health.gov.il/hozer/sbn09_2016.pdf Circular of the Deputy Director General for Supervision of the Health Funds and Additional Health Services 09/2016 from 21.12.2016] - Services in the field of child development - updated.
 +
* [https://www.health.gov.il/hozer/MR19_2013.pdf The Medical Administration circular 19/2013 from 08.07.2013] - the provision of services in the field of child development by the health funds.
 +
* [http://www.health.gov.il/hozer/sbn01_2010.pdf Circular of the Deputy Director General for Supervision of the Health Funds and Additional Health Services 1/10 from 21.1.2010] - Services in the field of child development.
 +
*[https://www.health.gov.il/hozer/sbn04_2010.pdf  Circular of the Deputy Director General for Supervision of the Health Funds and Additional Health Services 4/10 from 22.3.2010] - provision of child development services for children in the special education system.
 +
* [http://www.health.gov.il/hozer/sbn03_2009.pdf Circular of the Deputy Director General for Supervision of the Health Funds and Additional Health Services 3/09 from 22.1.2009] - Services in the field of child development.
 +
* [http://www.health.gov.il/hozer/mr42_2005.pdf The Medical Administration circular 42/2005 from 06.11.2005] - Early referral of newborns born at a very low weight to developmental assessment.
 +
* [http://cms.education.gov.il/EducationCMS/applications/mankal/arc/s8ak1_2_25.htm Circular of the Director General of the Ministry of Education תשס/8(א) from 02.04.2000] - Paramedical services for students in special education programs, and updates found in the [http://cms.education.gov.il/EducationCMS/applications/mankal/arc/sb8ak1_2_31.htm standing order circular 62/8(a)] and the [http://cms.education.gov.il/EducationCMS/applications/mankal/arc/sf4h1_2_2.htm messages and information circular 66/4].
 +
*[https://www.health.gov.il/hozer/mk28_1996.pdf Circular of the Director General of the Ministry of Health 28/96 from 14.11.1996] - recognition of clinics for diagnosis and treatment of child development issues.
  
 
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* Ministry of Health: [http://www.health.gov.il/PublicationsFiles/eco13022013.pdf "Health Insurance and Medical Services for Special Populations"] (in Hebrew)
 
* Ministry of Health: [http://www.health.gov.il/PublicationsFiles/eco13022013.pdf "Health Insurance and Medical Services for Special Populations"] (in Hebrew)
  
== Sources == <!--מקורות-->
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== Credits == <!--מקורות-->
*[http://www.health.gov.il/hozer/MR19_2013.pdf Medical Administration Circular 19/2013 from 08.07.2013] - Health plan provision of child development services  
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<!--*[http://www.health.gov.il/hozer/MR19_2013.pdf Medical Administration Circular 19/2013 from 08.07.2013] - Health plan provision of child development services  
 
* [http://www.health.gov.il/hozer/mr51_2006.pdf Medical Administration Circular 51/2006 from 21.12.2006] - the principles of health plan provision of child development services.
 
* [http://www.health.gov.il/hozer/mr51_2006.pdf Medical Administration Circular 51/2006 from 21.12.2006] - the principles of health plan provision of child development services.
 
* [http://www.health.gov.il/hozer/sbn03_2009.pdf Deputy Director of Supervision of the Health Plans and Additional Health Services Circular 3/09 from 22.01.2009] regarding child development services.
 
* [http://www.health.gov.il/hozer/sbn03_2009.pdf Deputy Director of Supervision of the Health Plans and Additional Health Services Circular 3/09 from 22.01.2009] regarding child development services.
 
* [http://www.health.gov.il/hozer/sbn01_2010.pdf Deputy Director of Supervision of the Health Plans and Additional Health Services Circular 1/10 from 21.01.2010] regarding child development services.
 
* [http://www.health.gov.il/hozer/sbn01_2010.pdf Deputy Director of Supervision of the Health Plans and Additional Health Services Circular 1/10 from 21.01.2010] regarding child development services.
 
* [http://www.health.gov.il/hozer/mr42_2005.pdf Medical Administration Circular 42/2005 from 06.11.2005] regarding early referral of newborns born with a very low birth weight for developmental assessment.
 
* [http://www.health.gov.il/hozer/mr42_2005.pdf Medical Administration Circular 42/2005 from 06.11.2005] regarding early referral of newborns born with a very low birth weight for developmental assessment.
* [http://cms.education.gov.il/EducationCMS/applications/mankal/arc/s8ak1_2_25.htm Ministry of Education Director Circular 5760/8(a) from 02.04.2000] - Paramedical services for schoolchildren in special education frameworks.
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* [http://cms.education.gov.il/EducationCMS/applications/mankal/arc/s8ak1_2_25.htm Ministry of Education Director Circular 5760/8(a) from 02.04.2000] - Paramedical services for schoolchildren in special education frameworks.-->
* Original translation by [[AACI - Association of Americans and Canadians in Israel|AACI]]'s [[The Shira Pransky Project|Shira Pransky Project]].
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* {{קרדיט/פרויקט שירה פרנסקי}}
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[[ar:تشخيصات وعلاجات مكمّلة للأطفال (خدمات تطور الطفل)]]
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[[he:טיפולים פרא רפואיים לילדים (שירותי התפתחות הילד)]]
[[he:אבחונים וטיפולים פרא רפואיים לילדים (שירותי התפתחות הילד)]]
 

Latest revision as of 19:46, 3 March 2021

Introduction:

Children with medical or developmental disabilities are entitled to paramedical treatments through their HMO as part of The Healthcare Basket
Children who receive Paramedical Treatments as Part of Special Education may also be entitled to treatments that are part of the healthcare basket
The health plans are required to provide reimbursement for services that were paidd for privately in cases in where the waiting time for diagnostic and treatment services at the health plan was longer than the amount established by the Ministry of Health
For more information on services included in child development services, see the "Kol Habriut website and the Ministry of Health website.


According to The National Health Insurance Law, the state is responsible for providing paramedical treatments (child development services) to children who require them due to developmental or medical problems.

  • Children are entitled to receive the treatment from the health plan in which they are enrolled, in accordance with a professional staff diagnosis.
  • The types of paramedical treatments included in the healthcare basket are: Physical therapy, occupational therapy, speech therapy, psychological (see expanded explanation on the Ministry of Health website) and psychosocial therapy, and social work.
  • The treatments are provided by a multidisciplinary professional staff, including: medical specialists in pediatric neurology or pediatrics with experience in the field of child development; psychologists; physical therapists; social workers; communications clinicians; and occupational therapists.
  • The health funds have expanded, through supplementary insurance, the entitlements established by the law (detailed in this page). For further information about the arrangements in each fund, see the Kol HaBriut website.

Who is Eligible?

Diagnosis

  • Children who do not suffer from a somatic developmental disability, but who do suffer from a complex developmental problem (children with a disorder/disability in more than one field of child development) will be diagnosed and treated at a facility or department recognized by the Ministry of Health.
  • Children up to age 4 who have a suspected developmental delay should be referred to a clinic recognized for child development and the diagnosis should be made in the clinic or by outside professionals that the child was referred to.
  • Children between the ages of 4 and 9 who do not suffer from a Somatic Developmental Disorder or complex disability, may undergo diagnosis by a qualified medical professional, even if they are not in a facility or department which is recognized by the Ministry of Health.
  • For more information regarding different children's populations, see the More Information section below.

Number of Treatments for Which Children are Eligible

  • Children suffering from a Somatic Developmental Disorder are en.titled to treatments, without limitation, based on medical need
  • Children that do not suffer a somatic developmental disorder and who are not on the autistic spectrum are entitled to the following number of treatments:
    • For children ages 0 to 3: An unlimited number of treatments are provided according to need and based on the professional opinion of the health plan's medical specialist.
    • For children ages 3 to 6: Up to 27 treatments per year per paramedical profession (with the total number of treatments not to exceed 54) are provided according to need and based on the professional opinion of the health plan's medical specialist.
    • For children ages 6 to 9: Up to 9 treatments per year per paramedical profession (with the total number of treatments not to exceed 18) are provided according to need and based on the professional opinion of the health plan's medical specialist.
    • Children diagnosed before age 6 are, in the first year of treatment, entitled to the number of treatments to which they were entitled on the day of the diagnosis. Meaning that in the first year the child is entitled to the number of treatments that a 3-6 year old receives.
  • The number of treatments given to children who do not have a somatic developmental disability is based on individual need, overall goals, and the objectives set by the professional staff in accordance with that which has been established by a qualified medical or healthcare professional.
  • Children requiring treatment in a field of child development due to other medical problems that are not developmental (such as recovery from a specific type of surgery or medical care after an accident) will receive services according to medical necessity, regardless of eligibility for the developmental services basket.
  • For further information about additional treatments provided through the supplemental plans of the health funds, see Ministry of Health website.

How to Claim It?

  • First, a diagnosis will be made for the children who according to the opinion of the treating staff, require it. For more information, see Developmental Medical Diagnosis for Children (Child Development Services).
  • The child will be referred for treatment based on to the results of the diagnosis.
  • Diagnostic and treatment services are only provided with health plan approval provided by a medical specialist in pediatric neurology or pediatrics with experience in the field of child development. (The attending pediatric physician may provide a referral for diagnosis).
  • The health plans must provide the healthcare services themselves or through service providers.
  • Parents may choose an attending medical professional from among the service providers with whom their health plan has arrangements. If the health plan is connected to more than one service provider, the health plan will established the arrangements regarding the extent of personal choice.
  • Treatments must be provided within a reasonable amount of time and within a reasonable distance from the patient's residence.
  • Each treatment session performed by a healthcare professional should be one hour long, and never less than 45 minutes. Treatments may also include instruction and guidance for parents.
  • Stopping treatment - Treatment may be stopped before the full number of treatments established in the healthcare services basket are used used up, only if done with professional discretion.

Wait Times for Diagnosis and Treatment

Payment for Services

  • Treatment by a multidisciplinary professional staff is provided in exchange for a co-payment from the policyholder.
  • The co-payment for a child between ages 3 and 9 who does not suffer from a somatic developmental disorder for services in the field of child development is established in Section 6 of the second addendum to the National Health Insurance Law, and is updated every year according to the increase in the healthcare cost index.
  • Additional treatments provided through supplementary insurance also require a co-payment which varies by health plan. Supplementary insurance policyholders should check their arrangements according to their plan and level.
  • For updated information on the rates of co-payment, see the Ministry of Health website and the Ministry of Health price list.

Exemptions from Co-Payments

More Information

Premature Infants, Babies and Children at Risk for Developmental Disorders

  • Special newborn care units must refer any newborn weighing less than 1500 grams for a developmental examination and assessment at a recognized facility for child development and rehabilitation, and the wait time may not exceed 2 weeks from the date of the request. For more information, see: Early Referral to Child Development Services for Premature Infants.
  • Additionally, there is a list of cases for which the Ministry of Health recommends early referral of newborns, infants and children at risk for developmental disorders to child development centers. For more information, see: Medical Administration Circular 28/2000 from 06.08.2000 - early referral of children at risk for developmental disorders to child development centers.

Children in Rehabilitative Day Care

  • According to the law, all children in rehabilitative daycare are entitled to receive paramedical treatments as part of the day care.
  • These treatments are funded by the health plan to which the toddler belongs, and there is no eligibility for treatments beyond them.

Children Receiving Paramedical Treatments as Part of Special Education

  • Receiving treatments from the health plan is not conditional on the school in which the child learns or the basket of services to which he/she is entitled.
  • The treatments provided as part of a special education framework in a special education school or as part of an integrated framework in a regular school do not replace the treatments to which a child is entitled from the health plan.
  • The treating professional at the health plan receives the child's personalized curriculum (TALA) established by the education system, which includes the type and number of paramedical treatments a child receives at school.
  • When making professional decisions, the treating professional at the health plan may take into account the fact that a child receives treatments at school.
  • Until the educational plan is put in place, the kupat cholim can not stop providing, or change the existing treatments the child is receiving.
  • When making professional decisions, the treating professional at the health plan may take into account the fact that a child is not receiving necessary treatments at school.

Children with Somatic Disorders

  • The basket of services for children under the age of 3 who have somatic disorders is generally provided in the framework of rehabilitative daycare in accordance with each child's specific needs.
  • Children of this age who are not in rehabilitative daycare are entitled to receive the services through their health plan.
  • From age 3 and up, the services are provided through the health plan to which they are members of.
  • There is no annual or other form of restriction or limitation placed on the number of treatment sessions children are entitled to through this framework.
  • The number of treatment sessions and their frequency should be in accordance with each child's specific needs, according to the decision of the health plan's treating professional (this is generally up to 3 treatments per week total in all fields of treatment).
  • Parents of children with somatic disorders are exempt from co-payments for treatments provided through the health plan.

Additional Populations

Please Note

  • Those for whom a health plan has refused to provide paramedical services may contact the National Health Insurance Law Ombudsman at the Ministry of Health.
  • The health funds are obligated to maintain continuity in the provision of services in the area of child development, even in the event of changes in the agreements or arrangements of the health fund with the service provider. For more information, see Maintaining Continuity of Care (Principle of Treatment Continuity).
  • Parents wishing to submit a claim against their health plan may do so through the regional labor courts in their area of residence.

Court Rulings

Aid Organizations

Government Agencies

Laws and Regulations

Additional Publications

Credits