In its judgment of 16 July 2025 (B 1 KR 3/24 R), the Federal Social Court ruled that the Institute for the Hospital Remuneration System (Institut für das Entgeltsystem im Krankenhaus, “InEK”) can lawfully designate nursing-sensitive areas as the entity entrusted with this task. The judgment upheld the InEK’s appeal on points of law and overturned the opposing judgments of the lower courts.
The dispute concerned section 137, letter (i) Social Security Code, Book V (Sozialgesetzbuch, Fünftes Buch), through which the Federal Government established requirements for minimum staffing levels in so-called nursing-sensitive areas in hospitals in order to improve patient care and relieve the burden on nursing staff. Based on this provision, the Federal Ministry of Health introduced the Ordinance on Minimum Nursing Staff Levels (Pflegepersonaluntergrenzenverordnung) in 2019.
The InEK – a company formed by the self-governing partners in the hospital financing system, namely the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), the German Hospital Federation (DKG e.V.) and the German Association of Private Health Insurers (PKV e.V.) – is responsible for designating the relevant nursing-sensitive areas in hospitals. In the proceedings, a hospital operator specifically objected to neurology being designated a nursing-sensitive area and argued that, due to its subspecialisation, the department did not require many nursing employees and should not have been designated a nursing-sensitive area.
The action was successful in the lower courts based on the arguments that authority had allegedly not been duly delegated to the InEK and it did not have the power to issue administrative acts, as well as that the Ordinance was incompatible with higher-ranking law. The Federal Social Court has now corrected this with its judgment of 16 July 2025. This judgment is of overarching importance due to the large number of procedures to determine nursing-sensitive areas from 2021 to 2025 and because it provides fundamental clarification of the InEK’s legal status and powers.
The following Gleiss Lutz team advised the Institut für das Entgeltsystem im Krankenhaus in these proceedings: Dr. Reimar Buchner (partner), Dr. Lenke Wettlaufer and Dilara Puls (all Public Law/Healthcare & Life Sciences, all Berlin).
Gleiss Lutz regularly assists clients in hospital financing and planning disputes of nationwide significance.
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