Hospitals in dispute before the courts in three nations

In a significant move, the states of Baden-Württemberg, Schleswig-Holstein, and Saxony-Anhalt have filed a lawsuit with the Federal Constitutional Court to review the constitutional validity of guidelines issued by the Joint Federal Committee (G-BA). The lawsuit aims to protect the constitutional right of the states to hospital planning against repeated interventions by the G-BA.

The crux of the dispute revolves around the G-BA's minimum quantity requirements for allogeneic stem cell transplantation and staffing requirements for stationary psychiatric and psychosomatic facilities. The G-BA increased the minimum quantity from 22 to 40 transplants for the year 2025, a decision met with criticism due to the lack of sufficient evidence from the states.

Manne Lucha, Baden-Württemberg's Minister of Health, stated that the lawsuit is a necessary last resort. Lucha also expressed concerns about the minimum staffing requirements for stationary psychiatric and psychosomatic facilities, stating that they may not be implementable due to chronic staff shortages.

The states fear that the G-BA's guidelines interfere with their responsibility for ensuring inpatient care and effectively undermine it. Kerstin von der Decken, Health Minister of Schleswig-Holstein, believes that specialization and concentration of highly complex services are essential components of modern hospital planning, but the states must remain flexible to ensure care that takes into account regional conditions.

Petra Grimm-Benne, Health Minister of Saxony-Anhalt, wants to have the current minimum quantity and staffing requirements of the G-BA reviewed to see if they are compatible with the responsibility of the states for adequate hospital care. Grimm-Benne also stated that it cannot be the observance of rigid limits for the fulfillment of minimum quantities that is decisive when it comes to ensuring comprehensive care for premature infants.

The G-BA has set a minimum quantity for allogeneic stem cell transplantation, and failure to meet this requirement results in a performance ban and non-reimbursement. The states fear that the minimum quantity requirement of the G-BA for the inpatient care of premature infants with a birth weight of less than 1,250 grams will lead to shifts and gaps in care.

The G-BA has suspended sanctions for not meeting the prescribed staff numbers, but the plaintiffs fear that sanctions will apply from 2026, potentially leading to hospital closures or care restrictions. The outcome of the review could send an important signal to the federal government, as stated by Petra Grimm-Benne.

A downloadable expert opinion on behalf of Baden-Württemberg discusses the legality of the Mm-R and the PPP-RL of the G-BA in terms of the planning authority of the federal states. The lawsuit underscores the states' concerns about the G-BA's interference in their responsibility for ensuring inpatient care.

The Federal Ministry responsible for Social Affairs, Health, and Integration in the current government is led by Federal Minister Johannes Rauch. The lawsuit marks a significant development in the ongoing debate between the G-BA and the states regarding hospital planning and the responsibility for inpatient care.