How Belgium funds home nursing: Katz, BelRAI, RIZIV

In Belgium, assessing and financing home nursing is split across two levels: the federal level (RIZIV/INAMI) pays for the nursing care itself through the nomenclature, keyed off the Katz scale, while the regions and communities (Flanders, Wallonia, Brussels) run the surrounding social-care budgets, increasingly keyed off BelRAI. If you build or run software for a home-nursing or home-care organisation here, that split is the shape of your data: one patient, two rulers, two payers, and a stack of digital plumbing between them.

This guide gives the operator’s view of the whole landscape: the two assessment instruments, how RIZIV/INAMI actually funds home nursing, where the federal-regional line falls, the eHealth and MyCareNet plumbing that ties it together, and the reforms in motion. The reform dates are the moving part, so read them as “true when checked”, not “settled”.

The Belgian home-nursing landscape in one picture

Belgium’s sixth state reform (2014) split responsibility for care of dependent people. Curative home nursing — the reimbursed acts a home nurse performs — stayed federal, financed by the compulsory health insurance that RIZIV/INAMI administers. A large block of long-term-care and elderly-support competences moved to the regions and communities: Flanders folded them into its Vlaamse sociale bescherming (Flemish social protection), Wallonia runs them through AViQ, and in Brussels the bicommunautaire body Iriscare handles them.

The practical consequence is that a single frail person at home can be simultaneously a RIZIV/INAMI patient (for the nurse’s visits) and a beneficiary of a regional care budget (for non-medical support), assessed by different instruments, paid from different pots. Software that models only one of those two worlds will keep bumping into the other.

Katz or BelRAI: which ruler applies, and when?

Belgium uses two care-dependency instruments in parallel, and confusing them is the most common mistake.

The Katz scale is the federal one. It is the “evaluation scale” of article 8 of the RIZIV/INAMI nomenclature: a home nurse scores six activities of daily living from 1 (independent) to 4 (fully dependent), and that profile decides whether care is billed per act or falls under a daily forfait A, B or C. Katz is narrow by design — six physical items plus disorientation in time and space — because its only job is to gate the nursing forfaits.

BelRAI is the broader one. It is the Belgian implementation of the internationally-validated interRAI instruments, hosted centrally on the federal eHealth platform, and it maps physical, cognitive, psychological and social functioning in far more detail. The regions are adopting BelRAI (and its shorter BelRAI Screener) as the shared language for social care, and it is being tested federally as a future basis for home-nursing financing.

The simplest way to hold it: Katz decides how the nurse’s visit is paid today; BelRAI is where the assessment world is heading, and where the regions already are. For a fuller treatment of each, the Katz scale guide covers the scoring and the forfait thresholds, and the BelRAI guide covers the Screener, the full Home Care assessment, and the shift between them.

How is home nursing actually financed?

RIZIV/INAMI finances home nursing through the nomenclature — the official list of reimbursable acts and their conditions. There are two ways a day of care gets paid.

For patients who are not heavily dependent, care is billed per act (per verstrekking / à l’acte): each reimbursed procedure — a wound dressing, an injection, a hygiene session — has its own nomenclature code and fee.

For heavily dependent patients, per-act billing is replaced by a daily lump sum, the forfait, which covers the whole day’s nursing regardless of how many acts it contains. There are three levels, forfait A, B and C, in rising order of dependency, and the Katz profile decides which one applies (the Katz scale guide sets out exactly which score combinations reach A, B or C). The mechanism matters more than the euro figure: the forfait amounts are re-set each year — indexed on 1 January — and published in the nomenclature, so look them up on the RIZIV/INAMI nurses page rather than trusting a number you saw once.

Not every dependent patient reaches a forfait, and that is where a subtle piece of the mechanism lives. A patient whose Katz profile falls short of forfait A is still billed per act, but if they are dependent for hygiene care they can receive the reimbursed hygiene sessions the nomenclature calls “toilets” — capped at two a week by default, and up to one a day in specific situations. Disorientation in time and space, when the treating physician attests it, can open more frequent hygiene care even at lower physical scores. For a product this matters because “no forfait” is not “no reimbursable care”: the same Katz assessment that misses forfait A can still drive a per-act plan the software has to bill correctly.

Two structural features shape how the money moves, and both are covered in depth in the RIZIV/INAMI home-nursing financing guide. First, home nurses almost always work under the third-party payer system (derdebetalersregeling / régime du tiers payant): for reimbursed care the patient does not pay the nurse and then claim it back — the mutuality pays the provider directly, and the patient owes at most a co-payment where one applies. Second, because they bill under third-party payer, nurses are required to verify the patient’s identity at each contact, an obligation in force since 1 October 2017.

Where the federal line stops and the regional one begins

The clean rule of thumb: the nurse’s reimbursed acts are federal; the social scaffolding around the patient is regional.

Federally, RIZIV/INAMI owns the nomenclature, the Katz forfaits, and the compulsory-insurance financing behind them. Regionally, each entity runs its own care budgets and its own assessment machinery. Flanders is the furthest along and the most documented: its zorgbudget voor ouderen met een zorgnood (care budget for older people with a care need) is a regional social-protection benefit, distinct from anything RIZIV pays, and Flanders has moved the assessment for that budget onto the BelRAI Screener — from 1 March 2026 for new applications, in place of the older medical-social scale (true when checked). Wallonia (AViQ) and Brussels (Iriscare) organise their long-term-care supports under their own frameworks, which are less uniform and less publicly documented than the Flemish one.

For an operator this means the assessment obligations you face depend on your region and your sector, not on “Belgium” as a whole. A Flemish family-care service and a Brussels home-nursing practice do not answer to the same assessment rulebook, even though both may bill federal RIZIV acts for the same patient.

The digital plumbing that ties it together

None of this runs on paper. Two federal systems carry the data.

The federal eHealth platform is the secure backbone for exchanging health data between actors — hospitals, nurses, mutualities, regional bodies. BelRAI itself runs as a service on eHealth, which is what lets an assessment made by one team be shared, with consent, with the others around a patient (see the eHealth BelRAI service page).

MyCareNet is the exchange layer between care providers and the mutualities, run by RIZIV together with the mutualist sector. For a home nurse it does the practical work: checking a patient’s insurability, transmitting the Katz evaluation-scale notification to the mutuality’s advisory physician, and carrying the electronic third-party-payer invoicing (eFact) so that no paper invoice goes to the insurer. The MyCareNet and eHealth billing guide walks through how these exchanges fit a nurse’s week. The point for software is that assessment and billing are not local forms inside your program — they are messages that have to travel over eHealth and MyCareNet in the right format, at the right moment.

Is the system shifting?

Yes, and this is the part to hold loosely. Two moves are worth tracking, both covered in the BelRAI guide rather than re-argued here.

Federally, a pilot on new home-nursing financing is testing a model built around BelRAI instead of the Katz forfaits: BelRAI maps the care needs and financing is decoupled from the Katz forfaits, though the Katz scale is still recorded alongside. It is a voluntary, roughly two-year pilot running from mid-2026, evaluated before any general rollout — so as of this writing it has not replaced the Katz forfaits, and whether or when it will is not settled (true when checked).

Regionally, Flanders has shifted its zorgbudget voor ouderen onto the BelRAI Screener. That is a regional social-protection change, on its own timeline, and it is easy to conflate with the federal financing pilot — they are different reforms in different pots. Treat every specific date in this area as “true when checked”.

What this means for your software

Put the pieces together and the requirement is clear: a serious home-nursing product cannot just store a score. It has to carry the Katz evaluation and produce the right forfait, hold BelRAI data where the region or the federal pilot requires it, run third-party-payer billing over MyCareNet (insurability, evaluation-scale notification, eFact), and speak the eHealth services underneath. And it has to let Katz and BelRAI coexist during a transition whose end state nobody has fixed yet.

That coexistence is the hard part. Off-the-shelf packages tend to model one payer and one instrument cleanly, then bolt the other on. Where an operator loses time is in the seams: reconciling a federal forfait with a regional budget for the same client, keeping a Katz score and a BelRAI assessment from drifting apart, making the billing export and the care plan tell the same story.

A few concrete demands follow from that. The Katz evaluation has to reach the mutuality’s advisory physician over MyCareNet on time, and its result has to flow straight into the day’s billing so the right forfait — or the right per-act plan — is what gets sent. Where BelRAI applies, the Screener and, when it is triggered, the full Home Care assessment have to live as structured data on eHealth, not as a PDF stapled to a file. And during the transition, the software should make the Katz-and-BelRAI overlap visible rather than hidden, so a team can see at a glance which instrument drove which decision for a given client. None of these is exotic on its own; the cost is in wiring them so they stay consistent as the rules move.

A worked example

Take Mevrouw V., a frail woman living at home in Flanders. Her home nurse scores the Katz scale and the profile reaches forfait B: under RIZIV/INAMI, her whole day of nursing is now paid as a daily lump sum rather than act by act, and the nurse bills it under third-party payer over MyCareNet, so Mevrouw V. never settles that invoice herself. At the same time, because she also needs non-medical support, her family draws on a regional care budget in Flanders — a different pot, assessed not with Katz but with the BelRAI Screener. So the same person, in the same week, generates a federal Katz forfait B and a regional BelRAI-based assessment, paid from two systems that do not talk to each other by default. Nothing here is exotic; it is an ordinary Flemish home-care caseload. But a product that only knows the Katz-and-forfait half of that picture will silently leave the regional half to spreadsheets — which is exactly the seam where operators lose time.

Related guides

Each part of the Belgian system above has its own deep-dive:

• The Katz scale: scoring and the forfait A/B/C thresholds
• BelRAI: the Screener, Home Care, and the shift from Katz
• RIZIV/INAMI home-nursing financing: nomenclature, forfaits and third-party payer
• MyCareNet and eHealth: home-care billing and data exchange

Frequently asked questions

Who pays for home nursing in Belgium, the federal level or the regions?

Both, for different things. Home nursing care itself (verpleegkundige zorg / soins infirmiers) is financed federally through RIZIV/INAMI, under the nomenclature and keyed off the Katz scale. The regions and communities (Flanders, Wallonia through AViQ, Brussels through Iriscare) run the surrounding social-care budgets and supports, increasingly assessed with BelRAI. A single client can draw on both at once.

What is the difference between the Katz scale and BelRAI here?

They are two rulers. The Katz scale of article 8 is the federal instrument that decides whether RIZIV/INAMI home nursing is billed per act or under a daily forfait A, B or C. BelRAI is the broader, internationally-based instrument the regions are adopting for social care, and it is being tested federally as a future basis for home-nursing financing. Today, for the nursing forfaits, Katz still governs.

How is home nursing actually billed and paid?

Home nurses generally work under the third-party payer system (derdebetalersregeling / régime du tiers payant): the patient does not pay the nurse directly for reimbursed care, the mutuality pays the provider. Billing runs electronically over MyCareNet, which also carries the electronic Katz evaluation-scale notification and insurability checks, on top of the federal eHealth platform.

Is the financing about to change?

Parts of it, yes, and this is the moving piece. A federal pilot is testing a new home-nursing financing model built around BelRAI rather than the Katz forfaits, while Flanders keeps shifting its own elderly-care budget onto the BelRAI Screener. Neither has replaced the Katz forfaits across the board. Treat any specific reform date as “true when checked”, not settled.

When two payers meet one patient, your software has to hold both

Belgium turns home care into two streams of structured data — a federal Katz-and-forfait stream and a regional BelRAI stream — that have to move over eHealth and MyCareNet while the rules keep shifting. Off-the-shelf software tends to model one stream and improvise the other. AppSky builds custom software for home-nursing and home-care teams, where assessment, care planning and billing sit in one flow and can follow the rules as they change. Building Domihome, the detail that surprised us most was how much of the trust in an at-home health service comes down to the paperwork behind the visit lining up — the same lesson that pushes us to keep the Katz score, the MyCareNet submission and the care plan on one record rather than three. See what we did for Domihome, or book an intro call.

---

This guide is informational and not billing, legal or medical advice. Belgium’s home-care assessment and financing rules are split between the federal and regional levels and several 2025-2026 reforms are still in transition. Confirm current rules and figures with the official sources, including RIZIV/INAMI for nurses, the federal eHealth BelRAI service, and, in Brussels, Iriscare. Last verified 14 July 2026.