In its judgment, the Federal Supreme Court (the Court) partially upheld an appeal by a home-care organisation (Spitex-Organisation) and its managing director against amendments to the health insurance legislation of the Canton of Thurgau, and annulled the cantonal tariff set for nursing care provided by relatives. At issue was whether the newly introduced tariff of CHF 50.50 per hour for basic nursing care delivered by relatives employed by home-care organisations was compatible with federal law.

The appellants challenged, by way of abstract review, several enactments: the Grand Council's amendment of 7 May 2025 to the cantonal Health Insurance Act (Krankenversicherungsgesetz des Kantons Thurgau, TG KVG) and Health Act (Gesundheitsgesetz des Kantons Thurgau, TG GG), the Cantonal Government's implementation decree (RRB No. 640), and its amendment of 9 December 2025 to the cantonal Health Insurance Ordinance (Krankenversicherungsverordnung des Kantons Thurgau, TG KVV, RRB No. 664).

The Court held admissible only the appeal against § 43a para. 3 TG KVV. It found the challenge to the Grand Council's amendment time-barred, the 30-day period under art. 101 of the Federal Supreme Court Act (Bundesgerichtsgesetz, BGG) having run from publication that the referendum deadline had lapsed unused; the appeal, filed in December 2025, was late. It further held that RRB No. 640, being a mere act putting the amendments into force, was not an enactment under art. 82 let. b BGG but an individual decision, for which the cantonal administrative court had jurisdiction; that part was transferred to the Administrative Court of the Canton of Thurgau (Verwaltungsgericht des Kantons Thurgau).

On the merits, the Court recalled that under art. 25a para. 5 of the Health Insurance Act (Bundesgesetz über die Krankenversicherung, KVG), the cantons regulate the residual financing of nursing costs and enjoy wide discretion in doing so, including the freedom to set tariffs or maximum rates. However, such rates must cover the costs of economical service provision. Compulsory health insurance (obligatorische Krankenpflegeversicherung, OKP) contributes a fixed amount of CHF 52.60 per hour to ambulatory basic nursing care under art. 7a para. 1 let. c of the Ordinance on Healthcare Benefits (Krankenpflege-Leistungsverordnung, KLV), and this figure represents the amount at which federal law values the cost of economical basic nursing care, regardless of whether it is provided by relatives or others.

The Court held that the canton could, in principle, set a tariff for care by relatives and was free to choose its calculation method, including a "bottom-up" approach; it was not obliged to rely on the accounts of an individual provider. Nevertheless, by fixing the tariff at CHF 50.50 per hour – below the federal floor of CHF 52.60 – the Cantonal Government fell short of the minimum set by federal law and thereby violated it. The Court accordingly annulled § 43a para. 3 TG KVV, leaving residual financing to be governed by § 25 TG KVG until the Cantonal Government enacts a new, federally compliant provision.

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