Decree No. 101 / 2006 Coll.
Decree amending Decree No. 550 / 2005 Coll., determining the amount of health care payments paid from public health insurance, including regulatory restrictions, for the first half of 2006
Valid
Effective from 01.04.2006
101
DECLARATION
of 20 March 2006
amending Decree No 550 / 2005 Coll., determining the amount of the public health insurance contributions, including regulatory restrictions, for the first half of 2006
According to § 17 (11) (b) of Act No. 48 / 1997 Coll., on Public Health Insurance, and amending and supplementing certain related laws, as amended by Act No. 459 / 2000 Coll., hereinafter referred to as "the Act":
Decree No 550 / 2005 Coll., determining the amount of the health care payments paid from public health insurance, including regulatory restrictions, for the first half of 2006, is amended as follows:
1. in Article 1 (a) (5), the words "in expertise 222, 801 to 807, 809 and 812 to 823" shall be replaced by "in expertise 222, 801, 802, 804, 805, 807, 809, 812 to 819, 822 and 823";
2. In Paragraph 2 (2), the words "small number of insured persons' are replaced by the words" 100 and less insured persons' and the last sentence is deleted.
3. Paragraph 3 (3) reads as follows:
"(3) The health insurance company shall provide a monthly payment to the healthcare establishment of 105% of one sixth of the remuneration due to the healthcare establishment in the reference period."
4. In Article 3, paragraphs 4 and 5 are added:
"(4) Where a healthcare institution provides healthcare to 50 and less hospitalised insured persons of the relevant health insurance undertaking, paragraph 1 shall not apply and the healthcare provided shall be reimbursed according to the performance list.
(5) The price of the point for reimbursement of health care referred to in paragraph 4, set for the first half of 2001, remains valid for the first half of 20062. '
5. In Paragraph 4 (4), the word "preliminary 'is deleted.
6. In Article 4 (5), "103 'is replaced by" 105', and at the end of the paragraph, the sentence "Reimbursement restrictions shall not apply if the healthcare establishment has provided healthcare for 50 and less unique insurers of the relevant health insurance company during the reference period or assessment period. ';
7. In Article 4, the following paragraph 7 is added:
"(7) In addition to the total remuneration referred to in paragraph 5, the health insurance undertaking shall pay the amount of medicinal products specifically charged by the health insurance undertaking to the healthcare establishment in the second half of 2005, converted into a unique treated insured person and a diagnosis in the second half of 2005 and multiplied by the number of individuals treated with the appropriate diagnosis during the evaluation period. ';
8. In Article 5 (2), the words "with the relevant age index referred to in Annex 4 (C) to this Decree 'are inserted after the words" registered insured persons'.
9. Paragraph 5 (3) reads as follows:
"(3) The actions not included in the capitalisation payment, except those showing preventive examinations under Decree No. 56 / 1997 Coll., laying down the content and time limits of preventive examinations, as amended, (hereinafter referred to as the" Preventive Inspection Order ') and vaccination under Decree No. 439 / 2000 Coll., on vaccination against communicable diseases, as amended, (hereinafter referred to as "the Decree on Vaccination') and on the performance of unregistered insured persons as referred to in paragraphs 1 (a) and (b) shall be paid according to the list of benefits, the price agreed for the 2nd semester 2005 and published in the Ministry of Health Bulletin shall remain valid for the first half of 20063). ';
10. in Article 5, the following paragraph 4 is inserted after paragraph 3:
"(4) The performance of preventive inspections under the Preventive Inspection and Vaccination Ordinance, not included in the surrender payment referred to in points (a) and (b) of paragraph 1, shall be paid in accordance with the performance list by remuneration for the medical performance provided, subject to the limitation of the maximum payment on the individual insured. The price of the item agreed for the 2nd half of 2005 and published in the Ministry of Health Bulletin remains valid for the 1st half of 20063). The maximum remuneration for a unique treated insured person for a particular health care establishment shall be determined as a proportion of the total remuneration for such performance during the reference period corresponding to the half of the last year and the number of unique treated insured persons for whom such performance has been declared. The calculated proportion shall be multiplied by the number of individual insured persons and a coefficient of 1,05. The maximum remuneration limitation shall not apply where 50 and less unique treated insured persons of the relevant health insurance undertaking have been treated during the reference or assessment period. ';
Paragraphs 4 to 7 shall be renumbered paragraphs 5 to 8.
11. in Article 5 (5), "2 and 3" is replaced by "2 to 4."
12. in Paragraph 5 (8):
"(8) The total remuneration for the performance not included in the capitalisation payment, except for the performance to be reported by preventive inspections under the Preventive Inspection and Vaccination Ordinance, the performance for unregistered insured persons referred to in paragraph 3, which shall not exceed 105% of the total remuneration for the performance other than the capitalisation payment and performance for non-registered insured persons during the reference period corresponding to the calendar half of last year, shall be increased by a coefficient of change in the income and expenditure of the health insurance undertaking in connection with the migration of insured persons. The calculation and application of the adjustment coefficient for the health insurance undertaking's income and expenditure is set out in Annex 7 to this decree. The limitation of remuneration shall not apply if the health care establishment provides healthcare to 50 or less insured persons of the relevant health insurance undertaking during the reference period or assessment period. ';
13. in Paragraph 6 (4), the words "and 7" shall be inserted after the words "paragraph 1."
14. In Article 6, the following paragraph 7 is added:
"(7) Where a healthcare establishment provides healthcare to 50 and less unique insured persons of the relevant health insurance undertaking, paragraph 1 shall not apply and the healthcare provided shall be paid according to the performance list. ';
15. in Paragraph 7 (1), "222, 801 to 807, 809 and 812 to 823" is replaced by "222, 801, 802, 804, 805, 807, 809, 812 to 819, 822 and 823."
16. in Paragraph 7 (2):
"(2) For health institutions where, as a result of the significantly fluctuating volume of public health care provided, the healthcare establishment provided a flat rate as referred to in paragraph 1 (a) in the reference period corresponding to the calendar quarter of last year, the care of 50 and less unique insured persons of the relevant health insurance undertaking, and where it is not objectively possible to set a flat rate for each health insurance undertaking in accordance with paragraph 1 (a), the healthcare provided shall be reimbursed according to the performance list. The price of the expert point 222, 801, 802, 804, 805, 807, 809, 812 to 819, 822 and 823 agreed for the 2nd half of 2005 and published in the Ministry of Health Bulletin remains valid for the 1st half of 20063). '
17. in Article 8 (3), "103" is replaced by "105," and at the end of the paragraph, the sentence "Limitation of remuneration shall not apply if, in the reference period or assessment period, the healthcare establishment has provided health care to 50 and less unique insurers of the relevant health insurance company."
18. in Paragraph 9 (4), "103" is replaced by "105" and at the end of the paragraph, the sentence "Limitation of remuneration shall not apply if, in the reference period or in the assessment period, the healthcare establishment has provided healthcare to 50 and less unique insured persons of the relevant health insurance company."
19. in Paragraph 11 (3), "103" is replaced by "105" and at the end of the paragraph, the sentence "The limitation of remuneration shall not apply if the healthcare establishment has provided healthcare to 50 and less unique insured persons of the relevant health insurance undertaking during the reference or assessment period."
20. in Annex 1, Part A, the text "PS = {[(CÚref - ÚZÚLMref) + 0,98 x ÚZÚLMref] x 1,03} x Ks x Kpv + MNP + PCN 'is replaced by" PS = (CÚref x 1,05 x Ks x Kpv) + ÚZÚLMref + MNP + PCN';
21. In Annex No 1, Part A, the text "Cúref - the total remuneration due to the health care facilities provided, reported and recognised by the health insurance undertaking in the reference period corresponding to the calendar half of last year, after settlement of contractually agreed regulations, with the exception of the regulatory mechanism for the volume of prescribed medicinal products and medical devices. This remuneration shall include the treatment provided to health care establishments during the reference period, not later than the reporting date for November 2005 and recognised by the health insurance undertaking. 'is replaced by" Cúref - the total remuneration due to the health care facilities provided, declared and the health insurance company recognised in the reference period, which corresponds to the calendar half of the last year, after settlement of contractually agreed regulations, with the exception of the regulatory mechanism for the volume of prescribed medicinal products and medical devices, after deduction by the declared and health insurance undertaking recognised by the specifically charged medicinal products, including those specifically charged by the revision doctor, and the material separately charged, provided in the reference period [Part B) points 1 and 6.]. This remuneration shall include the care provided to the healthcare establishment during the reference period, not later than with the accounts for November 2005 and recognised by the health insurance undertaking.';
22. in Annex No 1 (A), the words "point (B)" shall be replaced by "Part (B)" and the text "Ks = 1 + ((ZF - ZM) / VD) x 0,3" shall be replaced by "Ks = 1 + [(ZF - ZM) / VD] x 0,3."
23. in Annex 1 (A), the words "and their extent, as at 30.9.2005" shall be replaced by "and their extent, as at 31.12.2005."
24. in Annex No 1 (A), the words "in the reference period" shall be deleted from the symbol "PCN" and the words "in the second half of 2005, calculated in the unique treated insured person and the diagnosis in the second half of 2005 and multiplied by the number of unique treated insured persons with the appropriate diagnosis in the evaluation period" shall be added.
25. in Annex 1, Part A, the text "MU = {[(CÚref - ÚZÚLMref) + 0,98 x ÚZÚLMref] x 1,03 x Ks + PCN} / 6" is replaced by "MU = [(CÚref x 1,05 x Ks) + ÚZÚLMref] / 6."
26. In Annex No 1 (A), the words "medical establishment by 15.1.2006 'shall be replaced by the words" medical establishment by 30.4.2006'.
27. in Annex 1 (B) (1) and (4), "(A)" is replaced by "(A)";
28. in Annex 1 (B) (6):
'6. If the total remuneration for medicinal products and medical devices prescribed by the medical institution in the first half of 2006, including medicinal products authorised by the medical practitioner, exceeds 100% of the remuneration for medicinal products and medical devices prescribed in the reference period, including medicinal products authorised by the medical practitioner, the health insurance undertaking shall not, within the framework of the overall remuneration of the medical institution, pay an amount corresponding to the excess of the reimbursement for medicinal products and medical devices prescribed in the reference period above 100%. The total amount of remuneration for medicinal products and medical devices prescribed in the reference period shall be increased by an amount corresponding to the prescribed and medical insurance company to the health care institution in addition to the amount of medical treatment provided to the medicinal products in the reference period, which in this case is the 2nd half of 2005, converted into a unique treated insured person and a diagnosis in the 2nd half of 2005, multiplied by the number of unique treated insured persons with the appropriate diagnosis during the evaluation period. ';
29. in Annex 1 (B) (7):
'7. If the total number of points for requested care in another medical institution, in the experts 222, 801, 802, 804, 805, 807, 812 to 819, 822 and 823, according to the list of performance, exceeds 106% of the total number of points in the reference period in the first half of 2006, the health insurance company shall not pay an amount corresponding to the excess in the overall remuneration of the medical establishment. ';
30. in Annex 1 (B), the following points 8, 9 and 10 are inserted:
'8. If the total number of points for requested care in another medical institution, in the expert level 809 according to the performance list, other than those of screening mammography according to the performance list, exceeds 110% of the total number of points in the reference period in the first half of 2006, the health insurance undertaking shall not pay an amount corresponding to excess within the overall remuneration of the medical establishment.
9. If, in the first half of 2006, health care is provided to 100 and less insured persons by the relevant health insurance undertaking, the health insurance company shall not apply the regulation referred to in the preceding paragraphs.
10. If the health care institution proves that due to the health condition of the insured person could not prescribe another medical device above 15 000 CZK approved by the medical examiner, the health insurance company will not apply the appropriate regulation unless a comparable medical device has been prescribed to a comparable extent in the reference period. "
31. Annex 2 shall read as follows:
"Annex No 2 to Decree No 550 / 2005 Coll.
Procedure for calculating the flat rate and the regulatory restrictions referred to in Article 3 (2)
(A) Procedure for calculating the flat rate
The flat rate shall be fixed at 105% of the total remuneration due to health care establishments in the first half of 2005 for the health care provided, reported and recognised by the health insurance undertaking in the reference period corresponding to the calendar half of last year, after settlement of contractually agreed regulations, with the exception of the regulatory mechanism for the volume of prescribed medicinal products and medical devices, multiplied by the adjustment coefficient for the income and expenditure of the health insurance undertaking in connection with the migration of insured persons. The calculation and application of the adjustment coefficient for the health insurance undertaking's income and expenditure is set out in Annex 7 to this decree. The total remuneration shall include the care provided to the healthcare establishment during the reference period, not later than with the accounts for November 2005 and recognised by the health insurance company.
(B) Regulatory restrictions
(1) Reimbursement of the amount set out in Part A shall belong to a healthcare establishment, provided that it provides at least 100% of the amount of healthcare in the first half of 2006, declared by the healthcare establishment and recognised by the health insurance undertaking compared to the reference period, expressed as 100% of the number of points per treatment day according to the performance list.
2. The number of points for the reference period shall not include points for health care no longer provided in the first half of 2006.
3. The number of points for the first half of 2006 shall not include points for health care declared and recognised under the new capacity, provided that it has been contracted for the first half of 2006.
4. In the case of less reported and recognised health care than referred to in point 1, the amount of the part A remuneration shall be reduced by the same percentage as the lower amount of healthcare expressed in terms of the number of points in the performance list.
5. If the total remuneration for medicinal products and medical devices prescribed by the medical institution in the first half of 2006, including medicinal products authorised by the medical practitioner, exceeds 100% of the total remuneration for medicinal products and medical devices prescribed in the reference period, including medicinal products authorised by the medical practitioner, the health insurance undertaking shall not pay the sum corresponding to the excess of the reimbursement for medicinal products and medical devices prescribed in the reference period above 100%.
6. If the total number of points for requested care in another medical institution, in the experts 222, 801, 802, 804, 805, 807, 812 to 819, 822 and 823, according to the list of performance, exceeds 106% of the total number of points in the reference period in the first half of 2006, the health insurance company shall not pay the amount corresponding to the excess in the overall remuneration of the medical establishment.
7. If the total number of points for requested care in another medical institution, in the expert 809 according to the performance list, exceeds 110% of the total number of points in the reference period in the first half of 2006, the health insurance undertaking shall not pay an amount corresponding to the excess in the overall remuneration of the medical establishment.
8. The limitation provided for in the preceding points shall not apply where, during the reference period or evaluation period, a health care facility has provided 50 and less hospitalised insurers with the relevant health insurance undertaking.
9. If the health care institution proves that due to the health condition of the insured person could not prescribe another medical device above 15 000 CZK approved by the medical examiner, the health insurance company will not apply the appropriate regulation unless a comparable medical device has been prescribed to a comparable extent in the reference period. "
32.
"Annex No 3 to Decree No 550 / 2005 Coll.
Regulatory restrictions pursuant to Article 4 (6)
1. If the average remuneration for medicinal products and medical devices prescribed for one unique insured person in the first half of 2006, including medicinal products authorised by the medical practitioner, exceeds the average remuneration for medicinal products and medical devices prescribed in the reference period, including medicinal products authorised by the medical practitioner, within a range of 101% to 105%, the health insurance company shall not pay the sum corresponding to 20% of the excess of the reimbursement for medicinal products and medical devices prescribed in the reference period between 101% and 105% within the overall remuneration of the medical institution.
2. If the average remuneration for medicinal products and medical devices prescribed for one unique insured person in the first half of 2006, including medicinal products authorised by a medical practitioner, exceeds the average remuneration for medicinal products and medical devices prescribed in the reference period, including medicinal products authorised by a medical practitioner, within a range of 105% to 110%, the health insurance undertaking shall not pay an amount equivalent to 40% of the excess of the reimbursement for medicinal products and medical devices prescribed in the reference period of 105% to 110% within the overall remuneration of a medical institution.
3. If the average remuneration for medicinal products and medical devices prescribed for one individual insured person in the first half of 2006, including medicinal products authorised by a medical practitioner, exceeds 110% of the average remuneration for medicinal products and medical devices prescribed for the reference period, including medicinal products authorised by a medical practitioner, the health insurance undertaking shall not, in the context of the overall remuneration for a medical institution, pay an amount corresponding to the excess of the remuneration for medicinal products and medical devices prescribed for the reference period above 110%.
4. If the average number of points for required care in the experts 222, 801, 802, 804, 805, 807, 812 to 819, 822 and 823 according to the performance list, per individual insured person in the first half of 2006, exceeds 106% of the average number of points in the reference period, the health insurance company shall not pay an amount corresponding to the excess within the overall remuneration of the medical institution.
5. If the average number of points for the required care in a professional capacity 809 according to the performance list per individual insured person in the first half of 2006 exceeds 110% of the average number of points in the reference period, the health insurance undertaking shall not pay an amount corresponding to the excess in the overall remuneration of the health care establishment.
6. The restriction provided for in points 1 to 5 shall not apply where the health care establishment has provided healthcare to 50 and less unique insured persons of the relevant health insurance undertaking during the reference or assessment period. ';
33. The heading of Annex 4 reads as follows: "The method of matching the capitalisation and the regulatory restriction referred to in Article 5 (7) and the age index table referred to in Article 5 (2)."
34. in Annex 4 (B):
"(B) Regulatory restrictions
1. Where the average remuneration for medicinal products and medical devices prescribed by medical devices in the 1st and 2nd quarter of 2006, including medicinal products authorised by a medical practitioner, per registered insured person, taking into account age groups, exceeds the average remuneration for medicinal products and medical devices per registered insured person, taking into account age groups prescribed in the reference period, including medicinal products authorised by a medical practitioner, between 101% and 105%, the health insurance undertaking shall not pay the total remuneration for medical devices equivalent to 20% of the excess payment for medicinal products and medical devices prescribed in the reference period between 101% and 105%.
2. Where the average remuneration for medicinal products and medical devices prescribed by medical devices in the 1st or 2nd quarter of 2006, including medicinal products authorised by a medical practitioner, per registered insured person, taking into account age groups, exceeds the average remuneration for medicinal products and medical devices per registered insured person, taking into account age groups prescribed in the reference period, including medicinal products authorised by a medical practitioner, within a range of 105% to 110%, the health insurance undertaking shall not pay an amount corresponding to 40% of the compensation for medicinal products and medical devices prescribed in the reference period between 105% and 110% in the reference period.
3. Where the average remuneration for medicinal products and medical devices prescribed by medical devices in the 1st or 2nd quarter of 2006, including medicinal products authorised by a medical practitioner, per registered insured person, taking into account age groups, exceeds 110% of the average remuneration for medicinal products and medical devices per registered insured person, taking into account the age groups prescribed in the reference period, including medicinal products authorised by a medical practitioner, the health insurance undertaking shall not pay the amount corresponding to the excess payment for medicinal products and medical devices prescribed in the reference period above 110%.
4. The reference period for regulatory purposes shall be the corresponding calendar quarter of last year.
5. If the total remuneration for treated non-registered insured persons exceeds 5% of the total remuneration for registered insured persons in the first and second quarters of 2006, the health insurance company shall be entitled not to pay the sum corresponding to one half of the excess of the total payment for registered insured persons in the framework of the total remuneration. This regulatory mechanism shall not apply to the care of unregistered insured persons in the ordinary capacity and shall not be applied in the case of reimbursement of health care under Section 5 (1) (c).
6. If the average number of points in the 1st or 2nd quarter of 2006 for the required care in the experts 222, 801, 802, 804, 805, 807, 812 to 819, 822 and 823 according to the performance list, per registered insured person, taking into account age groups, exceeds 106% of the average number of points in the reference period, the health insurance undertaking shall not pay an amount corresponding to the excess for the overall remuneration of the medical institution.
7. If the average number of points in the 1st or 2nd quarter of 2006 for the required care in the skill list 809 according to the performance list, except the performance of the screening mammography according to the performance list, per registered insured person, taking into account age groups, exceeds 110% of the average number of points in the reference period, the health insurance company shall not pay an amount corresponding to the excess in the overall remuneration of the medical establishment.
8. If the average remuneration for the healthcare provided per treated unregistered insured person, taking into account age groups, exceeds by more than 10% the average remuneration for the reference period and by more than 20% the specific part of the health care provided (i.e. either the medical performance payment, or the prescribed medicinal products and medical devices, or the requested care, including the medicinal products specifically charged and the material specifically charged, in the experts 222, 801, 802, 804, 805, 807, 809, 812 to 819, 822 and 823 according to the performance list), the health insurance undertaking shall be entitled not to pay an amount corresponding to one quarter of the above.
9. The regulatory restrictions referred to in the preceding points shall not apply where, in a reference period or an assessment period, 50 or less insured persons have registered the relevant health insurance undertaking or provided health care to 50 or less unregistered insured persons of the relevant health insurance undertaking.
10. If the health care institution proves that due to the health condition of the insured person could not use another treatment or prescribe another medical device above CZK 15,000 approved by the medical examiner, the health insurance company will not apply the appropriate regulation unless comparable medicinal products or medical devices have been prescribed by medical devices to a comparable extent in the reference period. "
35. the following part C is added to Annex 4:
"(C) Table of age indices
| věková skupina | Index |
| 0 - 4 let | 3,80 |
| 5 - 9 let | 1,65 |
| 10- 14 let | 1,30 |
| 15 - 19 let | 1,00 |
| 20 - 24 let | 0,90 |
| 25 - 29 let | 0,95 |
| 30 - 34 let | 1,00 |
| 35 - 39 let | 1,05 |
| 40 - 44 let | 1,05 |
| 45 - 49 let | 1,10 |
| 50 - 54 let | 1,35 |
| 55 - 59 let | 1,45 |
| 60 - 64 let | 1,50 |
| 65 - 69 let | 1,70 |
| 70 - 74 let | 2,00 |
| 75 - 79 let | 2,40 |
| 80 - 84 let | 2,90 |
| 85 a více let | 3,40“. |
36. In the title of Annex 5, the words "and regulatory restrictions' shall be inserted after the words" amount of remuneration '.
37. in Annex 5 (A) (2), the text "MUO = POPzpo x [PBPo x CB + (PUZUMO + PUZULPo) x 0,98] x 1,03" is replaced by "MUO = POPzpo x [(PBPo x CB) x 1,05 + PUZUMO + PUZULPo]."
38. In Annex 5 (A) (4), "31 January 2006 at the latest 'is replaced by" 30 April 2006 at the latest'.
39. in Annex 5 (A) (5):
"5. The maximum remuneration limit referred to in point 1 shall not apply where, during the reference period, a health care facility has not provided medical care in some expertise. ';
40. In Annex 5 (A), the following point 6 is added:
'6. In addition to the maximum remuneration referred to in point 1, the health insurance undertaking shall pay the amount of medicinal products specifically charged by the health insurance company to the health insurance company in the 2nd half of 2005, converted into a unique treated insured person and a diagnosis in the 2nd half of 2005 and multiplied by the number of individuals treated by the health insurance company with the appropriate diagnosis during the evaluation period. ';
41. in Annex 5 (B):
"(B) Regulatory restrictions
1. If the average remuneration for medicinal products and medical devices prescribed by a medical institution per unique insured person in the first half of 2006, including medicinal products authorised by a medical practitioner, exceeds the average remuneration for medicinal products and medical devices prescribed in the reference period, including medicinal products authorised by a medical practitioner, within a range of 101% to 105%, the health insurance company shall not pay an amount equivalent to 20% of the excess of the average remuneration for medicinal products and medical devices prescribed in the reference period between 101% and 105% within the overall remuneration for medical devices.
2. If the average remuneration for medicinal products and medical devices prescribed by a medical institution on a unique insured person in the first half of 2006, including medicinal products authorised by a medical practitioner, exceeds the average remuneration for medicinal products and medical devices prescribed in the reference period, including medicinal products authorised by a medical practitioner, within a range of 105% to 110%, the health insurance company shall not pay an amount equivalent to 40% of the excess of the reimbursement for medicinal products and medical devices prescribed in the reference period of 105% to 110%.
3. If the average remuneration for medicinal products and medical devices prescribed by a medical institution to a unique insured person in the first half of 2006, including medicinal products authorised by a medical practitioner, exceeds 110% of the average remuneration for medicinal products and medical devices prescribed in the reference period, including medicinal products authorised by a medical practitioner, the health insurance undertaking shall not pay the sum corresponding to the excess of the remuneration for medicinal products and medical devices prescribed in the reference period above 110% within the overall remuneration of the medical institution.
4. The total amount of remuneration for medicinal products and medical devices prescribed in the reference period shall be increased by an amount corresponding to the prescribed and health insurance company of the healthcare institution in addition to those provided to medicinal products in the 2nd half of 2005, converted into a unique treated insured person and a diagnosis in the 2nd half of 2005, multiplied by the number of unique treated insured persons with the appropriate diagnosis in the evaluation period.
5. If the average number of points for the required care in the experts 222, 801, 802, 804, 805, 807, 812 to 819, 822 and 823 according to the performance list, per individual insured person in the first half of 2006, exceeds 106% of the average number of points in the reference period, the health insurance company shall not pay an amount corresponding to the excess in the overall remuneration of the medical institution.
6. If the average number of points for required care in the skill list 809 according to the performance list, excluding the performance of screening mammography, according to the performance list, per individual insured person in the first half of 2006, exceeds 110% of the average number of points in the reference period, the health insurance undertaking shall not pay an amount corresponding to the excess within the overall remuneration of the medical institution.
7. The regulatory restrictions referred to in the preceding points shall not apply where the healthcare establishment has provided health care to 50 and less unique insured persons of the relevant health insurance undertaking during the reference or assessment period.
8. If the health care institution proves that due to the health condition of the insured person could not use another treatment or prescribe another medical device above CZK 15,000 approved by the medical examiner, the health insurance company will not apply the appropriate regulation unless comparable medicinal products or medical devices have been prescribed by medical devices to a comparable extent in the reference period. "
42. in Annex 6 (A), the text "(A) The flat-rate procedure" shall be replaced by "(A) The procedure for establishing the flat-rate rate for competence 222, 801, 802, 804, 805, 807, 812 to 819, 822 and 823 in the performance list."
43.In Annex 6 (A) (1), the text "PS = [(Cúref - ÚZÚLMref) + 0,98 x ÚZÚLMref] x Kpv 'is replaced by" PS = (Cúref x Kpv) + ÚZÚLMref';
44. In Annex 6 (A) (1), the words "after deduction of any medicinal products separately charged, including those specifically charged, approved by the medical examiner, and the material specifically charged, provided in the reference period, declared and recognised by the health insurance undertaking, shall be added to the symbol" CÚref '.
45. in Annex 6 (A), point 2 is deleted and the designation of point 1 (A) is deleted;
46. in Annex 6, the following Part B is inserted after Part A:
"(B) Procedure for establishing a flat rate for competence 809 according to the performance list
The quarterly flat rate shall be determined using the formula:
PS = (Cúref x 1,03 x Kpv) + ÚZÚLMref
where:
PS flat rate for the relevant quarter
Cúref total reimbursement to the healthcare establishment for health care provided, reported and reported by the health insurance undertaking recognised in the reference period corresponding to the calendar quarter of last year, after settlement of contractually agreed regulations, excluding performance-based screening mammography performance, after deduction of all specifically charged medicinal products, including those specifically charged by the medical practitioner and the material specifically charged, provided in the reference period, reported and recognised by the health insurance company
ÚZÚLMref amount of reimbursement of all specifically charged medicinal products, including the specifically charged medicinal products approved by the revision doctor, and the material specifically charged, provided during the reference period, reported and recognised by the health insurance company
The rate of change in income and expenditure of the health insurance company in connection with the migration of insured persons. The calculation and application of the coefficient are set out in Annex 7 to this Decree. '
Part B shall be renumbered "C '.
47. in Annex 6 (C) (1) (a), the words "range 97 to 103%" shall be replaced by the words "range 98% to 105%," at the end of the text in point (a), the dot and the sentence "the reference number of points shall not include the performance of the screening mammography according to the performance list."
48. in Annex 6 (C), point 1 (b) is replaced by "97" by "98" and "103" by "105" and the sentence "No screening mammography performance according to the performance list shall be added to the reference number of points at the end of the text (b)."
49. In Annex 6 (C), point 3 is replaced by "31 January 2006." by "30 April 2006."
50. The heading of Annex No 7 shall read "Calculation and application of the coefficient of change in income and expenditure of a health insurance undertaking in connection with the migration of insured persons pursuant to Articles 4 (5), 5 (8), 8 (3), 9 (4), 11 (3), Annex 1 (A), Annex 2 (A), Annex 5 (A) (3) and Annex 6 (A)."
51. In Annex 7, "Kpv = (P / VD) - 0,03 'is replaced by" Kpv = (P / VD) - 0,05'.
52. In Annex 7, in symbol P, the comma and the words "after deduction of refundable financial assistance from the State Budget under Section 12 (2) of Act No. 592 / 1992 Coll., on General Health Insurance Insurance, as amended," shall be added after the words "on 30.6.2006."
53. In Annex 7, in the last sentence, "1,03 'is replaced by" 1,05'.
Transitional provisions
1. For the calculation of the total remuneration for the first half of 2006 pursuant to Sections 4, 5, 8, 9, 11, for the calculation of the flat rate referred to in Annex 1, Annex 2, for the calculation of the maximum remuneration referred to in Annex 5 and for the calculation of the flat rate referred to in Annex 6, the sickness insurance undertaking's income and expenditure relating to the migration of insured persons provided for in this Decree shall be used.
2. For the calculation of the flat rate and monthly remuneration referred to in Annex 1, the stabilisation coefficient laid down in this Decree shall apply.
3. A different method of payment of health care in the first half of 2006 than laid down in Decree No. 550 / 2005 Coll., as amended by that Decree, is possible if the health insurance company agrees with the health care establishment and if the health care establishment proves that the application of the method of payment provided for in Decree No. 550 / 2005 Coll., as amended by that decree, would reduce the scope and availability of the healthcare provided by it. The first sentence cannot be followed if the health insurance undertaking's health insurance plan is not complied with.
This Decree shall take effect on 1 April 2006.
Minister:
MUDr. Rath v. r.
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Regulation Information
| Citation | Decree No. 101 / 2006 Coll., amending Decree No. 550 / 2005 Coll., determining the amount of health care payments paid from public health insurance, including regulatory restrictions, for the first half of 2006 |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 28.03.2006 |
|---|---|
| Effective from | 01.04.2006 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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