Decree No. 201 / 2018 Coll.
Declaration on the establishment of the value of the item, the amount of the fees paid and the regulatory restrictions for 2019
Valid
Effective from 01.01.2019
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201
DECLARATION
of 5 September 2018
on the determination of the value of the points, the amount of the fees paid for the services and the regulatory restrictions for 2019
According to Article 17 (5) of Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, as amended by Act No. 117 / 2006 Coll., Act No. 245 / 2006 Coll., Act No. 261 / 2007 Coll., Act No. 298 / 2011 Coll., Act No. 369 / 2011 Coll. and Act No. 200 / 2015 Coll.:
(1) This Decree provides for 2019
(a) the value of the point;
(b) the amount of compensation paid to insured persons under Article 2 (1) of Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended, (hereinafter referred to as "the Act");
(c) the level of reimbursement of paid services to insured persons from other Member States of the European Union, the Member States of the European Economic Area and the Swiss Confederation under the directly applicable provisions of the European Union governing the coordination of social security systems (1) and to insured persons of other States with which the Czech Republic has concluded international social security agreements covering the field covered by the services (2) (hereinafter referred to as "foreign insured persons"),
(d) the regulatory restriction on the remuneration referred to in Sections 3 to 21 provided by the contracting health service providers (hereinafter referred to as the provider).
(2) The provider referred to in paragraph 1 is:
(a) a bed care provider;
(b) a provider in general medical practice and a provider in practical medicine for children and adolescents;
(c) a provider of specialised outpatient care, a provider of hemodialysis health care and a provider of expertise 905, 919 and 927 in accordance with the Decree issuing a list of health performances with points (3) (hereinafter referred to as "the list of performances");
(d) a provider of outpatient care in expertise 603 and 604 according to the performance list;
(e) dental care provider,
(f) the provider of outpatient care in the field of expertise 222, 801, 802, 806 to 810, 812 to 819 and 823, in accordance with the performance list (hereinafter referred to as "the listed expertise"),
(g) the provider of outpatient care in the 911, 914, 916, 921 and the provider of home care in the 925 and 926 expertise according to the performance list;
(h) an outpatient care provider in expertise 902 and 917 according to the performance list;
(i) a provider of medical emergency services, a provider of patient transportation urgent care, a provider of medical transport services, a provider of medical emergency services and a provider of dental emergency services;
(j) a provider of spa rehabilitation care and recovery,
(k) a provider of medical care.
(1) The reference period for the purposes of this Decree is 2017.
(2) The evaluation period for the purposes of this Decree is 2019.
(3) This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.
(4) This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.
(5) If two health insurance companies are merged in the assessment period, the sum of the data for the reference period of the merged health insurance companies shall be used for the calculation of the remuneration.
(1) For the purposes of this Decree, a unique insured person shall mean an insured person of a health insurance undertaking treated by a provider in a specific professional capacity in an assessment or reference period at least once, and it shall not be determined whether it is a treatment under its own health services or health services requested unless otherwise specified.
(2) Where a unique insured person has been treated more than once by the provider in a particular professional capacity in the evaluation period or reference period, the number of unique insured persons shall include the relevant health insurance undertaking treated in that professional activity only once.
(3) In the event of a merger of health insurance undertakings, an insurer who has been treated in more than one of the merged health insurance companies during the evaluation period or reference period shall only be included once in the number of unique insured persons.
(4) For the purposes of this decree, a global unique insurer means an insurer of a health insurance undertaking treated by a sleeper care provider in any professional capacity within the framework of his own or requested health services in an evaluation or reference period at least once, unless otherwise specified.
(5) If a global unique insured person has been treated by the provider more than once during the evaluation period or reference period, regardless of the number of specialists in which the insured person has been treated, the number of global unique insured persons shall include the relevant health insurance companies treated with that provider only once.
(6) In the event of a merger of health insurance undertakings, an insured person who has been treated in more than one of the merged health insurance companies during the evaluation period or reference period shall only be included once in the number of global unique insured persons.
In the case of the provision of paid services to foreign insurers, the remuneration shall be set at the same amount as those provided for in Section 2 (1) of the Act.
(1) For paid services provided by bed care providers, with the exception of paid services provided by post-bed care providers, long-term bed care or special bed care, the value of the point, the amount of payment of the services paid and the regulatory limit shall be set out in Annexes 1, 9, 10, 12, 13 and 14 to this Decree.
(2) For paid services provided by providers of post-bed care, long-term bed care, special bed care or special outpatient care provided under § 22 (c) of the Act, the value of the point, the amount of payments paid by the services and the regulatory limit are set out in Annex 1 to this Decree.
For paid services provided by providers in general practice or by providers in the field of practical medicine for children and youth covered by a combined capitalisation payment, a combined capitalisation payment with a top-up of the capitalisation or according to the list of performance, the value of the item, the amount of the payments of the services paid and the regulatory limit shall be set out in Annex 2 to this Decree.
For specialised outpatient care provided by outpatient care providers covered by the performance list, the value of the item, the amount of the payments of the services paid and the regulatory limit shall be as set out in Annex 3 to this Decree.
For outpatient care provided to outpatient care providers in expertise 603 and 604 according to the performance list paid under the performance list, the value of the point, the amount of payment of the services paid and the regulatory limitation shall be as set out in Annex 4 to this Decree.
The amount of the remuneration of the paid services provided by dental care providers and the relevant regulatory limit is set out in Annex 11 to this Decree.
For paid services provided by outpatient care providers in the listed expertise covered by the performance list, the value of the point and the amount of the payment of the services paid shall be as set out in Annex 5 to this Decree.
For paid services provided by providers of outpatient care in the 911, 914, 916, 921 and home care providers in the 925 and 926 professional area according to the performance list, the value of the point and the amount of payments of the services paid shall be as set out in Annex 6 to this Decree.
For paid services provided by outpatient care providers in expertise 902 and 917 according to the performance list covered by the performance list, the value of the point and the amount of payment of the services paid shall be as set out in Annex 7 to this Decree.
For paid services provided by hemodialysis providers covered by the performance list, the value of the point and the amount of the payment of the services paid shall be as set out in Annex 8 to this Decree.
(1) The value of a point of CZK 1.16 shall be determined for the services provided by the health rescue service providers under the performance list, except for the contracted performance of transport according to the performance list, for which the value of a point of CZK 1.17 is determined and with the exception of the performance no. 06714 according to the performance list, for which the value of a point of CZK 1 is determined. However, the maximum remuneration to the provider for the reported performance No 06714 according to the performance list in the evaluation period shall not exceed the remuneration limit for those performance in 2017.
(2) For paid services provided by the patient transport provider of urgent care paid according to the performance list, the value of the point is 1,15 CZK, except for the performance No. 06714 according to the performance list, for which the value of the point of CZK 1 is determined. However, the maximum remuneration to the provider for the reported performance No 06714 according to the performance list in the evaluation period shall not exceed the remuneration limit for those performance in 2017.
(1) For the services provided by the health transport service provider, the amount of remuneration shall be determined on the basis of the performance list by remuneration for the services provided to the provider.
a) providing a 24-hour medical transport service with a point value of CZK 1.08;
b) not providing a health service in continuous operation with a value of CZK 0.88.
(2) Handling of an immobile patient with an excessive body weight of more than 140 kg when transported by an ambulance in a sitting or lying position will be paid at the price agreed.
For paid services provided by providers in the framework of medical emergency or dental emergency services covered by the list of performances, the value of the point is set at CZK 1.
(1) For comprehensive spa rehabilitation care for adults provided in the health facilities of the spa rehabilitation care provider, payment for 1 day of stay is fixed at 105% of the contracted remuneration for 1 day of stay for 2018. If the payment for 1 day's stay for 2018 has not been agreed on 31 December 2018, the remuneration shall be set at the level of the remuneration to comparable providers. The payment for the accommodation and food of the insured person's guide is set at the same amount as the payment for these components for insured persons who are provided with comprehensive spa rehabilitation care for adults.
(2) For comprehensive spa rehabilitation care for children and adolescents up to 18 years of age provided in the health facilities of the spa rehabilitation care provider, a payment for 1 day of stay shall be set at 100% of the contracted remuneration for 1 day of stay for 2018. If the payment for 1 day's stay for 2018 has not been agreed on 31 December 2018, the remuneration shall be set at the level of the remuneration to comparable providers. The payment for the accommodation and food of the insured person's guide is set at the same amount as the payment for these components for insured persons who are provided with comprehensive spa rehabilitation care for adults.
(3) For the benefit of the spa rehabilitation care for adults provided in the health facilities of the spa rehabilitation care provider, payment for 1 day of stay shall be fixed at 105% of the contracted remuneration for 1 day of stay for 2018. If the payment for 1 day's stay for 2018 has not been agreed on 31 December 2018, the remuneration shall be set at the level of the remuneration to comparable providers.
(4) For the benefit of the spa rehabilitation treatment for children and under 18 years of age provided in the health facilities of the spa rehabilitation care provider, a payment shall be made for 1 day of stay equal to 100% of the contracted remuneration for 1 day of stay for 2018. If the payment for 1 day's stay for 2018 has not been agreed on 31 December 2018, the remuneration shall be set at the level of the remuneration to comparable providers.
(5) The payment of CZK 30 for the declared performance No. 09543 according to the list of performances is determined for the spa rehabilitation care. This performance may be declared to the insurance undertaking no more than three times during one medical stay of the insured person.
(6) For the services provided in the health care centre, the payment for 1 day's stay is set at CZK 908, which consists of the accommodation, meals and recovery programme component. The remuneration increase compared to 2018 shall be made in the recovery programme component. The payment for the accommodation and food of the insured person's guide shall be set at the same rate as the payment for these components for the insured persons who are provided with the services paid at the health care centre.
(1) For each provider declared and the health insurance company recognised performance No. 09543 according to the list of performances, a remuneration of CZK 30 is determined. The maximum remuneration to the provider for the reported performance No 09543 according to the performance list in the assessment period shall not exceed 30 times the number of performance No 09543 according to the performance list, as effective in 2017, by the provider declared and the health insurance undertaking recognised in 2017.
(2) For a provider that did not exist in 2017, or did not have a contract with a health insurance undertaking, the health insurance company will use the number of performance No 09543 reported by comparable providers and recognised by the health insurance company in 2017.
(3) The remuneration referred to in paragraphs 1 and 2 shall not be included in the maximum remuneration for the services paid.
(4) Paragraphs 1 and 2 shall not apply to providers of spa rehabilitation care in the provision of spa rehabilitation care.
(1) For each provider declared and the health insurance company recognised performance No. 09552 according to the list of performances, a remuneration of CZK 14 is determined. The maximum remuneration to the provider for the declared performance No 09552 according to the list of performance during the evaluation period shall not exceed 14 times the number of types of medicinal products or food for special medical purposes specified in the recipes on the basis of which the medicinal product was partially or fully covered by public health insurance in 2014.
(2) For a provider that did not exist during the reference period, or did not have a contract with a health insurance undertaking, the health insurance company will use the number of types of medicinal products or food for special medical purposes listed in the recipes on the basis of which a medicinal product partly or wholly covered by public health insurance was issued in 2014 by comparable providers.
For each provider declared and the health insurance company recognised the performance no. 78890 according to the list of performances, a remuneration of CZK 10 000 is determined. This remuneration shall not be taken into account in the amount of remuneration for the services to be paid as set out in Annex 1 to this Order.
Grounded services provided by providers in the expertise 005 - hospital pharmacies are paid according to the list of performances with the value of a point of CZK 1. This remuneration shall not be taken into account in the amount of remuneration for the services to be paid as set out in Annex 1 to this Order.
Grounded services provided by providers in expertise 006 - clinical pharmacy is paid according to the list of performances with the value of a point of CZK 1.
This Decision shall enter into force on 1 January 2019.
Minister for Health:
Mgr. et Mgr. Vojtěch v. r.
Příloha č. 1
Annex No 1 to Decree No 201 / 2018 Coll.
Value of the point, amount of payments of services paid and regulatory restrictions pursuant to § 5
A) Bounded services pursuant to § 5 (1)
1. The payment to the provider in 2019 shall include the contractually agreed remuneration component, the case flat-rate remuneration, the remuneration to be paid in the form of a case flat-rate payment and the payment for outpatient care (the "outpatient remuneration component"). In order to calculate the reference values, the contractually agreed remuneration components, the case flat-rate remuneration, the remuneration allocated to the case flat-rate remuneration and the outpatient remuneration components shall be included in the calculation in 2017, the provider declared by 31 March 2018 and the health insurance company recognised by 31 May 2018.
2. Individual contractually agreed payment component
2.1 The health insurance company and the provider may agree on a different level and method of payment of the services paid and for services other than those included in the payment by case flat rate or by payment by case flat rate. In such cases, the remuneration for such services shall not be included in the remuneration referred to in points 3 and 4.
2.2 The amount of the reimbursement of medicinal products and foodstuffs for special medical purposes (hereinafter referred to as "the medicinal product"), marked "S" in accordance with Paragraph 39 (1) of Decree No. 376 / 2011 Coll., implementing certain provisions of the Public Health Insurance Act, shall be determined according to the provider declared and the health insurance company of the recognised medicinal product at the unit price, but not exceeding the amount specified in points 2.2.1 to 2.2.4.
2.2.1. For HIV / AIDS, hereditary angioedema and prophylaxis of children at risk exposed to respiratory syncytic virus exposure, a maximum remuneration per administered medicinal product shall be set at the level of the provider declared and the health insurance company recognised remuneration in 2017.
2.2.2 For groups:
| a) | Dermatologie (Aktinická keratóza, Psoriáza těžká) |
| b) | Dýchací soustava 1 (Astma, CHOPN) |
| c) | Dýchací soustava 2 (Idiopatická plicní fibróza) |
| d) | Endokrinologie (Akromegalie, Endokrinní oftalmopatie, Toxická struma štítné žlázy, Růstové hormony) |
| e) | Hematoonkologie (Leukemie, Lymfomatózní meningitida, Lymfomy, Mnohočetný myelom, Myelo-dysplastické syndromy, Podpůrná hematoonkologie, Zhoubné imunoproliferativní nemoci, Hematologie) |
| f) | Imunitní systém (Autoinflamatorní onemocnění, Digitální ulcerace u systémové sklerodermie, Polyangiitida, Transplantace) |
| g) | Infekce (Chronická hepatitida) |
| h) | Metabolické vady (Fabryho choroba, Gaucherova choroba, Metabolické vady |
| i) | Neurologie (Epilepsie, Narkolepsie, Parkinsonova choroba, Roztroušená skleróza, Substituční léčba) |
| j) | Oběhový systém (Plicní arteriální hypertenze) |
| k) | Oftalmologie (Centrální venózní okluze, Makulární degenerace, Oftalmologie – DM, Vitreomakulární trakce, Oftalmologie – jiné) |
| l) | Onkologie – solidní nádory (Hepatocelulární karcinom, Nádory hlavy a krku, Nádory kolorekta, Nádory ledviny, Nádory močového ústrojí, Nádory mozku, Nádory ovarií, Nádory plic, Nádory prostaty, Nádory prsu, Nádory slinivky, Nádory štítné žlázy, Nádory z embryonálních buněk, Nádory žaludku, Osteosarkom, pNET, Sarkomy měkkých tkání, Jiné nádory měkkých tkání, Jiné ZN kůže, Kožní lymfomy, Maligní melanom, Mezoteliom pleury) |
| m) | Osteoporóza |
| n) | Revmatologie (Bechtěrevova choroba, Artritida, Lupus erythematosus, Psoriatická artritida) |
| o) | Trávicí soustava (Crohnova choroba, Ulcerózní kolitida) |
| p) | Cystická fibróza |
| q) | Ostatní – výše neuvedená onemocnění |
the maximum remuneration shall be fixed as follows:
Uhrmax, 2019 * INi
where:
Uhrmax, 2019 is the maximum remuneration in the evaluation period.
i takes the values and up to q, where and to q are the diagnostic groups referred to in paragraph 2.2.2.
Uhri, 2017 is the total remuneration in the reference period for the treatment of disease i.
INi is the index of the remuneration increase for group i, as referred to in point 2.2.3.
The maximum payment is set for all groups of diseases together.
2.2.3 The index of the increase in remuneration shall be set at:
| Diagnostická skupina | Index navýšení úhrady |
|---|---|
| Dermatologie | 1,16 |
| Dýchací soustava 1 | 1,10 |
| Dýchací soustava 2 | 1,40 |
| Endokrinologie | 1,00 |
| Hematoonkologie | 1,00 |
| Imunitní systém | 1,04 |
| Infekce | 1,25 |
| Metabolické vady | 1,05 |
| Neurologie | 1,04 |
| Oběhový systém | 1,13 |
| Oftalmologie | 1,25 |
| Onkologie – solidní nádory | 1,02 |
| Osteoporóza | 1,00 |
| Revmatologie | 1,12 |
| Trávicí soustava | 1,19 |
| Cystická fibróza | 1,10 |
| Ostatní | 1,13 |
2.2.4. For the treatment of Spinraza 12 mg (nusinersen), the maximum payment shall be as follows:
Uhrmax, 2019 = Uhr2018 * 1,30
where:
Uhrmax, 2019 is the maximum remuneration in the evaluation period.
Uhr2018 is the total remuneration in the reference period for the treatment of the disease.
2.2.5 Reimbursement for treatment of medicinal products provided to insured persons during the evaluation period above the total reimbursement limit set out in points 2.2.1 to 2.2.4 shall be paid in accordance with the prior agreement between the health insurance company and the provider.
3. Reimbursement by case flat rate
3.1 In calculating CM2019,016 and CM2017,016 hospitalisation cases, hospitalisation cases, translated by the rules for the classification of hospitalised patients for the year 20194, hereinafter referred to as "Classification."
3.2 For the performance of escorts No 00031 and 00032 according to the list of performances, excluded from the payment by case flat rate, a flat rate is fixed for the treatment day of CZK 447.
3.3. Medicinal products excluded from the flat-rate payment and listed in Annex 12 to this Regulation shall be paid by the health insurance undertaking to the provider at the level of their declared unit price but not more than their declared unit price in 2018.
3.4 Required extramural care means care related to the hospitalisation of an insurer with a provider requested by the provider and provided to the insurer at the time of hospitalisation by another provider charging it to the health insurance company.
3.5. The flat-rate payment shall include the services covered by the Classification in the groups related to the diagnosis listed in Annex 10 to this Order and shall be set at CELK Pudrg, 2019 as follows:
CELK Pudrg, 2019 = min1; CMred, 2019,016,100,97 * CM2017,016,10 * IPU * IZP + ODAnnex 9,, 10-EM2019,10
where:
CM2017,016,10 is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised which have been completed in the reference period which are classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree, multiplied by the relative weights 2019 listed in Annex 10 to this Decree.
EM2019,10 is the total value of the requested extramural care in the context of hospitalisation cases by the provider declared and the health insurance company recognised, completed in the evaluation period and classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, valued at the Points (HB) values applicable in the evaluation period, including the cost of separately charged material and medicinal products separately charged.
min function minimum which selects the lowest value from the range of values.
and where the IPU is an individual flat-rate remuneration calculated as follows:
(i) IPU = Pudrag, 2017,10 * KN10
where:
Pudrg, 2017,10 is the reference amount of the remuneration for the provider declared and recognised by the health insurance undertaking of the services provided during hospitalisation completed during the reference period which are classified under the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree. Pudrag, 2017,10 is calculated as follows:
Pudrag, 2017,10 = maxCM2017,016,10 * ZSmin, 10; CELK Pudrg, 2017 + IRELAND = 1nÚHRj2017 + EM2017
where:
CELK Pudrg, 2017 is the total flat-rate payment in the reference period.
ZSmin, 10 is a minimum basic rate, which is set at CZK 35 500 for a provider who also has the status of a centre of highly specialised cerebrovascular care, centres of highly specialised complex cardiovascular care for adults and centres of highly specialised oncological care according to § 112 (5) of Act No. 372 / 2011 Coll., on health services and the conditions for providing them. If the provider does not meet the conditions set out in the first sentence, but has the status of the centre of highly specialised oncological care as well as the status of the centre of highly specialised trauma care for children as well as the status of the centre of highly specialised cerebrovascular care or highly specialised care for patients with an event under Section 112 (5) of Act No. 372 / 2011 Coll., on health services and the conditions of their provision, then the minimum basic rate is set at CZK 32 500. For other providers, the minimum basic rate is CZK 27,000.
EM2017 is the total value of the requested extramural care in the context of hospitalisation cases by the provider of recognised and recognised health insurance companies that have been terminated in the reference period and are classified according to the Classification in the groups related to the diagnosis referred to in Annex 10 to this Regulation, valued at the Points (HB) values applicable in the reference period, including the costs of separately charged material and medicinal products separately charged.
The amount of assigned revenue in accordance with Article 21 (3) of the Financial Regulation is estimated at EUR 300000.
max function maximum that selects the highest value from the range of values.
and where:
KN10 is the increase coefficient to be calculated as follows:
KN10 = 1 + 0,14ARCTG137 * Pudrg, 2017,10CM2017,016,10- 24000
where:
ARCTG is the function of Arkus tangens
(ii) CMred, 2019,016,10 is calculated as follows:
(a) Where the number of providers declared and the health insurance undertaking recognised by hospitalisation is completed in the reference or evaluation period in the groups referred to in the Classification referred to in Annex 10 to this Regulation and which have been completed by the transfer of a patient to a downstream care provider or to a follow-up department of the same provider (hereinafter referred to as "treatment termination code 4") or by the transfer of a patient to another acute bed care provider (hereinafter referred to as "treatment termination code 5"), less than or equal to 100, or where PPRdrg, 2019,4,5 ≤ 0,1 * PPdrg, 2019 or where PPRdrg, 2017,4,5 ≤ 0,1 * PPdrg, 2017 is determined as follows:
where:
The value of X shall be 1,05 where the ratio of the number of insured persons of the insurance undertaking in that district, as set out in Annex 14 to this Decree, is greater than 0,01, and of 1,15 where the ratio of the number of insured persons of the insurance undertaking in that district is less than or equal to 0,01, as defined in Annex 14 to this Decree.
CM2019,016,10 is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised which have been completed in the evaluation period which are classified according to Classification in the groups related to the classification diagnosis and which are listed in Annex 10 to this Decree, multiplied by the relative weights 2019, as set out in Annex 10 to this Decree.
This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.
This Decision is addressed to the Member States.
(b) In other cases:
CMred, 2019,016,10 = CMred 1 + CMred 2,
where:
CMred1 = CM1,2019,016,10; CM1,2019,016,100,2 * X * PP1, drag, 2019 * CM1,2017,016,10PP1, drag, 20170,8,
where:
CM1,2019,016,10 is the number of hospitalisation cases reported by the provider and recognised health insurance company which have been completed in the evaluation period which are classified according to the Classification in the diagnostic groups listed in Annex 10 to this Regulation and which have not been terminated by the end code of treatment 4 or the end code of treatment 5 multiplied by the relative weights 2019 as set out in Annex 10 to this Regulation.
CM1,2017,016,10 is the number of hospitalisation cases reported and recognised by the health insurance company that have been completed in the reference period which are classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation and which have not been terminated by the end code of treatment 4 or the end code of treatment 5, multiplied by the relative weights 2019, as set out in Annex 10 to this Regulation.
PP1, drg, 2019 is the number of providers declared and the health insurance undertaking recognised by hospitalisation, completed in the evaluation period included in the classification groups listed in Annex 10 to this Regulation and not terminated by the treatment termination code 4 or treatment termination code 5.
PP1, drg, 2017 is the number of providers declared and the health insurance company recognised by hospitalisation, completed in the reference period classified in groups related to the diagnosis according to the Classification as set out in Annex 10 to this Decree and not terminated by the cessation code of treatment 4 or the cessation code 5.
and where:
CMred2 = CM2019,016,10,4,5 * min1; 1,05 * PPRdrg, 2017,4,5PPRdrg, 2019,4,5 * PPdrg, 2019PPdrg, 2017,
where:
CM2019,016,10,4,5 is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised which have been completed in the evaluation period which are classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation and which have been terminated by the end-of-treatment code 4 or the end-of-treatment code 5, multiplied by the relative weights 2019, as set out in Annex 10 to this Regulation.
PPRdrg, 2019,4,5 is the number of providers declared and the health insurance company recognised by hospitalisation, completed in the evaluation period classified in groups related to the diagnosis according to the Classification, which are listed in Annex 10 to this Decree, and which have been terminated by treatment termination code 4 or treatment termination code 5.
PPRdrg, 2017,4,5 is the number of providers declared and the health insurance company recognised by hospitalisation, completed in the reference period in groups related to the diagnosis according to the Classification as set out in Annex 10 to this Decree, which have been terminated by the end-of-treatment code 4 or the end-of-treatment code 5.
(iii) IZP is the index of the change in production calculated as follows:
where:
IGUP is the change index of the number of global unique insured persons calculated as:
(a) If CMred, 2019,016,10CM2017,016,10 --1, then:
b) If CMred, 2019,016,10CM2017,016,10 = 1, then IGUP = 1.
where:
GUP2019 is the number of global unique insured persons for whom recognised services have been declared and recognised by a health insurance company during hospitalisation completed during the evaluation period, classified according to Classification in the groups related to the diagnosis listed in Annex 10 to this Decree.
GUP2017 is the number of global unique insured persons for which recognised and recognised services provided by the health insurance company during hospitalisation completed in the reference period, classified according to Classification in the groups related to the diagnosis listed in Annex 10 to this Decree.
(iv) Paragraph 9.10 is an increase in the remuneration of health care providers calculated as follows:
where:
CetOD2017,10, i is the number of reported and health insurance undertakings of recognised performance of the treatment day type i that have been reported in hospitalisation cases completed in the reference period classified according to the classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, where it also reaches 1 to n and indicates the type of treatment day according to the performance list.
CetOD2019,10, i is the number of reported and health insurance undertakings of recognised performance of the treatment day type i that have been reported in hospitalisation cases completed in the evaluation period classified according to the classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, where i is equal to 1 to n and indicates the type of treatment day according to the performance list.
Increase Odi is the increase for the treatment day of type i, as set out in Annex 9 to this Decree.
4. Reimbursement in the form of a flat rate payment
4.1 The remuneration to be paid in the form of a flat-rate payment shall include the services covered by the Classification in the groups related to the diagnosis listed in Annex 13 to this Decree.
4.2 Hospital cases are, when calculating CM2019,016,13, CM2019,016,13, trans and CM2017,016,13, cases of hospitalisation translated by the rules for the classification and compilation of hospital cases applicable for 2019.
4.3 Medicinal products excluded from the flat-rate payment referred to in Annex 12 to this Regulation shall be paid by the health insurance undertaking to the provider at the level of their declared unit price, but not more than their declared unit price in 2018.
4.4 For the services covered by the Classification included in the groups related to the diagnosis and listed in Annex 13 to this Order, which are excluded from the remuneration in the form of a flat rate, by the provider declared and by the health insurance undertaking recognised for the period of assessment, except in cases classified under the Classification under Articles 0001 and 0002, a remuneration shall be set at:
KN13 * CM2019,016,13 * maxIZS2017,13; ZSmin, 13 + ODAnnex 9,13-EM2019,13,
where:
CM2019,016,13 is the number of hospitalisation cases completed in the evaluation period and by a health insurance undertaking recognised under the Classification, which are classified in the groups related to the diagnosis listed in Annex 13 to this Regulation, except in cases classified in Bases 0001 and 0002, multiplied by the relative weights 2019 listed in Annex 13 to this Regulation.
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Regulation Information
| Citation | Decree No. 201 / 2018 Coll., on the setting of the values of the points, the amount of payments of services paid and regulatory restrictions for 2019 |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 14.09.2018 |
|---|---|
| Effective from | 01.01.2019 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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