Decree No. 242 / 2021 Coll.
Decree establishing the method of including compensation in the amount of compensation for services paid in 2021
Valid
Order
Effective from 01.07.2021
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242
DECLARATION
of 22 June 2021
establishing the method for including compensation in the remuneration of services paid in 2021
According to § 1 (2) of Act No. 160 / 2021 Coll., the Ministry of Health provides for compensation to persons providing services to cover the effects of the disease epidemic COVID-19 in 2021:
(1) In order to determine how compensation is to be included in the remuneration of the services paid in 2021, this Decree provides:
(a) the compensation values of the point (hereinafter referred to as "the values of the point");
(b) the compensatory amount of the remuneration for the services to be paid (hereinafter referred to as "the amount of compensation") to insured persons pursuant to Article 2 (1) of Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, as amended, (hereinafter referred to as "the Act") and to the services provided to insured persons from other Member States of the European Union, Member States of the European Economic Area and the Swiss Confederation pursuant to the directly applicable European Union provisions 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 contracts covering the services (hereinafter referred to as "foreign insured persons");
(c) the compensatory regulatory restriction on the remuneration referred to in Sections 3 to 19 (hereinafter referred to as the regulatory restriction); and
(d) the amount of the compensation advances.
(2) The provider is the provider
(a) bed care;
(b) in the field of general practical medicine and the provider of practical medicine for children and adolescents;
(c) specialised outpatient care, a provider of dialysis 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) outpatient care in expertise 603 and 604 according to the performance list;
(e) dental medicine;
(f) outpatient care in the field of expertise 222, 801, 802, 806 to 810, 812 to 819 and 823 according to the performance list (hereinafter referred to as "the listed expertise"),
(g) outpatient care in 911, 914, 916, 921 and home care provider in 925 and 926 according to the performance list;
(h) outpatient care in expertise 902 and 917 according to the performance list;
(i) emergency care services, patient transport providers, medical transport service providers, medical emergency services providers and dental emergency services providers;
(j) spa rehabilitation and rehabilitation services,
(k) medical care;
(l) social services which have a special contract with the health insurance company under the law.
(1) The reference period for the purposes of this Decree is 2019. The benchmark values of the provider shall be the values of the relevant payment indicators of the provider in the reference period.
(2) The evaluation period for the purposes of this Decree is 2021.
(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) All services paid in 2021, the provider declared by 31 March 2022 and the health insurance undertaking recognised by 31 May 2022 shall be included in the evaluation period.
(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, the insured person for whom more than one of the merged health insurance companies has been paid during the evaluation period or reference period shall be included only once in the number of individual 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 for which more than one of the merged health insurance companies has been paid for during the evaluation period or reference period shall be included only once in the number of global unique insured persons.
(7) If the health insurance undertaking is to use the values of the remuneration indicators of comparable providers when determining the level of remuneration or regulatory restrictions, it shall use the relevant values of all contractual providers that provide health services in a comparable overall scale and structure over the evaluation period as the provider for which the provisions on comparable providers are applied.
(8) International classification of diseases for the purposes of this Decree means the International Statistical Classification of diseases and associated health problems in its current version (MKN-10) 4.
In the case of the provision of paid services to foreign insured persons, the remuneration shall be determined in accordance with § 5 to 19.
(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 providers, the value of the point, the amount of payment of the services paid, the regulatory limit and the amount of the compensation advances are set out in Annexes 1, 9, 10 and 12 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 (b). (c) the law and, for paid services provided by social services providers having a special contract with a health insurance undertaking under the law, the value of the item, the amount of the payment of the services paid, the regulatory limit and the amount of the compensation advances shall be as set out in Annex 1 to this Decree.
(1) For paid services provided by general practitioners and providers of practical medicine for children and young people 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 payment of the services paid, the regulatory limit and the amount of the compensation advances shall be set out in Annex 2 to this Decree.
(2) For the purposes of Annex 2 to this Ordinance, office hours are agreed in a contract between a health insurance company and a provider where at least one doctor with specialised competence is available at the place of work of the insured person, with a period devoted to the visiting service and administrative activities not included in the operating hours.
For specialised outpatient care provided by the outpatient care providers covered by the performance list, the value of the point, the amount of the payment of the services paid, the regulatory limit and the amount of the compensation advances 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, the value of the point, the amount of payment of the services paid, the regulatory limits and the amount of compensation advances 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, the amount of the payment of the services paid and the amount of the compensation advances 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.
The value of the point and the amount of the payment of the services paid shall be set out in Annex 8 to this Decree for the services provided by the dialysis providers covered by the list of services.
(1) The value of a point of CZK 1.23 shall be determined for the services provided by the health rescue service providers under the performance list, with the exception of the transport performance according to the performance list, for which the value of a point of CZK 1.13 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. The maximum remuneration to the provider for the reported performance No 06714 according to the list of performance during the evaluation period shall not exceed the limit of remuneration for those performance in 2019.
(2) For paid services provided by patient transport providers of urgent care paid according to the performance list, the value of the point of CZK 1.21 shall be determined, with the exception of the performance of the transport according to the performance list, for which the value of the point of CZK 1.13 is determined and with the exception of the performance no. 06714 according to the performance list, for which the value of the point of CZK 1 is determined. The maximum remuneration to the provider for the reported performance No 06714 according to the list of performance during the evaluation period shall not exceed the limit of remuneration for those performance in 2019.
(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 value of CZK 1.23,
b) not providing a health service in continuous operation with a value of CZK 1.00.
(2) For the performance of transport No. 69 according to the list of performances, the value of the point is 1,11 CZK.
(1) For paid services provided by providers in the framework of the medical emergency service paid according to the performance list, the value of the point is set at CZK 1 for medical and transport performance according to the performance list.
(2) Paragraph 9 shall apply in order to determine the level of remuneration of paid services provided by providers in the context of dental emergency services and to establish regulatory restrictions on such services.
(1) For comprehensive spa rehabilitation care for adults, children and adolescents, provided in the health facilities of the spa rehabilitation care provider, a payment of 107,7% of the contracted remuneration for the 1 day of stay for 2019 multiplied by the CompenzaceDPKCOVID shall be fixed. If the payment for one day's stay for 2019 has not been agreed upon by 31 December 2019 inclusive, the payment for one day's stay for 2019 shall be set at the rate of the remuneration paid 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. The compensation coefficient DPKCOVID shall be calculated as follows for the purposes of determining the total remuneration for 2021:
where:
CompenzaceDPKCOVID is the compensation coefficient for the provider declared and the health insurance company recognised the days of residence of the comprehensive spa rehabilitation care facility for adults, children and adolescents during the evaluation period.
PDPK2021 is the number of days of residence within the framework of a comprehensive spa rehabilitation care facility for adults, children and adolescents provided in the evaluation period, by the provider declared by 31 March 2022 and by a health insurance company recognised by 31 May 2022.
PDPK2019 is the number of days of residence within the framework of a comprehensive spa rehabilitation care facility for adults, children and adolescents provided in the reference period, by the provider declared by 31 March 2020 and by a health insurance company recognised by 31 May 2020.
(2) For the benefit of the spa rehabilitation care for adults, children and adolescents provided in the health facilities of the spa rehabilitation care provider, a remuneration of 107,7% of the contracted remuneration for the 1 day of stay for 2019 multiplied by the CompenzaceDPCOVID shall be fixed. If the payment for one day's stay for 2019 has not been agreed upon by 31 December 2019 inclusive, the payment for one day's stay for 2019 shall be set at the rate of the remuneration paid to comparable providers. The compensation coefficient DPCOVID shall be calculated as follows for the purposes of determining the total remuneration for 2021:
where:
CompenzaceDPCOVID is the compensation coefficient for the provider declared and the health insurance company recognised the days of residence of the contributory spa rehabilitation treatment facility for adults, children and adolescents during the period of assessment.
PDP2021 is the number of days of residence in the framework of the adult, children and youth rehabilitation and rehabilitation care allowance provided in the evaluation period, by the provider declared by 31 March 2022 and by the health insurance company recognised by 31 May 2022.
PDPP2019 is the number of days of residence within the framework of the adult, children and youth rehabilitation and rehabilitation care allowance provided in the reference period, the provider declared by 31 March 2020 and the health insurance company recognised by 31 May 2020.
(3) 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.
(4) For the services provided in the recovery rooms, the payment for 1 day's stay is set at CZK 980, which consists of an accommodation, catering and 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.
(5) The advance payment for compensation is granted to the Spa Rehabilitation Care Provider on a monthly basis until the 20th day following the end of the month on which the advance is calculated. The amount of the monthly advance shall be as follows:
Compensation advance, m = max0; Hotj = 1m0,95 * 1,077 * Reimbursement 2019, j-Reimburse2021, j-Reimbursement = 1m-1Compensation advance, k
where:
Backup compensation, m is the advance on compensation in the month of the evaluation period.
j represents months of the year and takes values from 1 to m, where m is the month for which the advance payment is calculated.
Reimburse2019, j is the remuneration of the provider for the provider declared and the health insurance company recognised by the days of residence in month j of the reference period.
Reimbursement 2021, j is the remuneration of the provider to the provider declared and the health insurance company recognised the days of residence in month j of the period of assessment.
k represents months of the year and takes values from 1 to m-1, where m is the month for which the advance payment is calculated.
Backup compensation, k is the advance on compensation in a month to the period of assessment.
(1) For each provider declared and the health insurance company recognised performance No. 09543 according to the list of performances, a remuneration of CZK 35 is determined.
(2) For each provider declared and the health insurance undertaking recognised performance No. 09115 according to the list of performance reported for patients diagnosed with U07.1 or U69.75 according to the international classification of diseases, the provider is increased by CZK 100, except for the performance performed in his own social environment by the insured person, for which the provider is increased by CZK 300. This increase in remuneration shall not be included in the amount of remuneration determined in accordance with Annexes 1 to 8 to this Order.
(3) The remuneration referred to in paragraphs 1 and 2 shall not be included in the maximum remuneration for the services paid.
(4) Paragraph 1 shall not apply to providers of spa rehabilitation care and to providers of general medical practice, to providers of practical medicine for children and adolescents, to providers of dental care and to providers of outpatient care in the field of expertise 603 and 604 according to the performance list.
(1) For each provider declared and the health insurance company recognised performance No. 09552 according to the list of performances, a remuneration of CZK 16 is determined.
(2) After the evaluation period, the health insurance company will pay the provider CZK 12 for each transfer of the paper recipe into electronic form.
(1) Providers in accordance with Sections 6 to 15, if, in 2021, during the period of the continuation of the disease, COVID-19 provided paid services from 1 January 2021 to 31 March 2021 and reported to the health insurance undertaking, in order to compensate for additional personnel costs resulting from the payment of exceptional remuneration to healthcare professionals, the remuneration is increased by the amount of the remuneration Comparison, 2021 calculated as follows:
Remuneration Comparison, 2021 = max {0; Reward 2021 - Reward 2020}
where:
The remuneration of 2021 is the amount of compensation calculated on the basis of the number of health workers in 2021 calculated as follows:
Remuneration 2021 = Remuneration * 1,338 * min (Number ZP2021; Capacity ZP2021 Type of capacity) * Kród * min (1; Comparison _ value _ care 2021,1Q0,75 * Comparison _ value _ care 2019,1Q)
The amount of compensation calculated on the basis of the number of health workers in 2020, calculated as follows:
Remuneration 2020 = Rewards * 1,338 * min (Number of ZP2020; Capacity ZP2020 Type of capacity) * Kród * min (1; Comparison _ value _ care 2020,4Q0,75 * Comparison _ value _ care 2018,4Q)
and where:
The remuneration shall be at the rate of 75 000, with the exception of providers of health care services, for which it shall be set at 120 000.
The number of ZP2020 is the number of healthcare professionals providing paid services from providers that have been included in the contract between the provider and the health insurance company as effective on 31 December 2020.
The number of ZP2021 is the number of health workers providing paid services to a provider registered by a health insurance company on 30 June 2021.
Capacity ZP2020 is the sum of the weekly hourly time-out capacity of healthcare professionals providing paid services to the provider that was included in the contract between the provider and the health insurance company as effective on 31 December 2020.
Capacity ZP2021 is the sum of weekly hourly time-out capacity of healthcare professionals providing paid services to a provider registered by a health insurance company on 30 June 2021.
Typability is the typical weekly hourly capacity of a healthcare professional providing paid services to a provider, determined according to the provider's type according to the following table:
| Typ poskytovatele | Hodnota Typkapacity |
|---|---|
| 25 | |
| 30 | |
| 30 | |
| 35 | |
| 40 | |
| 35 | |
| 40 | |
| 35 | |
| 30 | |
| 40 | |
| 40 |
The county is the ratio of the number of insured persons of the insurance undertaking in the given region where the provider provides the services covered, which are listed in Part A, point 3, of Annex 2 to this Decree.
The comparative _ value of care 2021,1Q is the comparative value of the services paid in the period from 1 January 2021 to 31 March 2021, by the provider recognised by 31 May 2021 and by the health insurance undertaking recognised by 31 July 2021, calculated as follows:
Comparison _ value _ care 2021,1Q = PB2021,1Q + KP2021,1Q
where:
PB2021,1Q is the number of points for the services paid by the provider during the period from 1 January 2021 to 31 March 2021, reported by 31 May 2021 and by the health insurance undertaking recognised by 31 July 2021.
This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.
and where:
The benchmark _ value _ care 2019,1Q is the benchmark value by the provider of the recognised and health insurance undertaking of recognised paid services provided between 1 January 2019 and 31 March 2019, calculated as follows:
Compare _ value _ mine2019,1Q = PB2019,1Q + KP2019,1Q
where:
PB2019,1Q is the number of points per provider reported and recognised by the health insurance undertaking for the period from 1 January 2019 to 31 March 2019.
KP2019,1Q is the value of the crown items per provider reported and recognised by the health insurance undertaking for the period from 1 January 2019 to 31 March 2019.
The comparison _ value _ care 2020,4Q is the comparative value of the services provided between 1 October 2020 and 31 December 2020 by the provider reported by 31 March 2021 and the health insurance undertaking recognised by 31 May 2021, calculated as follows:
Comparison _ value _ care 2020,4Q = PB2020,4Q + KP2020,4Q
where:
PB2020,4Q is the number of points for the services paid by the provider for the period from 1 October 2020 to 31 December 2020, reported by 31 March 2021 and by the health insurance undertaking recognised by 31 May 2021.
KP2020,4Q is the value of the crown items for the services paid by the provider for the period from 1 October 2020 to 31 December 2020, reported by 31 March 2021 and by the health insurance undertaking recognised by 31 May 2021.
and where:
The comparison _ value _ care 2018,4Q is the comparison value by the provider of the recognised and the health insurance company of recognised paid services provided between 1 October 2018 and 31 December 2018, calculated as follows:
Compare _ value _ mine2018,4Q = PB2018,4Q + KP2018,4Q
where:
PB2018,4Q is the number of points per provider reported and recognised by the health insurance undertaking for the period from 1 October 2018 to 31 December 2018.
KP2018,4Q the value of the crown items per provider declared and the health insurance undertaking recognised by the services provided during the period from 1 October 2018 to 31 December 2018.
(2) In the case of a provider who did not provide the services covered during the period from 1 October 2018 to 31 December 2018, the comparison _ value _ care 2018,4Q is set at 1.
(3) In the case of a provider who did not provide paid services or provided paid services to ten and less unique insured persons of the health insurance company concerned between 1 January 2019 and 31 March 2019, the comparative _ value of care 2019,1Q is set at 1.
(4) The increase in the remuneration referred to in paragraph 1 shall not be included in the amount of the remuneration determined in accordance with § 6 to 15.
(5) The advance payment shall be granted to the provider at the rate of the increase in remuneration referred to in paragraph 1 by 31 July 2021 at the latest.
This Decision shall enter into force on 1 July 2021.
Minister:
Mgr. et Mgr. Vojtěch, MHA, v. r.
Příloha č. 1
Annex No 1 to Decree No. 242 / 2021 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 2021 shall include the contractually agreed remuneration component referred to in point 2, the flat-rate remuneration referred to in point 3, the remuneration allocated to the flat-rate payment referred to in point 4, the case flat-rate payment referred to in point 5, the payment for acute bed-keeping for a small number of insured persons and foreign insured persons referred to in point 6, the payment for outpatient care referred to in point 7 (the "outpatient remuneration component") and the other remuneration referred to in point 8. In order to calculate the reference values, the individually contracted remuneration components, flat-rate remuneration, the remuneration earmarked for the flat-rate remuneration, the case flat-rate remuneration and the outpatient remuneration components shall be included in the calculation in all the services provided in 2019, the provider declared by 31 March 2020 and the health insurance company recognised by 31 May 2020.
2. Individual contractually agreed payment component
2.1 Where the health insurance undertaking and the provider agree on a different amount and method of payment of the services paid and for the services covered by the flat-rate payment, in the payment of the flat-rate payment or in the form of a flat-rate payment, the remuneration for those services shall not be included in the remuneration referred to in points 3 to 7.
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 (hereinafter referred to as "Decree No. 376 / 2011 Coll."), shall be determined according to the provider declared and the health insurance company of the recognised medicinal product in the unit price, but not more than the amount mentioned in points 2.2.1 to 2.2.3.
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 reported by the provider and by the health insurance company recognised in 2019.
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 (Hepatitida C) |
| h) | Metabolické vady (Fabryho choroba, Gaucherova choroba, Metabolické vady) |
| i) | Neurologie 1 (Epilepsie, Narkolepsie, Parkinsonova choroba, Substituční léčba) |
| j) | Neurologie 2 (Roztroušená skleróza) |
| k) | Neurologie 3 (Spinální svalová atrofie) |
| l) | Oběhový systém (Plicní arteriální hypertenze) |
| m) | Oftalmologie (Centrální venózní okluze, Makulární degenerace, Oftalmologie – DM, Vitreomakulární trakce, Oftalmologie – jiné) |
| n) | 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) |
| o) | Osteoporóza |
| p) | Revmatologie (Bechtěrevova choroba, Artritida, Lupus erythematosus, Psoriatická artritida) |
| q) | Trávicí soustava (Crohnova choroba, Ulcerózní kolitida) |
| r) | Cystická fibróza |
| s) | Ostatní – výše neuvedená onemocnění s výjimkou skupiny hepatologie |
| t) | Hepatologie – onemocnění jater a žlučových cest |
the maximum remuneration shall be fixed as follows:
Uhrmax, 2021 = Uhrt, 2020 + Istrii = asUhri, 2019 * INi
where:
Uhrmax, 2021 is the maximum remuneration in the evaluation period.
i takes the values and up to s, where and up to s are the diagnostic groups referred to in paragraph 2.2.2.
Uhri, 2019 is the total payment in the reporting period for the treatment of the disease i.
Uhrt, 2020 is the total remuneration for the treatment of hepatology disease in 2020.
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 | 1,29 |
| Dýchací soustava 1 | 1,60 |
| Dýchací soustava 2 | 1,24 |
| Endokrinologie | 1,00 |
| Hematoonkologie | 1,14 |
| Imunitní systém | 1,16 |
| Infekce | 1,18 |
| Metabolické vady | 1,03 |
| Neurologie 1 | 1,26 |
| Neurologie 2 | 1,05 |
| Neurologie 3 | 1,20 |
| Oběhový systém | 1,01 |
| Oftalmologie | 1,16 |
| Onkologie – solidní nádory | 1,20 |
| Osteoporóza | 1,00 |
| Revmatologie | 1,03 |
| Trávicí soustava | 1,04 |
| Cystická fibróza | 1,80 |
| Ostatní | 1,30 |
2.2.4 Reimbursement for the 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 2.2.3 shall be paid in accordance with a prior agreement between the health insurance undertaking and the provider.
2.3 For each case of hospitalisation by the provider and recognised by the health insurance company, completed in the evaluation period for which testing for COVID-19 has been indicated, the payment to the provider shall be increased by CZK 1,113 in the case of hospitalisation declared until 30 June 2021 and CZK 614 in the case of hospitalisation declared from 1 July 2021:
(a) for each power declared, Nos 82301 and 82304, according to the performance list, if the case is diagnosed with U07.1 according to the international classification of diseases,
(b) once for a case with a diagnosis of U69.75 according to the international classification of diseases and at least once a performance No 82302 according to the list of performance has been declared.
Such increases in remuneration shall not be included in the remuneration referred to in points 3 to 6.
2.4 In the case of hospitalisation cases with a diagnosis of U07.1 according to the international classification of diseases by the provider of recognised and health insurance, completed in the evaluation period, classified according to the rules for the classification of hospitalised patients for the year 20215 (hereinafter referred to as "Classification"), where performance No 55227 has been declared by the provider according to the list of performance, or one of the DRG markers No 90901 to 90907 according to the classification, the remuneration of the provider shall be increased by CZK 59 064 for each treatment day (hereinafter referred to as "OD") No 00051 to 00078 according to the list of performance, provided within 20 days of the first provision of performance No 82301 to 90907 according to the list of performance or the performance of screening testing by the provider during the last 180 calendar days using the PCR method with a positive result or performance of the SARSARS-CoV-2 antigen test. For hospitalisation cases with a diagnosis of U07.1 according to the international classification of diseases by the provider recognised and the health insurance company recognised, completed in the evaluation period, classified according to the Classification, for which the condition according to the first sentence is not met, the payment to the provider shall be increased by CZK 39 967 for each OD no. 00051 to 00078 according to the performance list provided within 20 days of the first provision of output No 82301 according to the COVID-19 screening test list, using the PCR method with a positive result or performance on the SARS-CoV-2 antigen with a positive result in the absence of performance No 82301 or 82302 according to the list of performance by any provider during the last 180 calendar days. This increase in remuneration shall not be included in the remuneration referred to in points 3 to 6 and shall be intended to compensate for the increased personnel costs of medical care for patients with COVID-19.
2.5 In cases of hospitalisation with a diagnosis of U07.1 according to the international classification of diseases by the provider of recognised and health insurance, completed in the evaluation period, classified according to the classification rules, the payment to the provider shall be increased by CZK 1 000 for each OD, except for OD No 00051 to 00078 according to the list of performance, provided within 20 days of the first provision of performance No 82301 according to the list of performance or screening performance COVID-19 by the PCR method with a positive result or performance on the SARS-CoV-2 antigen, with a positive result in the absence of performance No 82301 or 82302 according to the list of performance by any provider during the last 180 calendar days. This increase in remuneration shall not be included in the remuneration referred to in points 3 to 6.
3. Flat payment
3.1 The flat-rate payment shall include the services covered by the Classification in the groups related to the diagnosis listed in Annex 10, Part A, to this Decree.
3.2 In the calculation of variables in the reference period, hospitalisation cases are defined as those converted by the Classification.
3.3 For performances from 00031 and 00032 according to the list of performances, excluded from the flat rate payment, the flat rate for the treatment day is set at CZK 484.
3.4. Medicinal products exempted from the flat-rate payment and listed in Annex 12 to this Order 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 2020.
3.5 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. In cases of hospitalisation with a diagnosis of U07.1 according to the international classification of diseases, the declared performance No 82301 and 82304 according to the list of performance shall not be included in extramural care. In cases of hospitalisation with a diagnosis of U69.75 according to the international classification of diseases, the first declaration of performance No 82302 according to the list of performance shall not be included in extramural care.
3.6. The amount of the flat-rate remuneration shall be determined as the FOREIGN, CZK-DRG, 2021 as follows:
EMBRPU, CZ- DRG, 2021 = min1; CM2021, CZ- DRG, A0,95 * CM2019, CZ- DRG, A * IPU * IZP-EM2021, A
where:
CM2021, CZK-DRG, A is the number of hospitalisation cases reported by the provider and by a health insurance undertaking recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Decree, multiplied by the relative weights 2021 listed in Annex 10, Part A 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.
EM2021, A 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, terminated in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Regulation, valued at the values of the points applicable in the assessment period, including remuneration for the material separately charged and the medicinal products separately charged.
min function minimum which selects the lowest value from the range of values.
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Regulation Information
| Citation | Decree No. 242 / 2021 Coll., establishing the method of including compensation in the amount of compensation for services paid in 2021 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 30.06.2021 |
|---|---|
| Effective from | 01.07.2021 |
| Effective until | - |
| Status | Valid |
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