Decree No. 251 / 2002 Coll.
Decree of the Ministry of Health determining the amount of health insurance payments paid from public health insurance, including regulatory restrictions for the 2nd half of 2002
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Effective from 01.07.2002
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25.06.2002
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251
DECLARATION
Ministry of Health
of 13 June 2002
determining the amount of the public health insurance coverage including the regulatory restrictions for the 2nd half of 2002
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":
This decree provides for an agreement under Paragraph 17 (8) of the Act where the conciliation procedure does not result,
(a) the amount of health care payments paid from public health insurance, including regulatory restrictions on health care in health care institutions, including professional medical institutions, treatment of long-term sick and health care establishments reporting on treatment day No 00005 under the Decree issuing a list of health performance with point values (1) (hereinafter referred to as the "performance list");
(b) the amount of compensation for the provision of emergency medical care in non-contractual medical establishments.
(1) Health care provided in health care institutions, except for medical care in professional medical institutions, long-term sick hospitals and in health care institutions reporting on day 00005 according to the list of performance (hereinafter referred to as "bed facilities"), is paid in accordance with the contractual agreement between the health insurance company and the bed establishment
(a) a flat rate; or
(b) according to the list of performances; or
(c) on a proposal of a sleeper, agreed by a method of payment combined with a diagnosis payment.
(2) The price of the point of reimbursement of health care referred to in paragraph 1 (b) set for the first half of 2001 remains valid for the second half of 2002.2)
(3) The amount of the remuneration referred to in paragraph 1 (c) shall be agreed in the contract between the health insurance undertaking and the bed establishment, the amount of the payment for the provision of emergency bed care being fixed at a flat rate and the other health care paid.
(4) A method of payment other than that referred to in paragraph 1 may be used where the total amount of payment is higher than the payment provided for in paragraph 1 (a) or (b), the bed establishment and the health insurance undertaking have agreed on such a method of payment on the basis of the proposal of the bed establishment and this method is not contrary to public health insurance legislation.
(5) If the bed establishment and the health insurance undertaking agree an amendment to the contract, or agree a new contract containing new medical performance provided by the bed establishment, or agree a new structure of the healthcare provided, the health insurance undertaking shall include this in the total amount of the remuneration for the 2nd half of 2002, unless this is contrary to the public health insurance legislation.
(6) The procedure for calculating the flat rate, the amount and the conditions for reimbursement referred to in points (a) and (b) of paragraph 1 is laid down in Annex 1 thereto.
(7) Where payment is made at a flat rate as referred to in paragraph 1 (a), the health insurance undertaking shall, in addition to the flat rate and without the application of other regulatory restrictions, provide, unless they are specified directly in points (a) to (u), in the second half of 2002, a separate remuneration
(a) for cardioverters and pacemakers, including electrodes, provided in the second half of 2002 in the case of reimplantation (performances No 55217 and 55219 included in the list of performance),
(b) for neuromodulation stimulators provided for the treatment of epilepsy and Parkinson's disease in the 2nd half of 2002;
(c) for neuromodulation stimulators and intrathecal pumps provided for the treatment of chronic painful conditions, peripheral nerve stimulation (PNS), spinal cord stimulation or back roots (SCS), deep brain and cortical stimulation, and for the stimulators of the anterior corners of the spinal cord (SARS) in transverse spinal lesions provided in the second half of 2002 in the bed facilities listed in Annex 3 to this Decree; the sleeper establishments listed in Annex 3 to this Decree may apply in total to health insurance companies in the Czech Republic a maximum of 30 programmable prostheses,
(d) for in vitro fertilisation treatment provided in the 2nd half of 2002 by sleeper establishments carrying out standard sterilisation treatment using an extra-body fertilisation method;
(e) for the medical performance of haemodialysis No 18051, 18052, 18510, 18513, 18521, 18522, 18530, 18550, 18560, 18570, 18580 and 18590 according to the list of performance provided for in the second half of 2002, the price of the point for the reimbursement of those performance laid down for the first half of 2001 remains valid for the second half of 2002; (3) for the health performance No 18521, 18522, 18530, 18550, 18560, 18570, 18580 and 18590 referred to in the decree shall be fixed the overhead costs of 4 points per minute;
(f) for the specifically charged medicinal products for the treatment of haemophilia listed in Annex 4 to this Decree, provided in bed facilities in the second half of 2002;
(g) for the specifically charged HIV / AIDS medicinal products, antiretroviral medicinal products and medicinal products for the comprehensive treatment of opportunistic infections, provided at the second half of 2002 in the bedding facilities listed in Annex 5 to this Decree; antiretroviral medicinal products and medicinal products for the comprehensive treatment of opportunistic infections are listed in Annex 6 to this Decree,
(h) for the specifically charged Cerezyme medicinal product, in the treatment of Morbus Gaucher disease, provided in the 2nd half of 2002 only by a clinic of paediatric and adolescent medicine of the General Faculty Hospital Prague,
(i) for the treatment and intensive care days No 00051, 00052, 00053, 00055, 00057, 00058, 00061, 00065, 00068 according to the list of performances provided in the second half of 2002 for the treatment of extensive burns, in the sleeper facilities listed in Annex 7 to this Decree, the price of the point for the reimbursement of these performances set out for the first half of 2001 remains valid for the second half of 2002.4)
(j) for medicinal products specifically charged in the second half of 2002 for the treatment of cystic fibrosis in bed facilities listed in Annex 8 thereto; the list of medicinal products specifically charged is set out in Annex 9 to this Regulation,
(k) for the specifically charged medicinal products provided in the 2nd half of 2002 in oncologically ill children treated at the centres of pediatric oncology of the bed facilities listed in Annex 10 to this Decree; the list of medicinal products specifically charged is set out in Annex 11 to this Decree,
(l) for separately charged balloon catheters and stents provided during the 2nd half of 2002 in connection with the implementation of a direct percutaneous transluminal angioplasty (PTCA) in the acute myocardial infarction of the performance No 89435, 89437 and 17117 of the performance list in the bedding facilities listed in Annex 12 to this Decree,
(m) for the separately charged platelet glycoprotein receptor blockers IIb / IIIa (ATC Group B01AC13 and B01AC16) listed in Annex No 19 to this Decree, provided for the treatment of acute myocardial infarction in the bed facilities listed in Annex No 12 to this Decree in the second half of 2002,
(n) for specially charged balloon catheters, stents, stent- graphs, embolizing spirals, adhesive mixtures, microcatheters and cerebrovascular protective devices provided in the 2nd half of 2002 for endovascular treatment (performance No 89323, 89331 and 89423 listed in the performance list) of arterial aneurysms and dissection, stenosis of the cerebral arteries, cerebral arteriovenous shortages and malformations, in the bed facilities listed in Annex 13 to this Decree,
(o) for separately charged material (code 24684 and 71032) provided in the second half of 2002 for hernia operations using the PHS method (performances No 51517 and 51519 listed in the list of performance),
(p) for the separately charged material (code 67162) provided in the second half of 2002 for the operational treatment of urinary stress incontinence in women (performance No 76601 in the list of performances) in the bedding facilities listed in Annex 14 to this Decree,
(q) for medicinal products specifically charged (codes 75379, 90996, 93706 and 93707), provided in the second half of 2002 for the treatment of rabies in sleeper establishments,
(r) for the medicinal products separately charged, containing the active substance erythropoietin listed in Annex 15, for the treatment of multiple myeloma and chronic lymphoid leukaemia, provided for in the second half of 2002 in the bedding establishments listed in Annex 16 to this Regulation,
(s) for the specifically charged medicinal products containing the active substance erythropoietin listed in Annex 15 for the treatment of germ tumours at stage II-IV, ovarian carcinomas at stage I-IIA, lung cancer, breast cancer at stage I and II, cervix carcinoma at stages Ib, IIa, IIb, orofacial carcinoma, placenta cancer provided in the second half of 2002 in the bed facilities listed in Annex 17 to this Regulation,
t) for specially charged material - splint, provided in the 2nd half of 2002 in the performance of thoracoplasty (performance no 57225 listed in the performance list), performed by the Children's Surgery Clinic of the Faculty Hospital Motol, Prague 5 and the Faculty Hospital Brno - Clinic of Children's Surgery, Orthopedia and Trauma. These facilities can apply a maximum of 15 individual splints in total to health insurance companies in the Czech Republic when solving pectus excavatum,
(u) for cochlear implantation systems provided by adults with sudden double-sided deafness, only in well-developed language; in children who are deaf, not earlier than six months, and in children who are deaf, not less than six years old, provided at the latest by the Faculty Hospital Motol, Prague 5 - ORL clinic of the 1st Faculty of Medicine and ORL clinic of the 2nd Faculty of Medicine (child implants). These devices can apply a maximum of 30 programmable cochlear implantation systems to health insurance companies in the Czech Republic.
(1) Health care provided in professional medical institutions is paid according to the contractual agreement between the health insurance company and the professional medical institution
(a) the flat rate referred to in Annex 2 (A); or
(b) in the combined manner referred to in Annex 2 (B),
(c) in accordance with the performance list.
(2) The price of the point for reimbursement of health care referred to in paragraph 1 (b), established for the first half of 2001, remains valid for the second half of 2002.5)
(3) The value of the overhead assigned to the point value of the relevant treatment days included in the list of performance shall be increased by 60 points from the contracted direction of those treatment days in the second half of 2001, the resulting value of the overhead must not exceed that of the power list.
(4) The flat-rate amount to be paid for medicinal products under Section 17 (12) of the Act is increased by CZK 10 compared to the 2nd half of 2001.
(5) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than that laid down in paragraph 1 (a) or (b), the professional medical institution and the health insurance undertaking have agreed on such a method of reimbursement on a proposal from the medical professional institution and this method is not contrary to the legislation governing public health insurance.
(6) If a medical professional institution and a health insurance undertaking agree an amendment to the contract, or agree a new contract containing new medical performance provided by the medical professional institution, or agree a new structure of healthcare provided, the health insurance undertaking shall include this in the total amount of remuneration for the 2-half of 2002, unless this is contrary to public health insurance legislation.
(7) The procedure for calculating the flat rate and reimbursement in the combined manner, the amount and the conditions for payment referred to in paragraph 1 (a) and (b) are set out in Annex 2 to this Decree.
(1) Health care provided in long-term patients' hospitals is paid according to the contractual agreement between the health insurance company and the healthcare establishment according to the performance list by remuneration for the medical performance provided.
(2) The price of the point of payment for health care referred to in paragraph 1 set for the first half of 2001 remains valid for the second half of 2002.6)
(3) The value of the overhead assigned to the point value of the treatment day No 00024 included in the list of performance increases by 60 points from the contracted direction of that treatment day at the second half of 2001, the resulting value of the treatment must not be higher than the performance list.
(4) The flat-rate amount to be paid for medicinal products under Section 17 (12) of the Act is increased by CZK 5 compared to the 2nd half of 2001.
(5) A different method of payment than that referred to in paragraph 1 may be possible if the total amount of remuneration is higher than the payment provided for in paragraph 1, the treatment facility of the long-term sick and health insurance undertaking has agreed on such a method of payment on the proposal of the treatment of long-term patients and this method is not contrary to public health insurance legislation.
(1) Health care provided in health care establishments reporting on treatment day No 00005 listed in the performance list shall be paid under the contractual arrangement between the health insurance undertaking and the healthcare establishment in accordance with the performance list by remuneration for the medical performance provided.
(2) The price of the point of payment for health care referred to in paragraph 1 set for the first half of 2001 shall remain valid for the second half of 2002.7)
(3) The value of the overhead agreed in the contract with the health insurance company, assigned to the point value of the treatment date No 00005 included in the list of performance, is increased by 60 points compared to the second half of 2001, the resulting value of the overhead must not be higher than the performance list.
(4) The flat-rate amount to be paid for medicinal products under Section 17 (12) of the Act is increased by CZK 5 compared to the 2nd half of 2001.
(5) A different method of payment than that referred to in paragraph 1 may be possible if the total amount of remuneration is higher than the remuneration fixed in accordance with paragraph 1, the health care establishment and the health insurance undertaking have agreed on such a method of reimbursement on the basis of a proposal from the health care establishment and this method is not contrary to public health insurance legislation.
(1) Reimbursement of urgent health care, unless a contract is concluded between a healthcare establishment and a health insurance company, is made for the health performance provided as follows:
(a) dental outpatient care shall be paid at the rates applicable to dental care provided by dental practitioners in the 2nd half of 2002;
(b) other healthcare is paid according to the performance list and the health insurance company may apply regulatory restrictions on the basis of the Act (8) similar to those of contractual health establishments.
(2) The price of the point for reimbursement of health care referred to in paragraph 1 (b), set for the first half of 2001, remains valid for the second half of 2002.9)
(1) If, in the second half of 2002, the actual income from the collection of the premiums after the reallocation is higher than the actual amount of the premium after the reallocation in the second half of 2001, health insurance companies shall increase the total amount of the remuneration calculated in accordance with this Decree by the procedure set out in Annex 18 to this Decree to the health insurance undertaking referred to in § 1 (a).
(2) The income from the collection of premiums after the reallocation will be included for the seventh to twelfth months of 2002.
(3) The increase referred to in paragraph 1 shall be paid by health insurance undertakings to contractual medical establishments by 31 May 2003.
(4) If, during the second half of 2002, there is a change in the list of performances, these changes shall be taken into account when calculating the increase referred to in paragraph 1.
(5) Health insurance companies will provide health care institutions with data on the actual income from the collection of premiums after the reallocation for the second half of 2002.
This Decree shall take effect on 1 July 2002.
Minister:
Prof. MUDr. Fisher, CSc.
Příloha č. 1
Annex No 1 to Decree No 251 / 2002 Coll.
Procedure for calculating the flat rate, the amount and the conditions for reimbursement referred to in Article 2 (1) (a) and (b)
(A) Reimbursement at a flat rate
1. The reimbursement of health care provided by bed facilities shall include:
(a) the payment of emergency bed care recorded in hospitalisation accounts, including the relevant performance of the complement (hereinafter referred to as "hospitalisation payment");
(b) the payment of outpatient care recorded in outpatient accounts, including the relevant performance of the complement ("outpatient payment");
(c) reimbursement of the performance of health transport (hereinafter referred to as "transport payment"),
(d) the reimbursement of other health care performance, where provided by the bed establishment, of complements for other healthcare establishments or, where appropriate, other contracted performances ("other remuneration").
If one of these types of healthcare does not provide bed facilities, it is not part of the remuneration.
2. Procedure for establishing the flat rate for the second half of 2002
The flat rate shall be calculated for the different types of healthcare referred to in points (1) (a) to (d) of the second half of 2001 from the volume of performance reported by the sleeper and recognised by the health insurance undertaking between 1 July 2001 and 31 May 2002 and, where appropriate, from the volume of performance of previous periods recognised by the health insurance undertaking but not included in the flat rate in previous periods, as follows:
The total volume of performance (points and separately charged medicinal products and separately charged material) is divided by the number of unique treated insured persons who have received health care in a bed establishment. A special insured person means one insured person, regardless of the number of times the number of times the bed establishment has shown health care on that insured person within a specified period of time. The performance and unique treatment of the insured person shall be calculated separately for each type of remuneration referred to in points 1 (a) to (d).
The flat rate shall include:
(a) the number of points per special insured person,
(b) a flat rate for the medicinal products specifically charged, the material specifically charged and the flat-rate, on 1 special insured person, in CZK.
2.1. Flat rate hospitalisation
PHB
where:
PHB = number of points per unique treated insured person for the 2nd half of 2001
BH = the number of points for all medical performance provided in hospitalisation, including points per patient category, for the second half of 2001 of the bed establishment in question, which were declared by the bed establishment and recognised by the health insurance company from 1 July 2001 to 31 May 2002, except for points:
(a) for medical performance paid in the 2nd half of 2002 in excess of the flat rate of hospitalisation or included in another flat rate;
(b) for recognised and recognised health performance provided in the course of hospitalisation in experts no longer contracted for the second half of 2002.
PHZ = flat rate for separately charged medicinal products, separately charged material and for a flat rate provided in the 2nd half of 2001 to hospitalised insured persons on 1 special treated insured person.
ZH = reimbursement for the medicinal products specifically charged, the material specifically charged and the flat-rate provided in the second half of 2001 to hospitalised insured persons who have been declared by the hospital and recognised by the health insurance company from 1 July 2001 to 31 May 2002, except for the material separately charged and the medicinal products separately charged:
(a) paid in the second half of 2002 in excess of the flat rate of hospitalisation or included in another flat rate;
(b) provided during hospitalisation in experts who are no longer contracted for the second half of 2002.
UH = number of unique treated insured persons who were hospitalised in the 2nd half of 2001 and who received the medical benefits provided by the bed establishment and recognised by the health insurance company from 1 July 2001 to 31 May 2002.
2.2. Outpatient flat rate
PAB
where:
PAB = number of points per unique treated insured person for the 2nd half of 2001.
BA = number of points for all medical performance provided in ambulances, for the 2nd half of 2001, which have been declared by the bed establishment and recognised by the health insurance company from 1 July 2001 to 31 May 2002, except for points:
(a) for medical performance paid in the 2nd half of 2002 in excess of the flat rate outpatient or included in another flat rate;
(b) for recognised and recognised health performance provided in ambulances in expert matters no longer contracted for the second half of 2002.
PAZ = flat rate for separately charged medicinal products and separately charged material provided in the 2nd half of 2001 in ambulances treated to insured persons on 1 unique treated insured person.
ZA = reimbursement for the medicinal products specifically charged and the material specifically charged provided in the second half of 2001 in ambulances treated to insured persons who have been declared by the hospital and recognised by the health insurance company from 1 July 2001 to 31 May 2002, except for the material separately charged and the medicinal products separately charged:
(a) paid in the second half of 2002 in excess of the flat rate outpatient or included in another flat rate;
(b) provided in ambulances in experts who are no longer contracted for the second half of 2002.
UA = number of unique treated insured persons who were treated in ambulances in the 2nd half of 2001 and the medical performance provided to them by sleepers and recognised by the health insurance company from 1 July 2001 to 31 May 2002.
2.3. Flat rate for health transport
PDB = INDIVIDUD PDZ = INDIVIDUAL
where:
PDB = number of points per unique treated insured person for the 2nd half of 2001
BD = the number of points for all medical performance provided for health transport in the second half of 2001 of the bed establishment in question, which have been declared by the bed establishment and recognised by the health insurance company from 1 July 2001 to 31 May 2002, except for points:
(a) for medical performance paid in the 2nd half of 2002 in excess of the flat rate for health transport or included in another flat rate;
(b) for recognised and recognised health performance in health transport which is no longer contracted for the second half of 2002.
PDZ = flat rate for separately charged medicinal products and separately charged material provided in the 2nd half of 2001 for medical transport transported or, where applicable, treated to insured persons on 1 special treated insured person.
ZD = reimbursement for the specifically charged medicinal products and the separately charged material provided in the 2nd half of 2001 for the transport of medical goods transported and, where applicable, treated insured persons who have been declared by the bed establishment and recognised by the health insurance company from 1 July 2001 to 31 May 2002, except for the material separately charged and the medicinal products separately charged:
(a) paid in the second half of 2002 in excess of the flat rate for health transport or included in another flat rate;
(b) provided for in the performance of health transport operations no longer contracted for the second half of 2002.
UD = number of unique treated insured persons who were transported to health transport in the 2nd half of 2001 and, where appropriate, treated and the medical performance provided to them was declared by bed facilities and recognised by the health insurance company from 1 July 2001 to 31 May 2002.
2.4. Flat rate for other health performance
PJB
where:
PJB = number of points per unique treated insured person for the 2nd half of 2001
BJ = the number of points for all other medical performance provided in the second half of 2001 of the bed establishment in question which have been declared by the bed establishment and recognised by the health insurance company from 1 July 2001 to 31 May 2002, except for points:
(a) for medical performance paid in the 2nd half of 2002 in excess of the flat rate for other medical performance or included in another flat rate;
(b) for recognised and recognised other medical performance provided by experts no longer contracted for the second half of 2002.
PJZ = flat rate for separately charged medicinal products and separately charged material provided in the 2nd half of 2001 for other health outcomes treated to insured persons on 1 special treated insured person.
ZJ = reimbursement for separately charged medicinal products and separately charged material provided in the 2nd half of 2001 for other health benefits to insured persons who have been declared by the bed establishment and recognised by the health insurance company from 1 July 2001 to 31 May 2002, except for separately charged material and specifically charged medicinal products:
(a) paid in the second half of 2002 in excess of the flat rate for other medical performance or included in another flat rate;
(b) provided for other health performance in the field of expertise no longer contracted for the second half of 2002.
UJ = number of unique insured persons who received other health benefits in the 2nd half of 2001, which were declared by the bed establishment and recognised by the health insurance company from 1 July 2001 to 31 May 2002.
3. Calculation of flat rate remuneration per point
The calculation of the flat-rate remuneration for 1 point is based on the individual rate of remuneration for 1 point in the second half of 2001, which is adjusted for a differentiated increase in the remuneration in 3 bands (as referred to in point 3.2).
3.1 The individual amount of remuneration for 1 point (IVUB) for the second half of 2001 represents the proportion of the total remuneration, excluding the medicinal products specifically charged and the material separately charged, to 1 point. It shall be determined according to the following formula:
IVUB2.pol.2001 = VYHRADA2.pol.2001-Z2.pol.2001 VYBODY2.pol.2001
where:
FOREIGN REVENUE This remuneration shall not include the medical performance which is paid in excess of the flat rate in the first half of 2002.
Z2.pol.2001 = remuneration for the medicinal products specifically charged and the material specifically charged, provided in the 2nd half of 2001, which was declared by the hospital and recognised by the health insurance company from 1 July 2001 to 31 May 2002; This remuneration shall not include the medicinal products separately charged and the material separately charged, which shall be paid in excess of the flat rate in the second half of 2002.
BODY2 pol.2001 = the number of points for health performance and patient categories provided by the bed establishment in question in the second half of 2001, which were declared by the bed establishment and recognised by the health insurance company from 1 July 2001 to 31 May 2002; These points shall not include points for health performance which are paid in excess of the flat rate in the second half of 2002.
3.2 The flat-rate remuneration for 1 point (PUB) for the second half of 2002 is based on the individual amount of remuneration for 1 point recorded for the second half of 2001. The following shall be determined:
a) if the calculated IVUB is less than CZK 0.89, then PUB for the 2nd half of 2002 is CZK 0.89,
b) if the calculated IVUB is equal to 0,89 CZK or less or equal to 0,99 CZK, add to this IVUB 0,01 CZK (PUB = IVUB + 0,01),
(c) if the calculated IVUB is equal to or greater than CZK 1, the calculated IVUB (PUB = IVUB) shall be used.
4. Calculation of total remuneration for healthcare provided
4.1 The flat-rate payment for the different types of healthcare referred to in points (1) (a) to (d) per single treated insured person shall be made by multiplying the number of points per unique treated insured person by the flat-rate payment per point (PUB) and by adding the amount of the flat-rate for the medicinal products separately charged and the materials separately charged per single treated insured person.
The calculation of the flat-rate remuneration per single insured person for the different types of healthcare referred to in points 1 (a) to (d) for the 2nd half of 2002 is as follows:
PHU = (PHB x PUB) + PHZ
PAU = (PAB x PUB) + PAZ
PDU = (PDB x PUB) + PDZ
PJU = (PJD x PUB) + PJZ
where:
PHU = flat-rate hospitalisation payment for 1 special insured person
PAU = flat-rate outpatient payment for 1 special insured person
PDU = flat-rate transport payment per special insured person
PJU = flat-rate other remuneration per special insured person
4.2. The remuneration for the different types of healthcare referred to in points 1 (a) to (d) shall be calculated by multiplying the flat-rate payment per single treated insured person by the number of individuals treated in the reporting period as follows:
HU = PHC x UHV
AU = PAC x UAV
DU = PDC x UDV
JU = PJC x UJV
where:
HU = hospitalisation remuneration
AU = outpatient remuneration
DU = transport payment
JU = other remuneration
UHV = number of hospitalised unique treated health care insurers reported in the 2nd half of 2002 and recognised by the health insurance company
UAV = Number of unique insured persons receiving outpatient health care reported in the 2nd half of 2002 and recognised by the health insurance company
UDV = number of unique insured persons to whom health transport has been provided reported in the 2nd half of 2002 and recognised by the health insurance company
UJV = Number of unique insured persons to whom other performance has been provided reported in the 2nd half of 2002 and recognised by the health insurance company
4.3 The total remuneration (CU) is the sum of each type of remuneration:
CU = HU + AU + DU + JU
The total remuneration is also part of the remuneration of the performance according to § 2 (5) of this Order.
5. Calculation of reimbursement in regulation of prescription of medicinal products and medical devices
In addition, regulatory mechanisms based on a comparison of the average remuneration for prescribed medicinal products and medical devices to one insured person between the 2nd half of 2001 and 2nd half of 2002 shall be applied to the calculation of the total remuneration of healthcare referred to in point 4.3. The comparison shall exclude medicinal products and medical devices authorised by a revision doctor or paid in excess of the flat rate referred to in Article 2 (7).
5.1 Where the average payment for prescribed medicinal products and medical devices for 1 treated insured person in the 2nd half of 2002 exceeds 104% of the average reference remuneration, which consists of payment for prescribed medicinal products and medical devices for 1 treated insured person in the 2nd half of 2001, a reduction of 60% of the total excess, calculated as the product of the treated number of insured persons during that period and the amount of the excess of the cost of the medicinal products and medical devices per insured person compared to 104% of the average reference remuneration for medicinal products and medical devices for 1 treated insured person
5.2. If the average remuneration for the prescribed medicinal products and medical devices per insured person in the 2nd half of 2002 does not reach 100% of the average reference remuneration, which is the remuneration for the prescribed medicinal products and medical devices per insured person in the 2nd half of 2001, the remuneration for the 2nd half of 2002 will be increased by 40% of the savings achieved. This saving shall be calculated as the product of the treatment of the number of insured persons during the period and the amount of underutilisation of the costs of medicinal products and medical devices per insured person per 100% of the average reference remuneration for medicinal products and medical devices per insured person.
6. Provision of a monthly advance
The sickness insurance company shall provide a monthly advance of 107% of one sixth of the amount of the remuneration paid to the bed establishment for the second half of 2001. If the amount of the advance thus calculated would be less than 108% of the amount of the remuneration paid to the bed-keeping establishment for the second half of 2000, the health insurance company would provide a monthly advance of 108% of one sixth of the amount of the remuneration for the second half of 2000.
B) Reimbursement according to the performance list
1. The method of payment referred to in Article 2 (1) (b) may be applied only to sleeper establishments where there is a significantly fluctuating amount of healthcare provided by public health insurance, where it is not possible to set a flat rate for the reference period due to a small number of insured persons of the relevant health insurance company and where on average the sleeper establishments do not charge one health insurance company more than CZK 300 000 per calendar quarter.
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Regulation Information
| Citation | Decree of the Ministry of Health No. 251 / 2002 Coll., which sets the amount of health care payments paid from public health insurance, including regulatory restrictions for the 2nd half of 2002 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 25.06.2002 |
|---|---|
| Effective from | 01.07.2002 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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