Decree No. 268 / 2019 Coll.
Declaration on the setting of the values of the points, the amount of the fees paid and the regulatory restrictions for 2020
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Order
Effective from 01.01.2020
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268
DECLARATION
of 18 October 2019
establishing the values of the points, the level of remuneration of the services paid and the regulatory restrictions for 2020
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 2020
(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 20 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 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) a provider of outpatient care in expertise 603 and 604 according to the performance list;
(e) the 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 2018. 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 2020.
(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) For the purposes of this Regulation, the following definitions shall apply:
(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.
(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 (MKN-10) 4.
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 providers, the value of the point, the amount of payment of the paid services and the regulatory limit shall be as set out in Annexes 1, 9, 10, 12, 13, 14 and 15 to this Decree.
(1) 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 value of the item, the amount of the payment of the services paid and the regulatory limit are set out in Annex 1 to this decree.
(1) For paid services provided by providers of general medical practice and providers 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 limitation 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 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.
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 the point of CZK 1.23 shall be determined for the services provided by the health rescue service provider, except for the performance of the transport according to the list of performances, for which the value of the point of CZK 1.10 is determined, and with the exception of the performance no. 06714 according to the list of performances, 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 remuneration limit for those performance in 2018.
(2) For paid services provided by patient transport providers of urgent care paid according to the performance list, the value of a point of CZK 1.21 shall be determined, except for transport performance according to the performance list, for which the value of a point of CZK 1.10 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 remuneration limit for those performance in 2018.
(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 1.10,
b) not providing a 24-hour medical transport service with a value of CZK 0.90.
(2) For the performance of transport No. 69 according to the list of performances, the value of the point is set at CZK 1.
(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 complex spa rehabilitation care for adults, children and adolescents provided in the health facilities of the spa rehabilitation care provider, a payment for 1 day's stay of 105.4% of the contracted remuneration for 1 day's stay for 2019 shall be provided. If the payment for 1 day of stay for 2019 has not been agreed upon by 31 December 2019 inclusive, the remuneration shall be set at the level 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.
(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 payment of 105,4% of the contracted remuneration for the 1 day stay for 2019 shall be provided for. If the payment for 1 day of stay for 2019 has not been agreed upon by 31 December 2019 inclusive, the remuneration shall be set at the level of the remuneration paid to comparable providers.
(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 health care centre, the payment for 1 day's stay is set at CZK 958, which consists of the accommodation, catering and recovery programme component. The increase in remuneration compared to 2019 shall be made in the recovery programme file. 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 35 is determined.
(2) The remuneration referred to in paragraph 1 shall not be included in the maximum remuneration for services paid.
(3) 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 15 is determined. The maximum remuneration to the provider for the reported performance No 09552 according to the performance list in the evaluation period shall not exceed 15 times the number of reported performance No 09552 according to the performance list in the reference period.
(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 performance No 09552 according to the list of performance reported by comparable providers and recognised by the health insurance undertaking in the reference period.
(3) After the evaluation period, the health insurance company will pay the provider CZK 12 for each transfer of the paper recipe into electronic form. This applies only to identified insured persons.
(1) 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.
(2) Grounded services provided by providers in a professional capacity 005 according to the list of performance lists are paid according to the value of the 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.
(3) Grounded services provided by providers in the area of competence 006 according to the list of performances are paid according to the list of performances with a value of CZK 1.
(4) For each episode of care associated with taking over the patient from the medical emergency care service with an acute bed care provider, a payment of CZK 1 000 shall be made. This care will be reported by the provider by power No. 09564 according to the performance list. 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.
This Regulation shall enter into force on 1 January 2020.
Minister for Health:
Mgr. et Mgr. Vojtěch, MHA, v. r.
Příloha č. 1
Annex No 1 to Decree No 268 / 2019 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 2020 shall include the contractually agreed remuneration component, flat-rate remuneration, the remuneration to be paid on a flat-rate basis, the case flat-rate remuneration and the payment for outpatient care ("outpatient remuneration component"). In order to calculate the reference values, the individually contracted remuneration components, flat-rate remuneration, the remuneration allocated to the flat-rate remuneration, the case flat-rate remuneration and the outpatient remuneration components shall be included in the calculation in 2018, the provider declared by 31 March 2019 and the health insurance undertaking recognised by 31 May 2019.
1.1. The health insurance company and the provider shall negotiate the marks of the CZK-DRG established under the CZ DRG Hospital Patient Classification for the year 20205 (hereinafter "CZ- DRG Classification") by 1 January 2020. For 2020, the provider is obliged to report the CZK-DRG markers regardless of whether it has the agreed form of remuneration in accordance with point 2.1. The health insurance company shall evaluate the compliance of the reporting of the CZK-DRG markers by the provider with the reporting methodology of the CZK-DRG markers specified in the CZ- DRG classification. In case of non-reporting of CZK-DRG markers in accordance with the methodology for more than 10% of hospitalisation cases, but at least 10 cases, the health insurance company may reduce the remuneration by 0,5% for cases where CZK-DRG markers have not been properly reported.
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 reimbursement of medicinal products and foodstuffs for special medical purposes (hereinafter referred to as the "medicinal product"), marked "S" in accordance with Article 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 disease, 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 2018.
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) | Oběhový systém (Plicní arteriální hypertenze) |
| l) | Oftalmologie (Centrální venózní okluze, Makulární degenerace, Oftalmologie - DM, Vitreomakulární trakce, Oftalmologie - jiné) |
| m) | 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) |
| n) | Osteoporóza |
| o) | Revmatologie (Bechtěrevova choroba, Artritida, Lupus erythematosus, Psoriatická artritida) |
| p) | Trávicí soustava (Crohnova choroba, Ulcerózní kolitida) |
| q) | Cystická fibróza |
| r) | Spinální svalová atrofie |
| 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, 2020
where:
Uhrmax, 2020 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, 2018 is the total remuneration in the reference period for the treatment of disease i.
Uhrt, 2019 is the total remuneration in 2019 for the treatment of hepatology disease.
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 | 1,219 |
| Dýchací soustava 1 | 1,461 |
| Dýchací soustava 2 | 1,214 |
| Endokrinologie | 1,184 |
| Hematoonkologie | 1,217 |
| Imunitní systém | 2,767 |
| Infekce | 1,368 |
| Metabolické vady | 1,067 |
| Neurologie 1 | 1,247 |
| Neurologie 2 | 1,338 |
| Oběhový systém | 1,116 |
| Oftalmologie | 1,299 |
| Onkologie - solidní nádory | 1,266 |
| Osteoporóza | 1,277 |
| Revmatologie | 1,008 |
| Trávicí soustava | 1,007 |
| Cystická fibróza | 2,800 |
| Spinální svalová atrofie | 1,570 |
| Ostatní | 1,190 |
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.
3. Flat payment
3.1 The flat-rate remuneration includes paid services classified under the rules for the classification of hospitalised patients for the year 20206 (hereinafter referred to as "Classification") in the groups related to the diagnosis listed in Annex 10 to this Decree which do not fall under the remuneration referred to in Part A (5) of this Annex at the same time. In the event that the provider fulfils the conditions set out in point 3.7 of Part A of this Annex, the flat-rate remuneration shall not include the services covered by the Classification 1901 to 1940 listed in Annex 10 to this Decree.
3.2 In the calculation of variables in the reference period, hospitalisation cases are those converted by classification in the groups related to the diagnosis listed in Annex 10 to this Decree. In calculating the variables in the evaluation period, hospitalisation cases are those converted by classification in the groups related to the diagnosis listed in Annex 10 to this Decree, which do not also fall within the definition of hospitalisation cases according to the variable CUi, CZ- DGR, 2020 as set out in point 5 of Part A of this Annex.
3.3 For the performance of the treatment day no. 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 447.
3.4. Medicinal products excluded 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 2019.
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.
3.6. The amount of the flat-rate remuneration shall be fixed as CELK Pudrg, 2020 in accordance with the expression:
CELK Pudrg, 2020 = min1; CMred, 2020,017,100,98 * CM2018,017,10-CMCZ- DRG, 2018-CMMDC19,2018 * IPU * Izp + 1,05 * Oddvate9,10-EM2020,10 + EMMDC19
where:
CM2018,017,10 is the number of hospitalisation cases referred to in point 3.2 by the provider declared and by the health insurance undertaking recognised, terminated in the reference period, classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, multiplied by the relative weights 2020 set out in Annex 10 to this Regulation.
CMCZ- DRG, 2018 is the number of hospitalisation cases according to point 3.2 reported by the provider with the status of a centre of highly specialised pneumooncosurgical care or the status of a centre of highly specialised medical care in oncogylogy under the Health Services Act (7) and by a health insurance company recognised in the reference period, classified under the classification in the groups related to the diagnosis referred to in point 3.2 of this Order, multiplied by the relative weights of 2020 set out in Annex 10 to this Regulation, as regards paid services which meet the rules for classification of cases for 2018 under the nomenclature of the CZ- DRG.
This Regulation shall be binding in its entirety and directly applicable in all Member States. In other cases CMMDC19,2018 is 0 and does not include any hospitalisation cases.
EM2020,10 is the total value of the requested extramural care in hospitalisation cases referred to in point 3.2 by the provider declared and the health insurance undertaking recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis referred to in Annex 10 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.
EMMDC19 where the provider fulfils the conditions set out in point 3.7, EMMDC19 shall be the total value of the requested extramural care in the context of hospitalisation cases referred to in point 3.2 by the provider declared and the health insurance undertaking recognised, completed in the evaluation period, classified as Bases 1901 to 1940 listed in Annex 10 to this Regulation, valued at the values of the point in force in the evaluation period, including remuneration for separately charged material and medicinal products separately charged. In other cases, EMMDC19 becomes 0.
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, 2018,10 * KN10
where:
Pudrag, 2018,10 is the reference amount of the remuneration for the provider declared and recognised by the health insurance company for the flat-rate payment. Pudrag, 2018,10 is calculated as follows:
Pudrg, 2018,10 = maxCM2018,017,10-CMCZ- DRG, 2018- CMMDC19,2018 * ZSmin, 10; 1-CMCZ- DRG, 2018 + CMMDC19,2018CM2018,017,10 * CELK Pudrg, 2018 + Hotj = 1nÚHRISU2018 + EM2018,10-OD2018, Sisters, 10
where:
CELK Pudrg, 2018 is the total amount of the flat-rate remuneration in the reference period.
ZSmin, 10 is the minimum basic rate, which is set at CZK 37 275 for a provider who has the status of a centre of highly specialised oncological care and at the same time the status of at least two centres of highly specialised cerebrovascular care from the following list: a centre of highly specialised cerebrovascular care, a centre of highly specialized complex cardiovascular care for adults, a centre of highly specialised pneumooncosurgical care, a centre of highly specialised medical care in oncogylology, a centre of highly specialised care for the isolation of patients suspected of highly contagious disease under the Health Services Act. If the provider does not meet the conditions set out in the first sentence but has the status of a centre of highly specialised oncological care as well as the status of at least two centres of highly specialised care from the following list - a centre of highly specialised cerebrovascular care, a centre of highly specialised complex cardiovascular care for adults, a centre of highly specialised pneumooncological care, a centre of highly specialised medical care in oncology, a centre of highly specialised care for patients with an id, a centre of highly specialised cardiovascular care according to the Health Services Act - the minimum basic rate is set at CZK 34 125. For other providers, the minimum standard rate is CZK 29,000.
EM2018 is the total value of the requested extramural care in hospitalisation cases as referred to in point 3.2 by the provider declared and the health insurance company recognised and terminated in the reference period classified under the Classification in the groups related to the diagnosis referred to in Annex 10 to this Regulation, valued at the values of the point applicable in the reference period, including the remuneration for the material separately charged and the medicinal products separately charged.
INTRODUCTION2018 total remuneration to the provider for services included in individually contracted bases during the reference period.
This Regulation shall be binding in its entirety and directly applicable in all Member States.
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 + 0,17ARCTG116,5 * Pudrag, 2018,10CM2018,017,10-CMCZ-DRG, 2018-CMMDC19,2018-26800
where:
ARCTG is the function of Arkus tangens
(ii) CMred, 2020,017,10 is calculated as follows:
(a) If the number of recognised hospital cases reported and reported by the health insurance company in accordance with point 3.2 is terminated in the reference or evaluation period, classified by classification in the groups related to the diagnosis listed in Annex 10 to this Regulation and not falling within the hospitalisation of CMCZ − DRG, 2018 and CMMDC19,2018, which have been completed by transferring the patient to the downstream care provider or by separating the follow-up care of the same provider (hereinafter "the treatment termination code 4") or by transferring the patient to another acute bed care provider (hereinafter "PPDC19,2020"), less or roven 100 or if (PPRdrg, 2020,4,5 - PPRDC19,20,4,5) ≤ 0,1 * (PPdrg, 2020 - PPDC19,2020), or (PPRdrg, 2018,4,5 − PCZ, 2018,4,5 − PDR, PDRG, PFRG, PPRD20,20,4,5) ≤ 0,1 * (hereinafter) (") (hereinafter) (" PPPC), "),").
CMred, 2020,017,10 = minCM2020,017,10-CMMDC19,2020; CM2020,17,10-CMMDC19,20200,2 * X * PPdrg, 2020-PPMDC19,2020 * CM2018,017,10-CMCZ-DRG, 2018-CMMDC19,2018PPdrg, 2018-PPCZ-DRG, 2018-PPMDC19,20180,8
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 referred to in point 1 of Annex 14 to this Regulation, is greater than 0,01 and 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 point 1 of Annex 14 to this Regulation.
CM2020,017,10 is the number of hospitalisation cases referred to in point 3.2 by the provider declared and the health insurance company recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, multiplied by the relative weights 2020 listed in Annex 10 to this Regulation.
CMMDC19,2020 where the provider fulfils the conditions set out in point 3.7, CMMDC19,2020 shall be the number of hospitalisation cases as referred to in point 3.2 by the provider declared and the health insurance undertaking recognised, completed in the evaluation period classified under headings 1901 to 1940 as listed in Annex 10 to this Regulation, multiplied by the relative weights 2020 as set out in Annex 10 to this Regulation. In other cases CMMDC19,2020 is 0 and does not include any hospitalisation cases.
This Regulation shall be binding in its entirety and directly applicable in all Member States.
In the event that the provider fulfils the conditions set out in point 3.7, PPMDC19,2020 shall be the number of providers declared and recognised by the health insurance undertaking in accordance with point 3.2, completed in the assessment period, classified under headings 1901 to 1940 as listed in Annex 10 to this Regulation. In other cases PPMDC19,2020 is 0 and does not include any hospitalisation cases.
This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.
PPCZ − DRG, 2018 is the number of providers declared and the health insurance undertaking of recognised hospitalisation cases as referred to in point 3.2, completed in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree as regards the services covered which meet the rules for the classification of cases for 2018 under the CZ- DRG classification.
In the event that the provider fulfils the conditions set out in point 3.7, PPMDC19,2018 shall be the number of providers declared and recognised by the health insurance undertaking in accordance with point 3.2, completed in the reference period, classified under headings 1901 to 1940 as listed in Annex 10 to this Decree. In other cases PPMDC19,2018 is 0 and does not include any hospitalisation cases.
(b) In other cases, the reduced casix shall be determined as follows:
CMred, 2020,017,10 = CMred 1 + CMred 2,
where:
CMred1 = minCM1,2020,017,10 − CMMDC19,1,2020; CM1,2020,017,10 − CMMDC19,1,20200,2 * X * (PP1, drag, 2020 − PPMDC19,1,2020) * CM1,2018,017,10 − CMCZ-DRG, 1,2018-CMMDC19,1,2018PP1, drg, 2018 − PPCZ-DRG, 1,2018-PPMDC19,1,20180,8
where:
CM1,2020,017,10 is the number of hospitalisation cases referred to in point 3.2 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 to this Regulation, which have not been terminated by the end-of-treatment code 4 or the end-of-treatment code 5 multiplied by the relative weights 2020 set out in Annex 10 to this Regulation.
CMMDC19,1,2020 where the provider fulfils the conditions set out in point 3.7, CMMDC19,1,2020 shall be the number of hospitalisation cases as referred to in point 3.2 by the provider declared and by the health insurance undertaking recognised, terminated in the evaluation period classified under headings 1901 to 1940 in Annex 10 to this Regulation, which have not been terminated by the cessation code of treatment 4 or the treatment termination code 5, multiplied by the relative weights 2020 in Annex 10 to this Regulation. In other cases CMMDC19,1,2020 is 0 and does not include any hospitalisation cases.
CM1,2018,017,10 is the number of hospitalisation cases referred to in point 3.2 by the provider declared and the health insurance company recognised, which were terminated in the reference period, classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree, which have not been terminated by the end code of treatment 4 or the end code of treatment 5, multiplied by the relative weights 2020 set out in Annex 10 to this Decree.
CMCZ − DRG, 1,2018 is the number of hospitalisation cases referred to in point 3.2 by the provider recognised and the health insurance company recognised, terminated in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, which have not been completed by the end-of-treatment code 4 or the end-of-treatment code 5, multiplied by the relative weights 2020 set out in Annex 10 to this Regulation in respect of the services covered, which comply with the rules for the classification of cases for 2018 under the CZ- DRG.
CMMDC19,1,2018 where the provider fulfils the conditions set out in point 3.7, CMMDC19,1,2018 shall be the number of hospitalisation cases as referred to in point 3.2 by the provider declared and the health insurance undertaking recognised, terminated in the reference period classified under headings 1901 to 1940 in Annex 10 to this Regulation, which have not been completed by the cessation code of treatment 4 or by the treatment termination code 5 multiplied by the relative weights 2020 in Annex 10 to this Regulation. In other cases CMMDC19,1,2018 becomes 0 and does not include any hospitalisation cases.
PP1, drg, 2020 is the number of providers declared and the health insurance undertaking of recognised hospitalisation cases as referred to in point 3.2, completed in the evaluation period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, which have not been completed by the cessation code of treatment 4 or the treatment termination code 5.
PPMDC19,1,2020 where the provider fulfils the conditions set out in point 3.7, PPMDC19,1,2020 shall be the number of providers declared and the health insurance undertaking recognised by hospitalisation according to point 3.2, completed in the evaluation period, classified under the Classification as Bases 1901 to 1940 listed in Annex 10 to this Regulation, which have not been terminated by the treatment termination code 4 or the treatment termination code 5. In other cases PPMDC19,1,2020 is 0 and does not include any hospitalisation cases.
PP1, drg, 2018 is the number of providers declared and the health insurance company of recognised hospitalisation cases as referred to in point 3.2, completed in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree, which have not been terminated by the treatment termination code 4 or the treatment termination code 5.
PPCZ − DRG, 1.2018 is the number of providers reported and the health insurance company of recognised hospitalisation cases as referred to in point 3.2, completed in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree, which have not been terminated by the end-of-treatment code 4 or the end-of-treatment code 5 as regards the services covered, which at the same time comply with the rules for classification of cases for 2018 under the CZ- DRG.
PPMDC19,1,2018 where the provider fulfils the conditions set out in point 3.7, PPMDC19,1,2018 shall be the number of providers declared and by the health insurance undertaking of recognised hospitalisation cases as referred to in point 3.2, completed in the reference period classified according to the Classification in bases 1901 to 1940 listed in Annex 10 to this Regulation, which have not been terminated by the cessation code of treatment 4 or the treatment termination code 5. In other cases PPMDC19.1.2018 is 0 and does not include any hospitalisation cases.
and where:
CMred2 = CM2020,017,10,4,5-CMMDC19,2020,4,5 * min1; 1,05 * PPRdrg, 2018,4,5-PPRCZ-DRG, 2018,4,5-PPRMDC19,2018,4,5PPRdrg, 2020,4,5-PPRMDC19,2020,4,5 * PPdrg, 2020-PPMDC19,2020PRdrg, 2018- PPCZ-DRG, 2018- PPMDC19,2018,
where:
CM2020,017,10,4,5 is the number of hospitalisation cases referred to in point 3.2 by the provider declared and the health insurance company recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation which have been terminated by the end-of-treatment code 4 or the end-of-treatment code 5, multiplied by the relative weights 2020 set out in Annex 10 to this Regulation.
CMDC19,2020,4,5 where the provider fulfils the conditions set out in point 3.7, CMMDC19,2020,4,5 shall be the number of hospitalisation cases referred to in point 3.2 by the provider recognised and the health insurance undertaking recognised, completed in the evaluation period, classified as Bases 1901 to 1940 listed in Annex 10 to this Regulation, which have been terminated by the end code of treatment 4 or by the end code of treatment 5 multiplied by the relative weights 2020 set out in Annex 10 to this Regulation. In other cases CMMDC19,2020,4,5 is 0 and does not include any hospitalisation cases.
PPRdrg, 2020,4,5 is the number of providers declared and the health insurance company of recognised hospitalisation cases as referred to in point 3.2, completed in the evaluation period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, which have been terminated by the treatment termination code 4 or the treatment termination code 5.
PPRMDC19,2020,4,5 where the provider fulfils the conditions set out in point 3, PPRMDC19,2020,4,5 is the number of providers declared and by the health insurance undertaking of recognised hospitalisation cases as referred to in point 3.2, completed in the evaluation period, classified as Bases 1901 to 1940 listed in Annex 10 to this Decree, which have been terminated by the treatment termination code 4 or treatment termination code 5. In other cases PPRMDC19,2020,4,5 is 0 and does not include any hospitalisation cases.
PPRdrg, 2018,4,5 is the number of providers declared and the health insurance company of recognised hospitalisation cases as referred to in point 3.2, completed in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree, which were terminated by the treatment termination code 4 or the treatment termination code 5.
PPRCZ- DRG, 2018,4,5 is the number of providers reported and the health insurance company of recognised hospitalisation cases as referred to in point 3.2, completed in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree, which have been terminated by the end code of treatment 4 or the end code of treatment 5 as regards the covered services which at the same time comply with the rules for classification of cases for 2018 under the nomenclature of CZ- DRG.
PPRMDC19,2018,4,5 where the provider fulfils the conditions set out in point 3.7, PPRMDC19,2020,4,5 is the number of providers declared and by the health insurance undertaking of recognised hospitalisation cases as referred to in point 3.2, completed in the reference period, classified as Bases 1901 to 1940 listed in Annex 10 to this Regulation, which have been terminated by the end code of treatment 4 or by the end code of treatment 5. In other cases PPRMDC19,2020,4,5 is 0 and does not include any hospitalisation cases.
(iii) IZP is the index of the change in production calculated as follows:
IZP = max1; ARCTG3 * CMred, 2020,017,10CM2018,017,10-CMCZ- DRG, 2018- CMMDC19,2018- 1,443
(iv) Paragraph 9.10 is an increase in remuneration according to the type of treatment day calculated as follows:
Addendum 9.10 = min.
where:
CetOD2018,10, i is the number of reported and health insurance undertakings of recognised performance of the treatment day of type i, reported in the context of hospitalisation cases as referred to in point 3.2 completed in the reference period classified according to the Classification in the groups related to the diagnosis referred to 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.
Cetodcz-DRG, 2018,10, i is the number of reported and health insurance undertakings of recognised performance of the treatment day i, reported in the context of hospitalisation cases referred to in point 3.2, completed in the reference period, classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation as regards the services covered, which comply with the rules for the classification of cases for 2018 according to the CZ- DRG classification, where I will receive values from 1 to n and indicates the type of treatment day according to the performance list.
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Regulation Information
| Citation | Decree No. 268 / 2019 Coll., on the setting of the values of the points, the amount of the fees paid and the regulatory restrictions for 2020 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 29.10.2019 |
|---|---|
| Effective from | 01.01.2020 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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