Decree No. 305 / 2020 Coll.
Decree establishing the method of including compensation in the amount of compensation for services paid in 2020
Valid
Order
Effective from 01.07.2020
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305
DECLARATION
of 23 June 2020
establishing the method for including compensation in the amount of remuneration for services paid in 2020
According to Article 1 (2) of Act No. 301 / 2020 Coll., on compensation to persons providing covered health services taking into account the effects of the disease epidemic COVID-19 in 2020 ("the Compensation Act '):
(1) In order to determine how compensation is to be included in the remuneration of the services paid in 2020, this Decree provides:
(a) the compensation values of the point (hereinafter referred to as the "point value");
(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 20 (hereinafter referred to as the regulatory restriction); and
(d) the amount of the compensation advances.
(2) The provider under this Order 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 and 921 expertise, and the provider of home care in the 925 and 926 performance lists;
(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) the provider of medical care;
(l) a provider of social services who has a special contract with a health insurance company under the law.
(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 evaluation period, the sum of the data for the reference period of the merged health insurance companies shall be used for the calculation of the amount of 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 companies, an insured person to 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 to whom more than one of the merged health insurance undertakings have been paid 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 (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 20.
(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 payments, the regulatory limit and the amount of the compensation advances shall be set out in Annexes 1, 9, 10 and 12 to 15 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 the paid services provided by social services providers having a special contract with the health insurance company under the law, the value of the item, the amount of the payments, the regulatory limitation 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 youth covered by a combined capitalisation payment, a combined capitalisation payment with a top-up of the capitalisation or according to the performance list, the value of the item, the amount of the remuneration, 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 to outpatient care providers covered by the performance list, the value of the point, the amount of the remuneration, the regulatory limitation 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 item, the amount of payments, the regulatory limit 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. The remuneration for the services paid in accordance with Annex 11 provided from 1 July 2020 is increased by 14,76%, with the exception of code 00944, whose payment is increased by CZK 6. The advance payment shall be granted on a monthly basis to the provider, at the rate of the increase in remuneration according to the second sentence relating to the services declared.
For covered services provided by outpatient care providers in the listed expertise covered by the performance list, the value of the item, the amount of the remuneration and the amount of the compensation advances 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 and 921 competence lists and by providers of home care in the 925 and 926 competence lists, the value of the item, the amount of the remuneration 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 the field of expertise 902 and 917 according to the performance list, the value of the point and the amount of the payments shall be as set out in Annex 7 to this Decree.
The value of the point and the amount of the remuneration shall be set out in Annex 8 to this Decree for the services provided by the dialysis providers covered by the list of performance benefits.
(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.
(3) For the services provided from 1 July 2020, the value of the points referred to in paragraphs 1 and 2 shall be increased by CZK 0.08, except for the performance of transport according to the list of performances for which the value of the point is increased by CZK 0.07, and with the exception of the performance no. 06714 according to the list of performances.
(4) For the services provided in 2020, the value of the point referred to in paragraph 2 is further increased by CZK 0.11, except for the performance No. 06714 according to the list of performances. This increase in the value of the point is intended to compensate for the increased personal costs of healthcare professionals providing care during the outbreak of COVID-19 disease.
(5) The advance payment for compensation shall be granted to the provider at the rate of the increase in the remuneration referred to in paragraphs 3 and 4 relating to the services declared, not later than 31 May 2021.
(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.
(3) For the services provided from 1 July 2020, the value of the point referred to in paragraph 1 (a) shall be increased by CZK 0.22 and the value of the point referred to in paragraph 1 (b) shall be increased by CZK 0.18.
(4) For the services provided in 2020, the value of the point referred to in paragraph 1 (a) and (b) is further increased by CZK 0.11. This increase in the value of the point is intended to compensate for the increased personal costs of healthcare professionals providing care during the outbreak of COVID-19 disease.
(5) The advance payment for compensation shall be granted to the provider at the rate of the increase in the remuneration referred to in paragraphs 3 and 4 relating to the services declared, not later than 31 May 2021.
(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. For health performance according to the first sentence provided from 1 July 2020, the value of the point according to the first sentence is increased by CZK 0.1.
(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.
(3) The advance payment shall be granted to the provider monthly at the rate of the increase in the remuneration referred to in paragraph 1 relating to the services declared.
(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 111.7% of the contracted remuneration for 1 day's stay for 2019 shall be fixed. 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. The remuneration referred to in the first to third sentences shall be increased by 17% for the services provided from 1 July 2020.
(2) For the benefit of the spa rehabilitation care for adults, children and young people provided in the health facilities of the spa rehabilitation care provider, a remuneration of 111,7% of the contracted remuneration for the 1 day stay for 2019 shall be fixed. 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 remuneration according to the first and second sentences shall be increased by 17% for the services provided from 1 July 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 health 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. The remuneration referred to in the first to third sentences shall be increased by 17% for the services provided from 1 July 2020.
(5) The advance payment shall be granted to the provider on a monthly basis, at the rate of the increase in the remuneration referred to in paragraphs 1 and 2 and in paragraph 4 of the last sentence relating to the services declared.
(1) For each provider declared and the health insurance company recognised performance No. 09543 according to the performance list, the remuneration is set at CZK 35, while for the performance declared in connection with the paid service provided from 1 July 2020 this remuneration is increased by CZK 6.
(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.
(4) The advance payment shall be granted to the provider on a monthly basis, at the rate of the increase in the remuneration referred to in paragraph 1 relating to the services declared.
(1) For each provider declared and the health insurance company recognised performance No. 09552 according to the performance list, the remuneration is set at CZK 15, while for the performance declared in connection with the issue of the medicinal product from 1 July 2020, this remuneration is increased by CZK 4.
(2) The health insurance company will pay the provider CZK 12 for each transfer of the paper recipe into electronic form as part of the bill pursuant to Section 2 (1) of the Compensation Act. This applies only to identified insured persons.
(3) The advance payment shall be granted to the provider monthly at the rate of the increase in the remuneration referred to in paragraph 1 relating to the services declared.
(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 included in the amount of the remuneration determined in accordance with 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 included in the amount of the remuneration determined in accordance with 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 is reported by the provider with power No. 09564 according to the performance list. This remuneration shall not be included in the amount of the remuneration determined in accordance with Annex 1 to this Order.
(5) For each provider declared and health insurance company recognised performance No. 09115 according to the performance list, reported for patients diagnosed with U07.1 or U69.75 according to the international classification of diseases, the provider is increased by CZK 50. This increase in remuneration shall not be included in the amount of remuneration determined in accordance with Annexes 1 to 8 to this Order.
(6) A provider that has operated a sampling centre for COVID-19 testing during the evaluation period, which is to be considered as a body for the purpose of collecting biological material for testing for COVID-19 disease, shall, for each calendar day of operation of this centre in the month in which it has been declared and recognised by the health insurance company in patients with a diagnosis of U07.1 or U69.75 according to the international classification of diseases, at least one power of 09115 according to the list of performance, be increased by K x 8,000 CZK in respect of the collection centre established outside the internal premises of the provider and K x 3,000 CZK in other cases where K takes up to a corresponding ratio of the number of insured companies of the health insurance companies in the region in which the sampling centre is operated, under point 3 of Annex 2 to that decree. Where the provider has operated several sampling centres according to the first sentence, the payment shall be increased for each sampling centre. This increase in remuneration shall not be included in the amount of remuneration determined in accordance with Annexes 1 to 8 to this Order.
(7) The advance payment for compensation is granted to the provider monthly at the rate of the increase in the remuneration referred to in paragraphs 5 and 6 relating to the services declared.
(1) Providers under Sections 6 to 15 and providers of pharmacy care, provided that, during the second wave of the CoVID-19 epidemic, from 1 October 2020 to 31 December 2020, they have provided paid services and reported them to health insurers, in order to compensate for the increased personnel costs resulting from the payment of exceptional remuneration to healthcare professionals, the remuneration is increased by the amount of the Reward 2. wool calculated as follows:
| ( | KapacitaZP2020 | ) | ( | Porovnávací_hodnota_péče2020,4Q | ) | ||||
| Odměna2.vlna=Výšeodměny*1,338*min | PočetZP2020; | ————————— | *Kkraj*min | 1; | ———————————————————— | ||||
| Typkapacity | 0,75 * Porovnávací_hodnota_péče2018,4Q |
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 health professionals providing paid health services to the provider listed in the contract between the provider and the health insurance company effective on 31 December 2020. For healthcare providers, the number of ZP2020 is calculated as the number of health workers held by the provider for the year 2020 in the National Register of Health Workers under Section 76 of the Health Service Act (7).
Capacity ZP2020 is the sum of the weekly hourly time-out capacity of healthcare professionals providing paid health services to the provider listed in the contract between the provider and the health insurance company effective on 31 December 2020. For healthcare providers, the CapacityZP2020 is calculated as the cumulative weekly working hours of healthcare professionals held by the provider for 2020 in the National Register of Health Workers under Section 76 of the Health Services Act.
Typability is the typical weekly hourly capacity of a healthcare professional providing paid health services to a provider, determined according to the provider's type according to the following table:
| Typ poskytovatele | Hodnota Typkapacity |
|---|---|
| poskytovatel podle § 6 | 25 |
| poskytovatel podle § 7 | 30 |
| poskytovatel podle § 8 | 30 |
| poskytovatel podle § 9 | 35 |
| poskytovatel podle § 10 | 40 |
| poskytovatel podle § 11, v odbornosti 911, 914 a 916 podle seznamu výkonů | 35 |
| poskytovatel podle § 11, v odbornosti 921, 925 a 926 podle seznamu výkonů | 40 |
| poskytovatel podle § 12 | 35 |
| poskytovatel podle § 13 | 30 |
| poskytovatel podle § 14 | 40 |
| poskytovatel podle § 15 | 40 |
| poskytovatel lékárenské péče | 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 comparison _ value _ care 2020,4Q is the comparative value of the covered health services provided between 1 October 2020 and 31 December 2020 by the provider declared by 31 March 2021 and by the health insurance undertaking recognised by 31 May 2021, calculated as follows:
Compare _ value _ care 2020,4Q = PB2020,4Q + KP2020,4Q where:
PB2020,4Q is the number of points for the covered health services provided by the provider for the period from 1 October 2020 to 31 December 2020, reported until 31 March 2021 and by the health insurance undertaking recognised until 31 May 2021.
KP2020.4Q is the value of the crown items for the covered health services provided 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 comparative value by the provider of the recognised and health insurance company of recognised covered health 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 is the value of the krone items for the services paid in the period from 1 October 2018 to 31 December 2018.
(2) In the case of a provider who did not provide the medical services covered during the period 1 October 2018 to 31 December 2018, the comparison _ value _ care 2018,4Q is set at 1.
(3) 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.
(4) The advance payment shall be granted to the provider at the rate of the increase in remuneration referred to in paragraph 1 by 31 May 2021 at the latest.
This Decision shall enter into force on 1 July 2020.
Minister:
Mgr. et Mgr. Vojtěch, MHA, v. r.
Příloha č. 1
Annex No 1 to Decree No. 305 / 2020 Coll.
Value of the point, amount of payments 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 shall evaluate the compliance of the reporting of CZK-DRG markers by the provider with the reporting methodology for CZK-DRG markers specified in CZ DRG hospitalised patient classification for 20205 (hereinafter "CZ- DRG classification") in accordance with the obligations of the provider according to Annex 1, Part A, point 1.1, of Decree No 268 / 2019 Coll., establishing the values of the points, the level of reimbursement of the services paid and the regulatory restrictions for 2020 (hereinafter "Decree No 268 / 2019 Coll."). 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 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 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 | je maximální úhrada v | ||
| i | nabývá hodnot a až s, kde a až s jsou diagnostické skupiny uvedené v bodě 2.2.2. | ||
| Uhri,2018 | je celková úhrada v | ||
| Uhrt,2019 | je celková úhrada v roce 2019 za léčbu onemocnění hepatologie. | ||
| INi | je index navýšení úhrady pro skupinu i, uvedený v bodě 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 |
2.3 For each hospitalisation case reported by the provider and recognised by the health insurance company, completed in the evaluation period for which testing for COVID-19 was indicated, the payment to the provider is increased by CZK 1 674:
(a) for each current declaration of performance No 82040 and 82041 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 at the same time performance No 82040 and 82041 have been reported according to the list of performance.
Such increases in remuneration shall not be included in the remuneration referred to in points 3 to 6.
2.4 In cases of hospitalisation with a diagnosis of U07.1 according to the international classification of diseases by the provider declared and the health insurance company recognised, completed in the evaluation period, classified according to the rules for the classification of hospitalised patients for the year 20206 (hereinafter referred to as "Classification"), the payment to the provider is increased by CZK 2,331 for each reported treatment day, except for treatment days Nos 00051 to 00078 according to the list of benefits for which the payment is increased by CZK 59 064. 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.
3. Flat payment
3.1 The flat-rate remuneration shall include the services covered by the 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 also do not fall within the definition of hospitalisation cases according to the variable CUi, CZ-DRG, 2020 according to Part A, point 5 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. In cases of hospitalisation with a diagnosis of U07.1 according to the international classification of diseases, the declared performance No 82040 and 82041 according to the performance list shall not be included in the extramural care. In cases of hospitalisation with a diagnosis of U69.75 according to the international classification of diseases, the first simultaneous declaration of performance No 82040 and 82041 according to the list of performance shall not be included in extramural care.
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, 10,82 * CM2020,017,10- CMMDC19,20CM2018,017,10- CMCZ- DRG, 2018- CMMDC19,2018 + min0,03 * Share COVID * IPU * IZP + 1,05 * ODAnnex 9,10- EM2020,10 + EMMDC19
where:
| CM2018,017,10 | je počet případů |
| CMCZ-DRG, 2018 | je počet případů |
| CMMDC19,2018 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, CMMDC19,2018 je počet případů |
| EM2020,10 | je celková hodnota vyžádané extramurální péče v rámci případů |
| EMMDC19 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, EMMDC19 je celková hodnota vyžádané extramurální péče v rámci případů |
| PodílCOVID | je podíl počtu případů |
| min | funkce minimum, která vybere z oboru hodnot hodnotu nejnižší. |
and where the IPU is an individual flat-rate remuneration calculated as follows:
(i) IPU = Pudrag, 2018,10 * KN10
where:
| PUdrg,2018,10 | je referenční výše úhrady za poskytovatelem vykázané a zdravotní pojišťovnou uznané služby hrazené paušální úhradou. PUdrg,2018,10 se vypočte následovně: | |||||
Pudrg, 2018,10 = maxCM2018,017,10-CMcz-DRG, 2018- CMMDC19,2018 * ZSmin, 10 Vol. 1-CMcz-DRG, 2018 + CMMDC19,2018CM2018,017,10 * CELK Pudrg, 2018 + Vol. = 1nÚHRISU2018 + EM2018,10-OD2018, Sis, 10
where:
| CELK PUdrg,2018 | je celková výše paušální úhrady v referenčním období. | ||
| ZSmin,10 | je minimální základní sazba, která se stanoví ve výši 37 275 Kč pro poskytovatele, který má statut centra vysoce specializované onkologické péče a zároveň statut alespoň dvou center vysoce specializované péče z následujícího seznamu: centrum vysoce specializované cerebrovaskulární péče, centrum vysoce specializované komplexní kardiovaskulární péče pro dospělé, centrum vysoce specializované pneumoonkochirurgické péče, centrum vysoce specializované zdravotní péče v onkogynekologii, centrum vysoce specializované péče pro izolaci pacientů s podezřením na vysoce nakažlivou nemoc podle zákona o zdravotních službách. Pokud poskytovatel nesplňuje podmínky uvedené ve větě první, ale má statut centra vysoce specializované onkologické péče a zároveň statut alespoň dvou center vysoce specializované péče z následujícího seznamu - centrum vysoce specializované cerebrovaskulární péče, centrum vysoce specializované komplexní kardiovaskulární péče pro dospělé, centrum vysoce specializované pneumoonkochirurgické péče, centrum vysoce specializované zdravotní péče v onkogynekologii, centrum vysoce specializované péče pro izolaci pacientů s podezřením na vysoce nakažlivou nemoc, centrum vysoce specializované péče o pacienty s iktem, centrum vysoce specializované kardiovaskulární péče podle zákona o zdravotních službách - minimální základní sazba se stanoví ve výši 34 125 Kč. Pro ostatní poskytovatele se minimální základní sazba stanoví ve výši 29 000 Kč. | ||
| EM2018 | je celková hodnota vyžádané extramurální péče v rámci případů hospitalizací podle bodu 3.2 poskytovatelem vykázaných a zdravotní pojišťovnou uznaných, ukončených v referenčním období, zařazených podle Klasifikace do skupin vztažených k diagnóze podle přílohy č. 10 k této vyhlášce, oceněná hodnotami bodu platnými v referenčním období, včetně úhrady za zvlášť účtovaný materiál a zvlášť účtované léčivé přípravky. | ||
| celková úhrada poskytovateli za služby zařazené do individuálně smluvně sjednaných bazí v referenčním období. | |||
| OD2018,sestry,10 | navýšení úhrad podle typu ošetřovacího dne uvedené v příloze č. 9 k této vyhlášce v referenčním období za ošetřovací dny případů hospitalizací podle bodu 3.2 zařazených do skupin vztažených k diagnóze uvedených v příloze č. 10 k této vyhlášce. | ||
| max | funkce maximum, která vybere z oboru hodnot hodnotu nejvyšší. | ||
and where:
| KN10 | je koeficient navýšení, který se vypočte následovně: | ||
KN10 = 1 + 0,17ARCTG116,5 * Pudrag, 2018,10CM2018,017,10-CMCZ-DRG, 2018-CMMDC19,2018-26800
where:
| ARCTG | je funkce Arkus tangens | ||
(ii) CMred, 2020,017,10 is calculated as follows:
(a) Where the number of recognised hospital cases reported and reported by a health insurance company in accordance with point 3.2 is terminated in the reference or assessment period, classified by classification in the groups related to the diagnosis listed in Annex 10 to this Regulation and not in the cases of hospitalisation according to the CMCZ- DRG, 2018 and CMMDC19,2018, which have been completed by transferring a patient to a downstream care provider or by separating a follow-up care of the same provider (PPRDRG) ≤ 0,1 * (PPdrg, 2020 - PPDC19,2020) or by transferring a patient to another acute bed care provider (PPRdrg, 2018,4,5 - PPRDRG, 20,4,5 - PPRDRG, PPRDC19,20,4,5) ≤ 0,1 * (PPdrg, 2020 - PPDC19.2020), or (PPRdrg, 2018,4,5 - PPRDRG, PPRDRG, PPRDRg, PPRDCG, PCRG) ≤ 0,1 * (PDRg) ≤ 0,1 * (PPdcdcdg, 2018).
CMred, 2020,017,10 = minCM2020,017,10-CMMDC19,2020, CM2020,017,10-CMMDC19,200,2 * X * PPdrg, 2020-PPMDC19,2020 * (CM2018,017,10-CMCZ-DRG, 2018-CMMDC19,2018) (PPdrg, 2018-PPCZ-DRG, 2018-PPMDC19,2018) 0,8
where:
| X | nabývá hodnoty 1,05 v případě, kdy je koeficient poměru počtu pojištěnců dané pojišťovny v daném okrese podle bodu 1 přílohy č. 14 k této vyhlášce větší než 0,01, a hodnoty 1,15 v případě, kdy je koeficient poměru počtu pojištěnců dané pojišťovny v daném okrese podle bodu 1 přílohy č. 14 k této vyhlášce menší nebo roven 0,01. | ||
| CM2020,017,10 | je počet případů | ||
| CMMDC19,2020 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, CMMDC19,2020 je počet případů | ||
| PPdrg,2020 | je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPMDC19,2020 | je počet v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, PPMDC19,2020 počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPdrg,2018 | je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPCZ-DRG,2018 | je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPMDC19,2018 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, PPMDC19,2018 je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
(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-CMMMDC19,1,20200,2 * X * PP1, drg, 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 | je počet případů | ||
| CMMDC19,1,2020 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, CMMDC19,1,2020 je počet případů | ||
| CM1,2018,017,10 | je počet případů | ||
| CMCZ-DRG, 1,2018 | je počet případů | ||
| CMMDC19,1,2018 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, CMMDC19,1,2018 je počet případů | ||
| PP1,drg,2020 | je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPMDC19,1,2020 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, PPMDC19,1,2020 je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PP1,drg,2018 | je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPCZ-DRG,1,2018 | je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPMDC19,1,2018 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, PPMDC19,1,2018 je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
and where:
CMred2 = CM2020,017,10,4,5-CMMDC19,2020,4,5 * min11,05 * PPRdrg, 2018,4,5-PPRCZ-DRG, 2018,4,5-PPRMDC19,2018,4,5PPRdrg, 2020,4,5-PPRMDC19,2020,4,5 * PPdrg, 2020-PPMDC19,20PPdrg, 2018-PPCZ-DRG, 2018-PPMDC19,2018,
where:
| CM2020,017,10,4,5 | je počet případů | ||
| CMMDC19,2020,4,5 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, CMMDC19,2020,4,5 je počet případů | ||
| PPRdrg,2020,4,5 | je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPRMDC19,2020,4,5 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3., PPRMDC19,2020,4,5 je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPRdrg,2018,4,5 | je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPRCZ-DRG,2018,4,5 | je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
| PPRMDC19,2018,4,5 | v případě, že poskytovatel splňuje podmínky uvedené v bodě 3.7, PPRMDC19,2020,4,5 je počet poskytovatelem vykázaných a zdravotní pojišťovnou uznaných případů | ||
(iii) IZP is the index of the change in production calculated as follows:
IZP = 1 + IZP1 + IZP2
IZP1 = max0; 0,66 * min0,87; CM2020,017,10-CMMDC19,20CM2018,017,10-CMCZ-DRG, 2018-CMMDC19,2018 + min0,03; 4 * COMMDD-0,82
IZP2 = max0; ARCTG1,7 * CMred, 2020,017,10CM2018,017,10- CMCZ- DRG, 2018- CMMDC19,2018 + min0,03; 4 * Intermediate COVID + 0,12- 1,0347
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Regulation Information
| Citation | Decree No. 305 / 2020 Coll., on determining how compensation is to be included in the remuneration of services paid in 2020 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 30.06.2020 |
|---|---|
| Effective from | 01.07.2020 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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