Act No. 310 / 2017 Coll.
Act amending Act No. 187 / 2006 Coll., on sickness insurance, as amended, and other related laws
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Law
Effective from 01.06.2018
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310
THE LAW
of 16 August 2017
amending Act No 187 / 2006 Coll., on sickness insurance, as amended, and other related laws
Parliament has decided on this law of the Czech Republic:
Amendment to the sickness insurance law
Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011, Act No. 100 / 2011 Coll.
1. In the first sentence of Article 1 (1), the words "and treatment 'are replaced by the words", treatment' and the words "and organisation 'are replaced by the words", long-term care and organisation'.
2. In Article 3 (l), the words "cash entry 'are replaced by the words" long-term care needs, cash entry'.
3. in Article 4, the following point (e) is inserted after point (d):
"(e) long-term nursing care,"
Point (e) shall be renumbered as point (f).
4. Footnote 17 reads:
"17) For example § 68k paragraphs 1 and 2 of Act No. 221 / 1999 Coll., as amended, § 124 paragraph 5 of Act No. 361 / 2003 Coll., as amended."
5. footnote 17 (a) shall read:
"17a) § 61a of Act No. 221 / 1999 Coll., as amended. '
6. In Paragraph 18 (7) (c), the words "or nursing 'are replaced by the words", nursing or long-term nursing'.
7. In Article 19, the following paragraph 5 is inserted after paragraph 4:
"(5) The relevant period for long-term care shall be determined on the date of the need for long-term care or on the date of the first taking of long-term care, if it is the insured person who has taken over long-term care. '
Paragraphs 5 to 13 shall be renumbered paragraphs 6 to 14.
8. In Paragraph 19 (8), "paragraph 6 'is replaced by" paragraph 7';
9. in Article 21 (1) (a), the words "and the treatment" shall be replaced by the words "nursing and long-term nursing."
10. In Paragraph 32, the following paragraph 6 is inserted after paragraph 5:
"(6) An insurer who is a caregiver or a person in a register who has been entitled to the payment of maternity allowance as a caregiver or a person in a register shall not be paid for the period during which a foster child's remuneration is provided under the Child Protection Act (13) to another spouse or guardian. '
Paragraphs 6 to 9 shall be renumbered paragraphs 7 to 10.
11. in Paragraph 38 (h), the words "on '76)' are replaced by the words" on '84';
footnote 84 is replaced by the following:
"84) § 452 of Act No. 292 / 2013 Coll., on Special Judicial Proceedings. '.
12. In Article 39, at the end of paragraph 3, the sentence "A staff member shall not be entitled to medical treatment because of the treatment of the person referred to in paragraph 1 (a) or because of the care of the child referred to in paragraph 1 (b), if another insured person is entitled to payment of the long-term care to the person referred to in paragraph 1. ';
13. In Part Three, the following Title VII is inserted after Title VI, including the title and footnote 85:
_
Conditions for entitlement to long-term treatment
(1) A long-term nursing allowance is entitled to an insured person who takes care of a person in need of long-term care in the home environment and who does not work in the employment from which the long-term nursing allowance belongs, or in any other employment, if he does not work for an employee or personally pursue a self-employed activity.
(2) For the purposes of long-term nursing care, the treated person is a natural person who:
(a) there has been a serious health disorder which has requested hospitalisation in which treatment has been provided for at least 7 calendar days of consecutive treatment, if not for acute bed care, to the standard provided to the treated person in order to perform a health performance that cannot be performed by outpatient 85); the date of hospitalisation shall also be considered as the date of admission of the treated person to the health care provider's health care service and the date of release from such establishment; and
(b) it is assumed that her health will necessarily require the provision of long-term care for at least 30 calendar days after leaving the hospital.
(3) The condition for entitlement to long-term medical care is that the insured person is
(a) spouse of the treated person or registered partner (registered partner) of the treated person;
(b) relatives in a direct line with the treated person or is her sibling, mother-in-law, father-in-law, daughter-in-law, son-in-law, niece, nephew, aunt or uncle,
(c) a spouse, a registered partner (registered partner) or a member of a natural person referred to in (b); or
(d) the species (cooperative) of the treated person or other natural person living with the treated person in the household.
(4) If the insured person claims a long-term treatment (mate) in accordance with paragraph 3 (c), it is another condition of entitlement to a long-term treatment, that the insured person has the same place of residence with the natural person referred to in paragraph 3 (b) (5), and that he is a stranger, the same place of residence (6) in the Czech Republic or a similar stay abroad for at least 3 months immediately preceding the date of the need for long-term care or the date of the first receipt of such care. If he claims a long-term nursing (spouse) or other natural person living with a treated person in the household as referred to in paragraph 3 (d), he / she shall be entitled to a long-term nursing pension that he / she has the same place of residence as the treated person (5), and if he / she is a foreigner, the same place as he / she has been notified of residence (6) in the Czech Republic or similar stay abroad for at least 3 months immediately preceding the date of the need for long-term care or the date of the first receipt of such care.
(5) The right to long-term nursing benefits from the insured activity, which is an employment, shall be subject to participation in the employee's insurance for at least 90 calendar days in the last 4 months immediately preceding the date of the need for long-term care or the date of the first receipt of such care.
(6) The condition for entitlement to long-term medical care from an insured activity which is a self-employed activity shall be that of participation in insurance as a self-employed person in accordance with Article 11 for at least three months immediately preceding the date on which the need for long-term care arises or the date of the first taking over of such care. The first sentence shall also apply mutatis mutandis to foreign staff.
(7) Where a claim for multiple-insurance long-term treatment is claimed, the condition of participation in insurance referred to in paragraphs 5 and 6 shall be fulfilled in each of those insurance contracts.
(8) The insured person may be entitled to additional long-term medical fees not earlier than 12 months after the date for which he was last entitled to payment of the long-term care for the same long-term care requirement.
(1) The condition for entitlement to long-term medical fees under Section 41a (1) is that the person treated has given written consent to the provision of long-term care to the insured person on the prescribed form.
(2) Only one insured person may be authorised to provide long-term care on one calendar day.
(3) No consent to long-term care is required for minors who have not acquired full capacity. If, during the period of long-term care, the minor is fully self-employed, the consent shall be deemed to have been granted in accordance with paragraph 1 to the insured person who provides long-term care to the treated person on the date on which he becomes fully competent.
(4) Consent to long-term care can only be withdrawn in writing. This appeal must state the date of termination of long-term care. In addition, the signature of the insured person certifying that he has been informed of the withdrawal of the consent and the date on which he was informed, or the signature of two witnesses to confirm that that insured person has been informed of the withdrawal of the consent shall be indicated. The withdrawal of consent shall be effective at the earliest from the day following the date on which the insured person providing long-term care of the withdrawal of such consent was informed. Paragraph 39 of the Civil Code applies mutatis mutandis to witnesses.
(5) The insured person shall, without delay, forward his consent to the sickness insurance institution and, if he is a member, to the service department which pays the long-term care allowance.
(6) If the treated person is unable to write, Article 563 of the Civil Code shall apply mutatis mutandis to the grant and withdrawal of consent.
(1) Long-term medical fees are not eligible
(a) staff working under an agreement to carry out the work;
(b) staff members shall take part in insurance due to the employment of a small scale;
(c) a conviction in the execution of a custodial sentence and a person in the exercise of a detention order,
(d) insured persons who are pupils or students from a job which falls exclusively within the period of school holidays or holidays;
(e) soldiers in reserve in the exercise of military active duty;
(f) carers and persons in the register.
(2) An insured person shall not be entitled to long-term medical care for the provision of long-term care to a child if another natural person is entitled to payment of maternity allowance for the care of that child or is entitled to parental allowance under special legislation31); This does not apply if the other person has been ill, has suffered an accident, has been in the situation referred to in § 57 (1) (b) or (c), has given birth or has been ordered to be quarantined and therefore cannot take care of the child.
(3) If the insured person provides long-term care to more than one treated person at the same time, he shall only receive long-term care once.
(1) In the case of the provision of long-term care to the same treated person, the long-term care allowance shall be granted only once and only to one authorised or gradually more justified if they are replaced with the same long-term care requirement. Replacement according to the first sentence is possible also repeatedly.
(2) In the case of an insured person who has taken over long-term care, the conditions for entitlement to long-term care shall be assessed on the date of the first taking over of such care; This also applies in the case of a repeated receipt of long-term care for the same treated person with the same need for long-term care.
(3) In one calendar day, only one authorised person may provide long-term care with entitlement to long-term care.
Support period for long-term care
(1) The duration of the long-term nursing allowance shall begin on the first day of the need for long-term care and end on the day on which the need for care ends; However, the support period shall not exceed 90 calendar days.
(2) Long-term medical care is paid on calendar days in which the insured person provided long-term care and in which this need for care was maintained.
(3) Long-term medical fees are not paid on the calendar days on which the hospitalisation of the treated person took place, except for the first and last calendar days of hospitalisation.
(4) Long-term medical care shall not be paid to staff members for the period for which they are entitled under the special legislation17) from the employment from which this allowance belongs, with the exception of the service allowance granted under the Law on Workers of the Profession17a).
(5) Long-term medical care shall not be paid to staff members for the period for which the leave of absence of income was to take place, if the need for long-term care arose at the earliest on the day following the date of taking such leave. In addition, long-term medical fees shall not be paid for the working days of the calendar week, unless the staff member has been entitled to pay the long-term medical fees for at least one calendar day, which should have been the working day of the calendar week for the staff member and the need for long-term care lasted.
Long-term care
The amount of long-term treatment per calendar day shall be 60% of the daily assessment basis.
85) Paragraph 9 (2) (b) (2) of Act No. 372 / 2011 Coll., on health services and the conditions for their provision (Health Services Act). '.
Titles VII and VIII shall be renumbered Titles VIII and IX.
14. in Paragraph 43 (2) (b), the words "or treated" shall be replaced by "treated" and the words "or long-term care" shall be added at the end of the text of point (b).
15. in the first sentence of Article 47 (1), the words "and the medical charges" shall be replaced by the words "nursing and long-term nursing."
16. in Paragraph 48 (1) (b), the words "and the treatment" shall be replaced by the words "nursing and long-term nursing."
17. in Article 48 (1), the following point (c) is inserted after point (b):
"(c) entitlement to the payment of long-term nursing care over entitlement to the payment of sickness and nursing care,";
Point (c) shall be renumbered (d).
18. In the first sentence of Paragraph 48 (3), the words "and long-term nursing care 'shall be inserted after the words" sick leave'.
19. In the second sentence of Paragraph 48 (3), the words "long-term nursing care 'shall be inserted after the words" sick leave'.
20. in Article 53 (1) (c), the words "long-term treatment" shall be inserted after the words "nursing."
21. In the first sentence of Paragraph 54 (1), the words "treated person" shall be inserted after the words "provided by the insured person."
22. In Part Four, in the title of Title IV, the words "long-term 'shall be inserted after the words" long-term'.
23. In Part Four, Title IV, the following Part 3 is inserted after Part 2:
Health assessment for the provision of long-term nursing care
Long-term care
Long-term care is the provision of all-day care to a person treated by day care, the implementation of measures related to the provision of a treatment regime established by a health service provider or assistance in the care of the person being treated. Self-care is mainly care associated with the administration of food and drink, dressing, undressing, body hygiene and assistance in the exercise of physiological needs.
The creation of a need for long-term care
(1) Long-term care needs arise on the day of the release of the treated person from the hospital.
(2) The healthcare provider's medical practitioner, at the request of the person treated, his legal representative, guardian or the person designated by the person treated, shall decide on the need for long-term care on the day of the release of the treated person from hospitalisation to the home environment.
(3) If, after examination, the treating physician of the health care provider does not ascertain the reasons for the decision on the need for long-term care, but the treated person, his guardian, legal representative or the person designated by the treated person requires the granting of this decision, the treating doctor shall decide that the need for long-term care has not been established; specific legislation (76) on the provision of specific health services shall apply to this Decision and to the following procedure.
(4) If there is a need for long-term care for hospitalisation of the treated person, such hospitalisation does not create a new need for long-term care.
Progress of long-term care needs
(1) The medical practitioner of the outpatient care provider, who has taken over the treated person after being released from the hospital, shall, on the basis of a decision on the need for long-term care pursuant to Article 72b (2), assess whether the need for long-term care continues.
(2) The health care provider's treating physician shall determine the date of the next medical check taking into account the medical condition of the treated person. This term of the treating physician of the outpatient care provider indicates a decision on the need for long-term care.
Termination of long-term care
(1) The need for long-term care expires no later than the end of the period of support referred to in § 41e (1).
(2) The medical practitioner of the outpatient care provider shall decide whether to terminate the long-term care requirement before the expiry of the period referred to in paragraph 1,
(a) if the examination reveals that the medical condition of the treated person no longer requires further provision of long-term care, either on the date on which it was established, or not later than the third calendar day following the date of such examination; or
(b) if the treated person does not appear within the prescribed time limit to check the duration of the long-term care requirement laid down in Article 72c (2), Article 72f (a) or (c) or Article 72g (g), or does not undergo a medical examination with the designated health service provider without demonstrating the existence of serious reasons for which such examination or medical examination could not have been carried out; the need for long-term care is terminated on this day.
(3) If the treated person has demonstrated the existence of serious reasons for which he could not come to check the duration of the long-term care requirement laid down in § 72c (2), § 72f (a) or (c) or § 72g (g) or undergo a medical examination of the health status of the designated health care provider, the treating physician of the outpatient care provider shall take a new decision on the existence of the long-term care requirement. This need for long-term care is considered to be a continuation of the previous need for long-term care.
(4) The medical practitioner of the outpatient care provider shall indicate the date of termination of the long-term care requirement referred to in paragraph 1 or 2 on the decision to terminate the long-term care requirement.
(5) Specific legislation on the provision of specific health services shall apply to the procedure for disapproval of the treated person or insured person with the decision to terminate the long-term care requirement referred to in paragraph 1 or 2.
Decision on the need for long-term care
A decision on the need for long-term care, which, for the duration of long-term care, also serves the treated person to demonstrate the duration of the need for such care, the decision to terminate the need for long-term care and the confirmation of the duration of long-term care by the treating physician on the prescribed forms. Part of these forms, which are intended for employers, must not contain the statistical mark of the diagnosis (41) or any other indication from which the diagnosis can be derived.
Obligations of the nursing doctor of the health care provider
The treating doctor of the health care provider is obliged
(a) at the request of the treated person, his legal representative, guardian or person designated by the treated person, decide on the need for long-term care on the day of the release of the treated person from hospitalisation and on the decision on the need for long-term care to mark the date of admission and the date of dismissal from hospitalisation, the statistical mark of the diagnosis, which is the cause of the need for long-term care, instead of a permanent stay (5) of the treated person, and if it is a stranger, the place of residence (6) in the Czech Republic or a similar stay abroad, and the date by which the treated person is required to check the health status and the need for long-term care of the treating doctor of the health care provider of the outpatient, within 15 days from the date of the hospital,
(b) to refer to the treated person, his legal representative, guardian or person designated by the treated person on the day of his release from the hospital a decision on the need for long-term care and relevant parts of the decision on the need for long-term care;
(c) on release from hospitalisation during the duration of long-term care, establish the date by which the treated person is required to have a health check and long-term care needs with the nursing physician of the outpatient care provider, within a maximum period of 15 days from the date of such release, and forward it to that outpatient care provider;
(d) to send the relevant part of the decision on the need for long-term care to the competent district social security administration no later than the third working day following the date on which the decision was issued;
(e) confirm in writing, at the request of the person being treated, his legal representative, the guardian, the person designated by the person being treated or the sickness insurance authority, the admission to hospital of the person being treated with that health care provider and the duration of that hospitalisation.
Obligations of the nursing doctor of the outpatient care service provider
The treating doctor of the health care provider is obliged
(a) keep records of the treated persons whom he has taken custody of; Paragraph 61 (b) shall apply mutatis mutandis to the particulars of such registration,
(b) record in the decision on the need for long-term care the date on which the treated person is taken into custody and the date on which that person is released from his custody;
(c) notify the competent authority of sickness insurance on the prescribed form of the release of the treated person from his or her care and the taking of that person from the care of another treating doctor into his or her care, no later than the working day following the date on which this occurred,
(d) assess whether the need to provide long-term care persists;
(e) determine and indicate on the decision on the need for long-term care the date of the next medical check;
(f) confirm on the prescribed form at least once a month for the purpose of paying long-term nursing care as referred to in Article 72c (1), on the date of issue of this certificate or not more than 3 calendar days in advance; This certificate shall not be issued unless the treated person has given the medical practitioner the relevant part of the decision on the need for long-term care received when he was admitted from the hospital by the medical practitioner of the patient's health care services pursuant to § 72f (b);
(g) determine, as required by the doctor of the competent sickness insurance authority, the date of the health check for the purpose of carrying out the examination of the need for long-term care and, to that end, call the person treated for inspection;
(h) decide to terminate the long-term care requirement in the cases referred to in Article 72d (2), mark the termination of the long-term care requirement in accordance with Article 72d (4) and forward the decision to the treated person, its legal representative, guardian or person designated by the treated person,
(i) to send to the competent sickness insurance authority the relevant part of the form of termination of the long-term care requirement, no later than the third working day following the day on which the decision to terminate the long-term care requirement was issued;
(j) provide the competent sickness insurance authority with the necessary synergies in the examination of the need for long-term care, in particular to enable such checks to be carried out at its place of work or to be made available to the competent sickness insurance authority, and to inform the staff of the sickness insurance authority entitled to carry out the check on request of the facts necessary for carrying out the check, to the extent that the sickness insurance authority is entitled to carry out such checks;
(k) keep in the medical file data on the course of the medical condition for assessing the need for long-term care on the basis of own examinations and medical reports issued by other doctors;
(l) perform the duties of the treating physician referred to in § 61 (t) and (w). ';
Part 3 is renumbered as Part 4.
24. in Article 74 (1) (a) and (b), the words "and treatment needs" shall be replaced by the words "care needs and long-term care needs."
25. In Article 74, at the end of the text of paragraph 2, the words "and the examination of the need for long-term care 'are added.
26. In Paragraph 75 (1), the words "or nursing needs' are replaced by the words", nursing needs or long-term care needs'.
27. in Article 75 (2), the words "or the day on which the treatment is to end" shall be replaced by the words "the day on which the treatment is to end or the day on which the long-term care is to end," the words "or the treated person" shall be inserted after the word "the treated person," and the words "this shall apply mutatis mutandis to the treated person."
28. in Paragraph 77 (1), the text "and long-term care needs" shall be added at the end of the text of points (a) and (b).
29. in Article 83 (2), the following point (d) is inserted after point (c):
"(d) the place of work of the treating physician, where decisions are taken on the need for long-term care,"
Point (d) shall be renumbered as point (e).
30. in Article 84 (2) (a) (5), the words "or nursing needs" shall be replaced by the words "nursing needs or long-term care needs."
31. in Paragraph 84, at the end of paragraph 2, the dot is replaced by a comma and the following point (u) is added:
"(u) notify employers that the insured person has not been entitled to long-term medical treatment on the grounds that he does not fall within the scope of the Qualifying Persons under Paragraph 41a (3).";
32. in Article 84 (3) (a), the words "and persons with a need for care," shall be replaced by the words "people with a need for care and treated persons," and the words "long-term care" shall be inserted after the word "incompetence."
33.In Article 84 (3) (e), the words "and treatment needs' are replaced by the words", nursing needs or long-term care needs';
34. in Article 84 (3) (h), the words "or treated persons" shall be inserted after the word "insured persons" and the words "or long-term care needs" shall be added at the end of the text of point (h).
35. in Article 84 (3) (k), the words "or the need for treatment" are replaced by the words "the need for care or the need for long-term care."
36. in Paragraph 90 (d), the words "and treatment needs" are replaced by the words "care needs and long-term care needs."
37. in Paragraph 95 (1) (d), the words "maternity period" shall be replaced by the words "duration of long-term care, period of maternity care" and the words "and nursing care" shall be replaced by the words "nursing and long-term care."
38. In Article 103, at the end of paragraph 1, the dot is replaced by a comma and the following points (f) and (g) are added:
"(f) notify the competent sickness insurance authority without delay and, if he is a national, to the service department of the withdrawal of consent to the provision of long-term care by the treated person pursuant to § 41b (5);
(g) to transfer the relevant part of the decision on the need for long-term care to the insured person who takes turns providing long-term care. "
39. In Paragraph 109, the following paragraph 6 is inserted after paragraph 5:
"(6) The right to payment of the long-term nursing allowance shall be applied on the prescribed form and proof of consent to the provision of long-term care, and in the cases referred to in Article 41a (3) or (4) by a certificate of the established facts. For the payment of long-term care for a certain period of time, the duration of the long-term care needs must be certified by certifying the treating physician that the long-term care needs on the prescribed form or by decision of the treating doctor or sickness insurance authority to terminate the long-term care requirement. ';
Paragraphs 6 to 8 shall be renumbered paragraphs 7 to 9.
40. in Paragraph 110 (2), the words "and medical charges" shall be replaced by the words "medical and long-term medical charges";
41. in Article 128 (1), the word "or" shall be deleted at the end of point (a).
42. In Article 128, at the end of paragraph 1, the dot is replaced by a comma and the following points (c) and (d) are added:
"(c) shall not notify the withdrawal of consent to long-term care provided for in Article 103 (1) (f); or
(d) it shall not transmit to the insured person in exchange for long-term care the relevant part of the decision on the need for long-term care under Paragraph 103 (1) (g). "
43. In Article 128 (2) (d), the words "under § 64 (1) (h)" shall be deleted and the words "under § 64 (1) (h)" shall be inserted after the word "place";
44. in § 128 (2) (e), the words "under § 64 (1) (g)" shall be deleted and the words "under § 64 (1) (g)" shall be added at the end of the text of point (e).
45. in Article 131 (1) (f), the words "under § 94 (1)" shall be deleted and the words "under § 94 (1)" shall be added at the end of the text of point (f).
46. in § 131 (1) (i), the words "under § 97 (1), first and second sentences" shall be deleted and the words "under § 97 (1), first and second sentences" shall be added at the end of the text of (i).
47. in § 131 (1) (r), the words "under § 62 (1)" shall be deleted and the words "under § 62 (1)" shall be added at the end of the text (r);
48. In Article 133 (1), the words "under § 112 (2), third sentence 'are deleted and the words" under § 112 (2), third sentence' are added at the end of the text of paragraph 1.
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Regulation Information
| Citation | Act No. 310 / 2017 Coll., amending Act No. 187 / 2006 Coll., on sickness insurance, as amended, and other related laws |
|---|---|
| Regulation Type | Law |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 19.09.2017 |
|---|---|
| Effective from | 01.06.2018 |
| Effective until | - |
| Status | Valid |
Legal Areas:
Social security law
Diseases, Sickness benefits
The regulation text is for informational purposes only.
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