Decree No. 324 / 2014 Coll.
Declaration on the determination of the value of the item, the amount of the fees paid and the regulatory restrictions for 2015
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Order
Effective from 01.01.2015
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23.12.2014
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324
DECLARATION
of 17 December 2014
on the determination of the value of the points, the amount of the fees paid and the regulatory restrictions for 2015
The Ministry of Health provides pursuant to § 17 paragraph 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. and Act No. 369 / 2011 Coll.:
This Decree sets out for 2015 the value of the item, the amount of the payment of the services paid to insured persons under Section 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 the services paid to insured persons from other Member States of the European Union, the European Economic Area and the Swiss Confederation under the directly applicable European Union provisions governing the coordination of social security systems (hereinafter referred to as" the Act'), and the regulatory restrictions on the remuneration referred to in Sections 3 to 15 provided by the Contracting Health Services Providers (hereinafter referred to as "the Provider '):
(a) providers of bed care and providers of special bed care pursuant to Article 22a of the Act;
(b) providers in general medical practice and providers in practical medicine for children and adolescents;
(c) providers of specialised outpatient care, providers of hemodialysis healthcare and providers of expertise 903, 905, 919 and 927 in accordance with the Decree issuing a list of health performances with point values (3) (hereinafter referred to as "the list of performances"),
(d) providers of outpatient care in expertise 603 and 604 according to the performance list;
(e) dental practitioners;
(f) providers of outpatient care in the field of expertise 222, 801, 802, 804, 805, 806, 807, 808, 809, 810, 812 to 819, 822 and 823 according to the performance list (hereinafter referred to as "the listed expertise"),
(g) providers of outpatient care in the 911, 914, 916, 921 and 925 competence lists;
(h) providers of outpatient care in expertise 902 and 917 according to the performance list;
(i) emergency care providers, patient transport providers, medical transport service providers, medical emergency services providers and dental emergency services providers;
(j) providers of spa rehabilitation and rehabilitation facilities; and
(k) care providers.
(1) Reference period means the year 2013 for the purposes of this Decree.
(2) The evaluation period is the year 2015 for the purposes of this decree.
(3) All services paid in 2013, the provider reported by 31 March 2014 and the health insurance undertaking recognised by 31 May 2014 are included in the reference period. All services paid in 2015, the provider reported by 31 March 2016 and the health insurance company recognised by 31 May 2016 are included in the assessment period.
(4) For the purposes of this Order, a special insurer shall mean an insurer of a health insurance undertaking treated by a provider in a specific professional capacity in an assessment or reference period at least once, and shall not be responsible for whether it is a treatment within the framework of his or her own health or health services requested. If the 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 individual insured persons shall include the relevant health insurance undertakings treated in that professional capacity only once. In the event of the merger of health insurance undertakings, the number of unique insured persons shall be counted as the sum of the unique insured persons of health insurance undertakings that have merged. If the insured person has been insured by more than one health insurance company during the reference period, the number of individual insured persons shall be included only once.
(5) 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 in the context of his own or requested health services during an evaluation or reference period at least once, unless otherwise specified. If the insured person has been treated more than once by the provider, regardless of which expertise, in the evaluation period or reference period, the number of global unique insured persons covered by the health insurance scheme treated with that provider shall only be included once. In the event of a merger of health insurance undertakings, the number of global unique insured persons shall be counted as the sum of the global unique insured persons of health insurance undertakings that have merged. If the insured person was insured by more than one health insurance company during the reference period, the number of global unique treated insured persons shall be included only once.
(6) For the calculation of the total number of points recognised by the provider and the health insurance undertaking as health performance (hereinafter referred to as "performance ') for the reference period referred to in Annexes 1, 3, 5 to 8 to this Regulation, these points shall be understood as those points converted according to the list of benefits as effective on 1 January 2015 in which points for the services paid to foreign insurers are not included.
(7) Where two health insurance undertakings have merged in the reference period, the sum of the data for the reference period of the merged health insurance undertakings shall be used for the calculation of the remuneration.
In the case of the provision of paid services to foreign insured persons, the remuneration shall be set at the same amount as for Czech insured persons.
(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 providers and special-bed care providers, the value of the point, the amount of payment of the services paid and the regulatory limit shall be set out in Annexes 1, 9, 10, 12 to 14 to this Decree.
(2) For paid services provided by post-bed care providers, long-term bed care providers and special-bed care providers, paid at a flat rate per day of hospitalisation or according to the list of benefits, the value of the point, the amount of payment of the services paid and the regulatory limit shall be as set out in Annex 1 to this Decree.
For paid services provided by providers of general medical practice and providers of practical medicine for children and youth covered by a combined capital charge, a combined capital charge with a top-up cap or a list of benefits, the value of the item, the amount of the fees paid for the services and the regulatory limit shall be set out in Annex 2 to this Decree.
For specialised outpatient care provided by the outpatient health care providers covered by the performance list, the value of the point, the amount of the payment 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 health care providers in expertise 603 and 604 according to the performance list, the value of the point, the amount of payment of the services paid and the regulatory limitation shall be as set out in Annex 4 to this Decree.
(1) For paid services provided by dental care providers, the value of the point is CZK 0.95.
(2) The amount of the remuneration of the paid services provided by dental care providers not covered by paragraph 1 and the relevant regulatory restrictions are set out in Annex 11 to this Decree.
(3) The health insurance company shall limit the amount of remuneration to dental care providers so that the total cost of the health insurance undertaking paid for the services provided by dental care providers in 2015 does not exceed the total amount of these costs set out in the health insurance plan of the health insurance undertaking. If the excess of the total amount of remuneration for the paid services provided by dental care providers, as set out in the health insurance plan of the health insurance company for those services, would be due to the provision of more urgent care compared to 2013, the health insurance company will pay this higher amount.
For covered services provided by outpatient health 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 health care services in the 911, 914, 916, 921 and 925 expert expertise according to the performance list, the value of the point and the amount of the payments of the services paid shall be as set out in Annex 6 to this Decree.
For paid services provided by outpatient health care providers in the field of expertise 902 and 917 according to 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 of CZK 1,11 is determined for the services provided by the health rescue service providers according to the performance list and the value of the point of CZK 1,10 for the services provided by the patient transport providers.
For paid services provided by health transport service providers 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 8 to this Decree.
For paid services provided by providers in the framework of medical emergency or dental emergency services paid according to the list of performances, the value of the point of CZK 0.95 is determined.
(1) For complex spa rehabilitation care for adults provided in the health facilities of the spa rehabilitation care provider, payment for one day's stay is fixed at the amount agreed on 31 December 2013, plus CZK 100. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 1 050.
(2) For complex spa rehabilitation care for children and adolescents under 18 years of age provided in the health facilities of the spa rehabilitation care provider, a payment for one day's stay is provided for at the amount agreed on 31 December 2013, plus 300 CZK. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 1,350.
(3) For the benefit of the spa rehabilitation care for adults provided in the health facilities of the spa rehabilitation care provider, payment shall be made for one day's stay at the level agreed on 31 December 2013. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 380.
(4) A payment for one day's stay at the level agreed on 31 December 2013 shall be provided for the childcare and youth allowance for the spa rehabilitation care provider's health facilities. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 480.
(5) 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.
(6) For the services provided in the recovery centres, the payment for one day's stay is set at the amount agreed on 31 December 2013, plus CZK 100. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 740.
For each provider declared and the health insurance company recognised performance No. 09543 according to the list of performances, a remuneration of CZK 30 is determined. The maximum remuneration to the provider for the reported performance No 09543 according to the performance list in the assessment period shall not exceed 30 times the number of performance No 09543 according to the performance list, as effective in the reference period, reported to the health insurance undertaking in the reference period. This remuneration shall not be included in the maximum remuneration for services rendered. This provision does not apply to providers of spa rehabilitation care in the provision of a spa rehabilitation care allowance.
For each provider declared and the health insurance company recognised performance No. 09552 according to the list of performances, a remuneration of CZK 12 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 12 times the number of recipes in the reference period on the basis of which the medicinal product partly or fully covered by public health insurance has been issued.
This Decree shall enter into force on 1 January 2015.
Minister:
MUDr.
Příloha č. 1
Annex No 1 to Decree No 324 / 2014 Coll.
The value of the point, the amount of the payments of the services paid and the regulatory limitation referred to in § 4
A) Bound services pursuant to § 4 (1)
1. The remuneration of the provider in 2015 includes the contractually agreed remuneration component, case flat-rate remuneration and the payment for outpatient care ("outpatient remuneration component"). For the calculation of the individual flat-rate remuneration, all the services paid in 2014, the provider reported by 31 March 2015 and the health insurance company recognised by 31 May 2015 are included in the calculation.
2. Individual contractually agreed payment component
2.1. Amount and method of reimbursement of paid services classified according to the Classification of hospitalised patient4) (hereinafter referred to as "Classification")
(a) 0501, 0507, 0511 and 0516,
(b) 0522, 0523, 0524, 0526, 0527 and 0528
as listed in Annex 9 to this Order (hereinafter referred to as "the listed basis') shall be negotiated in a contract between the health insurance undertaking and the provider. Where the contractually agreed remuneration component includes services other than those referred to in the first sentence, neither the remuneration nor the remuneration for the services covered by the Classification in the listed bases shall be included in the remuneration referred to in point 3.
In the absence of an agreement on the amount of the remuneration of the individually contracted remuneration component between the provider and the health insurance undertaking by 30 May 2015, the health insurance undertaking shall provide the provider with a remuneration of the ÚHRzzho calculated as follows:
ÚHRzzho = min.
where
| Úhrada poskytovateli v hodnoceném období. | |
| Počet případů u daného poskytovatele ve vyjmenované bazi v hodnoceném období, kde i = 1 až n, kde n je počet vyjmenovaných bazí. | |
| X | nabývá hodnoty 0,95 pro baze uvedené v bodě 2.1 písm. a) a hodnoty 0,75 pro baze uvedené v bodě 2.1 písm. b) |
| Celková úhrada poskytovateli za vyjmenovanou bázi v roce 2014, kde i = 1 až n, kde n jsou baze vyjmenované v bodě 2.1 písm. a), resp. v bodě 2.1 písm. b). | |
| Počet případů u daného poskytovatele ve vyjmenované bázi v roce 2014 kde i = 1 až n, kde n je počet vyjmenovaných bazí. | |
| min | Funkce minimum, která vybere z oboru hodnot hodnotu nejnižší. |
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, shall be determined by the provider declared and the health insurance company of the recognised medicinal product, but not more than the amount specified in points 2.2.1 to 2.2.5:
2.2.1. For diseases:
(a) Fabry disease,
(b) Gaucher disease,
(c) Niemen-Pick's disease,
(d) Mukopolysaccharidosis I,
(e) Mukopolysaccharidosis II,
(f) Mucopolysaccharidosis VI,
(g) Pompe's disease;
(h) Hyperamonaemia in children with hereditary disorders of urea and glutamine metabolism; and
(i) Hereditary Tyrosinaemia Type I
the maximum remuneration per unique insured person is set at 100% 12 times the average monthly remuneration calculated from the months of 2014 during which the treatment was granted. The maximum remuneration on a unique insured person shall be calculated as follows:
Uhrmax, i = 12 * Uhri, 2014Mi, 2014
where:
i gets 1 to n, where n is the number of the above diseases
Uhrmax, i is the maximum remuneration in 2015 per unique insured person for the disease i
Uhri, 2014 is the total payment in 2014 for the treatment of the disease i
Mi, 2014 is the sum of months during which the treatment of the disease was also provided to each individual insured person with this disease in 2014.
2.2.2. For diseases:
(a) rheumatoid arthritis,
(b) Bechoreva's disease,
(c) psoriatic arthritis,
(d) Crohn's disease;
(e) colitis ulcerosa,
(f) heavy psoriasis,
(g) pulmonary arterial hypertension;
(h) asthma,
(i) Parkinson's disease; and
(j) juvenile arthritis
a maximum remuneration of 96% 12 times the average monthly remuneration calculated from the months in which the treatment was provided, multiplied by 108% of the number of unique insured persons treated in 2014, shall be set. The maximum remuneration shall be calculated as follows:
Uhrmax = dost r i = 1n0,96 * 12 * Uhri, 2014Mi, 2014 * UOPi, 2014 * 1,08
i gets 1 to n, where n is the number of the above diseases
Uhrmax is the maximum remuneration in 2015
Uhri, 2014 is the total payment in 2014 for the treatment of the disease i
Mi, 2014 is the sum of months during which treatment was also given to each individual patient with this disease in 2014
UOPi, 2014 is the number of unique insured persons treated in 2014 for the relevant disease referred to in points (a) to (j).
2.2.3. For multiple sclerosis, a maximum remuneration of 96% 12 times the average monthly remuneration calculated from the months of treatment in 2014 multiplied by 108% of the number of unique insured persons treated in 2014 is set. The maximum remuneration shall be calculated as follows:
Uhrmax = 0,96 * 12 * Uhr2014M2014 * UOP2014 * 1,08
Uhrmax is the maximum remuneration in 2015
Uhr2014 is a total remuneration in 2014 for the treatment of multiple sclerosis
M2014 is the sum of months after which treatment with multiple sclerosis was given to each individual patient with this disease in 2014
UOP2014 is the number of unique insured persons treated in 2014 for multiple sclerosis diseases.
2.2.4. 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 2014.
2.2.5. For diseases not referred to in points 2.2.1 to 2.2.4, a maximum remuneration of 96% of the total remuneration granted by the health insurance undertaking for 2014, multiplied by 104%, shall be fixed. The maximum remuneration shall be calculated as follows:
Uhrmax = dost r i = 1n0,96 * Uhri, 2014 * 1,04
i is 1 to n where n is the number of diseases covered by point 2.2.5
Uhrmax is the maximum remuneration in 2015
Uhri, 2014 is the total payment in 2014 for the treatment of the disease i
2.2.6 Reimbursement of medicinal products provided to insured persons for treatment during the evaluation period above the total reimbursement limit set in accordance with points 2.2.1 to 2.2.5 shall be paid in accordance with a prior agreement between the health insurance undertaking and the provider.
2.2.7. In addition, medicinal products prescribed in 2014 for the recipe shall be included in the total payment limit set out in points 2.2.1 to 2.2.5 if, in the evaluation period, those medicinal products are reported as separately charged medicinal products and at the same time if, in the evaluation period, they continue to meet the conditions for medicinal products marked with the symbol "S 'under Decree No. 376 / 2011 Coll.
3. Reimbursement by case flat rate
3.1 In calculating CM2015,012 and CM2013,012, hospitalisation cases are converted by the rules for the classification and compilation of hospitalisation cases applicable for 2015.
3.2 For the performance of the escort No 00031, 00032 and 31130 according to the list of performances excluded from the payment by case flat rate, a flat-rate payment of CZK 100 is fixed.
3.3. Medicinal products excluded from the flat-rate payment and listed in Annex 14 to this Regulation 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 2014.
3.4 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.
3.5 The flat-rate payment includes paid services classified under the Classification in groups related to the diagnosis referred to in Annex 10 to this Decree and is set at CELK Pudrg, 2015, according to the expression (i), where the individual flat-rate payment (IPU) is reduced proportionately, unless at least 96% of the production of the reference period (CM2013,012), weighted by the rate of transfer of insured persons (Kpp13), and the reduced individual flat-rate payment is deducted for the requested extra-moral care in the evaluation period (EM2015).
The individual flat-rate payment (IPU) shall be calculated on the basis of the expression (ii) as 103% of the 2014 remuneration multiplied by the transfer coefficient of the insured persons (Kpp14).
The volume of production of the evaluation period (CMred, 2015,012) is determined on the basis of the expression (iii) by reducing the volume of production to 105% of the average reference production per case CM2013,012PPdrg, 2013 multiplied by the number of cases in the evaluation period (PPdrg, 2015) by the full value (CM2015,012), and above that limit by the amount of production relative to the lack of the required number of cases (PPdrg, 2015).
The calculation of all the above components of remuneration shall be as follows:
(i) CELK Pudrg, 2015 = min1; CMred, 2015,0120,96 * Kpp13 * CM2013,012 * IPU-EM2015,
and where the IPU is an individual flat-rate remuneration calculated as follows:
(ii) IPU = 1,03 * Pudg, 2014 + RPhosp, 2013 * Kpp14
| Kpp14 | koeficient změny podílu počtu pojištěnců příslušné zdravotní pojišťovny čerpajících | |
| PUdrg,2014 | je celková výše úhrady za poskytovatelem vykázané a zdravotní pojišťovnou uznané | |
| RPhosp,2013 | je objem regulačních poplatků za akutní lůžkovou péči, vybraných poskytovatelem v | |
| CM2013,012 | je počet případů | |
| EM2015 | je celková hodnota vyžádané extramurální péče v rámci případů | |
| Kpp13 | koeficient změny podílu počtu pojištěnců příslušné zdravotní pojišťovny čerpajících | |
| min | funkce minimum, která vybere z oboru hodnot hodnotu nejnižší. |
and where:
(iii)
CMred, 2015,012 = minCM2015,012; CM2015,0120,2 * 1,05 * PPdrg, 2015 * CM2013,012PPdrg, 20130,8,
and where:
CM2015,012 is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised that have been completed in the assessment period that are classified under the Classification in the diagnostic groups multiplied by indices 2015.
This Decision is addressed to the Member States.
This Decision is addressed to the Member States.
4. In the case of paid services provided to foreign insured persons, and in the case that the provider provides 100 or less insured persons with paid services to the relevant health insurance company during the reference period, those services shall be paid according to the list of performances with a value of CZK 1.
5. The umbilical component of the remuneration includes the reimbursement of specialised outpatient health care, paid services in the fields of expertise 603 and 604 according to the list of performance, paid services provided by general practitioners and providers in the field of practical medicine for children and adolescents, paid services provided by dental practitioners, paid services in the fields of expertise, medical transport services, medical emergency services and paid services provided by providers in the field of general medical practice, 903, 905, 911, 914, 919, 921, 925 and 927 (hereinafter referred to as "outpatient care ') with the exception of the performance of the examination of the patient in the admission to hospitalisation and discharge.
5.1. For paid services provided by providers in general medical practice and by providers in the field of practical medicine for children and adolescents, covered by the combined capital charge, the combined capital charge with the top-up of the capitalisation or according to the list of performance, the value of the point and the amount of remuneration of the services paid shall be as set out in Annex 2 to this Decree, with the exception of the regulatory restrictions set out in Part D of Annex 2 to this Decree, which shall not apply to the covered services provided by providers in the field of general medical practice and providers in the field of practical medicine for children and training.
5.2. For specialised outpatient health care covered by the list of performance services and providers in competence 903, 905, 919 and 927 according to the list of performance services, the resulting value of the point shall be determined at the level of the value of the point referred to in Annex 3 to this Regulation, with the exception of the regulatory restrictions set out in Part B of Annex 3 to this Regulation, which shall not apply to specialised outpatient health services covered by the list of performance services and providers in competence 903, 905, 919 and 927.
5.3. For the services provided by experts 603 and 604 in accordance with the performance list, the value of the item shall be set out in point (A) (1) of Annex 4 to this Regulation, with the exception of the regulatory restrictions set out in point (B) of Annex 4 to this Regulation, which shall not apply to the services provided by experts 603 and 604.
5.4. For the services covered by the listed expertise covered by the performance list, the resulting value of the point shall be set at the value of the point referred to in points 1 and 2 of Annex 5 to this Decree.
5.5. For the services provided in the 911, 914, 921 and 925 expert services covered by the performance list, the resulting value of the point shall be determined at the value of the points referred to in points 1 and 2 of Annex 6 to this Decree.
5.6. For the services provided by experts 902 and 917 according to the performance list, the resulting value of the point shall be set at the value of the point referred to in points 1 and 2 of Annex 7 to this Decree.
5.7. For the performance provided by the health transport service providers covered by the performance list, the resulting value of the point shall be set at the value of the point referred to in point 1 of Annex 8 to this Decree.
5.8. Grounded services provided by dental care providers shall be paid in accordance with Section 8.
5.9. Grounded services provided under the medical emergency service shall be paid in accordance with Section 14.
5.10. The maximum remuneration for the service declared by the provider under points 5.1 to 5.9 shall be:
Edge _ ambmax = Ehr _ amb2014 * 1,03 * Kpp14
where:
Edge _ ambmax is the maximum total payment to the provider for the services paid, including the medicinal products specifically charged and the material specifically charged, with the exception of those specifically charged with the "S 'symbol under Paragraph 39 (1) of Decree No 376 / 2011 Coll. and with the exception of the products listed in Annex 14 to that decree, provided in the evaluation period under paragraphs 5.1 to 5.9.
Edge _ amb2014 is the total amount of compensation to the provider for the services paid in 2014 under paragraphs 5.1 to 5.9, including reimbursement for the medicinal products separately charged and the material separately charged, except for those specifically charged with the "S 'symbol under Paragraph 39 (1) of Decree No 376 / 2011 Coll. and with the exception of those listed in Annex 14 thereto.
Kpp14 coefficient of change in the proportion of the number of insured persons of the relevant health insurance undertaking receiving the services paid to that provider in the total number of insured persons receiving the services paid to that provider between 1 January 2015 and 1 January 2014. This coefficient shall be defined as the index of the change in the number of insured persons of the relevant health insurance undertaking in the region of the provision of the services paid between 1 January 2014 and 1 January 2015, the coefficients of the change in the number of insured persons of the health insurance undertakings according to the regions of the Czech Republic being set out in Annex 12 to this Decree;
5.11. For the contracted power No. 09563 according to the list of performances the value of the point is set at CZK 1 and for the contracted power No. 88101 according to the list of performances the value of the point is determined at CZK 1. The performance referred to in the sentence of the first health insurance undertaking shall not be included in the calculation of the regulation in paragraphs 5.1 to 5.10.
5.12. The medicinal products listed in Annex 14 to this Order shall be paid by the health insurance company to the provider at the level of their declared unit price but not more than their unit price in 2014.
6. Changes in the scope and structure of the services provided as compared to the reference period shall be agreed in the contract between the provider and the health insurance undertaking, including related changes in the calculation of the remuneration.
7. The monthly interim payment shall be granted to a provider of 103% of the average monthly advance in 2014, multiplied by the conversion coefficient of Kpp14 insured persons in accordance with Annex 12, plus one twelfth of the volume of the regulatory fees for outpatient care collected by the provider in 2013, reported to the health insurance undertaking by power of 09543 according to the performance list applicable in the reference period. In the amount of the advance payment, the health insurance undertaking shall include changes in the scope and structure of the services provided, agreed in accordance with point 6, including changes in the number of hospitalizations, the number of points and the number of unique insured persons. The interim remuneration for the period under assessment shall be settled financially within the framework of the overall financial settlement, including regulatory restrictions, no later than 180 days after the date of the end of the period under assessment.
B) Gross services pursuant to § 4 (2)
1. Flat rate per day hospitalization except special bed care
(a) The flat rate per day of hospitalisation shall be determined for each patient category and type of treatment day separately and shall include the value of the relevant treatment day, including the direction assigned to the treatment day and patient category according to the performance list, the standard amount to be paid for the medicinal products referred to in Article 17 (6) of the Act and the performance to be reported as income and discharge tests according to the performance list.
(b) The flat rate for one day of hospitalisation in the evaluation period shall be 109% of the flat rate for one day of hospitalisation agreed for 2014.
(c) Changes in the scope and structure of the services provided as compared to the reference period shall be agreed in the contract between the provider and the health insurance undertaking, including related changes in the calculation of payments.
2. Reimbursement of outpatient care and special outpatient care with the exception of payment of such care provided by the provider of special bed care
a) For outpatient care paid according to the performance list, the value of the point (HB) is set at CZK 0.95.
(b) For special outpatient care provided under Paragraph 22 (c) of the Act, the resulting value of the point (HBred) shall be determined. The resulting point value is the sum of the variable remuneration component and the fixed remuneration component:
HBred = FS + VS
where
HBred is the final value of the point used in the evaluation period for the evaluation of the health performance provided
FS is the fixed component of the remuneration referred to in point (c)
VS is the variable component of the remuneration calculated according to the formula:
VS = HB-FS * min1; PBrefu
where:
HB value of point (c)
PBref total number of recognised by the provider and health insurance undertaking of recognised points in the reference period
PBho total number of recognised points by the provider and the health insurance undertaking in the assessment period
UOPref Number of unique insured persons in the reference period
UOPho number of unique insured persons in the evaluation period to which the unique insured persons are not included, to which only the power of No 09513 has been declared
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Regulation Information
| Citation | Decree No. 324 / 2014 Coll., on the setting of the values of the points, the amount of the fees paid and the regulatory restrictions for 2015 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 23.12.2014 |
|---|---|
| Effective from | 01.01.2015 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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