Decree No. 348 / 2016 Coll.
Decision on the establishment of the value of the item, the amount of the fees paid and the regulatory restrictions for 2017
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Order
Effective from 01.01.2017
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01.01.2017
31.10.2016
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348
DECLARATION
of 19 October 2016
on the determination of the value of the points, the amount of the remuneration of the services paid and the regulatory restrictions for 2017
According to Article 17 (5) of Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, as amended by Act No. 117 / 2006 Coll., Act No. 245 / 2006 Coll., Act No. 261 / 2007 Coll., Act No. 298 / 2011 Coll., Act No. 369 / 2011 Coll. and Act No. 200 / 2015 Coll.:
This Decree sets out for 2017 the value of the item, the amount of the remuneration 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 pursuant to the directly applicable European Union provisions governing the coordination of social security systems (hereinafter referred to as" the Act') and to insured persons of other States with whom the Czech Republic has concluded international social security agreements covering the services covered (hereinafter referred to as "foreign insurers'), and regulatory restrictions on the remuneration referred to in Sections 3 to by these 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 health care and providers of expertise 905, 919 and 927 according to 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) The reference period is the year 2015 for the purposes of this Decree.
(2) The evaluation period is the year 2017 for the purposes of this Decree.
(3) All the services provided in 2015, the provider reported by 31 March 2016 and the health insurance undertaking recognised by 31 May 2016 are included in the reference period. All services provided in 2017, the provider reported by 31 March 2018 and the health insurance company recognised by 31 May 2018 are included in the evaluation period.
(4) 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. 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 that insured person has been treated more than once by the provider, regardless of the expertise, in the evaluation period or reference period, the number of global unique insured persons of the relevant health insurance undertaking 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) In calculating the total number of points declared by the provider and by the health insurance undertaking recognised as health performance (hereinafter referred to as "performance ') for the reference period referred to in Annexes 5 and 8 to this Regulation, those points shall be those points converted according to the list of performance, as effective on 1 January 2017, in which points are not included for the services paid to foreign insurers.
(7) If two health insurance companies are merged in the assessment period, the sum of the data for the reference period of the merged health insurance companies shall be used for the calculation of the remuneration.
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 as set out in Annexes 1, 9, 10, 12, 13 and 14 to this Decree.
(2) For paid services provided by post-bed care providers, long-term bed care providers, special outpatient care provided under § 22 (c) and (e) of the Act and special-bed care providers, paid at a flat rate per day of hospitalisation or per performance list, the value of the point, the amount of the payment of the services paid and the regulatory limit shall be 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 capitalisation payment, a combined capitalisation payment with a top-up of the capitalisation or according to the list of performance, the value of the item, the amount of the payments of the services paid and the regulatory limitation shall be set out in Annex 2 to this Decree.
For specialised outpatient care provided by outpatient care providers covered by the performance list, the value of the item, the amount of the payments of the services paid and the regulatory limit shall be as set out in Annex 3 to this Decree.
For outpatient care provided to outpatient care providers in expertise 603 and 604 according to the performance list paid under the performance list, the value of the point, the amount of payment of the services paid and the regulatory limitation shall be as set out in Annex 4 to this Decree.
(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 the 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 2017 does not exceed the total amount of those 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 2015, the health insurance company will pay this higher amount.
For paid services provided by outpatient care providers in the listed expertise covered by the performance list, the value of the point and the amount of the payment of the services paid shall be as set out in Annex 5 to this Decree.
For paid services provided by providers of outpatient care in the 911, 914, 916, 921 and 925 expertise under 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 care providers in expertise 902 and 917 according to the performance list covered by the performance list, the value of the point and the amount of payment of the services paid shall be as set out in Annex 7 to this Decree.
(1) The value of a point of CZK 1.13 shall be determined for the services paid to the health rescue service provider under the performance list, except for the contracted transport codes under the performance list, for which the value of a point of CZK 1.12 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 performance list in the evaluation period shall not exceed the remuneration limit for those performance in 2016.
(2) For paid services provided by the patient transport provider of urgent care paid according to the performance list, the value of the point of CZK 1.12 shall be determined, except for contracted transport codes according to the performance list, for which the value of the point of CZK 1.11 is determined, and with the exception of the performance no. 06714 according to the performance list, 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 performance list in the evaluation period shall not exceed the remuneration limit for those performance in 2016.
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 covered by the list of performances, the value of the point is set at CZK 1.
(1) For comprehensive spa rehabilitation care for adults provided in the health facilities of the spa rehabilitation care provider, a payment for one day's stay of 104% of the contracted remuneration for one day's stay for 2016 shall be fixed. If the payment for one day's stay for 2016 was not agreed on 31 December 2016, the payment is set at CZK 1 092. 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 insured persons who receive comprehensive spa rehabilitation care.
(2) For comprehensive spa rehabilitation care for children and adolescents under 18 years of age provided in the health facilities of the spa rehabilitation care provider, payment for one day of stay shall be fixed at 104% of the contracted remuneration for one day of stay for 2016. If the payment for one day's stay for 2016 was not agreed on 31 December 2016, the payment is set at CZK 1,404. 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 insured persons who receive comprehensive spa rehabilitation care.
(3) For the benefit of the spa rehabilitation care for adults provided in the health facilities of the spa rehabilitation care provider, payment for one day of stay shall be fixed at 104% of the contracted remuneration for one day of stay for 2016. If the payment for one day's stay for 2016 was not agreed on 31 December 2016, the payment is set at CZK 395.
(4) For the benefit of the spa rehabilitation care for children and under 18 years of age provided in the health facilities of the spa rehabilitation care provider, a payment shall be made for one day's stay of 104% of the contracted remuneration for one day's stay for 2016. If the payment for one day's stay for 2016 has not been agreed on 31 December 2016, the payment is set at CZK 499.
(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 rooms, the payment for one day's stay is set at CZK 839.
(1) 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 2014, reported to the health insurance undertaking in 2014.
(2) For a provider that did not exist in 2014, or did not have a contract with a health insurance undertaking, the health insurance company will use the performance figures of 09543 comparable providers in 2014.
(3) The remuneration referred to in paragraphs 1 and 2 shall not be included in the maximum remuneration for the services paid.
(4) The provisions referred to in paragraphs 1 and 2 shall not apply to providers of spa rehabilitation care in the provision of a spa rehabilitation care allowance.
(1) For each provider declared and the health insurance company recognised performance No. 09552 according to the performance list, a remuneration of CZK 13 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 13 times the number of recipes in 2014 on the basis of which the medicinal product partly or fully covered by public health insurance was issued.
(2) For a provider that did not exist in 2014, or did not have a contract with a health insurance undertaking, the health insurance company will use the number of recipes of comparable providers in 2014.
For each provider declared and the health insurance company recognised the performance no. 78890 according to the list of performances, a remuneration of CZK 10 000 is determined. This remuneration shall not be taken into account in the amount of the remuneration for the services paid, determined in accordance with points 2.1.1, 3.5, 4 and 6 of Annex 1 to this Decree.
For paid services provided by providers in the expertise 005 - hospital pharmacies covered by the list of performances the value of the point is set at CZK 1.
This Decision shall enter into force on 1 January 2017.
Minister:
MUDr.
Příloha č. 1
Annex No 1 to Decree No 348 / 2016 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 payment to the provider in 2017 shall include the contractually agreed remuneration component, the case flat-rate remuneration, the remuneration to be paid in the form of a case flat-rate payment and the payment for outpatient care (the "outpatient remuneration component"). In order to calculate the reference values, the individually contracted remuneration component, the case flat-rate remuneration, the remuneration allocated to the case flat-rate remuneration and the outpatient remuneration component, all the services provided in 2015, the provider declared by 31 March 2016 and the health insurance company recognised by 31 May 2016 shall be included in the calculation.
2. Individual contractually agreed payment component
2.1.1. Amount and method of payment of services paid classified according to the Classification of hospitalised patient4) (hereinafter referred to as "Classification")
(a) 0501, 0507, 0511, 0516,
(b) 0522, 0523, 0524, 0526, 0527, 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. The remuneration for the services covered by the Classification in the listed bases shall not be included in the remuneration referred to in points 3 and 4.
In the absence of an agreement on the amount of the remuneration of the individually contracted component of the remuneration between the provider and the health insurance undertaking by 31 March 2017, the health insurance undertaking shall provide the provider with a remuneration of the ÚHRH calculated as follows:
where:
The remuneration shall be paid by the provider during the evaluation period.
Pi number of cases with a given provider in the listed basis in the evaluation period where i = 1 to n, where n is the number of listed bases.
PPi2015 number of cases for a given provider in the listed basis in the reference period where i = 1 to n, where n is the number of listed bases.
X shall be 1,03 for the bases referred to in point 2.1.1 (a) and 1 for the bases referred to in point 2.1.1 (b).
EM2017,92017 is the total value of the requested extramural care in the context of hospitalisation cases by a provider recognised and recognised by a health insurance company that has been terminated in the assessment period and which are classified in the listed bases according to the Classification, valued at the values of the points in force in the assessment period, including the cost of the separately charged material and of the medicinal products separately charged.
EHRi2015 Total remuneration of the provider for the listed basis in the reference period where i = 1 to n, where n is the number of listed bases, increased by the value of the requested extramural care in the reference period valued at the values of the point in force in the evaluation period, including the cost of the separately charged material and medicinal products separately charged.
2.1.2 The individually contracted remuneration component may include services other than those referred to in point 2.1.1. The remuneration for these services shall not be included in the remuneration referred to in points 3 and 4.
a. The health insurance company and the provider may agree on a different amount and method of payment of the services paid under the Classification Nos 0001, 0002, 0003, 0014, 0204, 0802, 0804, 0818 and 1101 to take into account the change in the prices of the materials contained in the individual bases.
b. A health insurance company and a provider which has the status of a high-level care centre pursuant to Section 112 (5) of Act No. 372 / 2011 Coll., on health services and the conditions for providing them may agree on a different amount and method of payment of the paid services classified in Bases Nos 2250 to 2255, taking into account the increased costs of providing highly specialised care and ensuring sufficient capacity of the provider, necessary to ensure availability even in emergencies.
c. The health insurance company and the provider may agree on a different amount and method of payment of the services covered by the Classification Nos 0138 to 0140, 0638, 0733, 1801 to 1834 and 2401 to 2435 and allow for improved provision of care for infectious patients and for higher fixed costs.
d. The health insurance company and the provider may agree on a different amount and method of payment of the services covered by the Classification No 1105, provided that, within that basis, the performance No 76419 is declared according to the list of performance.
e. The health insurance company and the provider may agree on a different amount and method of payment of the services covered by the Classification No 0403, provided that performance No 25112 is declared within that basis according to the performance list.
f. The health insurance company and the provider may agree on a different amount and method of payment of the services paid under the Classification in the groups related to the diagnosis listed in Annex 10 to this Order, provided that DRG marker No 07257 or 07258 is declared under the basis of the Classification.
g. The health insurance undertaking and the provider may agree on a different amount and method of payment of the services covered by the Classification No 0819, provided that, within that basis, the performance No 66039 or 66041 is recognised according to the list of performance.
h. The health insurance company and the provider may negotiate in the contract a different amount and method of payment of the services paid also for services other than those referred to in points 2.1.2 (a) to (g).
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 according to the provider declared and the health insurance company of the recognised medicinal product at the unit price, but not exceeding the amount specified in points 2.2.1 and 2.2.2:
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 2015.
2.2.2. For diseases or diagnostic groups:
a. Fabry disease,
b. Gaucher disease,
c. Niemen-Pick disease,
d. Mukopolysaccharidosis I,
e. Mucopolysaccharidosis II,
f. Mucopolysaccharidosis VI;
g. Pompe's disease
h. Hyperamonaemia in children with hereditary disorders of urea and glutamine metabolism,
i. Hereditary Tyrosinaemia Type I,
j. Crohn's disease,
k. Colitis ulcerosa,
I. Pulmonary arterial hypertension,
Juvenile arthritis
n. Revmatoid arthritis,
o. Bechoreva's disease,
Psoriatic arthritis
q. Psoriasis heavy,
r. Asthma,
s. Parkinson's disease,
t. Multiple sclerosis,
u. Hepatitis,
V. Melanoma,
w. Ovary tumors,
x. Ophthalmologie-diabetes mellitus,
y. Ophthalmology,
z. Pneumology,
a. malignant prostate tumors,
bb. Autoinflation disease,
cc. Acromegaly,
d. central venous occlusion,
Uh. Digital ulceration in systemic scleroderma,
ff. Endocrine ophthalmopathy,
gg. Idiopathic pulmonary fibrosis,
hh. Narcolepsy with cataplexy,
ii. Tumours of the head and neck,
yj. Breast tumors
K. Nuclear medicine,
ll. Tumours of the stomach,
mm. Osteosarcoma,
nn. Soft tissue sarcomas,
O. Vitreomakular traction,
pp. Diseases not referred to in points 2.2.1 and 2.2.2 (a) to (oo).
the maximum remuneration shall be fixed as follows:
Uhrmax = Hotch = 1v12 * Uhri, 2015Mi, 2015 * UOPi, 2017 + Hotch = 1qUhrj, 2015 * 1,10 + Hotch = 1rUhrk, 2015 * 1,20 + UhrRS, 2015 * 1,24 + Uhrhep, 2016 * 1,10 + Hotch = 1sUhrl, 2015 * 1,60 + Hotch = 1tUhrm, 2015 * 1,30 + Hotn = 1uUhrn, 2015 * 1,20
where:
Uhrmax is the maximum remuneration in 2017.
i is 1 to p, where p is the number of diseases mentioned in point 2.2.2 (a) to (i).
j is 1 to q, where q is the number of diseases mentioned in point 2.2.2 (j) to (l).
k is 1 to r where r is the number of diseases mentioned in point 2.2.2 (m) to (s).
l is 1 to s where s is the number of the above diseases in point 2.2.2 (v) to (aa).
m is 1 to t, where t is the number of diseases listed in point 2.2.2 (bb) to (oo).
n equals 1 to u, where u is the number of the above diseases in point 2.2.2 (pp).
Uhri, 2015 is the total payment in 2015 for the treatment of disease i.
Mi, 2015 is the sum of the months during which the treatment was also provided to each individual insured person with this disease in 2015.
UOPi, 2017 is the number of unique insured persons treated in 2017 for the relevant disease i.
Uhrj, 2015 is the total remuneration in 2015 for the treatment of disease j.
Uhrk, 2015 is the total remuneration for the treatment of disease k.
UhrRS, 2015 is the total remuneration in 2015 for the treatment of the disease referred to in point 2.2.2 (t).
Uhrhep, 2016 is the total remuneration in 2016 for the treatment of the disease referred to in point 2.2.2 (u).
Uhrl, 2015 is the total remuneration for the treatment of disease l.
Uhrm, 2015 is the total payment for the treatment of disease in 2015.
Uhrn, 2015 is the total remuneration in 2015 for the treatment of disease n.
The maximum payment is set for all groups of diseases together.
2.2.3 Reimbursement of medicinal products provided to insured persons for treatment during the evaluation period above the total payment limit laid down in points 2.2.1 and 2.2.2 shall be paid in accordance with the prior agreement between the health insurance undertaking and the provider.
3. Reimbursement by case flat rate
3.1 In calculating CM2017,014 and CM2015,014, hospitalisation cases are converted by the rules for the classification and compilation of hospitalisation cases applicable for 2017.
3.2 For the performance of escorts No 00031 and 00032 according to the list of performances, excluded from the payment by case flat rate, a flat rate is fixed for the treatment day of CZK 406.
3.3. Medicinal products excluded from the flat-rate payment and listed in Annex 12 to this Regulation shall be paid by the health insurance undertaking to the provider at their declared unit price, but not more than their declared unit price in 2016.
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 shall include the services to be paid under the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree and shall be set at CELK Pudrg, 2017 as follows:
CELK Pudrag, 2017 = min1; CMred, 2017,014,100,96 * CM2015,014,10 * IPU * IZP-EM2017,10,
where:
CM2015,014,10 is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised which have been completed in the reference period which are classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree, multiplied by the indices 2017 listed in Annex 10 to this Decree.
EM2017,10 is the total value of the requested extramural care in the context of hospitalisation cases by a provider recognised and recognised by a health insurance undertaking that has been terminated in the assessment period and which are classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, valued at the values of the points applicable in the assessment period, including the costs of the separately charged material and the medicinal products separately charged.
min function minimum which selects the lowest value from the range of values.
and where the IPU is an individual flat-rate remuneration calculated as follows:
(i) IPU = 1,092 * Pudrag, 2015,10,
where:
Pudrg, 2015,10 is the reference amount of the remuneration for the provider declared and recognised by the health insurance company of the services provided during hospitalisation completed in the reference period which are classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree. If the provider holds a quality and safety certificate in accordance with Act No. 372 / 2011 Coll., on health services and the conditions for its provision, as amended, during the entire period of assessment, the health insurance company may increase Pudrg, 2015,10 by up to one percentage for the purpose of calculating the IPU. Pudrag, 2015,10 is calculated as follows:
Pudrg, 2015,10 = maxCM2015,012 * ZSmin, 10; CELK Pudrg, 2015 + EM2015 * CM2015,012,10CM2015,012
where:
CELK Pudrg, 2015 is the total flat-rate payment in the reference period.
ZSmin, 10 is the minimum basic rate, which is set at CZK 33,500 for the provider, who also has the status of a centre of highly specialised oncology care, centres of highly specialised cerebrovascular care, centres of highly specialised cardiovascular care, centres of highly specialised trauma care, centres of highly specialised oncological care and centres of highly specialised haematooncological care with a transplant unit according to Section 112 (5) of Act No. 372 / 2011 Coll., on health services and conditions of provision; for other providers, the minimum basic rate is CZK 24,000.
EM2015 is the total value of the requested extramural care in the context of hospitalisation cases by the provider declared and the health insurance company recognised, which have been terminated in the reference period and which are classified according to the Classification in the groups related to the diagnosis referred to in Annexes 10 and 13 to this Regulation, valued at the values of the points in force in the reference period, including the costs of separately charged material and medicinal products separately charged.
CM2015,012,10 is the number of hospitalisation cases reported by the provider and the health insurance company recognised, completed in the reference period and classified according to the Classification in the groups related to the diagnosis according to Annex 10 to this Decree, multiplied by indices 2015.
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Regulation Information
| Citation | Decree No 348 / 2016 Coll., on the determination of the values of the points, the amount of the fees paid and the regulatory restrictions for 2017 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 31.10.2016 |
|---|---|
| Effective from | 01.01.2017 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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