Decree No. 353 / 2017 Coll.
Decision on the establishment of the value of the item, the amount of the payments of the services paid and the regulatory restrictions for 2018
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Order
Effective from 01.01.2018
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353
DECLARATION
of 19 October 2017
on the determination of the values of the points, the amount of the remuneration of the services paid and the regulatory restrictions for 2018
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 2018 the value of the item, the amount of the payment of the services paid to insured persons under Section 2 (1) of the 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, Member States of 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 to insured persons of other States with whom the Czech Republic has concluded international social security agreements covering services (hereinafter referred to as "foreign insurers'), and regulatory restrictions on the remuneration referred to in Sections 3 to by the Contracting Providers of Health Services (hereinafter referred to as" the Provider '), and:
(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, 806, 807, 808, 809, 810, 812 to 819 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;
(k) care providers;
(l) Providers of home palliative care of the patient in a terminal state of expertise 926.
(1) The reference period for the purposes of this Decree is 2016.
(2) The evaluation period for the purposes of this Decree is 2018.
(3) All covered services provided in 2016, the provider reported by 31 March 2017 and the health insurance undertaking recognised by 31 May 2017 are included in the reference period.
(4) All the services provided in 2018, the provider reported by 31 March 2019 and the health insurance undertaking recognised by 31 May 2019 are included in the evaluation period.
(5) 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.
(6) 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 in the assessed 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.
(7) In calculating the total number of points recognised by the provider and by the health insurance undertaking 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 understood as points converted according to the list of performance, as effective on 1 January 2018, in which points are not included for the services paid to foreign insurers.
(8) 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 points. (c) the law and the providers of special bed care, paid at a flat rate per day of hospitalisation or according to the list of performance, 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 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 covered by the performance list, the value of the point for this expertise is set at 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 2018 does not exceed the total amount of these costs as laid down 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 than in 2016, the health insurance company will pay for this larger 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 1.15 shall be determined for the services provided by the health rescue service providers under the performance list, with the exception of the contracted performance of the transport according to 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 the contracted performance of the transport 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, payment for one day's stay shall be fixed at the amount of the contractually agreed remuneration for one day's stay for 2017. If the payment for one day's stay for 2017 was not agreed on 31 December 2017, the payment shall be set at CZK 1 092. The payment for the accommodation and food of the insured person's guide is set at the same amount as the payment for these components for insured persons who are provided with comprehensive spa rehabilitation care for adults.
(2) For complex spa rehabilitation care for children and under 18 years of age provided in the health facilities of the spa rehabilitation care provider, a payment for one day's stay of 106% of the contracted remuneration for one day's stay for 2017 shall be provided. If the payment for one day's stay for 2017 was not agreed on 31 December 2017, the payment is set at CZK 1,404. The payment for the accommodation and food of the insured person's guide is set at the same amount as the payment for these components for insured persons who are provided with comprehensive spa rehabilitation care for adults.
(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 the amount of the contractually agreed remuneration for one day of stay for 2017. If the payment for one day's stay for 2017 was not agreed on 31 December 2017, the payment shall be 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 of 106% of the contracted remuneration for one day of stay for 2017 shall be provided for. If the payment for one day's stay for 2017 was not agreed on 31 December 2017, 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 is set for one day's stay of CZK 865. The payment for the accommodation and food of the insured person's guide shall be set at the same rate as the payment for these components for the insured persons who are provided with the services paid at the health care centre.
(1) For each provider declared and the health insurance company recognised performance No. 09543 according to the list of performances, a remuneration of CZK 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) Paragraphs 1 and 2 shall not apply to providers of spa rehabilitation care in the provision of spa rehabilitation care.
(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 remuneration for the services to be paid as set out in Annex 1 to this Order.
Grounded services provided by providers in the expertise 005 - hospital pharmacies are paid according to the list of health performance with the value of a point of CZK 1. This remuneration shall not be taken into account in the amount of remuneration for the services to be paid as set out in Annex 1 to this Order.
For paid services provided by professional providers 926 - home palliative care of the patient in the terminal state according to the performance list, the value of the point for this expertise is determined for adult patients of CZK 1 for 30 days, then CZK 0.50. In paediatric patients, the value of the point for this expertise is set at CZK 1 for 90 days, then CZK 0.50.
This Decision shall enter into force on 1 January 2018.
Minister:
JUDr.
Příloha č. 1
Annex No 1 to Decree No 353 / 2017 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 2018 shall include the contractually agreed remuneration component, the case flat-rate remuneration, the remuneration to be paid on the case flat-rate payment and the payment for outpatient care ("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 2016, the provider declared by 31 March 2017 and the health insurance company recognised by 31 May 2017 shall be included in the calculation.
2. Individual contractually agreed payment component
2.1 The individually contracted remuneration component may include the services paid in accordance with points 2.1.1 to 2.1.9. In such cases, the remuneration for such services shall not be included in the remuneration referred to in points 3 and 4.
2.1.1 The individually contracted component of the remuneration may include paid services classified under the Classification of hospitalised patients (4) (hereinafter referred to as "Classification") in bases 0501, 0507, 0511, 0516, 0522, 0523, 0524, 0526, 0527 and 0528 listed in Annex 10 thereto.
2.1.2 Furthermore, the health insurance company and the provider may agree on a different amount and method of payment of the services covered by the Basses Classification Nos 0001, 0002, 0003, 0014, 0204, 0802, 0804, 0818 and 1101, taking into account the change in the prices of the materials contained in the individual bays.
2.1.3 The health insurance company and the 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 high-level care and ensuring sufficient capacity of the provider, necessary to ensure availability and for emergencies.
2.1.4 The health insurance company and the provider may agree on a different level 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 care for infectious patients and for higher fixed costs.
2.1.5 The health insurance company and the provider may agree on a different amount and method of payment of the services covered by the Baza No 1105, provided that power is declared under that basis in accordance with the list of performance.
2.1.6 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 list of performance.
2.1.7 The health insurance company and the provider may agree on a different level 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.
2.1.8 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 0819, provided that performance No 66039 or 66041 is declared within that basis according to the list of performance.
2.1.9 The health insurance company and the provider may negotiate in the contract a different amount and method of payment of the services paid for and for services other than those referred to in points 2.1.1 to 2.1.8.
2.2 The amount of payments of medicinal products and foodstuffs for special medical purposes (hereinafter referred to as the "medicinal product"), marked "S" in accordance with § 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 a unit price, but not exceeding the amount specified in points 2.2.1 to 2.2.3:
2.2.1. For HIV / AIDS, 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 2016.
2.2.2 For groups:
| a) | Dermatologie (Aktinická keratóza, Psoriáza těžká) |
| b) | Dýchací soustava (Astma, CHOPN, Idiopatická plicní fibróza) |
| c) | Endokrinologie (Akromegalie, Endokrinní oftalmopatie, Toxická struma štítné žlázy, Růstové hormony) |
| d) | Hematoonkologie (Leukemie, Lymfomatózní meningitida, Lymfomy, Mnohočetný myelom, Myelo-dysplastické syndromy, Podpůrná hematoonkologie, Zhoubné imunoproliferativní nemoci, Hematologie) |
| e) | Imunitní systém (Autoinflamatorní onemocnění, Digitální ulcerace u systémové sklerodermie, Polyangiitida, Transplantace) |
| f) | Infekce (Chronická hepatitida) |
| g) | Metabolické vady (Fabryho choroba, Gaucherova choroba, Metabolické vady |
| h) | Neurologie (Epilepsie, Narkolepsie, Parkinsonova choroba, Roztroušená skleróza, Substituční léčba) |
| i) | Oběhový systém (Plicní arteriální hypertenze) |
| j) | Oftalmologie (Centrální venózní okluze, Makulární degenerace, Oftalmologie - DM, Vitreomakulární trakce, Oftalmologie - jiné) |
| k) | Onkologie - solidní nádory (Hepatocelulární karcinom, Nádory hlavy a krku, Nádory kolorekta, Nádory ledviny, Nádory močového ústrojí, Nádory mozku, Nádory ovarií, Nádory plic, Nádory prostaty, Nádory prsu, Nádory slinivky, Nádory štítné žlázy, Nádory z embryonálních buněk, Nádory žaludku, Osteosarkom, pNET, Sarkomy měkkých tkání, Jiné nádory měkkých tkání, Jiné ZN kůže, Kožní lymfomy, Maligní melanom, Mezoteliom pleury) |
| l) | Osteoporóza |
| m) | Revmatologie (Bechtěrevova choroba, Artritida, Lupus erythematosus, Psoriatická artritida) |
| n) | Trávicí soustava (Crohnova choroba, Ulcerózní kolitida) |
| o) | Ostatní - výše neuvedená onemocnění |
the maximum remuneration shall be fixed as follows:
Uhrmax, 2018 = Istrii = aoUhri, 2016 * INi
where:
Uhrmax. The maximum remuneration in the evaluation period shall be 2018.
i takes the values and up to, where and up to, the diagnostic groups referred to in paragraph 2.2.2.
Uhri, 2016 is the total remuneration in the reference period for the treatment of the disease i.
INi is the index of the remuneration increase for group i, as referred to in point 2.2.3.
The maximum payment is set for all groups of diseases together.
2.2.3 The index of the increase in remuneration shall be set at:
| Diagnostická skupina | Index navýšení úhrady |
|---|---|
| Dermatologie | 1,10 |
| Dýchací soustava | 1,15 |
| Endokrinologie | 0,95 |
| Hematoonkologie | 1,16 |
| Imunitní systém | 1,00 |
| Infekce | 1,20 |
| Metabolické vady | 1,00 |
| Neurologie | 1,15 |
| Oběhový systém | 1,15 |
| Oftalmologie | 1,20 |
| Onkologie - solidní nádory | 1,16 |
| Osteoporóza | 1,00 |
| Revmatologie | 1,05 |
| Trávicí soustava | 1,10 |
| Ostatní | 1,14 |
2.2.4. Reimbursement of medicinal products provided to insured persons for treatment in the evaluation period above the total reimbursement limit laid down in points 2.2.1 to 2.2.3 shall be paid in accordance with a prior agreement between the health insurance undertaking and the provider.
3. Reimbursement by case flat rate
3.1 In calculating CM2018,015 and CM2016,015, hospitalisation cases are converted by means of classification rules.
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 447.
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 the level of their declared unit price, but not more than their declared unit price in 2017.
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 covered by the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree and shall be set at CELK Pudrg, 2018, as follows:
CELK Pudrg, 2018 = min1; CMred, 2018,015,100,95 * CM2016,015,10 * IPU * IZP + Sisters, 10-EM2018,10
where:
CM2016,015,10 is the number of hospitalisation cases reported by the provider and the health insurance company recognised, which have been completed in the reference period and which are classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree, multiplied by the relative weights 2018 listed in Annex 10 to this Decree.
EM2018,10 is the total value of the requested extramural care in the context of hospitalisation cases by the provider of recognised and recognised health insurance, which has been completed in the evaluation 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 Points (HB) values applicable in the evaluation period, including the cost 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 = Pudrag, 2016,10 * KN10
where:
Pudrg, 2016.10 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 under 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, 2016.10 by up to one percentage for the purposes of calculating the IPU. Pudrg, 2016,10 is calculated as follows:
Pudrag, 2016,10 = maxCM2016,015,10 * ZSmin, 10; CELK Pudrg, 2016 + IRELAND = 1nÚHRj2016 + EM2016
where:
CELK Pudrg, 2016 is the total flat-rate payment in the reference period.
ZSmin, 10 is a minimum basic rate, which is set at CZK 35 500 for a provider who also has the status of a centre of highly specialised cerebrovascular care, centres of highly specialised complex cardiovascular care for adults and centres of highly specialised oncological care according to § 112 (5) of Act No. 372 / 2011 Coll., on health services and the conditions for providing them. If the provider does not meet the conditions set out in the first sentence, but has the status of the centre of highly specialised oncological care as well as the status of the centre of highly specialised trauma care for children as well as the status of the centre of highly specialised cerebrovascular care or highly specialised care for patients with an event under Section 112 (5) of Act No. 372 / 2011 Coll., on health services and the conditions of their provision, then the minimum basic rate is set at CZK 32 500. For other providers, the minimum standard rate is CZK 25,000.
The EM2016 is the total value of the requested extramural care in the context of hospitalisation cases by the provider of recognised and recognised health insurance companies that are terminated in the reference period and are classified according to the Classification in the groups related to the diagnosis referred to in Annex 10 to this Regulation, valued at the Points (HB) values applicable in the reference period, including the costs of separately charged material and medicinal products separately charged.
The amount of assigned revenue in accordance with Article 21 (3) of the Financial Regulation is estimated at EUR 5000000.
max function maximum that selects the highest value from the range of values.
and where:
KN10 is the increase coefficient to be calculated as follows:
KN10 = 1 + 0,15ARCTG140 * Pudrag, 2016,10CM2016,015,10-21000
where:
ARCTG is the function of Arkus tangens
(ii) CMred, 2018,015,10 is calculated as follows:
(a) Where the number of providers declared and the health insurance undertaking recognised by hospitalisation is completed in the reference or evaluation period in the groups referred to in the Classification referred to in Annex 10 to this Regulation and which have been completed by the transfer of a patient to a downstream care provider or to a follow-up department of the same provider (hereinafter referred to as "treatment termination code 4") or by the transfer of a patient to another acute bed care provider (hereinafter referred to as "treatment termination code 5"), less than or equal to 100, or if PPRdrg, 2018,4,5 ≤ 0,1 * PPdrg, 2018 or if PPRdrg, 2016,4,5 ≤ 0,1 * PPdrg, 2016 is determined as follows:
CMred, 2018,015,10 = minCM2018,015,10; CM2018,015,00,2 * X * PPdrg, 2018 * CM2016,015,10PPdrg, 20160,8
where:
The value of X shall be 1,05 where the ratio of the number of insured persons of the insurance undertaking in that district, as set out in Annex 14 to this Decree, is greater than 0,01, and of 1,15 where the ratio of the number of insured persons of the insurance undertaking in that district is less than or equal to 0,01, as defined in Annex 14 to this Decree.
CM2018,015,10 is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised which have been completed in the evaluation period which are classified according to Classification in groups related to the classification diagnosis and which are listed in Annex 10 to this Decree, multiplied by the relative weights 2018, as set out in Annex 10 to this Decree.
This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.
The applicant shall provide the following information:
(b) In other cases:
CMred, 2018,015,10 = CMred 1 + CMred 2,
where:
CMred 1 = minCM1,2018,015,10; CM1,2018,015,100,2 * X * PP1, drag, 2018 * CM1,2016,015,10PP1, drag, 20160,8,
where:
CM1,2018,015,10 is the number of hospitalisation cases reported and recognised by the health insurance company that have been completed in the evaluation period which are classified according to the Classification in the diagnostic groups listed in Annex 10 to this Regulation and which have not been terminated by the end code of treatment 4 or the end code of treatment 5, multiplied by the relative weights 2018, as set out in Annex 10 to this Regulation.
CM1,2016,015,10 is the number of hospitalisation cases reported by the provider and 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 Regulation and which have not been terminated by the end code of treatment 4 or the end code of treatment 5, multiplied by the relative weights 2018, as set out in Annex 10 to this Regulation.
PP1, drg, 2018 is the number of providers declared and the health insurance company recognised by hospitalisation, completed in the evaluation period included in the classification groups listed in Annex 10 to this Regulation and not terminated by the treatment termination code 4 or treatment termination code 5.
PP1, drg, 2016 is the number of providers declared and the health insurance company recognised by hospitalisation, completed in the reference period classified in the groups related to the diagnosis according to the Classification, which are listed in Annex 10 to this Decree and which have not been terminated by the treatment termination code 4 or the treatment termination code 5.
and where:
CMred 2 = CM2018,015,10,4,5 * min1; 1,05 * PPRdrg, 2016,4,5PPRdrg, 2018,4,5 * PPdrg, 2018PPdrg, 2016,
where:
CM2018,015,10,4,5 is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised which have been completed in the evaluation period which are classified according to the Classification in the diagnostic groups listed in Annex 10 to this Regulation and which have been terminated by the cessation code of treatment 4 or treatment code 5, multiplied by the relative weights 2018, as set out in Annex 10 to this Regulation.
PPRdrg, 2018,4,5 is the number of providers declared and the health insurance company recognised by hospitalisation, completed in the evaluation period classified in groups related to the diagnosis according to the Classification, which are listed in Annex 10 to this Decree, and which have been terminated by treatment termination code 4 or treatment termination code 5.
PPRdrg, 2016,4,5 is the number of providers declared and the health insurance company recognised by hospitalisation, completed in the reference period in groups related to the diagnosis according to the Classification, as set out in Annex 10 to this Decree, which have been terminated by treatment termination code 4 or treatment termination code 5.
(iii) IZP is the index of the change in production calculated as follows:
IZP = max1; ARCTG3 * CMred, 2018,015,10CM2016,015,10-1,56 * IGUP
where:
IGUP is an index of change in the number of global unique hospitalised insured persons calculated as:
(a) If CMred, 2018,015,10CM2016,015,10 ∞ 1, then:
IGUP = max0; min1; GUP2018GUP2016-10,5 * CMred, 2018,015,10CM2016,015,10-1
b) If CMred, 2018,015,10CM2016,015,10 = 1, then IGUP = 1.
where:
GUP2018 is the number of global unique hospitalised insured persons for whom the recognised and recognised services provided by the health insurance company during hospitalisation completed during the evaluation period, classified according to Classification in the groups related to the diagnosis listed in Annex 10 to this Decree.
GUP2016 is the number of global unique hospitalised insured persons for which recognised and recognised services provided by health insurance companies during hospitalisation completed in the reference period which are classified under the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree.
(iv) Secretaries, 10 is an increase in the remuneration of health care providers, calculated as follows, for health care providers, for health care providers carrying out a non-medical medical profession without professional supervision, alternately under three-shift or continuous operating arrangements:
Departmental, 10 = min.
where:
CetOD2016,10, i is the number of reported and health insurance undertakings of recognised performance of the treatment day type i that have been reported in hospitalisation cases completed in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree, where it also takes values 1 to n and indicates the type of treatment day according to the performance list.
CetOD2018,10, i is the number of reported and health insurance undertakings of recognised performance of the treatment day type i that have been reported in hospitalisation cases completed in the evaluation period classified according to the classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, where i is equal to 1 to n and indicates the type of treatment day according to the performance list.
Increase Odi is the increase for the treatment day of type i, as set out in Annex 9 to this Decree.
4. Reimbursement in the form of a flat rate payment
4.1 The remuneration to be paid in the form of a flat-rate payment shall include the services covered by the Classification in the groups related to the diagnosis listed in Annex 13 to this Decree.
4.2 Hospital cases are, when calculating CM2018,015,13, CM2018,015,13, trans and CM2016,015,13, cases of hospitalisation converted by the rules for the classification and compilation of hospital cases applicable for 2018.
4.3. 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 the level of their declared unit price, but not more than their declared unit price in 2017.
4.4 For the services covered by the Classification included in the groups related to the diagnosis and listed in Annex 13 to this Order, which are excluded from the remuneration in the form of a flat rate, by the provider declared and by the health insurance undertaking recognised for the period of assessment, except in cases classified under the Classification under Articles 0001 and 0002, a remuneration shall be set at:
KN13 * CM2018,015,13 * maxIZS2016,13; ZSmin, 13 + Sisters, 13-EM2018,13,
where:
CM2018,015,13 is the number of hospitalisation cases completed in the evaluation period and by a health insurance undertaking recognised under the Classification, which are classified in the groups related to the diagnosis listed in Annex 13 to this Decree, except in cases classified under the Classification headings 0001 and 0002, multiplied by the relative weights 2018 listed in Annex 13 to this Decree.
EM2018,13 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 according to the Classification in the diagnostic groups listed in Annex 13 to this Regulation, except for cases classified as Bases 0001 and 0002, valued by the Body (HB) values applicable in the evaluation period, including the cost of separately charged material and medicinal products separately charged.
ZSmin, 13 is the minimum basic rate of CZK 27,000.
IZS2016,13 is the individual base rate calculated as follows: Udrg, 2016,13CM2016,015,13,
where:
Udrg, 2016,13 is the total amount of remuneration for the provider declared and the health insurance undertaking recognised by the paid services provided during hospitalisation completed in the reference period, which, according to the Classification, are included in the diagnostic groups listed in Annex 13 to this Regulation, except in cases classified as Bases 0001 and 0002, including the settlement of regulatory restrictions, with the exception of the regulation on prescribed medicinal products and medical devices, increased by the value of the required extramural care valued at the Bod (HB) values in force in the reference period, including the costs of separately charged material and separately charged medicinal products reduced by the reimbursement of the medicinal products listed in Annex 12 to that decree.
CM2016,015,13 is the number of hospitalisation cases completed in the reference period and by a health insurance undertaking recognised under the Classification, which are included in the groups related to the diagnosis listed in Annex 13 to this Regulation, except in cases classified in Bases 0001 and 0002, multiplied by the relative weights 2018, set out in Annex 13 to this Regulation.
and where:
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Regulation Information
| Citation | Decree No 353 / 2017 Coll., establishing the values of the points, the amount of payment of the services paid and the regulatory restrictions for 2018 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 30.10.2017 |
|---|---|
| Effective from | 01.01.2018 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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