Decree No 396 / 2021 Coll.
Order setting the value of the item, the amount of the remuneration for the services paid and the regulatory restrictions for 2022
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Effective from 01.01.2022
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396
DECLARATION
of 21 October 2021
on the determination of the value of the points, the amount of the remuneration for services paid and the regulatory restrictions for 2022
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.:
(1) This Decree provides for 2022:
(a) the value of the point;
(b) the amount of compensation paid to insured persons under Article 2 (1) of Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended, (hereinafter referred to as "the Act");
(c) the level of reimbursement of paid services to insured persons from other Member States of the European Union, the Member States of the European Economic Area and the Swiss Confederation under the directly applicable provisions of the European Union relating to the coordination of social security systems (1), to UK insured persons under the Agreement on Trade and Cooperation (2) and to insured persons of other States with which the Czech Republic has concluded international social security agreements covering the field of paid services (3) (hereinafter referred to as "foreign insured persons"),
(d) the regulatory restriction on the remuneration referred to in Sections 3 to 19 provided by the contracting health service providers (hereinafter referred to as the provider).
(2) The provider is the provider
(a) bed care;
(b) in the field of general practical medicine and the provider of practical medicine for children and adolescents;
(c) specialised outpatient care, a provider of dialysis health care and a provider of expertise 905, 919 and 927 in accordance with the Decree issuing a list of health performances with points (4) (hereinafter referred to as "the list of performances"),
(d) outpatient care in expertise 603 and 604 according to the performance list;
(e) dental medicine;
(f) outpatient care in the field of expertise 222, 801, 802, 806 to 810, 812 to 819 and 823 according to the performance list (hereinafter referred to as "the listed expertise"),
(g) outpatient care in expertise 914, 916, 921 and home care provider 925 and 926 according to the performance list;
(h) outpatient care in expertise 902 and 917 according to the performance list;
(i) emergency care services, patient transport providers, medical transport service providers, medical emergency services providers and dental emergency services providers;
(j) spa rehabilitation and rehabilitation services,
(k) pharmacy care.
(1) The reference period for the purposes of this Decree is 2019. The benchmark values of the provider shall be the values of the relevant payment indicators of the provider in the reference period.
(2) The evaluation period for the purposes of this Decree is 2022.
(3) This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.
(4) All services provided in 2022, the provider declared by 31 March 2023 and the health insurance company recognised by 31 May 2023 are included in the evaluation period.
(5) 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.
(1) For the purposes of this Decree, a unique insured person shall mean an insured person of a health insurance undertaking treated by a provider in a specific professional capacity in an assessment or reference period at least once, and it shall not be determined whether it is a treatment under its own health services or health services requested unless otherwise specified.
(2) Where a unique insured person has been treated more than once by the provider in a particular professional capacity in the evaluation period or reference period, the number of unique insured persons shall include the relevant health insurance undertaking treated in that professional activity only once.
(3) In the event of a merger of health insurance undertakings, the insured person for whom more than one of the merged health insurance companies has been paid during the evaluation period or reference period shall be included only once in the number of individual insured persons.
(4) For the purposes of this decree, a global unique insurer means an insurer of a health insurance undertaking treated by a sleeper care provider in any professional capacity within the framework of his own or requested health services in an evaluation or reference period at least once, unless otherwise specified.
(5) If a global unique insured person has been treated by the provider more than once during the evaluation period or reference period, regardless of the number of specialists in which the insured person has been treated, the number of global unique insured persons shall include the relevant health insurance companies treated with that provider only once.
(6) In the event of a merger of health insurance undertakings, an insured person for which more than one of the merged health insurance companies has been paid for during the evaluation period or reference period shall be included only once in the number of global unique insured persons.
(7) If the health insurance undertaking is to use the values of the remuneration indicators of comparable providers when determining the level of remuneration or regulatory restrictions, it shall use the relevant values of all contractual providers that provide health services in a comparable overall scale and structure over the evaluation period as the provider for which the provisions on comparable providers are applied.
(8) International classification of diseases for the purposes of this Decree means the International Statistical Classification of diseases and associated health problems in its current version (MKN-10) 5.
(9) For the purposes of this Ordinance, office hours are the one agreed in the contract between the health insurance company and the provider where at least one health worker with specialised competence in the relevant field is available at the place of work of the insured person, not including the time devoted to the visiting service and administrative activities.
In the case of the provision of paid services to foreign insured persons, the remuneration shall be determined in accordance with § 5 to 19.
(1) For paid services provided by bed care providers, with the exception of paid services provided by post-bed care providers, long-term bed care or special bed care providers, the value of the point, the amount of payment of paid services and the regulatory limit shall be as set out in Annexes 1, 9, 10 and 12 to this Decree.
(2) For paid services provided by providers of post-bed care, long-term bed care, special bed care or special outpatient care provided under § 22 (c) of the Act, the value of the point, the amount of payments paid by the services and the regulatory limit are 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.
The amount of the remuneration of the paid services provided by dental care providers and the relevant regulatory limit is set out in Annex 11 to this Decree.
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 outpatient care providers in expertise 914, 916, 921 and home care providers in expertise 925 and 926 according to the list of performances paid according to the list of performances, the value of the point and the amount of the payments of the services paid is 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.
The value of the point and the amount of the payment of the services paid shall be set out in Annex 8 to this Decree for the services provided by the dialysis providers covered by the list of services.
(1) The value of a point of CZK 1.31 shall be determined for the services provided by the health rescue service provider, except for the performance of transport according to the performance list, for which the value of a point of CZK 1.23 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 1.15 is determined. The remuneration to the provider for the reported performance No 06714 according to the performance list in the assessment period shall not exceed 1,05 times the number of performance provided and reported in the reference period.
(2) For paid services provided by patients transport providers of urgent care paid according to the performance list, the value of the point of CZK 1.29 shall be determined, except for the performance of the transport according to the performance list, for which the value of the point of CZK 1.23 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 1.15 is determined. The remuneration to the provider for the reported performance No 06714 according to the performance list in the assessment period shall not exceed 1,05 times the number of performance provided and reported in the reference period.
(1) For the services provided by the health transport service provider, the amount of remuneration shall be determined on the basis of the performance list by remuneration for the services provided to the provider.
a) providing a 24-hour medical transport service with a value of CZK 1.23,
b) not providing a health transport service in continuous operation with a value of CZK 1.01.
(2) For the performance of transport No. 69 according to the list of performances, the value of the point is 1,11 CZK.
(1) The value of the point of CZK 1.05 for medical and transport performance according to the performance list shall be determined for the services provided by the provider.
(2) Paragraph 9 shall apply in order to determine the level of remuneration of paid services provided by providers in the context of dental emergency services and to establish regulatory restrictions on such services.
(1) For comprehensive spa rehabilitation care for adults, children and young people provided in the health facilities of the spa rehabilitation care provider, payment for 1 day of stay shall be fixed at 118% of the contracted remuneration for 1 day of stay for 2019. If the payment for 1 day of stay for 2019 has not been agreed upon by 31 December 2019 inclusive, the remuneration shall be set at the level of the remuneration paid to comparable providers. The payment for the accommodation and food of the insured person's guide is set at the same amount as the payment for these components for insured persons who are provided with comprehensive spa rehabilitation care for adults.
(2) For the benefit of the spa rehabilitation care for adults, children and young people provided in the health facilities of the spa rehabilitation care provider, payment shall be made for 1 day of stay equal to 118% of the contracted remuneration for 1 day of stay for 2019. If the payment for 1 day of stay for 2019 has not been agreed upon by 31 December 2019 inclusive, the remuneration shall be set at the level of the remuneration paid to comparable providers.
(3) For the benefit of spa rehabilitation care, the payment of CZK 32 is determined for the declared performance No. 09543 according to the list of performances. This performance may be declared to the insurance undertaking no more than three times during one medical stay of the insured person.
(4) For the services provided in the recovery rooms, the payment for 1 day's stay is set at CZK 1 068, which consists of an accommodation, catering and recovery programme component. 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 42 is set.
(2) For each provider declared and the health insurance undertaking recognised performance No. 09115 according to the list of performance reported for patients diagnosed with U07.1 or U69.75 according to the international classification of diseases, the provider is increased by CZK 100, except for the performance performed in his own social environment by the insured person, for which the provider is increased by CZK 300. This increase in remuneration shall not be included in the amount of remuneration determined in accordance with Annexes 1 to 8 to this Order.
(3) The remuneration referred to in paragraphs 1 and 2 shall not be included in the maximum remuneration for the services paid.
(4) Paragraph 1 shall not apply to providers of spa rehabilitation care and to providers of general medical practice, to providers of practical medicine for children and adolescents, to providers of dental care and to providers of outpatient care in the field of expertise 603 and 604 according to the performance list.
(1) For each provider declared and the health insurance company recognised performance No. 09552 according to the list of performances, a remuneration of CZK 18 is determined.
(2) No later than 150 days after the end of the period of assessment, the health insurance company will pay the provider CZK 13 for each transfer of the paper recipe into electronic form if, on the basis of this recipe, a medicinal product paid from the public health insurance was issued to its insured person.
This Decree shall take effect on 1 January 2022.
Minister:
Mgr. et Mgr. Vojtěch, MHA, v. r.
Příloha č. 1
Annex No 1 to Decree No 396 / 2021 Coll.
Value of the point, amount of payments of services paid and regulatory restrictions pursuant to § 5
A) Bounded services pursuant to § 5 (1)
1. The remuneration to the provider during the evaluation period shall include the contractually agreed remuneration component referred to in point 2, the flat-rate remuneration referred to in point 3, the remuneration allocated to the flat-rate payment referred to in point 4, the case flat-rate payment referred to in point 5, the payment for acute bed-keeping for a small number of insured persons and foreign insured persons referred to in point 6, the payment for outpatient care referred to in point 7 (the "outpatient remuneration component ') and the other remuneration referred to in point 8.
2. Individual contractually agreed payment component
2.1 Where the health insurance undertaking and the provider agree on a different amount and method of payment of the services paid and for the services covered by the flat-rate payment, in the payment of the flat-rate payment or in the form of a flat-rate payment, the remuneration for those services shall not be included in the remuneration referred to in points 3 to 7.
2.2 The amount of the reimbursement of medicinal products and foodstuffs for special medical purposes (hereinafter referred to as the "medicinal product"), marked "S" in accordance with Paragraph 39 (1) of Decree No. 376 / 2011 Coll., implementing certain provisions of the Public Health Insurance Act (hereinafter referred to as "Decree No. 376 / 2011 Coll."), shall be determined according to the provider declared and the health insurance company of the recognised medicinal product in the unit price, but not more than the amount mentioned in points 2.2.1 to 2.2.3.
2.2.1. For HIV / AIDS disease, hereditary angioedema and for prophylaxis of children at risk exposed to respiratory syncytic virus exposure, the maximum remuneration per administered medicinal product shall be set at the level of the provider declared and the health insurance company recognised remuneration in 2020.
2.2.2 For groups:
| a) | Dermatologie (aktinická keratóza, psoriáza těžká a jiná kožní onemocnění) |
| b) | Dýchací soustava 1 (astma, CHOPN) |
| c) | Dýchací soustava 2 (idiopatická plicní fibróza, intersticiální pneumonie) |
| d) | Endokrinologie (akromegalie, endokrinní oftalmopatie, toxická struma štítné žlázy, růstové hormony) |
| e) | Hematoonkologie (leukemie, lymfomatózní meningitida, lymfomy, mnohočetný myelom, myelo-dysplastické syndromy, podpůrná hematoonkologie, zhoubné imunoproliferativní nemoci, hematologie) |
| f) | Imunitní systém (autoinflamatorní onemocnění, digitální ulcerace u systémové sklerodermie, polyangiitida, transplantace) |
| g) | Infekce (hepatitida C) |
| h) | Metabolické vady (Fabryho choroba, Gaucherova choroba, Niemann-Pickova choroba, metabolické vady) |
| i) | Neurologie 1 (epilepsie, narkolepsie, migréna, Parkinsonova choroba, substituční léčba) |
| j) | Neurologie 2 (roztroušená skleróza) |
| k) | Neurologie 3 (spinální svalová atrofie) |
| l) | Oběhový systém (plicní arteriální hypertenze) |
| m) | Oftalmologie (centrální a periferní venózní okluze, choroidální neovaskularizace, věkem podmíněná makulární degenerace, oftalmologie – diabetes mellitus, vitreomakulární trakce, Leberova optická neuropatie, neinfekční uveitida, autologní buňky lidského rohovkového epitelu) |
| n) | Onkologie – solidní nádory (hepatocelulární karcinom, nádory hlavy a krku, nádory kolorekta, nádory ledviny, nádory močového ústrojí, nádory mozku, nádory ovarií a dělohy, nádory plic, nádory prostaty, nádory prsu, nádory slinivky, nádory štítné žlázy, nádory z embryonálních buněk, nádory žaludku, osteosarkom, neuroendokrinní tumory, sarkomy měkkých tkání, jiné nádory měkkých tkání, jiné zhoubné nádory kůže, kožní lymfomy, maligní melanom, mezoteliom pleury, hemangiom, gastrointestinální stromální tumory) |
| o) | Revmatologie (Bechtěrevova choroba, artritida, systémový lupus erythematosus, psoriatická artritida) |
| p) | Trávicí soustava (Crohnova choroba, ulcerózní kolitida) |
| q) | Cystická fibróza |
| r) | Ostatní – výše neuvedená onemocnění s výjimkou skupiny hepatologie |
| s) | Hepatologie – onemocnění jater a žlučových cest (primární biliární cholangitida) |
the maximum remuneration shall be fixed as follows:
Uhrmax, 2022 = Uhrs, 2021 + Istrii = arUhri, 2020 * INi
where:
Uhrmax, 2022 is the maximum remuneration in the evaluation period.
i takes the values and up to r, where and up to r are the diagnostic groups referred to in paragraph 2.2.2.
Uhri, 2020 is the total payment in 2020 for the treatment of disease i.
Uhrs, 2021 is the total remuneration in 2021 for the treatment of hepatology disease.
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 remuneration increase shall be set at:
| Skupina | Index navýšení úhrady |
|---|---|
| a) Dermatologie | 1,29 |
| b) Dýchací soustava 1 | 1,50 |
| c) Dýchací soustava 2 | 1,31 |
| d) Endokrinologie | 1,00 |
| e) Hematoonkologie | 1,19 |
| f) Imunitní systém | 1,31 |
| g) Infekce | 1,00 |
| h) Metabolické vady | 1,20 |
| i) Neurologie 1 | 1,21 |
| j) Neurologie 2 | 1,06 |
| k) Neurologie 3 | 1,21 |
| l) Oběhový systém | 1,10 |
| m) Oftalmologie | 1,14 |
| n) Onkologie – solidní nádory | 1,16 |
| o) Revmatologie | 1,09 |
| p) Trávicí soustava | 1,14 |
| q) Cystická fibróza | 1,20 |
| r) Ostatní | 1,35 |
2.2.4 Reimbursement for the treatment of medicinal products provided to insured persons during the evaluation period above the total reimbursement limit set out 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. Flat payment
3.1 The flat-rate payment includes paid services classified according to the rules for the classification of hospitalised patients for the year 20226 (hereinafter referred to as "Classification") into groups related to the diagnosis listed in Annex 10, Part A to this Decree.
3.2 In the calculation of variables in the reference period, hospitalisation cases are defined as those converted by the Classification.
3.3 For performances from 00031 and 00032 according to the list of performances, excluded from the flat rate payment, the flat rate for the treatment day is set at CZK 484.
3.4. Medicinal products excluded from the flat-rate payment and listed in Annex 12 to this Order shall be paid by the health insurance undertaking to the provider at the level of their declared unit price, but not more than their declared unit price in 2021.
3.5 Required extramural care means care related to the hospitalisation of an insurer with a provider requested by the provider and provided to the insurer at the time of hospitalisation by another provider charging it to the health insurance company.
3.6 The amount of the flat-rate remuneration shall be determined as the FOREIGN, CZ- DRG, 2022, depending on the expression:
EMBRPU, CZ- DRG, 2022 = min1; CMred, 2022, CZ- DRG, A0,95 * CM2019, CZ- DRG, A * IPU * IZP-EM2022, A
where:
CM2019, CZK-DRG, A is the number of hospitalisation cases recalculated in accordance with point 3.2 by the provider declared and the health insurance undertaking recognised, terminated in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Decree, multiplied by the relative weights 2022 listed in Annex 10, Part A to this Decree.
EM2022, A 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, terminated in the assessment period, classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Regulation, valued at the values of the points applicable in the assessment period, including remuneration for the material separately charged 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 = Pudrg, 2019 * 1,227 * CM2019, CZ- DRG, Apala indexyCM2019, CZ- DRG, A
where:
CM2019, CZK-DRG, APA indices are the number of hospitalisation cases converted in accordance with point 3.2 by the provider declared and the health insurance undertaking recognised and terminated in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Decree, multiplied by the plateadindexed relative weights listed in Annex 10, Part A to this Decree.
Pudrg, 2019 is the reference amount of the remuneration for the provider declared and the health insurance undertaking recognised by the services paid by the flat-rate payment, calculated as follows:
Pudrag, 2019 = maxCM2019, CZ- DRG, A-D, H * ZSmin, 2019, PU; CELK PUDRG, 2019 + ITEM = 1nÚHRISU2019 + EM2019, A-D, H * CM2019, CZ- DRG, ACM2019, CZ- DRG, A-D, H
where:
CM2019, CZK-DRG, A-D, H is the number of hospitalisation cases recalculated in accordance with point 3.2 by the provider recognised and the health insurance undertaking recognised, terminated in the reference period, classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Parts A to D and Part H to this Order, multiplied by the relative weights 2022 set out in Annex 10, Parts A to D and Part H to that decree.
CELK Pudrg, 2019 is the total amount of the flat-rate remuneration in the reference period, including the corresponding increase in the remuneration for the increase of the allowance to non-medical health professionals who are engaged in the non-medical profession alternately in a three-shift or continuous operating regime for providers of bed care services.
ZSmin, 2019, PU is a minimum basic rate, which is set at CZK 51 700 for a provider who has the status of a centre of highly specialised oncological care and at the same time the status of at least two centres of highly specialised cerebrovascular care from the following list: a centre of highly specialised cardiovascular care for adults, a centre of highly specialised pneumooncosurgical care, a centre of highly specialised medical care in oncogylology, a centre of highly specialised care for the isolation of patients suspected of highly contagious disease under the Law on Health Services (7). If the provider does not meet the conditions set out in the first sentence but has the status of a centre of highly specialised oncological care as well as the status of at least two centres of highly specialised care from the following list - a centre of highly specialised cerebrovascular care, a centre of highly specialised complex cardiovascular care for adults, a centre of highly specialised pneumooncosurgical care, a centre of highly specialised medical care in oncogylology, a centre of highly specialised care for patients suspected of highly contagious disease, a centre of highly specialised cardiovascular care according to the Health Services Act - a minimum basic rate of CZK 46 780. For other providers who provide care on urgent income, the minimum basic rate is CZK 39 395. For other providers who do not provide care on urgent income, the minimum base rate is CZK 32 105.
EM2019, A-D, H is the total value of the requested extramural care in the context of hospitalisation cases recalculated in accordance with point 3.2 by the provider declared and the health insurance undertaking recognised, terminated in the reference period, classified according to the Classification in the groups related to the diagnosis referred to in Annex 10, Parts A to D and Part H to this Regulation, valued at the values of the points applicable in the reference period, including remuneration for separately charged material and medicinal products separately charged.
INTRODUCTION2019 Total remuneration of the provider for services included in individually contracted bases in the reference period.
max function maximum that selects the highest value from the range of values.
(ii) CMred, 2022, CZ-DRG, A is calculated as follows:
(a) Where the number of recognised cases reported and reported by a health insurance undertaking is the number of recognised cases of hospitalisation, terminated in the evaluation period or terminated in the reference period and recalculated in accordance with point 3.2, classified according to the Classification in groups related to the diagnosis referred to in Annex 10, Part A to this Regulation, which have been terminated by the transfer of a patient to a downstream care provider or by the department of care of the same provider (hereinafter referred to as "the code of cessation of treatment 4,") or by the transfer of a patient to another acute bed care provider (hereinafter referred to as "PPRdrg"), less or equal to 100, or where PPRdrg, A, 2022,4,5 ≤ 0,1 * PPdrg, A, 2019 is determined as follows:
CMred, 2022, CZ- DRG, A = minCM2022, CZ- DRG, A; CM2022, CZ- DRG, A0,3 * X * PPdrg, A, 2022 * CM2019, CZ- DRG, APPdrg, A, 20190,7
where:
X shall be equal to 1.1 where the ratio of the number of insured persons of the insurance undertaking in the county concerned, as referred to in point 1 of Annex 9 to this Decree, is greater than 0,1, and 1,15 where the ratio of the number of insured persons of the insurance undertaking in that district is less than or equal to 0,1, in accordance with point 1 of Annex 9 to this Decree.
CM2022, CZ- DRG, A is the number of hospitalisation cases reported by the provider and the health insurance company recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Decree, multiplied by the relative weights 2022 listed in Annex 10, Part A to this Decree.
PPdrg, A, 2022 is the number of hospitalisation cases reported by the provider and the health insurance company recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A 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.
(b) In other cases, the reduced casix shall be determined as follows:
CMred, 2022, CZ-DRG, A = CMred 1 + CMred 2
where:
CMred1 = minCM1,2022, CZ- DRG, A; CM1,2022, CZ- DRG, A0,3 * X * PP1, drg, A, 2022 * CM1,2019, CZ- DRG, APP1, drg, A, 20190,7
where:
CM1,2022, CZ-DRG, A is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Order, which have not been terminated by the treatment termination code 4 or the treatment termination code 5, multiplied by the relative weights 2022 as set out in Annex 10, Part A 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.
PP1, drg, A, 2022 is the number of hospitalisation cases reported by the provider and by a health insurance undertaking recognised, terminated in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Regulation, which have not been terminated by the end code of treatment 4 or the end code 5.
PP1, drg, A, 2019 is the number of hospitalisation cases converted in accordance with point 3.2 by the provider declared and the health insurance company recognised, terminated in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Decree, which have not been terminated by the cessation code of treatment 4 or the treatment termination code 5.
and where:
CMred2 = CM2022, CZ- DRG, A, 4,5 * min1; X * PPRdrg, A, 2019,4,5PPRdrg, A, 2022,4,5 * PPdrg, A, 2022PPdrg, A, 2019
where:
CM2022, CZK-DRG, A, 4,5 is the number of hospitalisation cases reported by the provider and the health insurance company recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Decree, which have been terminated by the treatment termination code 4 or the treatment termination code 5, multiplied by the relative weights 2022 as set out in Annex 10, Part A to this Decree.
PPRdrg, A, 2022,4,5 is the number of hospitalisation cases reported by the provider and by a health insurance undertaking recognised, terminated in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Decree, which have been terminated by the end-of-treatment code 4 or the end-of-treatment code 5.
PPRdrg, A2019,4,5 is the number of hospitalisation cases recalculated in accordance with point 3.2 by the provider declared and the health insurance company recognised, terminated in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Decree, which have been terminated by the end-of-treatment code 4 or the end-of-treatment code 5.
(iii) IZP is the index of the change in production calculated as follows:
IZP = max1; ARCTG3 * CMred, 2022, CZ-DRG, ACM2019, CZ-DRG, A-1,443
4. Reimbursement on flat-rate remuneration
4.1 The remuneration allocated to the flat-rate remuneration shall include the services covered by the Classification in the groups related to the diagnosis listed in Annex 10, Parts C to F to this Decree.
4.2 In the calculation of variables in the reference period, hospitalisation cases are defined as those converted by the Classification.
4.3. Medicinal products exempted from the flat-rate payment and listed in Annex 12 to this Order shall be paid by the health insurance undertaking to the provider at the level of their declared unit price, but not more than their declared unit price in 2021.
4.4 The requested extramural care is the care related to the hospitalisation of the insured person with the provider requested by the provider and which is provided to the insured person at the time of hospitalisation with the provider by another provider that reports it to the health insurance undertaking.
4.5 For services covered by a flat-rate remuneration classified under the Classification in the groups related to the diagnosis listed in Annex 10, Parts C to F by the provider recognised and the health insurance undertaking recognised for the period of assessment, a remuneration shall be set at:
EQUITY, CZ- DRG, 2022 = IZS2022, CZ- DRG, CE * CM2022, CZ- DRG, CE + IZS2022, CZ- DRG, DF * CM2022, CZ- DRG, DF − EM2022, C-F
where:
CM2022, CZK-DRG, CE is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Parts C and E to this Order, multiplied by the relative weights 2022 listed in Annex 10, Parts C and E to this Decree.
CM2022, CZK-DRG, DF is the number of hospitalisation cases reported by the provider and by the health insurance undertaking recognised, completed in the assessment period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Parts D and F to this Order, multiplied by the relative weights 2022 listed in Annex 10, Parts D and F to this Decree.
EM2022, C-F 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, completed in the evaluation period, classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Parts C to F to this Decree, valued at the values of the points in force in the evaluation period, including remuneration for the material separately charged and the medicinal products separately charged.
IZS2022, CZ-DRG, CE is an individual basic rate of highly homogeneous hospitalisation calculated as follows:
(1) Where:
IZSinput, 2022 ≥ (1 + RCCE, upper) * ZSCZ-DRG
then:
> TABLE >
(2) Where:
IZSinput, 2022 ≤ (1 - RCCE, lower) * ZSCZ-DRG
then:
IZS2022, CZ- DRG, CE = TSCE, lower * (1 - RCCE, upper) * ZSCZ- DRG + (1 - TSCE, lower) * IZSventu, 2022
(3) In other cases:
IZS2022, CZ-DRG, CZ = IZSvodní, 2022
IZS2022, CZ-DRG, DF is the individual basic rate of moderate homogenous hospitalisation calculated as follows:
(1) Where:
IZSinput, 2022 ≥ (1 + RKDF, upper) * ZSCZ-DRG
then:
IZS2022, CZ-DRG, DF = TSDF, upper * (1 + RKDF, upper) * ZSCZ-DRG + (1 - TSDF, upper) * IZSventu, 2022
(2) Where:
IZSinput, 2022 ≤ (1 - RKDF, lower) * ZSCZ-DRG
then:
IZS2022, CZK-DRG, DF = TSDF, lower * (1 - RKDF, lower) * ZSCZ- DRG + (1 - TSDF, lower) * IZSventu, 2022
(3) In other cases:
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Regulation Information
| Citation | Decree No 396 / 2021 Coll., establishing the values of the point, the amount of the remuneration for services paid and the regulatory restrictions for 2022 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 29.10.2021 |
|---|---|
| Effective from | 01.01.2022 |
| Effective until | - |
| Status | Valid |
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