Decree No. 428 / 2013 Coll.
Decision on the determination of the value of the item, the amount of the fees paid and the regulatory restrictions for 2014
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Order
Effective from 01.01.2014
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01.01.2014
23.12.2013
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428
DECLARATION
of 13 December 2013
on the determination of the value of the points, the amount of the fees paid and the regulatory restrictions for 2014
The Ministry of Health provides pursuant to § 17 paragraph 5 of Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, as amended by Act No. 117 / 2006 Coll., Act No. 245 / 2006 Coll., Act No. 261 / 2007 Coll., Act No. 298 / 2011 Coll. and Act No. 369 / 2011 Coll.:
This Decree sets out for 2014 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 ("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 (" social security schemes') and those of other States with which the Czech Republic has concluded international social security agreements covering the field of paid services ("foreign insurers'), and regulatory restrictions on the methods of reimbursement referred to in Sections 3 to 15, provided by the following contractual health service providers (" the provider '):
(a) providers of bed care and providers of special bed care pursuant to Article 22a of the Act;
(b) providers in general medical practice and providers in practical medicine for children and adolescents;
(c) providers of specialised outpatient care, providers of hemodialysis healthcare and providers of expertise 903, 905, 919 and 927 according to the Decree issuing a list of health performance with points, as amended) (hereinafter referred to as "the list of performance"),
(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, 820, 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) medical emergency care providers, patient transport providers of emergency care, medical transport service providers, medical emergency services providers and dental emergency services providers; and
(j) providers of spa rehabilitation and rehabilitation facilities.
(1) The reference period is the year 2012 for the purposes of Annexes 1, 3 to 8 to this Decree.
(2) The evaluation period is the year 2014 for the purposes of Annexes 1, 3 to 8 to this Regulation.
(3) For the purposes of this Order, a special insurer shall mean an insurer of a health insurance undertaking treated by a provider in a specific professional capacity in an assessment or reference period at least once, and shall not be responsible for whether it is a treatment within the framework of his or her own health or health services requested. If the insured person has been treated more than once by the provider in a particular professional capacity in the evaluation period or reference period, the number of individual insured persons shall include the relevant health insurance undertakings treated in that professional capacity only once. In the event of a merger of health insurance undertakings, the number of unique insured persons shall be the sum of the unique insured persons of health insurance undertakings which 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.
(4) In calculating the total number of recognised health performance points (hereinafter referred to as "performance ') reported by the provider and the health insurance undertaking for the reference period referred to in Annexes No 3, 5 to 8 to this Regulation, those points are those points which are converted according to the performance list as effective on 1 January 2014, which have not been paid at a reduced value of the point and which do not include points for services paid to foreign insurers.
(5) Where two health insurance undertakings have merged in the reference period, the sum of the data for the reference period of the merged health insurance undertakings shall be used for the calculation of the remuneration.
In the case of the provision of paid services to foreign insured persons, the remuneration shall be set at the same amount as for Czech insured persons.
(1) For paid services provided by bed care providers, with the exception of paid services provided by post-bed care providers, long-term bed care providers and special-bed care providers, the value of the point, the amount of payment of the services paid and the regulatory limit shall be set out in Annexes 1, 9, 10, 12 to 14 to this Decree.
(2) For paid services provided by post-bed care providers, long-term bed care providers and special-bed care providers paid at a flat rate per day of hospitalisation or according to the list of benefits, the value of the point, the amount of payment of the services paid and the regulatory limit shall be 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 health care providers paid according to the performance list and by professionals 903, 905, 919 and 927 according to the performance list, the value of the point, the amount of payments of the services paid and the regulatory limit shall be set out in Annex 3 to this Decree.
For outpatient care provided to outpatient health care providers in expertise 603 and 604 according to the performance list, the value of the point, the amount of payment of the services paid and the regulatory limitation shall be as set out in Annex 4 to this Decree.
(1) For paid services provided by dental care providers, the value of the point is CZK 0.95.
(2) The amount of the remuneration of the paid services provided by dental care providers not covered by paragraph 1 and the relevant regulatory restrictions are set out in Annex 11 to this Decree.
(3) The health insurance company shall limit the amount of remuneration to dental care providers so that the total cost of the health insurance undertaking for the services covered by dental care providers in 2014 does not exceed the total amount of these costs set out in the health insurance plan of the health insurance undertaking. If the excess of the total amount of remuneration for the paid services provided by dental care providers, as set out in the health insurance plan of the health insurance company for those services, would be due to the provision of more urgent care compared to 2012, the health insurance company will pay this higher amount.
For covered services provided by outpatient health care providers in the listed expertise covered by the performance list, the value of the point and the amount of the payment of the services paid shall be as set out in Annex 5 to this Decree.
For paid services provided by providers of outpatient health care services in the 911, 914, 916, 921 and 925 expert expertise according to the performance list, the value of the point and the amount of the payments of the services paid shall be as set out in Annex 6 to this Decree.
For paid services provided by outpatient health care providers in the field of expertise 902 and 917 according to the performance list, the value of the point and the amount of payment of the services paid shall be as set out in Annex 7 to this Decree.
The value of the point of CZK 1.10 shall be determined for the services provided by the health rescue service providers under the performance list and the value of the point of CZK 1.10 shall be determined for the services provided by the patient transport providers under the performance list.
For services provided by health transport service providers covered by the performance list, the value of the point and amount of the payments and the regulatory limitation of the services paid shall be as set out in Annex 8 to this Decree.
For paid services provided by providers in the framework of medical emergency or dental emergency services paid according to the list of performances, the value of the point of CZK 0.95 is determined.
(1) For comprehensive spa rehabilitation care for adults provided in the health facilities of the spa rehabilitation care provider, a payment for one day's stay is set at the amount agreed on 31 December 2013, plus CZK 100. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 950.
(2) For complex spa rehabilitation care for children and adolescents under 18 years of age provided in the health facilities of the spa rehabilitation care provider, a payment for one day's stay is set at the amount agreed on 31 December 2013 plus 200 CZK. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 1 050.
(3) For the benefit of the spa rehabilitation care for adults provided in the health facilities of the spa rehabilitation care provider, the payment for one day's stay is set at the amount agreed on 31 December 2013 plus 100 CZK. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 380.
(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, the payment for one day's stay is set at the amount agreed on 31 December 2013 plus 200 CZK. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 480.
(5) For the services provided in the recovery facilities, the payment for one day's stay is set at the amount agreed on 31 December 2013 plus CZK 100. If the payment for one day's stay was not agreed on 31 December 2013, the payment is set at CZK 640.
This Decree shall take effect on 1 January 2014.
Minister:
MUDr. Holcat, MBA, Rev.
Příloha č. 1
Annex No 1 to Decree No 428 / 2013 Coll.
The value of the point, the amount of the payments of the services paid and the regulatory limitation referred to in § 4
A) Bound services pursuant to § 4 (1)
1. The remuneration of the provider in 2014 includes the contractually agreed remuneration component, case flat-rate remuneration and the payment for outpatient care ("outpatient remuneration component"). All services paid in 2012, the provider reported by 31 May 2013 and the health insurance company recognised by 30 September 2013 are included in the reference period. All services provided in 2014, the provider reported by 31 March 2015 and the health insurance company recognised by 31 May 2015 are included in the assessment period.
2. Individual contractually agreed payment component
2.1. The amount and method of payment of the paid services classified under the hospitalised patient classification (4) (hereinafter referred to as "Classification") in bases 0501, 0507, 0516, and 0511 listed in Annex 9 to this Decree (hereinafter referred to as "the listed basis") shall be negotiated in a contract between the health insurance company and the provider. The individually contracted remuneration component may include services other than those specified in the first sentence; in that case, this remuneration, as well as the services covered by the classication4) in the listed bases, shall not be included in the remuneration referred to in point 3.
In the absence of an agreement on the amount of the remuneration of the individually contracted component of the remuneration between the provider and the health insurance company by 30 April 2014, the health insurance undertaking shall provide the provider with a remuneration of ÚHRhozz calculated as follows:
ÚHRzzho = min-ii = 1nPPi, zzho * ÚHRi, zz2013PPi, zz2013; 0,75 * Ihri = 1nÚHRi, zz2013
where
EHRhozz Maximum remuneration by the provider during the evaluation period.
PPhoi, zz The number of cases with the given provider in the listed basis in the evaluation period where i = 1 to n, where n is the number of listed bases.
ÚR2013i, zz Total remuneration of the provider for the listed basis in 2013, where i = 1 to n, where n is the number of listed bases.
PP2013i, zz Number of cases with given provider in the listed basis in 2013 where i = 1 to n where n is the number of listed bases.
min The minimum function that selects the lowest value from the range of values.
The total amount of remuneration granted for all listed bases provided by the health insurance company to all providers in total shall be at least 85% of the remuneration of listed bases in 2013.
IUPAC Name
where
ÚR2013i, zz Total remuneration of health insurance companies to all providers in total for the listed basis in 2013, where i = 1 to n, where n is the total number of listed bases. The lower zz index refers to the provider of the health insurance company, zz = 1 to q, where q is the total number of providers of the health insurance company.
2.2 The amount of 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, but not more than the amount specified in points 2.2.1, 2.2.2 and 2.2.3:
2.2.1. For diseases:
(a) Fabry disease,
(b) Gaucher disease,
(c) Niemen-Pick's disease,
(d) Mukopolysaccharidosis I,
(e) Mukopolysaccharidosis II,
(f) Mucopolysaccharidosis VI,
(g) Pompe's disease;
(h) Hyperamonaemia in children with hereditary disorders of urea and glutamine metabolism; and
(i) Hereditary Tyrosinaemia Type I
the maximum remuneration per unique insured person is set at 100% 12 times the average monthly remuneration calculated from the months during which the treatment was provided. The maximum remuneration on a unique insured person shall be calculated as follows:
Uhrmax = 12 * Uhri, 2013Mi, 2013
where:
i gets 1 to n, where n is the number of the above diseases
Uhrmax is the maximum remuneration in 2014 per unique insured person for the disease i
Uhri, 2013 is the total payment in 2013 for the treatment of the disease i
Mi, 2013 is the sum of months during which the treatment of the disease was also provided to each individual insured person with this disease in 2013.
2.2.2. For diseases:
(a) rheumatoid arthritis,
(b) Bechoreva's disease,
(c) psoriatic arthritis,
(d) Crohn's disease;
(e) colitis ulcerosa,
(f) heavy psoriasis,
(g) multiple sclerosis,
(h) pulmonary arterial hypertension,
(i) asthma,
(j) Parkinson 's disease; and
(k) juvenile arthritis
a maximum remuneration of 98% 12 times the average monthly remuneration calculated from the months in which the treatment was provided, multiplied by 108% of the number of unique insured persons treated in 2013, shall be set. The maximum remuneration shall be calculated as follows:
Uhrmax = dost r i = 1n0,98 * 12 * Uhri, 2013Mi, 2013 * UOPi, 2013 * 1,08
i gets 1 to n, where n is the number of the above diseases
Uhrmax is the maximum remuneration in 2014
Uhri, 2013 is the total payment in 2013 for the treatment of the disease i
Mi, 2013 is the sum of the months during which the treatment was also given to each individual patient with this disease in 2013
UOPi, 2013 is the number of unique insured persons treated in 2013 for the relevant diseases referred to in points (a) to (k).
2.2.3. For diseases other than those referred to in points 2.2.1 and 2.2.2, a maximum remuneration of 98% of 12 times the average monthly remuneration calculated from the months in which the treatment was provided, multiplied by 102% of the number of unique insured persons who received the medicinal product in 2013 for one of the diseases not mentioned in point 2.2.1 or point 2.2.2, shall be set. The maximum remuneration shall be calculated as follows:
Uhrmax = dost r i = 1n0,98 * 12 * Uhri, 2013Mi, 2013 * UOPi, 2013 * 1,02
i is 1 to n, where n is the number of diseases covered by point 2.2.3
Uhrmax is the maximum remuneration in 2014
Uhri, 2013 is the total payment in 2013 for the treatment of the disease i
Mi, 2013 is the sum of the months during which the treatment was also given to each individual patient with this disease in 2013
UOPi, 2013 is the number of unique insured persons treated in 2013 for the relevant disease covered by point 2.2.3.
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.
2.2.5. Medicinal products prescribed in the reference period for the recipe shall be included in the total payment limit set out in paragraphs 2.2.1 to 2.2.3 if, during the evaluation period, those medicinal products are reported as separately charged medicinal products and at the same time if, in the evaluation period, they continue to meet the conditions for medicinal products marked with the symbol "S 'under Decree No. 376 / 2011 Coll.
3. Reimbursement by case flat rate
3.1. For the purposes of this Regulation, the following definitions apply:
3.2. Medicinal products excluded from the flat-rate payment and listed in Annex 14 to this Regulation shall be paid by the health insurance undertaking to the provider at the level of their declared unit price but not more than their unit price in 2013.
3.3 Required extramural care means care related to the hospitalisation of an insured person with a provider requested by the provider and which is provided by another provider at the time of hospitalisation to the provider, which charges it to the health insurance undertaking.
3.4 The flat-rate payment shall include paid services classified under the Classification in the groups related to the diagnosis listed in Annex 10 to this Decree and shall be set up up up to the level of CELK Pudrg2014 in accordance with the expression (i), where the individual flat-rate payment (IPU) is reduced proportionately, unless there is at least 97% of the production of the reference period (CMdrg, 2012) weighted by the transfer coefficient for insured persons (Kpp), and the reduced individual flat-rate payment is deducted for the requested extra-moral care (EM2014).
The individual flat-rate payment (IPU) shall be calculated on the basis of the expression (ii) as reference production (KS _ CMp, 2012) weighted health service specialisation coefficients according to the expression (iii) multiplied by the technical base rate (TZS) and the transition coefficient of the insured (Kpp). The flat-rate remuneration thus calculated shall not fall below 97% of the remuneration of the reference period (Pudrg, 2012) multiplied by the transfer coefficient of the insured (Kpp) and shall not exceed 150% of the remuneration of the reference year (Pudrg, 2013) multiplied by the transfer coefficient of the insured (Kpp).
The volume of production of the evaluation period (CMred) shall be determined on the basis of the expression (iv) by adding up to 105% of the average reference production per case CMdrg, 2012PPdrg, 2012 multiplied by the number of cases in the evaluation period (PPdrg, 2014) the full value (CMdrg, 2014) and above this limit the production volume is reduced proportionally depending on the amount of failure to achieve the required number of cases (PPdrg, 2014).
The calculation of all the above components of remuneration shall be as follows:
(i) CELK Pudrg, 2014 = min1; CMred0,97 * Kpp * CMdrg, 2012 * IPU-EM2014,
where:
IPU is an individual flat rate remuneration calculated as follows:
(ii) IPU = min {1,5 * Kpp * Pudrag, 2012; max {0,97 * Kpp * Pudrag, 2012; KS _ CM p, 2012 * TZS * Kpp - Úhr14}},
where:
(iii) KS _ CMp, 2012 = Ksp = 1nKsp, i * CMdrgi, 2012
CMdrgi, 2012 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 10 to this Regulation, multiplied by the indices of those groups laid down by the law governing the value of the point and the amount of the remuneration for 2012 (hereinafter referred to as "indices 2012 '), where i takes values from 1 to n and where n is the total number of groups related to the diagnosis listed in Annex 10 to this Regulation.
Ksp, i specialisation coefficient of individual groups related to the diagnosis listed in Annex 10 to this Decree.
Kpp coefficient of change in the proportion of the number of insured persons of the relevant health insurance undertaking receiving the services paid to that provider in the total number of insured persons receiving the services paid to that provider between 1 January 2014 and 1 January 2012, the individual insured persons weighing their costs of acute bed care during the reference period; if two or more health insurance undertakings have merged in the reference period or in 2013, this is a coefficient of change in the proportion of the number of insured persons of all merged health insurance undertakings. This coefficient shall be established as the index of the change in the number of insured persons weighted by the cost of acute bed care of the relevant health insurance undertaking in the region of the provision of the services covered between 1 January 2012 and 1 January 2014, the coefficients of the change in the weighted number of insured persons by region of the Czech Republic being set out in Annex 12 to this Decree; the coefficient is set at 1 if the number of insured persons in the county at 1 January 2014 is less than or equal to 0,5% of the total number of insured persons in the region.
Pudrg, 2012 is the total amount of remuneration for the provider declared and the health insurance undertaking recognised by the services provided during hospitalization completed in the reference period, classified according to the Classification in the groups related to the diagnosis listed in Annex 10 to this Regulation, including the settlement of regulatory restrictions with the exception of regulation for prescribed medicinal products and medical devices, increased by the value of the requested extramural care valued at the values of the points in force in the evaluation period, including the cost of the separately charged material and the specifically charged medicinal products, and reduced by the reimbursement of the medicinal products listed in Annex 14 to this Decree.
Total 14 is the remuneration for the medicinal products listed in Annex 14 to this Decree during the reference period
TZS is the technical basic rate set at CZK 22,000.
EM2014 is the total value of the requested extramural care in hospitalisation cases by the provider of the recognised and recognised health insurance company, which has been completed in the evaluation period, measured by the values of the point in force in the assessment period, including the cost of the separately charged material and the medicinal products separately charged.
and where:
(iv) CMred = minCMdrg, 2014; CMdrg, 20140,2 * 1,05 * PPdrg, 2014 * CMdrg, 2012PPdrg, 20120,8,
and where:
CMdrg, 2014 is the number of hospitalisation cases reported by the provider and by the health insurance company recognised that have been completed in the evaluation period that are classified under the Classification in the groups related to diagnosis, multiplied by indices 2014.
PPdrg, 2014 the number of providers declared and the health insurance company recognised by hospitalisation, completed in the evaluation period classified in the groups related to the diagnosis according to the Classification as set out in Annex 10 to this Decree.
CMdrg, 2012 The number of hospitalisation cases completed in the reference period and by a health insurance company recognised under the Classification are included in the groups related to the diagnosis listed in Annex 10 to this Decree multiplied by indices 2014.
PPdrg, 2012 number of providers declared and health insurance undertakings recognised by hospitalisation, completed in the reference period classified in groups related to the diagnosis according to the Classification as set out in Annex 10 to this Decree.
min function minimum which selects the lowest value from the range of values.
max function maximum that selects the highest value from the range of values.
4. In the case of paid services provided to foreign insured persons, and in the case that the provider provides 50 or less insured persons with paid services to the relevant health insurance company during the reference period, those services shall be paid according to the list of benefits with a value of CZK 1.
5. The umbilical component of the remuneration includes the reimbursement of specialised outpatient health care, paid services in the fields of expertise 603 and 604 according to the list of performance, paid services provided by general practitioners and providers in the field of practical medicine for children and adolescents, paid services provided by dental practitioners, paid services in the fields of expertise, medical transport services, medical emergency services and paid services provided by providers in the field of general medical practice, 903, 905, 911, 914, 919, 921, 925 and 927 (hereinafter referred to as "outpatient care ') with the exception of the performance of the examination of the patient in the admission to hospitalisation and discharge.
5.1. For paid services provided by providers of general medical practice and by providers of practical medicine for children and adolescents, 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 point and the amount of payment of the services paid shall be as set out in Annex 2 to this Decree.
5.2. For specialised outpatient health care covered by the list of performance and professional providers 903, 905, 919 and 927 according to the list of performance, the value of the point and the amount of health care payments shall be set out in Annex 3 to this decree, with the regulatory restrictions set out in Part B of Annex 3 to that decree not applicable.
5.3. For the services provided by experts 603 and 604 according to the performance list, the value of the item and the amount of the services paid shall be as set out in Annex 4 to this decree.
5.4. For the services provided by the listed experts covered by the performance list, the value of the item and the amount of the payments of the services paid shall be as set out in Annex 5 to this Decree.
5.5. For paid services provided by professionals 911, 914, 921 and 925 according to the performance list, the value of the item and the amount of payment of the services paid shall be as set out in Annex 6 to this Decree.
5.6. For services provided by experts 902 and 917 according to the list of performance paid according to the list of performance, 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.
5.7. For the performance provided by the health transport service providers 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 8 to this Decree.
5.8. Grounded services provided by dental care providers shall be paid in accordance with Section 8.
5.9. Grounded services provided under the medical emergency service shall be paid in accordance with Section 14.
5.10. The maximum remuneration for the service declared by the provider under points 5.1 to 5.9 shall be:
Ear _ ambmax = Ehr _ amb2012 * 1,05 * Kpp
where:
Edge _ ambmax is the maximum possible total payment to the provider for the services paid, including the medicinal products specifically charged and the material specifically charged, with the exception of those specifically charged with the symbol "S 'under Paragraph 39 (1) of Decree No 376 / 2011 Coll. and with the exception of the products listed in Annex 14 to this Decree, provided in the evaluation period referred to in paragraphs 5.1 to 5.9.
Emission _ amb2012 shall be calculated as the sum of the points declared by the provider and the health insurance undertaking of recognised points for the services paid in the reference period referred to in paragraphs 5.1 to 5.9 multiplied by the values of the point applicable in the evaluation period and the remuneration for the medicinal products separately charged and the material separately charged in the reference period, except for those specifically charged with the "S 'symbol under Paragraph 39 (1) of Decree No 376 / 2011 Coll. and with the products listed in Annex 14 to that decree.
Kpp is the coefficient of the change in the proportion of the number of insured persons of the relevant health insurance undertaking receiving the services paid to that provider in the total number of insured persons receiving the services paid to that provider between 1 January 2014 and 1 January 2012, the individual insured persons weighing their outpatient care costs during the reference period; if two or more health insurance undertakings have merged in the reference period or in 2013, this is a coefficient of change in the proportion of the number of insured persons of all merged health insurance undertakings. This coefficient shall be determined as an index of the change in the number of insured persons weighted by the cost of outpatient care of the relevant health insurance undertaking in the region of the provision of the services covered between 1 January 2012 and 1 January 2014, these coefficients of change in the weighted number of insured persons by region of the Czech Republic being listed in Annex 13 to this Decree; the coefficient is set at 1 if the number of insured persons in the county at 1 January 2014 is less than or equal to 0,5% of the total number of insured persons in the region.
5.11. For the contracted power 09563 according to the list of performances the value of the point is 1 CZK and for the contracted power 88101 according to the list of performances the value of the point is 1 CZK. The performance referred to in the sentence of the first health insurance undertaking shall not be included in the calculation of the regulation in paragraphs 5.1 to 5.10.
6. Changes in the scope and structure of the services provided as compared to the reference period shall be agreed in the contract between the provider and the health insurance undertaking, including related changes in the calculation of the remuneration.
7. The monthly interim payment shall be granted to the provider calculated from the data of the provider declared and the health insurance undertaking of recognised paid services provided in the reference period, using the amount of remuneration and the regulatory restrictions laid down in this Decree, including the conversion coefficient for KPP insured persons in accordance with Annexes 12 and 13 to this Decree, of one twelfth. In the amount of the advance payment, the health insurance undertaking shall include changes in the scope and structure of the services provided, agreed in accordance with point 6, including changes in the number of hospitalizations, the number of points and the number of unique insured persons. The interim remuneration for the period under assessment shall be settled financially within the framework of the overall financial settlement, including regulatory restrictions, no later than 180 days after the date of the end of the period under assessment.
B) Gross services pursuant to § 4 (2)
1. Flat rate per day hospitalization except special bed care
(a) The flat rate per day of hospitalisation shall be determined for each patient category and type of treatment day separately and shall include the value of the relevant treatment day, including the direction assigned to the treatment date and patient category according to the performance list, the flat amount to be paid for the medicinal products referred to in Article 17 (6) of the Act and the health performance to be reported as income and discharge tests according to the performance list.
(b) The flat rate for one day of hospitalisation in the evaluation period, with the exception of the flat rate for the treatment day 00026, 00027, 00028 and 00029 in the performance list, shall be 105% of the flat rate per day of hospitalisation belonging to the provider in the reference period.
(c) The flat rate for one day of hospitalisation in the evaluation period for the treatment day 00026 is set at 130% of the flat rate for one day of hospitalisation belonging to the provider in the reference period and the flat rate for one day of hospitalisation in the assessment period for treatment days 00027, 00028 and 00029 is fixed at 115% of the flat rate for one day of hospitalisation belonging to the provider in the reference period.
(d) Changes in the scope and structure of the services provided compared to the reference period shall be agreed in the contract between the provider and the health insurance undertaking, including related changes in the calculation of the payments.
2. Reimbursement of outpatient care and special outpatient care with the exception of payment of such care provided by the provider of special bed care
a) For outpatient care paid according to the performance list, the value of the point (HB) is set at CZK 0.95.
(b) For special outpatient care provided under Paragraph 22 (c) of the Act, the resulting value of the point (HBred) shall be determined. The resulting point value is the sum of the variable remuneration component and the fixed remuneration component:
HBred = FS + VS
where
HBred is the final value of the point used in the evaluation period for the evaluation of the health performance provided
FS is the fixed component of the remuneration referred to in point (c)
VS is the variable component of the remuneration calculated according to the formula:
VS = HB-FS * min1; PBrefu
where:
HB value of point (c)
PBref total number of recognised by the provider and health insurance undertaking of recognised points in the reference period
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Regulation Information
| Citation | Decree No. 428 / 2013 Coll., on the determination of the values of the points, the amount of the fees paid and the regulatory restrictions for 2014 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 23.12.2013 |
|---|---|
| Effective from | 01.01.2014 |
| Effective until | - |
| Status | Valid |
Legal Areas:
Administrative law
Health
The regulation text is for informational purposes only.
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