Decree No. 432 / 2025 Coll.
Order setting the value of the points, the amount of the payments of the services paid, the amount of the advances on the payment of the services paid and the regulatory restrictions for 2026
Valid
Order
Effective from 01.01.2026
Zobrazeno prvních 200 z celkem 1333 ustanovení tohoto předpisu.
Zobrazit celý předpis →
Pro stažení celého znění použijte tlačítko Stáhnout výše.
432
DECLARATION
of 22 October 2025
setting the value of the points, the amount of the payment of the services paid, the amount of the advances on payment of the services paid and the regulatory restrictions for 2026
According to Article 17 (5) of Act No. 48 / 1997 Coll., on Public Health Insurance, and amending and supplementing certain related laws, as amended by Act No. 371 / 2021 Coll. and Act No. 289 / 2025 Coll.:
(1) This Decree provides for 2026
(a) the value of the point;
(b) the amount of compensation paid to insured persons pursuant to 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") and to insured persons from other Member States of the European Union, Member States of the European Economic Area and the Swiss Confederation pursuant to the directly applicable European Union provisions governing the coordination of social security systems (1), UK insured persons under the Agreement on Trade and Co-operation (2) and insured persons from other States with whom the Czech Republic has concluded international social security agreements covering the field of paid servants (hereinafter referred to as "foreign insured persons");
(c) the amount of advances to cover the services paid;
(d) a regulatory restriction on the remuneration for the services covered, referred to in Sections 4 to 20, provided by the contracting health service providers (hereinafter referred to as the provider).
(2) This decree applies to providers
(a) bed care;
(b) in the field of general medical practice as defined in the Decree issuing a list of health performances with points (3) (hereinafter referred to as "the list of performances"),
(c) in the field of practical medicine for children and youth according to the performance list;
(d) specialised outpatient care in accordance with the list of performances not listed in this paragraph and stationary outpatient care (hereinafter referred to as "specialised outpatient care");
(e) dialysis healthcare;
(f) expertise 905, 919 and 927 according to the performance list;
(g) outpatient care in expertise 603 and 604 according to the performance list;
(h) dental medicine;
(i) outpatient care in the field of expertise 222, 801, 802, 806 to 810, 812 to 818 and 823 according to the performance list (hereinafter referred to as "the listed expertise"),
(j) outpatient care in expertise 914, 916 and 921 according to the performance list;
(k) home care in expertise 925 and 926 according to the performance list;
(l) outpatient care in expertise 902 and 917 according to the performance list;
(m) medical emergency services,
(n) the transport of patients with urgent care;
o) health transport services,
(p) medical emergency services,
(q) emergency dental services;
(r) spa rehabilitation and rehabilitation facilities;
(s) medical care; and
(t) day care.
(1) The reference period for the purposes of this Decree is 2024. 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 2026.
(3) All the services provided in 2024, the provider declared by 31 March 2025 and the health insurance company recognised by 31 May 2025 are included in the reference period.
(4) All the services provided in 2026, the provider declared before 28 February 2027 and the health insurance company recognised before 30 April 2027 are included in the evaluation period. The remuneration for services paid after 31 March 2027 calculated in accordance with § 4 to 20 is multiplied by 0,95.
(5) Where a merger of health insurance undertakings occurs during the evaluation 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.
(1) For the purposes of this Order, a unique insurer shall mean an insurer of a health insurance undertaking treated by a provider in a specific professional capacity in the evaluation period or in the reference period at least once, unless otherwise specified. Where it is provided that the services paid do not enter into the calculation of the total or similar amount of remuneration, the insured persons to whom only the services paid do not enter into the calculation of the total or similar amount of remuneration shall not enter into that calculation as unique insurers.
(2) If a unique insured person has been treated by the provider in a particular professional period or in a reference period more than once, the number of unique insured persons shall include the relevant health insurance undertaking treated in that professional period and the period only once.
(3) In the event of a merger of health insurance undertakings, an insured person for whom more than one of the merged health insurance companies has been paid for during the evaluation period or in the 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 in the context of own or requested health services in the evaluation period or in the reference period at least once, unless otherwise specified.
(5) Where a global unique insured person has been treated by the provider more than once in the evaluation period or in the 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 companies, an insurer for which more than one of the merged health insurance companies has been paid in the evaluation period or reference period, shall only be included 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 decree, office hours shall be those agreed in the contract between the health insurance company and the provider, where at least 1 health professional with specialised competence in the relevant field is available at the place of work of the insured person, excluding the period 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 20.
(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, social and health 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, 12, 14 and 15 to this Decree.
(2) For paid services provided by post-bed care providers, long-term bed care, social and health care, special bed care or special outpatient care provided under § 22 (c) of the Act, the value of the point, the amount of payments of the services paid and the regulatory limit are set out in Annex 1 to this Decree.
For paid services provided by general medical practitioners according to the list of performance and practical medical practitioners for children and adolescents according to the list of performance paid by the combined capitalisation payment or the list of performance, the value of the item, the amount of payment of the services paid and the regulatory limit shall be as 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 point, the amount of the payment of the services paid and the regulatory limit shall be set out in Annexes 3 and 15 to this Decree.
For outpatient care provided to outpatient care providers in expertise 603 and 604 according to the performance list paid by the combined capitalisation payment, the value of the point, the amount of payments of services paid and the regulatory limit shall be 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 providers of outpatient care in expertise 914, 916 and 921 and by providers of home care in expertise 925 and 926 according to the list of performance paid according to the list of performance, the value of the point and the amount of 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.
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) For paid services provided by the health rescue service provider and the transport of patients urgent care covered by the performance list, the value of the point of CZK 1.32 shall be determined, except for the performance of the transport according to the performance list, for which the value of the point of CZK 1.47 is determined, and with the exception of the performance with a point value ("performance ') No 06714 according to the performance list for which the value of the point of CZK 1.34 is determined.
(2) The reimbursement referred to in paragraph 1 shall be increased by CZK 1 550 for the provision of care to health insurance insurers including the receipt of an emergency call by the operator of the medical operating centre and the exit of the medical emergency service declared in accordance with paragraph 1.
(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 1.47,
b) not providing a health transport service in continuous operation with a value of CZK 1.21.
(2) For the performance of transport No. 69 according to the list of performances the value of the point is set at CZK 1.34.
(1) For the services provided by the provider under the medical emergency service paid according to the performance list, the value of the point of CZK 1,14 is determined for the performance, except for the performance of transport and power according to the performance list.
(2) Dental emergency services are paid on a flat-rate basis. The flat-rate remuneration component shall be set at CZK 9,600 multiplied by the ratio of the number of insured persons of the health insurance company in the region in accordance with Annex 9 to this Decree for one day of provision of these services on the days and at least to the extent specified in the Emergency Services Order at the workplace of the contractual dental emergency service provider. Paragraph 9 shall apply for the determination of the performance component of the remuneration and regulatory restrictions.
(1) For complex spa rehabilitation care for adults, children and adolescents provided in the health facilities of the spa rehabilitation care provider, a payment for 1 day's stay of 102% of the contracted remuneration for 1 day's stay for 2025 shall be fixed. If the payment for one day's stay for 2025 has not been agreed upon by 31 December 2025 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) A payment for 1 day of stay of 102% of the contracted remuneration for 1 day of stay for the health care facility of the spa rehabilitation facility provider shall be provided for. If the payment for one day's stay for 2025 has not been agreed upon by 31 December 2025 inclusive, the remuneration shall be set at the level of the remuneration paid to comparable providers.
(3) The value of the point of CZK 0.77 is determined for the spa rehabilitation care allowance for 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 health care centre, the payment for 1 day's stay is set at CZK 1 310, which consists of the 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 performance No. 09543 according to the list of performances the value of the point is set at CZK 1.12. The first sentence shall not apply to the provider of spa rehabilitation care, which shall be treated in accordance with Paragraph 17 (3).
(2) For performances Nos 09555 to 09557 according to the list of performances the value of the point is set at CZK 1.12.
(3) For performances Nos 09580 and 09581 according to the list of performances the value of the point is set at CZK 1.04.
(4) For each performance No. 09990 according to the list of performances, the payment is set at CZK 36.
(5) The remuneration referred to in paragraphs 1 to 4 does not enter into the calculation of the maximum, total or similar amount of remuneration for the services paid. Except as provided for in the second sentence of paragraph 1, paragraphs 1 to 4 shall not apply to covered overnight and bed care services.
(1) For each provider declared and the health insurance company recognised performance No. 09552 according to the list of performances, a remuneration of CZK 32 is determined.
(2) No later than 150 days after the end of the evaluation period, the health insurance company will pay the provider CZK 16 for each transfer of the paper recipe into electronic form if, on the basis of this recipe, a medicinal product or food for special medical purposes (hereinafter referred to as the "medicinal product ') has been issued to its insured person.
The amount of remuneration for overnight care services covered under the Health Services Act is set out in Annex 13 to this Decree.
This Decree shall take effect on 1 January 2026.
Minister:
Prof. MUDr. Válek, CSc., MBA, EBIR, v. r.
Příloha č. 1
Annex No 1
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 payment 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 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.
1.1 For the purposes of points 3 to 5, when calculating the variables in the reference period, hospitalisation cases shall mean hospitalisation cases converted according to the rules for the classification of hospitalised patients for the year 20266 (hereinafter referred to as "Classification ').
1.2 For the purposes of points 3 to 6, the requested extramural care shall mean care related to the hospitalisation of an insured person with a provider requested by the provider and provided to the insured person at the time of the hospitalisation of the provider by another provider that reports it to the health insurance undertaking.
1.3 For the performance of OD 00031 and 00032, the flat rate for the treatment day is set at CZK 572, the performance being excluded from the payment according to points 3 to 6. The services referred to in point 7.12 (c), if provided during the hospitalisation of the insured person, shall be exempt from the remuneration referred to in points 3 to 6 and shall be paid in accordance with point 7.
1.4 The medicinal products which provide for the reimbursement provided for in Annex 15 to this Order are excluded from the payment provided for in points 3 to 7. The medicinal products and medical devices listed in Annex 12 to this Order shall be reimbursed by the health insurance undertaking to the provider at their declared unit price, excluding those medicinal products and medical devices from the remuneration referred to in points 3 to 7 and Annex 15 to this Order.
1.5 For the purposes of points 3 to 8, a provider having the status of a high-level care centre shall mean a provider holding the status of a high-level health care centre or a high-level medical care centre for patients with rare diseases, or a contractual provider listed in the high-level health care centres under the Health Services Act.
1.6 If, in the context of the hospitalisation case, separately charged material for the robotic operation has been reported and at the same time power No 09539 according to the performance list and no other power according to the performance list or DRG marker according to the Classification indicating robotic operational performance has been reported, the increase in the partial relative weight of the hospitalisation case for material costs when exceeding the upper limit point of the material costs according to the Classification shall not apply when calculating the hospitalisation case under point 1.1.
2. Individual contractually agreed payment component
If 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 remuneration set out in the flat-rate payment or in the flat-rate payment, the remuneration for those services shall not be included in the remuneration referred to in points 3 to 6.
3. Flat payment
3.1 The flat-rate payment shall include the services covered by the Classification in the groups related to the diagnosis listed in Annex 10, Part A, to this Decree.
3.2. The amount of the flat-rate remuneration shall be determined as the FOREIGN, CZK-DRG, 2026, depending on:
FOREIGN, CZ- DRG, 2026 = min {1; CMred, 2026, CZ- DRG, A0,98 * CM2024, CZ- DRG, A} * IPU * IZP-EM2026, A
where:
(a) CM2024, CZK-DRG, A is the number of hospitalisation cases converted in accordance with point 1.1 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, Part A to this Decree, multiplied by the relative weights 2026 listed in Annex 10, Part A to this Decree.
(b) EM2026, 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 referred to 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.
(c) min of the minimum function which selects the lowest value from the range of values.
(d) IPU is an individual flat-rate remuneration calculated as follows:
IPU = Pudrag, 2024 * 1,03
where:
Pudrg, 2024 is the reference amount of the remuneration for the provider declared and recognised by the health insurance company for the flat-rate payment, which shall be determined as follows:
i. CM2024, CZ- DRG, A * 90,000 CZK for the provider, which in the evaluation period is part of the reference network of acute bed care providers according to § 41a of the Act, which has at least 8 status of the centre of highly specialised care during the evaluation period, and which has at least the status of the centre of highly specialised cerebrovascular care or centres of highly specialised haematooncological care for adult patients or centres of highly specialised care for patients suspected of highly contagious disease,
ii. CM2024, CZ- DRG, A * 85 000 CZK for a provider who does not meet the conditions of subpoint i., which has at least the status of a centre of highly specialised trauma care during the period of assessment and at least 4 other statuses of a centre of highly specialised care,
(iii. for a provider that does not meet the conditions of sub-points i. and ii., the reference amount of the remuneration shall be determined as follows:
Pudrag, 2024 = min {CM2024, CZ- DRG, A-C * ZSmax, 2024, PU; max [CM2024, CZ- DRG, A-C * ZSmin, 2024, PU; EMBRPU, CZ- DRG, 2024 + EMBREU, A- C2024 + EMBRIS, A- C2024 + EM2024, A- C]} * (CM2024, CZ- DRG, ACM2024, CZ- DRG, A- C)
where:
CM2024, CZK-DRG, A-C is the number of hospitalisation cases recalculated in accordance with point 1.1 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, Parts A to C to this Order, multiplied by the relative weights 2026 listed in Annex 10, Parts A to C to this Decree.
The total amount of the flat-rate remuneration paid by the provider during the reference period shall be the OGRP, CZK-DRG, 2024.
EM2024, A-C is the total value of the requested extramural care in the context of hospitalisation cases converted in accordance with point 1.1 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 C to this Regulation, valued at the values of the points in force in the reference period, including remuneration for the material separately charged and the medicinal products separately charged.
EXEMPTIONS, A-C2024 is the total remuneration to the provider for hospitalisation cases included in individually contracted bases in the reference period, and classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Parts A to C to this Decree.
EMBREU, A-C2024 is the total remuneration to the provider for cases of hospitalisation of foreign insured persons in the reference period classified according to the Classification in the groups related to the diagnosis listed in Annex 10, Parts A to C to this Decree.
ZSmin, 2024, PU is the minimum basic rate, which is set at CZK 65 000 for the provider, which in the evaluation period is part of the reference network of the acute bed care providers according to § 41a of the Act and provides care on the urgent income, CZK 60 000 for the provider, who in the evaluation period is not part of the reference network and provides care on the urgent income, and CZK 55 000 for the provider who in the evaluation period does not provide care on the urgent income.
ZSmax, 2024, PU is the maximum base rate to be determined as follows:
ZSmax, 2024, PU = 0,5 * MAX2024, PU + 0,5 * IZS2024, PU
where:
MAX2024, PU is worth CZK 110,000.
IZS2024, PU is the reference individual standard rate for flat-rate remuneration calculated as follows:
IZS2024, PU = FOREIGN, CZ- DRG, 2024 + FOREIGN, A-C2024 + FOREIGN, A-C2024 + EM2024, A-CCM2024, CZ- DRG, A-C
(e) CMred, 2026, CZ-DRG, A is calculated as follows:
i. Where the number of providers declared and the health insurance undertaking of recognised cases of hospitalisation, terminated in the evaluation period or terminated in the reference period and recalculated in accordance with point 1.1, classified according to the Classification in groups related to the diagnosis referred to in Annex 10, Part A to this Regulation, which have been completed 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 75, or where PPRdrg, A, 2026,5 ≤ 0,075 * PPdrg, A, 2024,5 ≤ 0,075 * PPdrg, A, 2024 are determined as follows:
CMred, 2026, CZ-DRG, A = CM2026, CZ-DRG, A
where:
PPRdrg, A, 2026,5 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 5.
PPRdrg, A, 2024,5 is the number of hospitalisation cases recalculated in accordance with point 1.1 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 treatment termination code 5.
PPdrg, A, 2026 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.
PPdrg, A, 2024 is the number of hospitalisation cases recalculated in accordance with point 1.1 by the provider declared and the health insurance undertaking recognised, terminated in the reference period classified under the Classification in the groups related to the diagnosis listed in Annex 10, Part A to this Decree.
and where:
CM2026, CZK-DRG, A = {DOZI = 1n [IJU = 1mmax (CM2026, JPL, A, ij; CM2026, CZ- DRG, A, ij)]}
where:
CM2026, CZK-DRG, A, ij is a case of hospitalisation by a provider recognised and recognised by a health insurance undertaking, completed in the assessment period, classified by classification as well as related to a diagnosis, which is one of the groups listed in Annex 10, Part A to this Order, valued by relative weights 2026 listed in Annex 10, Part A to this Decree. Index i denotes the individual groups listed in Annex 10, Part A to this Decree. Index j refers to individual hospitalisation cases classified according to Classification in group i.
CM2026, JPL, A, ij is a case of hospitalisation by a provider recognised and recognised by a health insurance company, completed in the evaluation period, classified by Classification as a group i related to a diagnosis, which is one of the groups listed in Annex 14, Part A to this Order, valued by relative weights 2026 listed in Annex 14, Part A to this Decree. In the cases of hospitalisation according to the previous sentence, only those which meet the conditions defined for the group and in Annex 14, Part A shall be included.
ii. In other cases the reduced casix shall be determined as follows:
CMred, 2026, CZ- DRG, A = CM1,2026, CZ- DRG, A + CMred.5
where:
CM1,2026, CZ-DRG, A = {DOZI = 1n [DOZj = 1mmax (CM1,2026, JPL, A, ij; CM1,2026, CZ-DRG, A, ij)]}
where:
CM1,2026, CZK-DRG, A, ij is a case of hospitalisation by a provider recognised and recognised by a health insurance company, completed in an assessment period which has not been terminated by the treatment termination code 5, classified by classification as well as related to a diagnosis, which is one of the groups listed in Annex 10, Part A to this Regulation, valued by relative weights 2026 listed in Annex 10, Part A to this Regulation. Index i denotes the individual groups listed in Annex 10, Part A to this Decree. Index j refers to individual hospitalisation cases classified according to Classification in group i.
CM1,2026, JPL, A, ij is a case of hospitalisation by a provider recognised and recognised by a health insurance company, completed in an evaluation period which has not been terminated by a treatment termination code 5, classified by classification as well as related to a diagnosis, which is one of the groups listed in Annex 14, Part A to this Regulation, valued at the relative weights 2026 listed in Annex 14, Part A to this Regulation. In the cases of hospitalisation according to the previous sentence, only those which meet the conditions defined for the group and in Annex 14, Part A shall be included.
and where:
CMred, 5 = {DOZi = 1n]
where:
CM2026, CZK-DRG, A, 5, ij is a case of hospitalisation by a provider recognised and recognised by a health insurance company, terminated in an evaluation period which has been terminated by the treatment termination code 5, classified by classification as well as related to a diagnosis, which is one of the groups listed in Annex 10, Part A to this Regulation, valued by relative weights 2026 listed in Annex 10, Part A to this Regulation. Index i denotes the individual groups listed in Annex 10, Part A to this Decree. Index j refers to individual hospitalisation cases classified according to Classification in group i.
CM2026, JPL, A, 5, ij is a case of hospitalisation by a provider recognised and recognised by a health insurance company, ending in an evaluation period which has been terminated by a treatment termination code 5, classified by classification as well as related to a diagnosis, which is one of the groups listed in Annex 14, Part A to this Regulation, valued at the relative weights 2026 listed in Annex 14, Part A to this Regulation. In the cases of hospitalisation according to the previous sentence, only those which meet the conditions defined for the group and in Annex 14, Part A shall be included.
X shall be equal to 1.1 where the ratio of the number of insured persons of the health insurance company concerned in that district, as referred to in point 1 of Annex 9 to this Regulation, is greater than 0,1 and 1,15 where the ratio of the number of insured persons of that health insurance company in that district is less than or equal to 0,1 in accordance with point 1 of Annex 9 to this Regulation.
(f) IZP is the index of the change in production calculated as follows:
IZP = max [1; ARCTG (3 * CMred, 2026, CZ- DRG, ACM2024, CZ- DRG, A-1,443)]
4. Reimbursement on flat-rate remuneration
4.1 The remuneration earmarked for 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 and E to this Order.
4.2 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 and E, by the provider declared and the health insurance undertaking recognised for the assessment period, a remuneration of:
Article 20 (1) (b) of Regulation (EU) No 1308 / 2013
where:
(a) CM2026, CZK-DRG, CE, ij is a case of hospitalisation declared by a provider and recognised by a health insurance undertaking, completed in the assessment period, classified by classification as well as related to a diagnosis, which is one of the groups listed in Annex 10, Parts C and E to this Order, valued at the relative weights 2026 listed in Annex 10, Parts C and E to that decree. Index i denotes the individual groups listed in Annex 10, Parts C and E to this Decree. Index j refers to individual hospitalisation cases classified according to Classification in group i. Inhospitalisation cases according to the first sentence shall not include cases of hospitalisation included in the EMCDDA variable, the JPL.
(b) REIMBURSEMENT, Optional JPL, ij is the overnight payment for hospitalisation j, classified by Classification as well as related to diagnosis and listed in Annex 14, Part B to this Decree. In the cases of hospitalisation according to the previous sentence, only cases meeting the conditions defined for the group as well as in Annex 14, Part B to this Decree shall be included.
(c) KCCE, ij is a centralisation factor for both the group and related to the diagnosis and referred to in Annex 10, Parts C and E to this Order, of 1,03, if the provider has at least 1 status for at least part of the period of assessment referred to for the group in Annex 10, Parts C and E to that decree, and if this condition is not met, at the level indicated for that group in Annex 719 to that list, if the provider does not have the full period of evaluation or 1 status for the group in Annex 10, Parts C and E to that decree, and at the level 1, if the group does not have any status for the highly specialised care centre in Parts C and E for that decree and in the cases of hospitalisation, when at least 1 day before the start of the hospital, it was the provider declared of performance No 9563 or 9564.
(d) The FOREIGN, the compulsory JPL, is the cumulative amount of the overnight reimbursement for hospitalisation cases classified under the Classification in the groups related to the diagnosis listed in Annex 14, Part C to this Decree, including only hospitalisation cases satisfying the conditions defined for these groups in Annex 14, Part C.
(e) EM2026, CE is the total value of the requested extramural care in the context of hospitalisation cases by the provider declared and by the health insurance undertaking recognised, terminated in the assessment period, classified according to the Classification group related to the diagnosis, which is one of the groups listed in Annex 10, Parts C and E to this Order, valued at the values of the points in force in the assessment period, including the remuneration for the material separately charged and the medicinal products separately charged.
(f) NM is the cost modifier for the dedicated remuneration, which shall be determined as follows:
i. 1,20 for providers with a casemix-index of the reference period (CMI) higher than 2,8. The CMI is calculated as follows:
CMI = CM2024, CZK-DRG, all ZPPPdrag, 2024, all ZP
where:
CM2024, CZ- DRG, all ZP cases are the number of hospitalisation cases of insured persons converted according to point 1.1 by the provider declared and the health insurance company recognised, terminated in the reference period classified by the Classification in the groups related to the diagnosis listed in Annex 10, multiplied by the relative weights 2026 listed in Annex 10 to this Regulation, for all health insurance companies combined.
PPdrg, 2024, all ZP is the number of cases of hospitalisation of insured persons converted under point 1.1 by the provider declared and the health insurance company recognised, terminated in the reference period classified by the classification in the groups related to the diagnosis listed in Annex 10 to this Regulation for all health insurance undertakings combined.
ii. 1,15 for a provider that does not meet the conditions of sub-point i., which is part of the reference network of acute bed care providers in the period under Article 41a of the Act, which has at least 8 status of a high-level care centre in the period under assessment and which has at least the status of a high-level cerebrovascular care centre or a high-level haematooncological care centre for adults or high-level care centres for patients with multi-resistant tuberculosis or high-level care centres for the isolation of patients with suspected highly contagious disease;
iii. 1,10 for a provider that does not meet the conditions of subpoints i. and ii, which has at least the status of a centre of highly specialised trauma care during the period of assessment and at least 4 other statutes of a centre of highly specialised care;
iv. 1 for other providers.
(g) IZS2026, CZ-DRG, CDE is the individual basic rate of care allocated to the flat-rate remuneration calculated as follows:
i. Where:
NM > 1
then:
Sign in for notes, favorites and notifications
Regulation Information
| Citation | Decree No. 432 / 2025 Coll., on the determination of the values of the points, the amount of payment of the services paid, the amount of advances on payment of the services paid and the regulatory restrictions for the year 2026 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 30.10.2025 |
|---|---|
| Effective from | 01.01.2026 |
| Effective until | - |
| Status | Valid |
Public Contracts 5
Dodatek STOM_přeshraniční/2026 (dále jen „Dodatek č. 1“) ke Smlouvě
Zdravotní pojišťovna ministerstva vnitra České rep...
STOMATOL SPÓŁKA Z OGRANICZONA ODPOWIEDZIALNOŚCIĄ
20.04.2026
Notifications
Dodatek soc/2026 ke zvláštní smlouvě o poskytování a úhradě ošetřovatelské péče
Domov pro seniory Hortenzie
Zdravotní pojišťovna ministerstva vnitra České rep...
25.03.2026
Notifications
Dodatek č.5 ke smlouvě o poskytování a úhradě hrazených služeb. Úhradový dodatek k odb.305 (IČZ: 891...
Univerzita Palackého v Olomouci
Zdravotní pojišťovna ministerstva vnitra České rep...
20.02.2026
Notifications
Dodatek č.4 ke smlouvě o poskytování a úhradě hrazených služeb. Úhradový dodatek k odb.901 (IČZ: 891...
Univerzita Palackého v Olomouci
Zdravotní pojišťovna ministerstva vnitra České rep...
20.02.2026
Notifications
Dodatek smlouvy SOC/2026
Domov seniorů Jankov, poskytovatel sociálních služ...
Zdravotní pojišťovna ministerstva vnitra
1 200 000 CZK
19.01.2026
Source:
Hlídač státu
(CC BY 3.0 CZ)
The regulation text is for informational purposes only.
Comments 0