Decree of the Ministry of Health No. 458 / 2001 Coll.
Decree of the Ministry of Health determining the amount of health insurance payments paid from public health insurance including regulatory restrictions for the first half of 2002
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Effective from 01.01.2002
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01.01.2002
31.12.2001
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458
DECLARATION
Ministry of Health
of 13 December 2001
determining the amount of the public health insurance contributions, including the regulatory restrictions for the first half of 2002
According to § 17 (11) (b) of Act No. 48 / 1997 Coll., on Public Health Insurance, and amending and supplementing certain related laws, as amended by Act No. 459 / 2000 Coll., hereinafter referred to as "the Act":
This decree provides for an agreement under Paragraph 17 (8) of the Act where the conciliation procedure does not result,
(a) amount of health care payments paid from public health insurance including regulatory restrictions on health care
1. in health care institutions, including professional medical institutions, treatment of long-term sick and medical establishments reporting treatment day No 00005 under the Decree issuing a list of health performance with point values (1) (hereinafter referred to as "the list of performance"),
2. in outpatient medical institutions providing specialised outpatient health care,
3. in outpatient medical institutions providing haemodialysis care,
4. in outpatient health care establishments providing home health care,
5. in outpatient health care institutions providing health care in the field of expertise 222, 801 - 807, 809, 812 - 823 according to the list of performance,
6. provided in the framework of medical emergency services, transport and medical first aid services,
7. in outpatient health care establishments providing medical care in expertise 902 and 918 according to the performance list;
(b) the amount of compensation for the provision of emergency medical care in non-contractual medical establishments.
(1) Health care provided in health care institutions, except for medical care in professional medical institutions, long-term sick hospitals and in health care institutions reporting on day 00005 according to the list of performance (hereinafter referred to as "bed facilities"), is paid in accordance with the contractual agreement between the health insurance company and the bed establishment
(a) a flat rate; or
(b) according to the list of performances; or
(c) on a proposal of a sleeper, agreed by a method of payment combined with a diagnosis payment.
(2) The price of the point for reimbursement of health care referred to in paragraph 1 (b), set for the first half of 2001, remains valid for the first half of 2002.2)
(3) The amount of the remuneration referred to in paragraph 1 (c) shall be agreed in the contract between the health insurance undertaking and the bed establishment, the amount of the payment for the provision of emergency bed care being fixed at a flat rate and the other health care paid.
(4) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1 (a) or (b), the bed establishment and the health insurance undertaking have agreed on such a method of payment on the basis of the proposal of the bed establishment and this method will not be contrary to public health insurance legislation.
(5) If the bed establishment and the health insurance undertaking agree an amendment to the contract or agree a new contract containing new medical performance provided by the bed establishment or agree a new structure of the healthcare provided, the health insurance undertaking shall include this in the total amount of the payments for the first half of 2002.
(6) The procedure for calculating the flat rate, the amount and the conditions for reimbursement referred to in points (a) and (b) of paragraph 1 is laid down in Annex 1 thereto.
(7) Where payment is made at the flat rate referred to in paragraph 1 (a), the health insurance undertaking shall pay, in addition to the flat rate in the first half of 2002, a separate payment:
(a) for cardioverters and pacemakers, including electrodes, which were provided in the first half of 2002 in the case of reimplantation (performances No 55217 and 55219 included in the list of performance),
(b) for neuromodulation stimulators that were provided in the first half of 2002 for the treatment of epilepsy and Parkinson's disease;
(c) for neuromodulatory stimulators and intrathecal pumps provided for the treatment of chronic painful conditions [peripheral nerve stimulation (PNS), spinal cord stimulation or back roots (SCS), deep brain and cortical stimulation] and for stimulators of the anterior corners of the spinal cord (SARS) in transverse spinal lesions provided in the bed facilities listed in Annex 3 to this Decree in the first half of 2002; the sleeper establishments listed in Annex 3 to this Decree may apply in total to health insurance companies in the Czech Republic a maximum of 30 programmable prostheses,
(d) for in vitro fertilisation treatment provided in the first half of 2002 by sleepers carrying out standard sterilisation treatment using the extracurricular fertilisation method;
(e) for the medical performance of haemodialysis No 18051, 18052, 18510, 18513, 18521, 18522, 18530, 18550, 18560, 18570, 18580 and 18590 according to the list of performances which were provided in the first half of 2002, the price of the point for the reimbursement of these performances set out for the first half of 2001 remains in force for the first half of 2002; 3) for health performance No 18521, 18522, 18530, 18550, 18560, 18570, 18580 and 18590 respectively, the general costs of 4 points per minute,
(f) for the specifically charged medicinal products for the treatment of haemophilia listed in Annex 4 to this Decree, provided in bed facilities in the first half of 2002;
(g) for the specifically charged HIV / AIDS medicinal products (antiretroviral medicinal products and medicinal products for the comprehensive treatment of opportunistic infections) provided in the bed facilities listed in Annex 5 to this Decree in the first half of 2002; antiretroviral medicinal products and medicinal products for the comprehensive treatment of opportunistic infections are listed in Annex 6 to this Decree,
(h) for the specifically charged Cerezyme medicinal product, for the treatment of Morbus Gaucher disease, provided in the first half of 2002 only by the General Faculty Hospital Prague,
(i) for the treatment and intensive care days No 00051, 00052, 00053, 00055, 00057, 00058, 00061, 00065, 00068 according to the list of performances provided in the first half of 2002 for the treatment of extensive burns, in the sleeper facilities listed in Annex 7 to this Decree, the price of the point for the reimbursement of these performances set out for the first half of 2001 remains valid for the first half of 2002.4)
(j) for the medicinal products specifically charged for the treatment of cystic fibrosis in bed establishments listed in Annex 8 to this Decree in the first half of 2002; the list of medicinal products specifically charged is set out in Annex 9 to this Regulation,
(k) for specifically charged medicinal products provided in the first half of 2002 for oncologically ill children treated at the centres of pediatric oncology of the bed facilities listed in Annex 10 to this Decree; the list of medicinal products specifically charged is set out in Annex 11 to this Decree,
(l) for separately charged balloon catheters and stents provided in the 1-half of 2002 in connection with the implementation of a direct percutaneous transluminal angioplasty (PTCA) in the acute myocardial infarction (performances No 89435, 89437 and 17117 listed in the list of performances) in the bedding facilities listed in Annex 12 to this Decree,
(m) for the separately charged platelet glycoprotein receptor blockers IIb / IIIa (ATC Group B01AC13 and B01AC16) provided in the first half of 2002 for the treatment of acute myocardial infarction in sleeper establishments listed in Annex 12 to this Decree,
(n) for specially charged balloon catheters, stents, stent- graphs, embolizing spirals, adhesive mixtures, microcatheters and cerebrovascular protective devices provided in the first half of 2002 for endovascular treatment (performances No 89323, 89331 and 89423 listed in the performance list) of arterial aneurysms and dissections, stenosis of the cerebral arteries, cerebral arteriovenous shortages and malformations, in the bed facilities listed in Annex 13 to this Decree,
(o) for separately charged material (codes 24684 and 71032) provided in the first half of 2002 for hernia operations by means of the PHS method (performances No 51517 and 51519 included in the list of performance),
(p) for the separately charged material (code 67162) provided in the first half of 2002 for the operational treatment of stress incontinence of urine in women in bedding establishments listed in Annex 14 to this Decree,
(q) for medicinal products specifically charged (codes 75379, 90996, 93706 and 93707) for the treatment of rabies in sleeper establishments,
(r) for the medicinal products separately charged, containing the active substance erythropoietin listed in Annex 21, for the treatment of multiple myeloma and chronic lymphocytic leukaemia, provided by the bedding facilities listed in Annex 22 to this Regulation in the first half of 2002,
(s) for the specifically charged medicinal products containing the active substance erythropoietin listed in Annex No 21 for the treatment of germ tumours at stage II-IV, ovarian carcinomas at stage I-IIA, lung cancer, breast cancer at stage I and II, cervix cancer at stages Ib, IIa, IIb, orofacal carcinomas, placenta cancer provided in the bed facilities listed in Annex 23 to this Regulation in the first half of 2002.
(1) Health care provided in professional medical institutions is paid according to the contractual agreement between the health insurance company and the professional medical institution
(a) a flat rate; or
(b) in the combined manner referred to in Annex 2 (B).
(2) The price of the point of payment for health care referred to in paragraph 1 (b) set for the first half of 2001 remains valid for the first half of 2002.5)
(3) The overhead value agreed in the contract with the health insurance company assigned to the point value of the treatment date No 00024 included in the performance list shall be increased by 60 points compared to 1 half of 2001, the resulting value of the treatment must not be higher than the output list.
(4) The flat-rate amount to be paid for medicinal products under Section 17 (12) of the Act is increased by CZK 10 compared to the 1st half of 2001.
(5) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1 (a) or (b), the professional medical institution and the health insurance undertaking have agreed, on a proposal from the medical institution, on such a method of payment and this method is not contrary to public health insurance legislation.
(6) If a medical professional institution and a health insurance undertaking agree an amendment to the contract or agree a new contract containing new medical performance provided by the medical professional institution or agree a new structure of healthcare provided, the health insurance undertaking shall include this in the total amount of the payments for the first half of 2002.
(7) The procedure for calculating the flat rate and reimbursement in the combined manner, the amount and the conditions for payment referred to in paragraph 1 (a) and (b) are set out in Annex 2 to this Decree.
(1) Health care provided in long-term patients' hospitals is paid according to the contractual agreement between the health insurance company and the healthcare establishment according to the performance list by remuneration for the medical performance provided.
(2) The price of the point of payment of health care referred to in paragraph 1, set for the first half of 2001, remains valid for the first half of 2002.6)
(3) The overhead value agreed in the contract with the health insurance company assigned to the point value of the treatment date No 00024 included in the performance list shall be increased by 60 points compared to 1 half of 2001, the resulting value of the treatment must not be higher than the output list.
(4) The flat-rate amount to be paid for medicinal products under Section 17 (12) of the Act is increased by CZK 5 compared to the 1st half of 2001.
(5) A different method of payment than that referred to in paragraph 1 may be possible if the total amount of remuneration is higher than the payment provided for in paragraph 1, the treatment facility of the long-term sick and health insurance company has agreed on such a method of payment on a proposal from the treatment of long-term patients and this method will not be contrary to public health insurance legislation.
(1) Health care provided in health care establishments reporting on treatment day No 00005 listed in the performance list shall be paid under the contractual arrangement between the health insurance undertaking and the healthcare establishment in accordance with the performance list by remuneration for the medical performance provided.
(2) The price of the point of payment of health care referred to in paragraph 1, set for the first half of 2001, remains valid for the first half of 2002.7)
(3) The overhead value agreed in the contract with the health insurance company assigned to the point value of the treatment date No 00005 included in the performance list shall be increased by 60 points compared to the 1 half of 2001, the resulting overhead value shall not be higher than the output list.
(4) The flat-rate amount to be paid for medicinal products under Section 17 (12) of the Act is increased by CZK 5 compared to the 1st half of 2001.
(5) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1, the health care establishment and the health insurance undertaking have agreed, on a proposal from the health care establishment, on such a method of payment and this method does not conflict with the public health insurance legislation.
(1) Reimbursement of urgent health care, unless a contract is concluded between a healthcare establishment and a health insurance company, is made for the health performance provided as follows:
(a) dental outpatient care shall be paid at the rates applicable to dental care provided by dental practitioners in the first half of 2002;
(b) other healthcare is paid according to the performance list and the health insurance company may apply regulatory mechanisms on the basis of the Act (8) similar to those for contractual health establishments.
(2) The price of the point for reimbursement of health care referred to in paragraph 1 (b) for the first half of 2001 remains valid for the first half of 2002.9)
(1) Specialised outpatient health care provided in outpatient medical institutions is paid in accordance with the contractual agreement between the health insurance undertaking and the healthcare establishment according to the performance list by remuneration for the medical performance provided up to a limit of 12 hours of performance per calendar day, with a limitation of the maximum remuneration for the expertise, following the number of insured persons treated in that professional capacity.
(2) The price of the point of payment of health care referred to in paragraph 1 agreed in the second half of 2001 and published in the Ministry of Health Bulletin remains valid for the first half of 2002.10)
(3) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1, the health care establishment and the health insurance undertaking have agreed, on a proposal from the health care establishment, on such a method of payment and this method does not conflict with the public health insurance legislation.
(4) The amount and conditions for reimbursement referred to in paragraph 1 are set out in Annex 15 to this Order.
(1) Hemodialysis care provided in outpatient medical establishments listed in Annex 16 to this Decree shall be paid under the contractual arrangement between the health insurance undertaking and the healthcare establishment in accordance with the performance list by remuneration for the medical performance provided.
(2) The price of the point of payment of health care referred to in paragraph 1 agreed in the second half of 2001 and published in the Ministry of Health Bulletin remains valid for the first half of 2002.10)
(3) The value of the direction assigned to the power score No 18521, 18522, 18530, 18550, 18560, 18570, 18580 and 18590 according to the power list is set at a minimum of 4 points per minute of power, the resulting value of the direction must not be higher than the power list allows.
(4) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1, the health care establishment and the health insurance undertaking have agreed, on a proposal from the health care establishment, on such a method of payment and this method does not conflict with the public health insurance legislation.
(5) The conditions for reimbursement referred to in paragraph 1 shall be laid down in Annex 17 to this Order.
(1) Domestic health care provided by outpatient medical institutions is paid under a contractual arrangement between the health insurance company and the healthcare establishment according to the performance list by remuneration for the health performance provided
(a) within 12 hours of the time limit of the time limit of the carrier's power per calendar day; or
(b) depending on the type of operation of the medical establishment, up to the 8-hour time limit of the carrier, provided that the healthcare is provided 7 days a week, or up to the 8-hour time limit of the carrier per working day, unless the 7-day period is provided.
(2) The price of the point of payment of health care referred to in paragraph 1 (a) and (b) agreed in the second half of 2001 and published in the Ministry of Health Bulletin remains valid for the first half of 2002.10)
(3) Minute overhead for competence 925 - domestic health care is set at a minimum of 1 point per minute of time of performance, the resulting value of the direction must not be higher than the performance list allows. The freedom of a contractual arrangement between a domestic health care provider and a health insurance company above the minimum amount of a minute overhead remains unaffected.
(4) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1, the health care establishment and the health insurance undertaking have agreed, on a proposal from the health care establishment, on such a method of payment and this method does not conflict with the public health insurance legislation.
(5) Health insurance companies shall provide pre-payment to the contractual health service for the relevant quarter at the rate of 106% of the amount of remuneration of the comparative period corresponding to the calendar quarter of the last year, with financial settlement after evaluation of the regulatory mechanisms. The condition is to provide and report an adequate amount of covered health care, maintain availability and extent of care as well as in the comparison period.
(1) Health care provided by outpatient health care institutions in the field of expertise 222, 801 - 807, 809, 812 - 823 according to the performance list is paid according to the contractual agreement between the health insurance company and the healthcare establishment
(a) a flat rate; or
(b) according to the list of performances.
(2) The price of the point of payment for health care referred to in paragraph 1 (b), negotiated in the second half of 2001 and published in the Ministry of Health Bulletin, remains valid for the first half of 2002.10)
(3) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1, the health care establishment and the health insurance undertaking have agreed, on a proposal from the health care establishment, on such a method of payment and this method does not conflict with the public health insurance legislation.
(4) The procedure for fixing the flat rate referred to in paragraph 1 (a), the amount and the conditions for reimbursement referred to in paragraph 1 (a) and (b) is set out in Annex 18 to this Decree.
(1) Health care provided in the framework of the medical emergency service (competence 709 according to the performance list) is paid under the contractual agreement between the health insurance company and the healthcare establishment
(a) a flat rate; or
(b) according to the list of performances.
(2) The price of the point of payment for health care referred to in paragraph 1 (b), negotiated in the second half of 2001 and published in the Ministry of Health Bulletin, remains valid for the first half of 2002.10)
(3) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1, the health care establishment and the health insurance undertaking have agreed, on a proposal from the health care establishment, on such a method of payment and this method does not conflict with the public health insurance legislation.
(4) The amount and conditions for reimbursement referred to in paragraph 1 (a) are set out in Annex 19 to this Decree.
(1) Health care provided in the context of transport and first-aid medical services is paid under the contractual arrangement between the health insurance undertaking and the healthcare establishment according to the performance list by remuneration for the medical performance provided.
(2) The price of the point of payment of health care referred to in paragraph 1 agreed in the second half of 2001 and published in the Ministry of Health Bulletin remains valid for the first half of 2002.10)
(3) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1, the health care establishment and the health insurance undertaking have agreed, on a proposal from the health care establishment, on such a method of payment and this method does not conflict with the public health insurance legislation.
(1) Health care provided by outpatient health care establishments in the field of competence 902 and 918 according to the performance list shall be paid according to the contractual agreement between the health insurance undertaking and the healthcare establishment in accordance with the performance list by remuneration for the medical performance provided up to the 10 hours time limit of the carrier per working day.
(2) The price of the point of payment of health care referred to in paragraph 1 agreed in the second half of 2001 and published in the Ministry of Health Bulletin remains valid for the first half of 2002.10)
(3) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1, the health care establishment and the health insurance undertaking have agreed, on a proposal from the health care establishment, on such a method of payment and this method does not conflict with the public health insurance legislation.
(4) Health insurance companies may provide for a preliminary remuneration for the relevant quarter to be fixed by the contractual health insurance undertaking at the rate of 106% of the amount of remuneration for the comparative period, which is separate from the first and second quarters of 2001. Preliminary payments shall be settled by health insurance companies within 30 days of the evaluation of the regulatory mechanisms.
(1) If, in the first half of 2002, the actual income from the collection of premiums after the reallocation is greater than the actual amount of the premium after the reallocation in the first half of 2001, health insurance companies shall increase the total amount of remuneration calculated in accordance with this decree in accordance with the procedure set out in Annex 20 to this decree by the medical institutions referred to in Article 1 (a).
(2) Redistribution data for the first six months will be included in the income from the collection of premiums after reallocation.
(3) The increase referred to in paragraph 1 shall be paid by health insurance undertakings to contractual health establishments by 30 November 2002.
(4) If there is a change in the list of performance during the first half of 2002, these changes shall be taken into account when calculating the increase referred to in paragraph 1.
(5) Health insurance companies shall, until 31 October 2002, provide health care institutions with data on actual income from the collection of premiums after the reallocation for the first half of 2002 of the sixth reallocation.
This Decree shall take effect on 1 January 2002.
Minister:
Prof. MUDr. Fisher, CSc.
Příloha č. 1
Annex No. 1 to Decree No. 458 / 2001 Coll.
Procedure for calculating the flat rate, the amount and the conditions for reimbursement referred to in Article 2 (1) (a) and (b)
(A) Reimbursement at a flat rate
1. The reimbursement of health care provided by bed facilities shall include:
(a) the payment of emergency bed care recorded in hospitalisation accounts, including the relevant performance of the complement (hereinafter referred to as "hospitalisation payment");
(b) the payment of outpatient care recorded in outpatient accounts, including the relevant performance of the complement ("outpatient payment");
(c) reimbursement of the performance of health transport (hereinafter referred to as "transport payment"),
(d) the reimbursement of other health care performance, where provided by the bed establishment, of complements for other healthcare establishments or, where appropriate, other contracted performances ("other remuneration").
If one of these types of healthcare does not provide bed facilities, it is not part of the remuneration.
2. Procedure for establishing the flat rate for the first half of 2002
The flat rate shall be calculated for the different types of healthcare referred to in points (1) (a) to (d) of the performance volume for the first half of 2001 which have been declared by the bed establishment and recognised by the health insurance undertaking between 1 January 2001 and 30 November 2001, or, where applicable, the performance of previous periods recognised by the health insurance undertaking but not included in the flat rate in previous periods, as follows:
The total volume of performance (points and separately charged medicinal products and separately charged material) is divided by the number of unique treated insured persons who have received health care in a bed establishment. A special insured person means one insured person, regardless of the number of times the number of times the bed establishment has shown health care on that insured person within a specified period of time. The performance and unique treatment of the insured person shall be calculated separately for each type of remuneration referred to in points 1 (a) to (d).
The flat rate shall include:
(a) the number of points per special insured person,
b) flat rate for separately charged medicinal products and separately charged material, on 1 special treated insured person, in CZK.
2.1. Flat rate hospitalisation
PHB
PHZ = INDIVIDUUM
where:
PHB = number of points per unique treated insured person for the first half of 2001
BH = the number of points for all medical performance provided for hospitalisation, including those for the patient category, for the first half of 2001 of the bed establishment in question, which have been declared by the bed establishment and recognised by the health insurance company from 1 January 2001 to 30 November 2001, except for:
(a) for medical performance paid in the first half of 2002 in excess of the flat rate of hospitalisation or included in another flat rate;
(b) for recognised and recognised health performance provided in the course of hospitalisation in experts no longer contracted for the first half of 2002.
PHZ = flat rate for separately charged medicinal products and separately charged material provided in the first half of 2001 to hospitalised insured persons on 1 special treated insured person.
ZH = remuneration for the specifically charged medicinal products and the separately charged material provided in the first half of 2001 to hospitalised insured persons who have been declared by the bed establishment and recognised by the health insurance company from 1 January 2001 to 30 November 2001, except for the separately charged material and the specifically charged medicinal products:
(a) paid in the first half of 2002 in excess of the flat rate of hospitalisation or included in another flat rate;
(b) provided during hospitalisation in experts who are no longer contracted for the first half of 2002.
UH = number of unique treated insured persons who were hospitalised in the first half of 2001 and the medical performance provided to them was declared by the bed establishment and recognised by the health insurance company from 1 January 2001 to 30 November 2001.
2.2. Outpatient flat rate
_
_
where:
PAB = number of points per unique treated insured person for the first half of 2001.
BA = number of points for all medical performance provided in ambulances, for the first half of 2001, which have been declared by the bed establishment and recognised by the health insurance company from 1 January 2001 to 30 November 2001, except for points:
(a) for the medical performance paid in the first half of 2002 in excess of the flat rate outpatient or included in another flat rate;
(b) for recognised and recognised health performance provided in ambulances in expert matters no longer contracted for the first half of 2002.
PAZ = flat rate for separately charged medicinal products and separately charged material provided in the first half of 2001 in ambulances treated to insured persons on 1 unique treated insured person.
ZA = reimbursement for the specifically charged medicinal products and the separately charged material provided in the first half of 2001 in ambulances treated to insured persons who have been declared by the hospital and recognised by the health insurance company from 1 January 2001 to 30 November 2001, except for the separately charged material and the medicinal products separately charged:
(a) paid in the first half of 2002 in excess of the flat rate outpatient or included in another flat rate;
(b) provided in ambulances in experts who are no longer contracted for the first half of 2002.
UA = number of unique treated insured persons who were treated in ambulances in the first half of 2001 and the medical performance provided to them by sleepers and recognised by the health insurance company from 1 January 2001 to 30 November 2001.
2.3. Flat rate for health transport
PDB = INDIBD INSTRUMENT
PDZ = ZD
where:
PDB = number of points per unique treated insured person for the first half of 2001
BD = the number of points for all medical performance provided for health transport in the first half of 2001 of the bed establishment in question which have been declared by the bed establishment and recognised by the health insurance company from 1 January 2001 to 30 November 2001, except for points:
(a) for medical performance paid in the first half of 2002 in excess of the flat rate for health transport or included in another flat rate;
(b) for declared and recognised health performance in health transport which are no longer contracted for the first half of 2002.
PDZ = flat rate for separately charged medicinal products and separately charged material provided in the first half of 2001 for medical transport transported and, where applicable, treated to insured persons on 1 special treated insured person.
ZD = reimbursement for the medicinal products specifically charged and the material specifically charged provided in the first half of 2001 for the transport of medical goods transported and, where applicable, to insured persons who have been declared by the hospital and recognised by the health insurance company from 1 January 2001 to 30 November 2001, except for the material separately charged and the medicinal products separately charged:
(a) paid in the first half of 2002 in excess of the flat rate for health transport or included in another flat rate;
(b) provided in the course of health transport operations no longer contracted for the first half of 2002.
UD = number of unique treated insured persons who were transported to health transport in the first half of 2001 and, where appropriate, treated and the medical performance provided to them was declared by bed facilities and recognised by the health insurance company from 1 January 2001 to 30 November 2001.
2.4. Flat rate for other health performance
PJB
_
where:
PJB = number of points per unique treated insured person for the first half of 2001
BJ = the number of points for all other medical performance provided in the first half of 2001 of the bed establishment in question which have been declared by the bed establishment and recognised by the health insurance company from 1 January 2001 to 30 November 2001, except for points:
(a) for medical performance paid in the first half of 2002 in excess of the flat rate for other medical performance or included in another flat rate;
(b) for recognised and recognised other medical performance provided by experts no longer contracted for the first half of 2002.
PJZ = flat rate for separately charged medicinal products and separately charged material provided in the first half of 2001 for other health benefits to insured persons on 1 special treated insured person.
ZJ = remuneration for the specifically charged medicinal products and the separately charged material provided in the first half of 2001 for other health benefits to insured persons who have been declared by the bed establishment and recognised by the health insurance company from 1 January 2001 to 30 November 2001, except for the material separately charged and the medicinal products separately charged:
(a) paid in the first half of 2002 in excess of the flat rate for other medical performance or included in another flat rate;
(b) provided for other health performance in the field of expertise which are no longer contracted for the first half of 2002.
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Regulation Information
| Citation | Decree of the Ministry of Health No. 458 / 2001 Coll., determining the amount of health care payments paid from public health insurance including regulatory restrictions for the first half of 2002 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 31.12.2001 |
|---|---|
| Effective from | 01.01.2002 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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