Decree No. 50 / 2005 Coll.
Order setting the amount of the public health insurance contributions, including regulatory restrictions, for the first half of 2005
Valid
Effective from 25.01.2005
50
DECLARATION
of 20 January 2005
determining the amount of the public health insurance contributions, including the regulatory restrictions for the first half of 2005
According to Article 17 (7) (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 sets out, where the conciliation procedure does not result in an agreement under Article 17 (8) of the Law, the amount of the payments
(a) health care covered by public health insurance, including regulatory restrictions on health care in health institutions, including professional medical institutions, treatment of long-term sick and health establishments reporting treatment day No 00005 under the Decree issuing a list of health performances with point values (1) (hereinafter referred to as "the list of performances");
(b) outpatient specialists;
(c) providing urgent health care in non-contractual health establishments.
(1) For the first half of 2005, the amount of the payment of health care in the health care institution, except for medical care in professional medical institutions, long-term sick hospitals and in healthcare institutions reporting on treatment day 00005, according to the list of performance (hereinafter referred to as the "institutional care facility"), is fixed at at least 103% of the total remuneration (including the material specifically charged, the medicinal products specifically charged and the payments in excess of the flat rate, if agreed) of the health care facility in the first half of 2004.
(2) The reimbursement provided for in paragraph 1 shall be subject to the provision of at least 90% of the amount of health care declared by the healthcare establishment and recognised by the health insurance undertaking compared to 1 half of 2004, expressed in terms of the number of points in the performance list. In the event of a lower amount of health care declared and recognised than that indicated in the first sentence, the amount of remuneration referred to in paragraph 1 shall be reduced by the same percentage as the lower amount of healthcare.
(3) If the institution and the health insurance undertaking agree an amendment to the contract or agree a new contract containing new health performance, provided by the institution, the health insurance undertaking shall pay the newly contracted health care in excess of the remuneration set out in paragraphs 1 and 2 by the method of remuneration and at the level agreed in the contract; if there is no agreement on the method of payment and the amount thereof, the health insurance company shall pay new health benefits according to the list of performances with a point price fixed for the first half of 2001 of CZK 0,89).
(4) The increase in the amount of health care provided to insured persons for whom the cost of health care provided in the first half of 2005 exceeded CZK 300,000 will be paid by the health insurance company of the institution in excess of the remuneration specified in paragraphs 1 and 2 by the method of payment and at the level agreed in the contract; if there is no agreement on the method of payment and the amount thereof, the health insurance company shall pay the financial amount of the costs for those insured persons in the first half of 2004 in accordance with the list of benefits with a point price fixed for the first half of 2001 of CZK 0,89).
(5) Where the institution provides health care to a small number of insured persons by the relevant health insurance undertaking, paragraphs 1 and 2 shall not apply and the healthcare provided shall be reimbursed in the manner of reimbursement and at the level agreed in the contract; If there is no agreement on the method of payment and the amount thereof, the health insurance company shall pay this health care according to the list of benefits with a point price fixed for the first half of 2001 of CZK 0,89). A small number of insured persons means 50 or less (regardless of the number of treatments).
(6) If, in the first half of 2005, a hospital care facility provides bed care of more than 105% of the number of insured insured persons (regardless of the number of treatments) compared to their number in the first half of 2004, the total health care payment provided for in paragraph 1 shall be increased by the same percentage as the number of insured persons exceeding 105%.
(7) The health insurance company shall provide the medical establishment with a monthly advance payment of at least one sixth of the medical care payment provided for in Paragraph 2 (1). The bill for the whole half-year shall be made and transmitted by the health insurance company to the institution of constitutional care within 60 days of the end of the half-year.
(8) Health insurance and health care institutions may agree to pay health care in the form of a payment for diagnosis; in that case, paragraphs 1 to 7 shall not apply.
For the first half of 2005, the level of health care payment in professional medical institutions, long-term sick hospitals and in healthcare institutions reporting treatment day No 00005 according to the performance list shall be set at a flat rate for the treatment day (point value of the treatment day, point value of the patient category, point value of the treatment day, and a flat amount to be paid for medicinal products according to the performance list) by increasing the total amount of the treatment facility in the first half of 2004 by index 1,13.
(1) Specialised outpatient health care provided in outpatient medical institutions is paid under the contractual arrangement between the health insurance undertaking and the health care establishment under the performance list by remuneration for the medical performance provided up to 12 hours of performance per calendar day, subject to a limit of maximum remuneration, following the number of insured persons treated in the health establishment concerned. The amount of the remuneration is set out in the annex to this decree.
(2) The price of the point of payment of health care referred to in paragraph 1 agreed in the 2nd half of 2004 and declared in the Ministry of Health Bulletin pursuant to Paragraph 17 (9) of the Act remains valid for the 1st half of 2005.
(3) A method of payment other than that referred to in paragraph 1 may be made where, on the basis of a proposal from the health care institution, the health care institution and the health insurance undertaking have agreed on such a method of payment, the total amount of remuneration shall be higher than the remuneration provided for in paragraph 1 and this method of payment is not contrary to 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 2005;
(b) other healthcare is paid according to the performance list and the health insurance company may apply regulatory measures on the basis of the Act (3), mutatis mutandis, as for contractual health establishments.
(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 20054).
This decree shall take effect on the day of its publication.
Minister:
Doc. MUDr. Emmer, CSc.
Annex to Decree No 50 / 2005 Coll.
Amount of the remuneration pursuant to Article 4 (1)
(1) The maximum remuneration to the competent outpatient health care institution (hereinafter referred to as "health care institution") for the first and second quarters (hereinafter referred to as "the relevant quarter") of the first half of 2005 shall be calculated as the product of the total number of unique insured persons treated by the health insurance undertaking concerned in the relevant quarter and the value of the maximum remuneration per unique treated insurer of the relevant health insurance undertaking treated by the healthcare institution.
2. The value of the maximum remuneration per unique treated insured person of the relevant health insurance undertaking treated with the medical establishment for the relevant quarter shall be calculated as the product of the maximum remuneration per unique treated insured person of the relevant health insurance undertaking treated with the medical establishment in the relevant quarter of the preceding year multiplied by 1,03. The value of the maximum remuneration per single treated insured person of the relevant health insurance undertaking treated in the relevant quarter of the previous year shall be determined as the value of the proportion of the total number of points reported by the health undertaking and recognised by the health insurance undertaking in the relevant quarter of the previous year divided by the number of unique treated insured persons treated by the health undertaking in the relevant quarter of the previous year.
2.1. If the value of the maximum remuneration per individual insured person of the relevant health insurance undertaking in that professional capacity for a health establishment is lower than the value of the national average of the maximum remuneration per unique treated insured person of the relevant health insurance undertaking, the value of the national average of the maximum remuneration per unique treated insured person in that professional, multiplied by the coefficient of 1,03, shall be used to calculate the maximum remuneration per single treated health undertaking.
2.2. A single insured person is a unique insured person, regardless of how many times the health care institution has reported to that insured person within a specified period of time.
2.3. The value of the national average of the maximum remuneration per unique treated insured person of the relevant professional with the relevant health insurance undertaking shall be determined as the proportion of all contractual health care establishments of the relevant professional declared and the relevant health insurance undertaking of recognised points in the relevant quarter and the total number of unique treated insured persons treated by the relevant health insurance undertaking's contractual establishments of the relevant professional.
2.4. The insured persons of the relevant health insurance undertaking treated in the relevant professional capacity shall be counted both in their own care and in their own care. The value of the national average of the maximum remuneration per unique treated insured person shall be reported by each health insurance undertaking to the healthcare establishment for each quarter of the preceding year and published on the Internet no later than 273 days after the end of the relevant quarter of the previous year.
2.5. In the absence of a medical institution during the reference period of the previous year, or less than 150 insured persons have been treated by the medical institution concerned, the maximum remuneration limit shall not apply.
3. The maximum remuneration for a health care establishment shall be the sum of the maximum remuneration per individual treated insured person in each of the expertise specified in the contract concluded between that health establishment and the health insurance company.
4. For health institutions where there has been a change in the scope of healthcare agreed in the contract compared to the reference period of the previous year, health insurance companies shall take into account the resulting amount of remuneration in the contract appendix.
5. Reimbursement for prescribed medicinal products, medical devices and required care shall be as follows:
5.1. If the total remuneration for prescribed medicinal products and medical devices, excluding medicinal products and medical devices approved by the medical examiner in excess of the reference period and for the required care in the experts 222, 801 to 805, 809, 812 to 823, according to the performance list exceeds the average of that medical institution in the relevant quarter of the preceding year, the health insurance undertaking shall apply a regulatory haircut of 25% on such excess, in accordance with the procedures contained in the contract concluded between the medical establishment and the health insurance undertaking.
5.2. If the total remuneration for prescribed medicinal products and medical devices, except for medicinal products and medical devices authorised by a revision doctor above the reference period and for required care in the professional fields 222, 801 to 805, 809, 812 to 823, according to the performance list, exceeds the national average of more than 20% per unique treated insured person for doctors of the relevant professional, type of medical establishment (in terms of the scope of the performance contained in the contract) and the type of healthcare provided taking into account age groups in the relevant calendar quarter, the health insurance undertaking shall apply a regulatory deduction of 25% of such excess, in terms of the contract concluded between the medical establishment and the health insurance undertaking.
5.3. The national averages of payments for prescribed medicinal products and medical devices, with the exception of medicinal products and medical devices approved by a revised doctor, shall be published by the health insurance company on the Internet for the relevant quarter of the previous year, on the internet within 273 days of the end of the relevant quarter of the previous year.
5.4. The health insurance company may apply to health care establishments the regulation of payments for prescribed medicinal products and medical devices and for the required care referred to in point 5.1 or point 5.2, which constitutes a smaller reduction for health care establishments.
5.5. Where the total remuneration in the relevant quarter for medicinal products and medical devices prescribed by medical devices, except for medicinal products and medical devices authorised by a medical practitioner, and for care requested by medical devices in the field of competence 222, 801 to 805, 809, 812 to 823 under the list of performance is lower than the total remuneration for medicinal products and medical devices authorised by a medical practitioner, with the exception of medicinal products and medical devices authorised by a medical practitioner, and for care requested by medical devices in the field of competence 222, 801 to 805, 809, 812 to 823 under the list of performance in the relevant quarter of the preceding year, the medical institution shall pay the amount of the bookkeeping of 30% of the required savings by 60 calendar days from the last day of the relevant quarter.
1) Decree No. 134 / 1998 Coll., which publishes a list of health performance with point values, as amended by Decree No. 55 / 2000 Coll., Decree No. 135 / 2000 Coll., Decree No. 449 / 2000 Coll., Decree No. 101 / 2002 Coll. and Decree No. 291 / 2002 Coll.
2) Article II of Act No. 459 / 2000 Coll., amending Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related acts, as amended. Annex No. 1, B, 1 to Government Decree No. 487 / 2000 Coll., establishing the value of the point and the amount of the health care payments paid from public health insurance for the first half of 2001.
3) Paragraph 40 (2) of Act No. 48 / 1997 Coll.
4) Article II of Act No. 459 / 2000 Coll. § 6 (b) of Government Decree No. 487 / 2000 Coll.
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Regulation Information
| Citation | Decree No. 50 / 2005 Coll., determining the amount of health care payments paid from public health insurance including regulatory restrictions for the first half of 2005 |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 25.01.2005 |
|---|---|
| Effective from | 25.01.2005 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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