165. Federal law on the establishment of a fund for the financing of private hospitals (Private Sickness Funds-Funding Fund Act-PRIKRAF-G)

The National Council has decided:

Section 1

General provisions

§ 1 Establishment of the Private Sickness Fund fund

§ 2 Tasks of the PRIKRAF

§ 3 Funds of the PRIKRAF

§ 4 Data collection and transfer, surveys

Section 2

Use of the PRIKRAF funds

§ 5 Invoice to PRIKRAF hospitals and claimants

§ 6 Invoice with PRIKRAF hospitals

§ 7 Akontation and final settlement

§ 8 Invoice with beneficiaries

Section 9 Accounting of the administrative expenditure

Section 3

Organisational provisions

§ 10 Institutions of the PRIKRAF

§ 11 Management

Section 12 Composition of the Fund Commission

Section 13 Rules of Procedure of the Fund Commission

Section 14 Tasks of the Fund Commission

§ 15 Sanctions

§ 16 Principles of the Gebarung of the PRIKRAF

§ 17 Supervision

Section 18 Control and information obligations

Section 4

Arbitration

§ 19 General

Section 20 Members of the Arbitration Commission

Section 21 procedural provisions

§ 22 Organisation

Section 5

Final provisions

Section 23 Fee exemption

Section 24 In-Power-Tretens and Transitional Provisions

Section 1

General provisions

Establishment of the Private Sickness Fund fund

§ 1. (1) A fund with its own legal personality shall be established for the financing of all benefits in accordance with § 149 (3) of the ASVG of Austria's private hospitals in the beating of the bed. It is called "Privatkrankenanstalten-financing-fund-PRIKRAF" and is referred to below as PRIKRAF. The headquarters of the PRIKRAF is Vienna.

(2) Unless otherwise specified in the following, the term "PRIKRAF hospitals" shall include those hospitals which are covered by the regulation of § 149 (3) ASVG and in which Appendix 1 of this law.

(3) As far as the following is exclusively referred to provisions of the ASVG, the parallel provisions of the other social security laws (B-KUVG, BSVG, GSVG) should be applied in accordance with the provisions of the ASVG.

(4) As beneficiaries within the meaning of this law, apart from the insured persons in particular also entitled persons according to § § 122, 123, 134 and 158 ASVG as well as persons who are a health insurance institution on the basis of legal provisions or are associated with the provision of benefits in kind under the legislation which it administers under intergovernmental or national law on social security.

Tasks of the PRIKRAF

§ 2. (1) The PRIKRAF shall, in particular, carry out the following tasks:

1.		The denials of all services of PRIKRAF hospitals in the stationary and daily clinical sector, including the benefits resulting from medical progress, for which there is a service obligation of the health insurance institutions. During steady-state care, all intra-or extramural examinations or treatments are covered by the fund offsetting.
2.		The performance of maintenance grants to insured persons in accordance with § 150 (2) ASVG, which were treated in a PRIKRAF hospital.
3.		Other tasks entrusted to the PRIKRAF by laws and regulations.

(2) Ambulant services and rehabilitation and spa services are not to be deducted from PRIKRAF funds.

Funding of the PRIKRAF

§ 3. The following resources will be allocated to the PRIKRAF:

1.		Funds of national social insurance institutions for hospital and day-care medical treatment pursuant to § 149 (3) of the ASVG as well as for maintenance grants pursuant to § 150 para. 2 ASVG for treatments in a PRIKRAF hospital. Corresponding credit transfers shall be carried out on a monthly basis;
2.		Reimbursement amounts of foreign social insurance institutions for inpatient and daily clinical treatment for those cases for which no agreements on the reimbursement of costs by flat-rate payments or on a waiver of expenses exist;
3.		Asset yields;
4.		other funds (e.g. donations).

Data collection and transfer, surveys

§ 4. (1) The carriers of the PRIKRAF hospitals are obligated to do so in the Federal Act on Documentation in the Health Care, BGBI. No 745/1996, as amended and in the regulations adopted for this purpose, and without prejudice to the data reported to the Federal Ministry of Health and Women, this data also to the PRIKRAF shall be transmitted. Furthermore, the PRIKRAF must submit the intensive and personnel data required for the settlement in accordance with the Federal Act on the Documentation in the Health Care and the Regulations which have been issued for this purpose. In addition, the carriers of the PRIKRAF hospitals are obliged to collect further data on request and to transmit them to the PRIKRAF, insofar as these data are required for the performance of the tasks of the PRIKRAF.

(2) The organs of the PRIKRAF and the members of the PRIKRAF are entitled to carry out surveys in PRIKRAF hospitals about the correctness and completeness of the medical documentation as well as the accounts with the PRIKRAF and to the PRIKRAF to consult the relevant documents.

(3) In the event of a breach of the obligations laid down in paragraph 1 or 2, the sanction mechanism to be regulated in accordance with § 15 shall apply.

Section 2

Use of the PRIKRAF funds

Offsetting against PRIKRAF hospitals and beneficiaries

§ 5. (1) Insofar as an individual contract with the competent health insurance institution exists, a direct settlement with the PRIKRAF-Krankenanstalt takes place in accordance with § 149 (3) of the ASVG.

(2) Unless there is a contract with the competent health insurance institution, the PRIKRAF provides care grants in accordance with § 150 para. 2 ASVG to the beneficiaries, who were treated in a PRIKRAF hospital.

Offsetting with PRIKRAF hospitals

§ 6. (1) The PRIKRAF funds shall be used for the settlement in accordance with § 5 (1) minus the funds in accordance with § § 8 and 9 (maintenance grants and administrative expenses).

(2) PRIKRAF hospitals are obliged to provide the PRIKRAF with the data in accordance with § 4 (1) as well as the requested additional data up to the 20. of the following month and an annual report by 31 March of the following year.

(3) The number of points (performance-oriented diagnostic case group-points-LDF points) are according to the performance-oriented hospital financing (LKF) standardized in § 27b KAKuG with the by the Federal Ministry of Health and Women to the To determine the relevant version of the reference program in the respective valid version of the PRIKRAF hospital and to forward it together with the data in accordance with paragraph 2 to the PRIKRAF. In the event of a late, incorrect or unreported notification by a PRIKRAF hospital, the sanction mechanism to be regulated in accordance with § 15 is to be applied.

(4) The funds referred to in paragraph 1 shall be transferred to the PRIKRAF hospitals as soon as possible after they have received the PRIKRAF in accordance with the reported data and taking into account the point value (paragraph 1) as soon as possible. 2 and 3). The funds are to be distributed to 100% without weighting (core area).

(5) The distribution of the funds available to each of the PRIKRAF hospitals is carried out in accordance with the ratio of the number of points determined for the PRIKRAF hospital to the total number of items for all PRIKRAF hospitals identified points. Each allocation of funds to the PRIKRAF hospitals shall be based on all the dismissal diagnostic reports of the current year and all the means available in the current year for this purpose. The amount to be paid off shall be deducted from those funds which the PRIKRAF hospital has already received in the current year in the case of the financial divisions referred to in section 7.

(6) The current year within the meaning of Section 5 also includes data reports which are related to the accounting year and which have been received by the PRIKRAF by 31 March of the following year at the latest. After that, incoming notifications do not justify any claims against the PRIKRAF, the health insurance institutions or the patients concerned.

(7) The distribution pursuant to para. 2 to 6 shall be based on an accrual accounting for each calendar year on the basis of all the performance-oriented diagnostic case groups or other relevant parameters reported for this year. to balance.

(8) The social security institutions shall be informed by the PRIKRAF of the resulting provisional and definitive points.

Acconation and final settlement

§ 7. (1) The funds available are each monthly accorted by the PRIKRAF to the carriers of the PRIKRAF hospitals.

(2) The allocation of funds shall be carried out in accordance with the number of LKF points determined for the respective PRIKRAF hospital, multiplied by the provisional point value established by the Fund Commission for Total Austria.

(3) In order to report the required data and the number of points, § 6 para. 2 shall apply mutafictily. A late, incorrect or incorrect notification of the required data by a PRIKRAF hospital has resulted in the exclusion of the data from the Akontation for the period in question.

(4) The distribution of the funds of the PRIKRAF to the PRIKRAF hospitals is subsequently, on the basis of a final accrual accounting for each calendar year, on the basis of all for this period of time within the , to carry out reported performance-oriented diagnostic case groups and other relevant parameters.

(5) The PRIKRAF shall transfer any remaining balance credit to the PRIKRAF hospitals in accordance with the actual points value.

(6) The PRIKRAF hospitals shall immediately return any surpluses to the PRIKRAF from the PRIKRAF hospitals immediately after the final settlement has been received, or shall be offset against the PRIKRAF with future accounts.

(7) With the final settlement in accordance with paragraph 4, all claims against the PRIKRAF and the health insurance institutions, with the exception of benefits and fees in accordance with § 59 (1) second sentence B-KUVG and § 96 (2) GSVG for the stationary and daily clinical Supply of eligible persons.

Crediting with eligible beneficiaries

§ 8. Maintenance grants pursuant to Article 5 (2) shall be provided in accordance with the following provisions:

1.		The PRIKRAF has insured insured persons who have been admitted to a PRIKRAF hospital, which does not have a contract with the health insurance institution responsible for the insured person, in the name of the social security system. .
2.		The amount of the care allowance shall be determined in the appropriate application of § 6 (3) and § 7 (2). The allowance shall be paid to the PRIKRAF within four weeks after the receipt of an account recognised by the competent health insurance institution.

Accounting for the administrative expenditure

§ 9. The costs of the administrative burden must be taken as evenly as possible from the PRIKRAF funds in the extent strictly necessary for the fulfilment of the PRIKRAF tasks.

Section 3

Organisational provisions

Organs of the PRIKRAF

§ 10. The organs of the PRIKRAF are:

1.		Management,
2.		Fund Commission.

Management

§ 11. (1) The management consists of one/one managing director/managing director and the required employees. It shall carry out all the tasks of the PRIKRAF, which are not expressly reserved for another institution. In particular, it has to assist the Fund Commission in the performance of the tasks assigned to it and to prepare and implement the decisions of the Fund Commission. It has also fulfilled all the obligations arising from the supervision of the PRIKRAF.

(2) The managing director/managing director is to be ordered for a limited period following a public call for tenders. The appointment and dismise are made by the Federal Minister for Health and Women (Federal Minister for Health and Women). Further employees of the management board can be hired and terminated by the managing director/managing director with the approval of the fund commission. in the EU.

Composition of the Fund Commission

§ 12. (1) The Fund Commission shall consist of ten members. As such, you belong to:

1.		three representatives of the Austrian Social Security Institutions (Hauptverband der Austrian Social Insurance),
2.		two representatives of the Federal Ministry of Health and Women,
3.		five representatives of the association of private hospitals and the Kurbetriebe of the Austrian Chamber of Commerce (hereinafter referred to as "Fachverband") sent representatives.

(2) If the posting of members to the Fund Commission is necessary, the management has to call on the institutions entitled to be sent to the fund under the conditions of a reasonable period of time. If these do not make use of their right, the Fund Commission shall, without prejudice to the provisions of Section 13 (3), also be deemed to have a quorum, without prejudice to the provision of Section 13 (3), until the missing members are subsequently posted.

(3) The function as a member of the Fund Commission shall, in particular:

1.		by revocation on the part of the institution entitled to pay,
2.		The path of action or business ability,
3.		Waiver.

(4) For each member, a substitute member must be made known by the institution appointed for the posting of the member. The substitute member shall be entitled to assume the representation in the fund commission if the member is not permanently prevented from taking place.

Rules of procedure of the Fund Commission

§ 13. (1) The chair shall be chaired by the member designated by the Federal Minister for Health and Women's Affairs; in the event of the latter's prevention, the deputy/deputy appointed by the association.

(2) The chairperson of the Fund Commission shall be convened by the Chairman/Chairperson of the Fund Commission. At least two sessions have been held each year. In addition, the Fund Commission shall be convened if at least three members request in writing.

(3) The Fund Commission shall be quorum if all members have been duly invited and more than half of their members, including at least one member posted by the main body of social insurance institutions, are present. Decisions shall be taken by a majority of the votes cast. In the event of a tie, the vote of the chairman shall indicate the rash. Decisions in matters pursuant to Section 14 (1) (2) (2) require the majority of two thirds of the votes cast.

(4) The Fund Commission shall have its own rules of procedure. The Rules of Procedure shall in particular provide that:

1.		the convening of Members for a meeting, on the basis of the agenda and the documents required, to be carried out not later than three weeks before the meeting;
2.		Requests for additional inclusion on the agenda may be submitted by any Member of the Fund Commission, including appropriate written documents, no later than 10 days before the meeting, with due regard for the deadline after the date of the postmark.

(5) If the Fund Commission is not in a quorum because a Member is not present by the main body of the social security institutions, a meeting on the same agenda has recently been held within three weeks. At that meeting, to which Members are demonstrably invited, decisions may be taken by a majority of the votes cast, even if no member sent by the main body of social security institutions is present.

(6) The Fund Commission may, if necessary to deal with individual items on the agenda, be able to provide expert assistance. The procedure shall be laid down in the Rules of Procedure.

(7) Information on matters relating to financing shall be provided to the members of the Fund Commission at the request of the Board of Directors.

Tasks of the Fund Commission

§ 14. (1) The Fund Commission shall have the following tasks:

1.		the identification and evaluation of the capacity of the fund to be financed by the fund;
2.		the definition of quality criteria and the coordination with the whole-country health planning;
3.		the determination of the provisional and final points value;
4.		approval of the annual estimates and establishment plan of the Fund, in particular with regard to the adequacy of the administrative burden;
5.		consent to the closure of the accounts;
6.		the transfer of functions of management to external service managers;
7.		the authorisation of a point of order;
8.		the establishment of a catalogue of breaches of duty leading to the triggering of the procedure in accordance with § 15, as well as the consequences of such breaches of duty (sanction statute);
9.		the definition of the modalities and the level of the PRIKRAF's quotations to the PRIKRAF hospitals;
10.		the establishment of principles for national accounting rules;
11.		the determination that certain tasks of the management are subject to the decision-making process of the Fund Commission.

(2) The members of the Fund Commission as well as expert experts shall be obliged to secrecy against third parties without prejudice to the provisions of section 16 (5) and § 17. The confidentiality requirements in accordance with § 460a (1), (2) and (5) of the ASVG are to be applied mutagenally. The management as well as the external employees are contractually bound to have comparable confidentiality obligations.

(3) General statement of the Fund's Commission shall be made available on the Internet or in an otherwise appropriate manner.

Penalties

§ 15. If a PRIKRAF-Krankenanstalt violates the provisions of the Public Health Documentation Act, the Federal Ministry of Health and Women's Federal Ministry of Health and Women's Health and Women's coding guidelines, or does it apply a catalogue in accordance with Article 14 (1) (8) (8), the Fund Commission shall initiate effective measures for the production of the legitimate state of the state. The procedure shall be laid down in the Rules of Procedure.

Principles of the Gebarung des PRIKRAF

§ 16. (1) The collection of the Private Sickness Fund has to be carried out in accordance with the principles of economy, economic efficiency and expediency.

(2) The management has to proceed in accordance with the principles of a prudent businessman in the use of the PRIKRAF funds.

(3) Existing funds of the PRIKRAF must be apported as cheaply as possible, subject to the availability of the necessary availability.

(4) The monthly amounts and attitutions to the PRIKRAF hospitals are to be shown separately in each case. Similarly, comparable accounting rules are to be applied in analogy to the Landesfonds and a period-based delimitation of the funds of the PRIKRAF is to be carried out.

(5) Every year an estimate, an establishment plan and, after the end of a calendar year, no later than 30 September of the following year, shall be drawn up in accordance with the provisions of the trade regulations and an activity report.

(6) Night-time certificates shall be carried out as soon as possible after the necessary data have been received with the current financial statements.

Supervision

§ 17. (1) The PRIKRAF is subject to the supervision of the Federal Minister of Health and Women's Federal Minister of Health.

(2) The decisions of the institutions of the PRIKRAF shall be subject to the approval of the Federal Minister for Health and Women in the following matters:

1.		the Rules of Procedure of the Fund Commission;
2.		the annual estimates, the annual accounts, the establishment plan and the activity report,
3.		the conclusion of legal transactions which have a permanent financial burden on the PRIKRAF,
4.		the conclusion of service contracts;
5.		the definition of quality criteria and the coordination with the whole-country health planning,
6.		the sanction statute.

(3) The Federal Minister for Health and Women's Federal Minister for Health and Women's Affairs or her/her representative bodies shall be entitled to inform themselves about all matters of the PRIKRAF. The institutions of the PRIKRAF are obliged to provide information on all matters of the PRIKRAF to the Federal Minister for Health and Women, or to the institutions responsible for it, as well as to other documents, business and other documents. on the subject-matter referred to above, to have the Federal Minister/Federal Minister/Federal Minister for Health and Women, or the representative bodies, carry out surveys and to carry out inspections on the spot.

(4) The Federal Minister for Health and Women (s) or the bodies appointed by her/him are entitled to attend the meetings of the Fund Commission. The minutes of the meetings of the Fund Commission of the PRIKRAF must be submitted without delay through the supervision of the Federal Minister for Health and Women's Federal Minister for Health and Women's Affairs.

Control and information requirements

§ 18. (1) The building of the PRIKRAF shall be subject to control by the Court of Auditors.

(2) In addition, the organs of the PRIKRAF are authorized to carry out necessary control measures, in particular for the diagnosis and performance coding of the PRIKRAF hospitals (data quality control) as well as for the determination of the other for billing purposes. to ensure the necessary data. These control measures can also be used to instructs people who are not in a service relationship with the PRIKRAF.

(3) The main association of the Austrian social insurance institutions and the trade association or bodies commissioned by them shall be entitled to inform themselves about all matters of the PRIKRAF. The institutions of the PRIKRAF shall be obliged to provide information on all matters of the PRIKRAF to the main association of the Austrian social insurance institutions and to the association or bodies responsible for such matters, as well as to the members of the PRIKRAF, as well as to submit other documents relating to the items referred to.

Section 4

Arbitration

General

§ 19. (1) In order to resolve disputes between the PRIKRAF and PRIKRAF hospitals over the mutual rights and obligations established in this law, the arbitral commission to be established at the headquarters of the PRIKRAF shall be responsible.

(2) The Arbitration Commission shall decide on a written request from the PRIKRAF or a PRIKRAF hospital.

Members of the Arbitration Committee

§ 20. (1) The Arbitration Commission shall consist of:

1.		one magistrate/judge as chairman,
2.		One representative/representative of the main association of Austrian social insurance institutions,
3.		One representative/representative of the association of private hospitals of the Austrian Chamber of Commerce.

(2) The Chairman is from the Federal Ministry of Health and Women on the basis of a tripartite proposal, in alphabetical order by the President of the Vienna Higher Regional Court, to be used by the Federal Ministry of Justice. is to be forwarded. Member of the Arbitration Commission can only be who can be elected to the National Council. A substitute member shall be ordered in the same way for each member. The members of the Arbitration Commission shall be appointed for a period of five years. However, they shall remain in office until the newly appointed members meet. Reorder is allowed.

(3) The Office as a member (substitute member) shall end-except in the case of the revitalization pursuant to paragraph 4-only with the expiry of the term of office and the omission of conditions necessary for the order.

(4) A member (substitute member) may, for important health or professional reasons, which does not appear to be guaranteed to be properly exercised by the Office, be removed from the Office by his own request.

(5) If a member (substitute member) is divorced before the expiry of the term of office for which it was appointed, a member (substitute member) shall be reordered for the remainder of the term of office in accordance with the provisions of paragraphs 1 and 2. If the Office ends as a member (substitute member) during a procedure pending before the Arbitration Commission, it shall be carried out anew.

Procedural provisions

§ 21. (1) The procedure before the Arbitration Commission is the General Administrative Procedure Act 1991-AVG, BGBl. No 51.

(2) If proceedings are made before the Arbitration Commission, the respective parties to the dispute shall each nominate one representative/representative for this procedure. These representatives shall be treated in the same way as members in accordance with Section 20 (1).

(3) The members of the Arbitration Commission shall be convened in good time at the meetings on the announcement of the agenda, after the requests have been made. The convocation must be made in writing and with proof of delivery.

(4) The Arbitration Commission shall be quorum if the convening of all members of the Arbitration Commission has been duly convened and, in any event, the Chairman and at least three other members are present.

(5) The decisions of the Arbitration Commission shall be taken with a simple majority of votes. The Chairman shall give her/his/his/his/his/his/his/his/his/his/his/his/his/her voice. Abstention is inadmissible.

(6) The decision and its essential reasoning are to be announced orally after the end of the trial. In addition, a written copy must be sent to the parties. If the communication cannot be announced orally, it shall be withheld from the written copy, which shall be made within four weeks of the end of the hearing.

(7) The decisions of the Arbitration Commission shall not be subject to the repeal or the amendment in the administrative proceedings.

Organization

§ 22. (1) The PRIKRAF shall set up an office for the management of the current business, in particular for the preparation of the negotiations, the management of the consulting and coordination protocols and the running of the law firms.

(2) The members of the Arbitration Commission shall be subject to appropriate remuneration for their activities. The amount of the remuneration shall be determined on the basis of the expenses incurred by the activity as a member (substitute member).

Section 5

Final provisions

Exemption from charges

§ 23. The Private Hospitals Funding Fund is exempt from all charges regulated by the federal law.

In-force-and transitional provision

§ 24. (1) The law shall enter into force 1. January 2005 in and with 31 December 2008 out of force. In any event, the PRIKRAF shall comply with the obligations which arose before and during the period of validity of this Act, even after 31 December 2008.

(2) proceedings before the Arbitration Commission, which are still pending in the event of inaction of force of this law, shall be completed.

Fischer

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