The Determination Of The Values Of The Point And The Amount Of The Reimbursement Paid Services For 2016

Original Language Title: stanovení hodnot bodu a výše úhrad hrazených služeb pro r. 2016

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273/2015 Sb.



The DECREE



of 15 July. October 2015



determining the point values, the amount of the reimbursement paid services and regulatory

limits for the year 2016



The Ministry of health shall determine in accordance with section 17 paragraph. 5 of Act No. 48/1997

Coll., on public health insurance and amending and supplementing certain

related laws, as amended by law No 117/2006 Coll., Act No.

245/2006 Coll., the Act No. 261/2007 Coll., Act No. 298/2011 Coll., Act No.

369/2011 Coll. and Act No. 200/2015:



§ 1



This Decree provides for the year 2016, the value of point, the amount of the reimbursement paid by the

the services provided to the insured under section 2 (2). 1 of Act No. 48/1997

Coll., on public health insurance and amending and supplementing certain

related laws, as amended, (hereinafter the "law")

and paid services provided by insurance policy holders from other Member

States of the European Union, European economic area and the Swiss

the Confederation by the directly applicable European Union legislation

regarding the coordination of social security systems ^ 1) and the insured

other States with which it has concluded international Czech Republic

of the Treaty on social security related to the area covered by the

Services ^ 2) (hereinafter referred to as "foreign beneficiary") and regulatory constraints for the

the remuneration referred to in sections 3 to 18, provided the contracting service providers

health services (hereinafter referred to as "provider"):



and bed care providers) and ISP special inpatient care

According to § 22a of the Act,



b) providers in general practical medicine and the provider

in the field of practical medicine for children and adolescents,



(c) specialized ambulatory care providers), ISP

hemodialysis health care and service providers in the fields of medicine, 903, 905

919 and 927 by Decree, which publishes a list of medical procedures with

point values of ^ 3) (hereinafter referred to as "the list of performance"),



d) providers of outpatient care in the fields of medicine and by the 603 604

performance,



e) providers in the field of dentistry,



(f)) in the fields of medicine outpatient care providers 222, 801, 802, 804,

805, 806, 807, 808, 809, 810, 812 to 819, 822 and 823 by list

performances (hereinafter referred to as "listed expertise"),



g) ambulatory care providers in the fields of medicine, 911 914, 916, 921 and

925 by list of performances,



h) ambulatory care providers in the fields of medicine and by the list of 902 917

performance,



I) providers of medical emergency services, transport providers

urgent care patients, providers of medical transport services,

medical emergency services providers and providers of emergency

services in the field of dental medicine,



j) providers of rehabilitation care and Spa ozdravovnami and



providers of care to).



§ 2



(1) the reference period shall mean for the purposes of this Decree the year 2014.



(2) Rated the means for the purposes of this Decree the year 2016.



(3) In the reference period are included with all paid services

in 2014, provided the provider reported to 31. March 2015 and

health insurance recognised until 31 March 2006. may 2015. In the evaluated period

included are all paid services provided in the year 2016,

the provider reported to 31. March 2017 and health insurance company

recognised until 31 March 2006. may 2017.



(4) a unique policyholder shall for the purposes of this order means a beneficiary

health insurance provider in the treated concrete expertise in

investigational or reference period, at least once, with the fact that it is not

applicable, whether it is about the treatment in the context of their own health services

or health services on-demand. If this beneficiary

provider in a specific expertise in the treatment period, or

the reference period, more than once, includes the number of unique policy holders

competent health insurance company treated in the skill only

once. In the event of a merger of health insurance, the number of unique

insured sum insured as counts of unique health

insurance companies, which merged. If the insured person in the reference

the period had more than one health insurance company, to the number of

unique treated policyholders are counted only once.



(5) the global unique beneficiary for the purposes of this Ordinance means

beneficiary health insurance provider of inpatient care in the treated

any expertise within custom or requested health services

in the reference period or at least once, if not further

unless otherwise provided for. If the beneficiary was the provider, regardless of

on it, in which expertise, treated in the period or reference

the period more than once, includes the number of global unique policyholders

competent health insurance company treated the only provider

once. In the event of a merger of health insurance, the number of global

unique counts as the sum insured global unique

policyholders of health insurance companies, which merged. If he was

the beneficiary during the reference period had more than one health

the insurance companies, the number of global unique treated policyholders are

counted only once.



(6) when calculating the total number of declared and health provider

insurance recognised points for health (hereinafter referred to as "the power")

the reference periods referred to in annexes 5 and 8 of this Decree, the following points

calculated in accordance with the list of points means a performance as effective to 1. January

2016, which are not counted as points for paid services provided

foreign insurance policy holders.



(7) if in the reference period to merge two health

insurance undertakings, it shall apply for the calculation of the sum of the payment information for the reference

the period of the merged health insurance companies.



§ 3



In the case of the provision of paid services to the insured with a foreign

provides for the payment of the same amount as in the case of Czech policy holders.



§ 4



(1) for the paid services provided by providers of inpatient care, with

the exception of the paid services provided by providers of subsequent bed

care, providers of long-term care beds and special

inpatient care, the point value, the amount of the reimbursement paid services and regulatory

the restrictions stipulated in the annexes, no. 1, 9, 10, 12 and 13 of this Decree.



(2) for the paid services provided by providers of subsequent bed care,

providers of long-term care beds, special out-patient care

provided under section 22 (b). (c)) and e) of the Act and of the Special

inpatient care, paid a flat rate per day of hospitalisation or

According to the list, the value of the item, the amount of the reimbursement paid by the services and

regulatory restrictions set out in annex No. 1 to this notice.



§ 5



For the paid services provided by service providers in the field of General

practical medicine and providers in the field of practical medicine for

children and adolescents met by the combined kapitačně power payment

combined kapitačně power payment with calling kapitace or

According to the list of performances with the point value, the amount of the reimbursement paid by the services and

regulatory restrictions set out in annex 2 to this Decree.



§ 6



For the specialised out-patient care provided by the ISP

outpatient health care paid for by the performance of the value

point, the amount of the reimbursement paid services and regulatory restrictions set out in annex

No. 3 to this notice.



section 7 of the



For outpatient care provided by provider, outpatient

care in the fields of medicine and 604 603 by the performance of paid according to

list of performances with the point value, the amount of the reimbursement paid services and regulatory

the restrictions set out in annex 4 to this notice.



§ 8



(1) for the paid services provided by service providers in the field of dental

medicine paid for by list of performances with the value of the point shall be

0.95 Usd.



(2) the amount of the reimbursement paid by the services provided by the provider in the field of

Dental Medicine nehrazených referred to in paragraph 1 and the relevant regulatory

the restrictions are set out in annex 11 of this Decree.



(3) the amount of compensation will limit health insurance providers in the field of dental

medicine, so that the total amount of the cost of health insurance

spent on paid services provided by service providers in the field of dental

medicine in 2016 does not exceed the total amount of these costs

provided for in the health insurance plan health insurance. If you would

overrunning of the total amount of remuneration paid by the services provided by

providers in the field of dentistry, provided for in the health insurance

health insurance plan on these paid services, was due to the

by providing a greater volume of urgent care as opposed to the year 2014, health

the insurance company will pay the greater amount.



§ 9



For the paid services provided by providers of ambulatory health care

in the listed skills paid according to performance with value list

point and the amount of the reimbursement paid by the services set out in annex 5 to this

the Decree.



§ 10



For the paid services provided by providers of ambulatory health care

in the fields of medicine, 911 914, 916, 921 and 925 according to the performance of paid

According to the list of performances with the point value and the amount of the reimbursement paid services

set out in annex 6 to this Ordinance.



§ 11



For the paid services provided by providers of ambulatory health care

in the fields of medicine and by the list of 902 917 performances paid by list

performances with the point value and the amount of the reimbursement paid by the services set out in annex

No. 7 of this Decree.



§ 12



For the paid services provided by providers of medical rescue

services paid by the list of performance shall be the value of the point of

1.11 and paid for services provided by transport providers

urgent care patients paid according to the list of performance shall

point value in the amount of $ 1.10.



section 13



For the paid services provided by providers of medical transport

services paid by the performance of the value of the item and the amount of the payments

paid services set out in annex 8 to this Ordinance.



§ 14



For the paid services provided by service providers in the medical

emergency services or emergency services in the field of dental medicine

paid by list of performance shall be the value of the item in the amount of $ 1.00.



§ 15




(1) for the complete spa sanatorium rehabilitation care for adults

provided in the medical facilities of the provider of Spa

hospital rehabilitation care shall be payment for a one day stay in the

the amount that was agreed upon for the year 2015. If the payment for one day

stay for the year 2015 negotiated to 31. December 2015, the remuneration shall be determined in

EUR 1 050 Czk.



(2) for the complete spa sanatorium rehabilitation care for children and

adolescents up to 18 years of age provided in health facilities

Spa sanatorium rehabilitation care provider shall be the remuneration for the

one day stay in the amount that has been agreed upon for the year 2015. If the

the remuneration for one day stay for the year 2015 negotiated to 31. December 2015

the remuneration shall be fixed at EUR 1 350 Czk. Remuneration for Board and lodging

accompaniment of patients shall be at the same level as the remuneration for these folders

patients a comprehensive Spa rehabilitation care.



(3) For contributory Spa sanatorium rehabilitation care for adults

provided in the medical facilities of the provider of Spa

hospital rehabilitation care shall be payment for a one day stay in the

the amount that was agreed upon for the year 2015. If the payment for one day

stay for the year 2015 negotiated to 31. December 2015, the remuneration shall be determined in

the amount of $ 380.



(4) For contributory Spa sanatorium rehabilitation care for children and

adolescents up to 18 years of age provided in health facilities

Spa sanatorium rehabilitation care provider shall be the remuneration for the

one day stay in the amount that has been agreed upon for the year 2015. If the

the remuneration for one day stay for the year 2015 negotiated to 31. December 2015

the remuneration is determined in the amount of $ 480.



(5) For contributory Spa sanatorium rehabilitation care shall be

payment of CZK 30 for reported performance no 09543 according to the list. This

the performance of the undertaking may be banned up to three times during a single

treatment barriers.



(6) for the paid services provided in ozdravovnách shall be the remuneration for the

one day stay in the amount of $ 807.



section 16 of the



(1) for each provider reported and recognized by the health insurance company

performance no 09543 according to the list of performance shall be the remuneration in the amount of CZK 30.

The maximum payment for the performance of service providers reported no 09543 according

list of performances in the period does not exceed the amount of

třicetinásobku the number of performances of no 09543 according to the list of performances, in the text of the

effective in the reference period, reported the health insurance company in

the reference period.



(2) in the case of a provider that did not exist in the reference period, originated in the

during the reference period or not, concluded a contract with health

the insurance company, health insurance company uses the reference values

comparable providers. This payment is not counted in the maximum

the reimbursement of paid services.



(3) the provisions referred to in paragraphs 1 and 2 shall not apply to the provider

Spa sanatorium rehabilitation care in the provision of subsidised

Spa sanatorium rehabilitation care.



§ 17



(1) for each provider reported and recognized by the health insurance company

performance no 09552 according to the list of performance shall be the remuneration in the amount of $ 12.

The maximum payment for the performance of service providers reported no 09552 according

list of performances in the period does not exceed the amount of

dvanáctinásobku number of the recipes in the reference period, on the basis of

the medicinal product was issued partly or fully paid from the public

health insurance.



(2) in the case of a provider that did not exist in the reference period, originated in the

during the reference period or not, concluded a contract with health

the insurance company, health insurance company uses the reference values

comparable providers.



section 18



Reported for each provider and health insurance company recognized performance

No 78890 according to the list of performance shall be the remuneration in the amount of 10 000 Czk. This

the remuneration shall be paid to the amount of the remuneration for the services provided by

part A) 2.1.1, 2.2 and 4 of annex 1 to this notice.



§ 19



This Decree shall take effect on 1 January 2005. January 2016.



Minister:



Mudr. Němeček, MBA, in r.



Annex 1



The value of the item, the amount of the reimbursement paid services and regulatory restrictions pursuant to § 4



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 2



The value of the item, the amount of the payment of health care and regulatory restrictions pursuant to § 5



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 3



The value of the item, the amount of the payment of health care and regulatory restrictions pursuant to § 5



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 4



The value of the item, the amount of the payments and the regulatory restrictions pursuant to § 7



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 5



The value of the item and the amount of the payments referred to in section 9



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 6



The value of the item and the amount of the payments referred to in section 10



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 7



The value of the item and the amount of the payments referred to in section 11



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 8



The value of the item and the amount of the payments referred to in section 13 of the



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 9



The group related to the diagnosis according to the classification of these groups, with indexes



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 10



The group related to the diagnosis according to the classification of these groups, with indexes



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 11



The amount of the reimbursement paid by the services according to § 8 paragraph. 2



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 12



Medicines extracted from the payment case flat



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



Annex 13



The group related to the diagnosis according to the classification of exempt from the payment of

case flat



_________________

*) Note. ASPI: the annex is available on the website http://ftp.aspi.cz/opispdf/2015.html#castka_111.



1) European Parliament and Council Regulation (EC) No 883/2004 on the coordination of

social security systems, in wording of later regulations.



Regulation of the European Parliament and of the Council (EC) no 987/2009

lays down the detailed rules for the application of Regulation (EC) No 883/2004 on the coordination of

of social security systems.



Regulation of the European Parliament and of the Council (EU) no 1231/2010, which

extends the scope of Regulation (EC) No 883/2004 and Regulation (EC) No.

987/2009 to nationals of third countries, to which this regulation

yet not apply only because of their nationality.



2) for example, a communication from the Ministry of Foreign Affairs No. 130/2002 SB., m.

with the negotiation of the Treaty, between the Czech Republic and the Federal Republic of

Yugoslavia on social security, the communication of the Ministry of foreign

things no 135/2004 Coll., on negotiation of the m.s. Treaty between the Czech Republic and

The Turkish Republic on social security, the Ministry of communication

Foreign Affairs No 2/2007 Sb. m. s., the negotiation of an Agreement between the Czech

Republic and the Republic of Macedonia concerning social security.



3) Decree No. 134/1998 Coll. issuing the list of health interventions

with point values, as amended.

Related Laws