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.
