550/2005 Sb.
The DECREE
of 21 April 2004. December 2005,
laying down the amount of reimbursement of health care paid for by the public
health insurance, including regulatory restrictions, for 1. half-year 2006
Change: 101/2006 Sb.
The Ministry of health shall determine in accordance with section 17 paragraph. 11 (a). (b)) of the Act
No. 48/1997 Coll., on public health insurance and amending and supplementing
some related laws, as amended by Act No. 459/2000 Coll. (hereinafter the
"the Act"):
§ 1
This Decree lays down, in cases where the result of the conciliation procedure
According to § 17 paragraph. 8 the Act is not an agreement, or where the agreement is contrary
the public interest,
and the amount of the reimbursement) of health care paid for by public health insurance
including the regulatory restrictions
1. provided in health establishments of institutional care, including
specialised therapeutic institutes for long-term patients, hospitals and
medical equipment, returning the length of the day no. 00005 according
the Decree, which publishes a list of medical procedures with spot
the values of ^ 1) (hereinafter referred to as "the list of performance"),
2. in the outpatient medical facilities providing
hemodialysis care
3. provided by practical doctors for adults and practical doctors for
children and adolescents,
4. in the outpatient medical facilities providing
specialised outpatient medical care,
5. in the outpatient medical facilities providing health
care in the fields of medicine, 801, 802 222, 804, 805, 807, 809, 812 to 819, 822
and a list of performances, 823
6. home health care, ambulatory health care provided
devices,
7. in the outpatient medical facilities providing health
care in the fields of medicine and 918 902 by the performance,
8. provided in the context of medical emergency services, transport and
medical first aid service
(b) the amount of the reimbursement) when providing emergency care in non-
medical facilities.
§ 2
(1) the Medical care provided in the medical facilities of the constitutional
care, with the exception of health care provided by specialised therapeutic
institutes, institutes for long-term patients and in medical institutions
returning the length of the day no. 00005 in accordance with the list of performances (hereinafter referred to as
"institutional care"), shall be paid a flat rate.
(2) if the establishments of institutional care provides health care for 100 and less
competent health insurance company insureds, paragraph 1 shall not apply, and
provided health care to be covered by the list of performances. Price point
set for 1. half of 2001 remains in force for 1. half of the
2006 ^ 2).
(3) the procedure for calculation of the lump-sum rate referred to in paragraph 1 and the regulatory restrictions
shall be laid down in the annex 1 to this notice.
(4) health insurance medical facility shall provide a monthly
the payment of the amount laid down in annex 1 to this notice.
§ 3
(1) the amount of reimbursement of health care in specialised therapeutic institutes,
Sanatorium for long-term patients and in medical devices
returning the length of the day no. 00005 in accordance with the list of performances for the 1.
half of 2006 provides for a flat rate.
(2) the procedure for calculation of the lump-sum rate referred to in paragraph 1 and the regulatory restrictions
are set out in annex 2 to this Decree.
(3) the health insurance company will provide medical equipment monthly
remuneration amounting to 105% of one sixth of the remuneration due the medical
the device in the reference period.
(4) If a medical facility shall provide health care for 50 and less
hospitalized insured the relevant health insurance, paragraph 1
shall not apply, and provided health care to be covered by the list of performances.
(5) the price point for the payment of health care referred to in paragraph 4, provided for the
1. half-year 2001 shall remain in force for 1. half of 2006 ^ 2).
§ 4
(1) care provided in outpatient Hemodialysis health care
devices shall be paid by the contractual arrangements between the health insurance company
and medical facilities, according to a list provided by remuneration for performance
health, including especially the posted material, and especially
posted in medicinal products.
(2) the price point for the payment of health care referred to in paragraph 1 is agreed for the
2. the first half of 2005 and published in the journal of the Department of health
shall remain in force for 1. half of 2006 ^ 3).
(3) if the health care facility to an increase in the number of insured persons,
requiring emergency dialysis treatment, compared to the reference period,
which is the relevant calendar half-year last year, is a health
the insurance company shall be entitled to, after consultation with the medical establishment, the increase in
the number of insured persons be taken into account in the payment order.
(4) health insurance medical facility shall provide a monthly
the payment of
and values) of the medical establishment recognised, where appropriate,
recognized by the health insurance, health care for the month, or
(b)) in the amount of at least one sixth of the total remuneration in the reference
period,
While the method of remuneration referred to in subparagraph (a) or (b))) will be retained in
throughout the semester.
(5) the total remuneration referred to in paragraph 1, which will not exceed 105% of the
total payments in the reference period, which is the corresponding calendar
half of last year, will be increased by a factor of change of income and expenditure
health insurance in connection with migration policy holders. The calculation and
application of the coefficient changes to the revenue and expenditure of health insurance companies is
set out in annex 7 to this Decree. The restriction does not apply, the remuneration
If the medical device provided in the reference or the investigational
the period of health care 50 and less unique to the insured, the competent
health insurance companies.
(6) regulatory restrictions are set out in annex 3 to this notice.
(7) beyond the total of the remuneration referred to in paragraph 5 of the health insurance
will pay the amount charged separately for medicinal products supplied by
health insurance medical facility in 2. first half of 2005,
calculated on a unique insured and treated the diagnosis in 2.
first half of 2005, and multiplied by the number of unique treated policyholders with
the diagnosis in the reviewed period.
§ 5
(1) the health care provided by the practitioners for adults and
practical doctors for children and adolescents in the 1. half of 2006, according to borne by the
the contractual arrangements between health insurance and medical facilities
and the combined kapitačně performance payment),
(b)) combined with kapitačně power payment, or by calling kapitace
(c)) under the list of performances.
(2) the amount of the kapitačně performance payments pursuant to paragraph 1 (a). and) is calculated
by the number of insured with the relevant age index
According to annex No 4, part C) this Decree multiplied by the base rate
contractually agreed with the medical establishment for 2. first half of 2005
plus 3%.
(3) the performances included in the kapitační of the payment, in addition to performance, which is
show the preventive examinations in accordance with the Decree No. 56/1997 Coll., which
provides the content and the time between visits, as amended by
amended, (hereinafter "the Decree on preventive visits")
and vaccination in accordance with Decree No. 439/2000 Coll., on inoculation against communicable
diseases, as amended, (hereinafter referred to as "Decree about vaccination")
and the performances for unregistered policyholder pursuant to paragraph 1 (b). and (b)),)
shall be paid in accordance with the list of performances, with the price point agreed to 2.
first half of 2005 and published in the journal of the Department of health
shall remain in force for 1. half of 2006 ^ 3).
(4) the performances, which are recognised by the Decree on preventive examinations
preventive examinations and vaccinations in accordance with the Decree of the vaccination,
not included in the kapitační of the payment referred to in paragraph 1 (b). and (b))) and shall be paid
According to the performance remuneration for provided health performances with restrictions
the maximum reimbursement to the insured's unique treated. Price point
negotiated for the 2. first half of 2005 and published in the Journal of the Department of
health care remains in force for 1. half of 2006 ^ 3). Maximum
the payment of the insured person is treated on the unique for the specific
medical equipment provides as a proportion of the total remuneration for the performance of
in the reference period, which is the corresponding half last year, and
the number of unique treated policyholders, those performances
reported. The calculated percentage is multiplied by the number of unique treated
policyholders and the factor 1.05. The maximum payment limit does not apply
in the event that, in the reference period or investigational was subjected to 50 and
less unique treated policyholders the competent health insurance company.
(5) the amount of the payment by calling kapitačně with the kapitace power under paragraph
1 (a). (b)), including the remuneration for the performance of the payment and paid out kapitační
performances to be unregistered, the insured shall be calculated in accordance with paragraphs 2 to 4.
(6) the price point for the payment of health care referred to in paragraph 1 (b). (c))
negotiated for the 2. first half of 2005 and published in the Journal of the Department of
health care remains in force for 1. half of 2006 ^ 3).
(7) method to call kapitace in accordance with paragraph 1 (b). (b)) and the regulatory
limitation of the reimbursement referred to in paragraph 1 (b). and (b))) and (c)) shall be laid down in the annex
No 4 to this notice.
(8) the total remuneration for the performance, not included in kapitační payments, in addition to
performances, which are recognised by the Decree on preventive examinations
preventive examinations and vaccinations, according to the Decree on vaccination, performance
for unregistered insured persons referred to in paragraph 3, which will not exceed
105% of the total remuneration for performances outside the kapitační payment and performance for
unregistered policyholders in the reference period, which is the corresponding
calendar semester last year, will be increased by a factor of change of income
and expenditure of health insurance in the context of migration policy holders.
The calculation and application of the coefficient changes to the revenue and expenditure of the health
the insurance company is set out in annex 7 to this Decree. Restriction of payment
shall not apply, if the medical facility will provide the reference or
the assessment of the period of health care and insurance policy holders less competent 50
health insurance companies.
§ 6
(1) Specialized outpatient care provided in out-patient
medical facilities are reimbursed under a contractual arrangement between the
health insurance and medical facilities under the list of performances
remuneration for provided health performances, including a particularly charged
medicinal products and medical devices, specifically charged with
by limiting the maximum reimbursement to the insured's unique respective health
insurance companies treated in the half of the medical
device in a given skill.
(2) a unique policyholder shall for the purposes of this order means a
the beneficiary of the relevant health insurance companies treated by the medical
the device in the expertise in the relevant six-month period at least once,
While it is not decisive whether the treatment in the context of their own care
or care requested. If the insured person by the device in the
expertise in the half treated with multiple times, includes the number of
unique expertise in the treated policyholders only once.
(3) the reference period corresponding to the previous calendar half-year
of the year.
(4) price point for the payment of health care referred to in paragraph 1 and in accordance with
paragraph 7 of the agreed to 2. first half of 2005 and published in the journal of the
The Ministry of health shall remain in force for 1. half of 2006 ^ 3).
(5) the amount of remuneration referred to in paragraph 1, including the regulatory constraints,
set out in annex 5 to this Decree.
(6) health insurance medical facility shall provide a monthly
the payment of
and values) of the medical establishment recognised, where appropriate,
recognized by the health insurance, health care for the month, or
(b)) in the amount of at least one-sixth of the 100% of the remuneration in the reference
period,
with the way the monthly remuneration under (a)) or subparagraph (b)), will be
maintained throughout the semester.
(7) if the medical facility shall provide health care for 50 and less
unique to the insured the relevant health insurance, paragraph 1
not apply, and provided health care to be covered by the list of performances.
section 7 of the
(1) the health care provided by health establishments in the ambulatory
proficiency 222, 801, 802, 804, 805, 807, 809, 812 to 819, 822 and 823
According to the list of performances shall be paid in accordance with the contractual arrangement between the health
insurance and medical facilities
and) flat-rate, or
(b)) according to the list.
(2) in the case of medical devices, where as a result of significantly within the volume of the
provided health care paid for by public health insurance,
When medical device provided in the reference period, which is
the corresponding calendar quarter last year, the care of 50 and less
unique to the insured, the competent health insurance company, and when it is not possible
objectively provide for individual health insurance companies flat rate
referred to in paragraph 1 (b). and), provided health care pays according to the
list of performances. The price point for the expertise of the 222, 801, 802, 804, 805, 807,
809 to 812, 819, 822 and 823, negotiated for 2. first half of 2005 and published
in the journal of the Department of health shall remain in force for 1.
half of 2006 ^ 3).
(3) the price point for the payment of health care referred to in paragraph 1 (b). (b))
negotiated for the 2. first half of 2005 and published in the Journal of the Department of
health care remains in force for 1. half of 2006 ^ 3).
(4) the procedure for the determination of the flat-rate referred to in paragraph 1 (b). and above)
the remuneration referred to in paragraph 1 (b). and (b))) and the regulatory restrictions are set out in
Annex No 6 to this Ordinance.
§ 8
(1) home health care, ambulatory health care provided
devices (hereinafter referred to as "home care") shall be paid in accordance with contractual arrangements
between health insurance and medical devices referred to in list
the performance payment for provided health performances, including a particularly charged
medicinal products and medical devices, according to the posted
the type of the operation of the medical device:
and to limit the time the wearer) 8 hours per calendar day, if
health care is provided 7 days a week, or
(b)) to the limit of time the wearer power 8 hours per working day, if not
health care is provided 7 days a week.
(2) the price point for the payment of health care referred to in paragraph 1 is agreed for the
2. half of the year 2003 and published in the journal of the Department of health
shall remain in force for 1. half of 2006 ^ 3).
(3) total remuneration referred to in paragraph 1, which will not exceed 105% of the
total payments in the reference period, which is the corresponding calendar
half of last year, will be increased by a factor of change of income and expenditure
health insurance in connection with migration policy holders. The calculation and
application of the coefficient changes to the revenue and expenditure of health insurance companies is
set out in annex 7 to this Decree. The restriction does not apply, the remuneration
If the medical device provided in the reference or the investigational
the period of health care 50 and less unique to the insured, the competent
health insurance companies.
§ 9
(1) the health care provided by health establishments in the ambulatory
proficiency and 918 902 by the list of performances shall be paid according to the contract
the arrangement between the health insurance company and medical facility under
the performance remuneration for health.
(2) the price point for the payment of health care referred to in paragraph 1 is agreed for the
2. half of the year 2003 and published in the journal of the Department of health
shall remain in force for 1. half of 2006 ^ 3).
(3) the health insurance companies can be contracted medical facility
to provide for the relevant quarter of the monthly payment in the amount of 100% of the volume
the remuneration of the reference period, which is separately corresponding calendar
quarter of last year.
(4) the remuneration referred to in paragraph 1, which will not exceed 105% of the
total payments in the reference period, shall be increased by a factor of change
income and expenditure of health insurance in the context of migration
policy holders. The calculation and application of the coefficient changes in revenue and expenditure
health insurance is set out in annex 7 to this Decree.
The limitations shall not apply if the remuneration of medical equipment provided in the
reference or investigational care period of 50 and less unique
the insured the competent health insurance company.
§ 10
(1) the health care provided by the medical emergency services in
709 list performance skills are reimbursed according to the contractual arrangements
between health insurance and medical devices referred to in list
performance remuneration for health.
(2) the price point for the payment of health care referred to in paragraph 1 is agreed for the
2. the first half of 2005 and published in the journal of the Department of health
shall remain in force for 1. half of 2006 ^ 3).
§ 11
(1) Health care provided within the transport shall be paid according to the contract
the arrangement between the health insurance company and medical facility under
the performance remuneration for health.
(2) the price point for the payment of health care referred to in paragraph 1 is agreed for the
2. the first half of 2005 and published in the journal of the Department of health
shall remain in force for 1. half of 2006 ^ 3).
(3) total remuneration referred to in paragraph 1, which will not exceed 105% of the
total payments in the reference period, which is the corresponding calendar
half of last year, will be increased by a factor of change of income and expenditure
health insurance in connection with migration policy holders. The calculation and
application of the coefficient changes to the revenue and expenditure of health insurance companies is
set out in annex 7 to this Decree. The restriction does not apply, the remuneration
If the medical device provided in the reference or the investigational
the period of health care 50 and less unique to the insured, the competent
health insurance companies.
§ 12
(1) the health care provided by the medical services, first aid,
under the contractual arrangement between the paid by the health insurance company and
medical facility under the performance remuneration for granted
health performance.
(2) the price point for the payment of health care referred to in paragraph 1 is agreed for the
2. the first half of 2005 and published in the journal of the Department of health
shall remain in force for 1. half of 2006 ^ 3).
section 13
(1) the reimbursement of emergency health care, if there is no contract between the
medical facilities and health insurance, shall be carried out for the
health performance as follows:
and) dental out-patient care are reimbursed according to the rates in force for
health care provided by dentists in the 1. half of 2006,
(b)) other health care expenses shall be reimbursed in accordance with the list of performance and health
the undertaking may, on the basis of the law ^ 4) exercise regulatory restrictions by analogy
as in the case of medical devices.
(2) the price point for the payment of health care referred to in paragraph 1 (b). (b))
set for 1. half of 2001 remains in force for 1. half of the
2006 ^ 2).
§ 14
This Decree shall take effect on 1 January 2005. January 1, 2006.
Minister:
Mudr. Rath v. r.
Annex 1
The calculation of flat-rate and regulatory restrictions in accordance with § 2 paragraph 3
And the procedure for calculating the flat-rate)
The flat rate shall be determined according to the formula:
PS = (CÚref x 1.05 x Pc x Kpv) + ÚZÚLMref + MNP + PCN
where:
PS the flat rate for the relevant calendar half-year
CÚref-the total payment due constitutional device
care for health care provided, and the reported health
insurance recognised in the reference period, which is the corresponding
the calendar half-year, last year, after the settlement contractually
the agreed regulations, with the exception of the regulatory mechanism
the amount of the prescribed medicinal products and medical
means, after deduction of the declared and health insurance company
recognised separately charged to medicinal products, including especially
posted in medicinal products approved review
doctor, and especially of the posted material, provided by the
in the reference period [part B) points 1. and 6.]. This remuneration
to include care, which was a medical device
granted in the reference period, reported the latest
with the Bills for the month of November 2005 and health insurance company
recognized.
The total payment in the reference period shall be included:
-payment for medical services that were paid during the reference period
performance, with the exception of mammography screening,
-remuneration for new capacity, in the case that they were for the reference period
negotiated.
The total payment in the reference period is not counted:
-the payment of health care, which is paid for by the otherwise, or you have already
medical devices does not provide,
-the impact of the financial settlement of the regulatory mechanism on the volume
prescribed medicinal products and medical devices applied
over the reference period.
ÚZÚLMref the volume of reported and health insurance company approved
separately charged to medicinal products, including especially
posted in medicinal products approved review
doctor, and especially of the posted material, provided by the
in the reference period (see part B) 1. and 6.)
KS stabilization coefficient
KS = 1 + [(ZZF-ZM)/VD] x 0.3
ZM = (VD/180) * 10
where:
ZZF indication referred to in line (B) (IV) a statement of the basic Fund
health insurance in accordance with Decree No. 274/2005 Coll.
about how to provide information on the management of
health insurance companies and their scope, to 31. 12.2005
VD the indication referred to in the line of URA.III. 1 of the statement of the basic Fund
health insurance in accordance with Decree No. 274/2005 Coll.
about how to provide information on the management of
health insurance companies and their extent, 30.6.2005
CHANGE the financial reserve of the competent health insurance company
Stabilization coefficient (Ks) will be applied only if the ZZF >
ZM.
Kpv coefficient changes to the revenue and expenditure of health insurance
in the context of migration policy holders. The calculation and
application of the coefficient is given in annex No. 7
to this Decree.
The increase in the volume of reported and BEST health insurance accepted
extremely expensive medical care provided in the 1.
half of 2006, compared to the reference period. Extremely
expensive health care, for the purposes of this order
means the health care provided by the medical
device whose volume exceeds the policyholder the amount 1
0000 0000 Czk. The volume of health care will be included
separately charged, especially medicinal products posted
the material and the point value of health performance
list of performances, multiplied by the price point set for
1. half 2001. ^ 2)
PCN share attributable to specific medical devices
for a particularly charged to medicinal products and separately billed
the material provided by the medical facility health
insurance in the 2. half-year 2005, calculated on the unique
the insured and treated the diagnosis in 2. first half of 2005
and multiplied by the number of unique treated policyholders
with the diagnosis in the period
The monthly payment is determined according to the formula:
MOO = [(CÚref x 1.05 x Pcs) + ÚZÚLMref]/6
where:
The monthly payment of YOUR MOO
The amount of the monthly payment of health insurance medical facility shall notify the
30. 4.2006. The monthly bill payments for 1. half-year 2006
health insurance passes medical device into the editor.
B) regulatory restrictions
1. the remuneration provided for in part A) belongs to the medical device
provide at least 100% of the volume of health care in the 1. half-year 2006
reported by medical institutions and recognized by the health insurance company in
comparison with the reference period, expressed as the number of points according to the list
performances. Other evidence, such as a separately charged on consumption of medicinal
products or separately posted material will not be disabled
insurance companies reported and will not be the basis for billing.
2. The number of points for the reference period will not count towards the points for
health care, which is no longer in the 1. half of 2006 is provided.
3. The number of points for the 1. half of 2006 will not count towards the points for
health care declared and recognized in the framework of the new capacity, if the
for the 1. half of 2006 has been agreed by contract.
4. in the case of a lower volume of declared and recognised health care than is
referred to in paragraph 1, the amount of remuneration referred to in part A of the same)
the percentage, which is the lower volume of health care expressed by the number of points
According to the list.
5. New capacity contractually agreed in the 1. half of 2006 is paid a flat-rate
the payment of a maximum amount equivalent to 30% of the national average
the half-yearly payment devices of the same type in the reference period.
Health insurance provides medical facility a month one
a sixth of the amount calculated in accordance with the first sentence.
6. If the total remuneration for medicinal products and medical devices
prescribed medical facility in the 1. half of 2006, including medicinal
products approved revision doctor, will exceed 100% of the remuneration for medicinal
products and medical devices prescribed in the reference period,
including medicinal products approved revision doctor, health
the insurance company within the total payment of the medical device does not pay
the amount corresponding to the overrun remuneration for medicinal products and
medical devices prescribed in the reference period, over 100%.
The total amount of remuneration for medicinal products and medical devices
prescribed in the reference period shall be increased by the amount corresponding to
prescribed and health insurance medical devices
medicines provided in the reference period, which is in this
case 2. first half of 2005, přepočtenou on the unique treated
the insured person and the diagnosis in 2. first half of 2005, multiplied by the number of
unique treated policyholders with the diagnosis in the investigational
the period.
7. If the total number of points for the pull in another health care
the device, in the fields of medicine, 801, 802 222, 804, 805, 807, 812 to 819, 822
and a list of performances, 823 in the 1. half of 2006 exceed the 106% of the total
the number of points in the reference period, the health insurance company, within the overall
reimbursement of the medical device does not pay the amount corresponding to the excess.
8. If the total number of points for the pull in another health care
the device, according to the list in the expertise of the 809 performances, in addition to the performance
Screening Mammograms according to a list of performances, in 1. half-year 2006
exceeds 110% of the total number of points in the reference period, the health
the insurance company within the total payment of the medical device does not pay
the amount corresponding to the excess.
9. in the event that the medical facilities provided in the 1. half-year 2006
Healthcare 100 and less competent health insurance company, the insured
health insurance does not apply the regulation referred to in the previous paragraphs.
10. If the medical device proves that due to health
the status of the policy holder could not prescribe a different medical device over 15
USD approved revision doctor, the health insurance company
the regulation does not apply, if the medical device is comparable
medical device in a comparable range of nepředepsalo in
the reference period.
Annex 2
The calculation of flat-rate and regulatory restrictions in section 3, paragraph 2
And the procedure for calculating the flat-rate)
The flat rate shall be determined in the amount of 105% of the total payment due
medical equipment in 1. half of 2005 for health care
granted, the area and the health insurance company recognized in the reference
period, which is the relevant calendar half-year, last year, after
the settlement contractually agreed regulations, with the exception of the regulatory
mechanism on volume of prescribed medicines and medical
resources, multiplied by the coefficient changes to the revenue and expenditure of the health
insurance companies in connection with migration policy holders. The calculation and application of the
the coefficient changes to the revenue and expenditure of health insurance is set out in
Annex No. 7 of this Decree. In the total remuneration includes care that
the medical facilities granted in the reference period, the reported
at the latest with the Bills for the month of November 2005 and health insurance company
recognized.
B) regulatory restrictions
1. the remuneration provided for in part A) belongs to the medical device,
provide at least 100% of the volume of health care in the 1. half of 2006,
reported by medical institutions and recognized by the health insurance company in
comparison with the reference period, in terms of 100% of the number of points for
the length of the days referred to in the list.
2. The number of points for the reference period will not count towards the points for
health care, which is no longer in the 1. half of 2006 is provided.
3. The number of points for the 1. half of 2006 will not count towards the points for
health care declared and recognized in the framework of the new capacity, if the
for the 1. half of 2006 has been agreed by contract.
4. in the case of a lower volume of declared and recognised health care than is
referred to in paragraph 1, the amount of remuneration referred to in part A of the same)
the percentage, which is the lower volume of health care expressed by the number of points
According to the list.
5. If the total remuneration for medicinal products and medical devices
prescribed medical facility in the 1. half of 2006, including medicinal
products approved revision doctor, will exceed 100% of the total remuneration for the
medicinal products and medical devices prescribed in the reference
period, including medicinal products approved revision doctor,
health insurance in the context of the total payment of the medical equipment
fail to pay the amount corresponding to the overrun of the reimbursement of medicinal products and
medical devices prescribed in the reference period, over 100%.
6. If the total number of points for the pull in another health care
the device, in the fields of medicine, 801, 802 222, 804, 805, 807, 812 to 819, 822
and 823, according to the list of performances, in 1. half of 2006 exceed the 106% of the total
the number of points in the reference period, the health insurance company, within the overall
reimbursement of the medical device does not pay the amount corresponding to the excess.
7. If the total number of points for the pull in another health care
the device, according to the list in the expertise of the 809 performances, at 1. half-year 2006
exceeds 110% of the total number of points in the reference period, the health
the insurance company within the total payment of the medical device does not pay
the amount corresponding to the excess.
8. the restrictions referred to in the preceding points shall not apply, if the medical
the equipment provided in the reference period or investigational medical care
50 and less hospitalized insured the relevant health insurance.
9. If the medical device proves that due to health
the status of the policy holder could not prescribe a different medical device over 15
USD approved revision doctor, the health insurance company
the regulation does not apply, if the medical device is comparable
medical device in a comparable range of nepředepsalo in
the reference period.
Annex 3
Regulatory restrictions pursuant to § 4 paragraph 6
1. If the average remuneration for medicinal products and medical devices
prescribed on a unique policyholder in the 1. half of 2006, including
medicinal products approved revision doctor, will exceed the average
remuneration for medicinal products and medical devices prescribed in the
the reference period, including medicinal products approved review
the doctor, in the range of 101% to 105%, health insurance company, within the overall
reimbursement of medical devices does not pay the amount corresponding to 20% of the
exceeding the reimbursement of medicinal products and medical devices
prescribed in the reference period in the range of 101% to 105%.
2. If the average remuneration for medicinal products and medical devices
prescribed on a unique policyholder in the 1. half of 2006, including
medicinal products approved revision doctor, will exceed the average
remuneration for medicinal products and medical devices prescribed in the
the reference period, including medicinal products approved review
the doctor, in the span of 105% to 110%, health insurance company, within the overall
reimbursement of the medical device does not pay the amount corresponding to 40% of the
exceeding the reimbursement of medicinal products and medical devices
prescribed in the reference period in the range of 105% to 110%.
3. If the average remuneration for medicinal products and medical devices
prescribed on a unique policyholder in the 1. half of 2006, including
medicinal products approved revision doctor, exceed 110% of the average
remuneration for medicinal products and medical devices prescribed in the
the reference period, including medicinal products approved review
doctor, health insurance in the context of the overall payment of medical
the device does not pay the amount corresponding to the overrun remuneration for medicinal
products and medical devices prescribed in the reference period over
110%.
4. If the average number of points for the requested care in the fields of medicine, 801, 222
802, 804, 805, 807, 812 to 819, 822 and 823 by list, on the
one of the unique insured persons in 1. half of 2006, will exceed 106%
the average number of points in the reference period, the health insurance company in
the total amount of remuneration does not pay medical facility
corresponding to the overrun.
5. If the average number of points for the requested care in 809 by skill
list of performances on one in a unique policyholder 1. half of 2006,
exceeds 110% of the average number of points in the reference period, the health
the insurance company within the total payment of the medical device does not pay
the amount corresponding to the excess.
6. the restrictions referred to in points 1 to 5 shall not apply if the health care facility
provided in the reference period or investigational care 50 and less
unique to the insured, the competent health insurance company.
Annex 4
How to call kapitace and regulatory restrictions pursuant to § 5 paragraph 7 and
age table indexes according to § 5 paragraph 2
Call kapitace Method):
1. Call kapitace is granted in cases where the practitioner for
adults or general practitioner for children and adolescents has, with regard to the
geographical conditions, a small number of the ppap submission of registered
policyholders than the 70% of the national average in the number of such
(the national average number of insured persons shall be always for the
the calendar year according to the data of the central register of insured persons,
managed by the general health insurance company in the Czech Republic) and
the provision of such health care is necessary to fulfil the obligations
health insurance companies according to § 46 paragraph. 1 of the Act.
2. the policyholder is Jednicovým registered for the purposes of this order
beneficiary means the age group 15 to 19 years of age, which is considered as
Unit in terms of the consumption of health care. The number of the ppap submission
insured shall be calculated by multiplying the number of registered
policyholders age index of that group. Age index expresses the ratio of the
the cost of the insured persons in the age group of the insured against the costs of
in the age group 15 to 19 years.
3. Call kapitace, you can provide up to 90% of the kapitační of the payment
calculated on the average number of registered nationwide the ppap submission
policy holders. He is involved in health insurance, with which it has
the competent general practitioner concluded a contract for the provision and payment of
health care share, which corresponds to the percentage of their policyholders from
the ppap submission insured this practitioner.
B) regulatory restrictions
1. If the average remuneration for medicinal products and medical devices
prescribed by the medical device in 1., or in the 2. quarter
2006, including medicinal products approved revision doctor, on
one registered insured, taking into account the age groups,
exceed the average remuneration for medicinal products and medical devices
on one registered insured, taking into account the age groups,
prescribed in the reference period, including medicinal products authorised
the review by a doctor, in the range of 101% to 105%, health insurance in
the total amount of remuneration does not pay medical facility
corresponding to 20% of the exceeded the remuneration for medicinal products and medical
means prescribed in the reference period in the range of 101% to 105%.
2. If the average remuneration for medicinal products and medical devices
prescribed by the medical device in 1., or in the 2. quarter
2006, including medicinal products approved revision doctor, on
one registered insured, taking into account the age groups,
exceed the average remuneration for medicinal products and medical devices
on one registered insured, taking into account the age groups,
prescribed in the reference period, including medicinal products authorised
the review by a doctor, in the span of 105% to 110%, health insurance in
the total amount of remuneration does not pay medical facility
corresponding to 40% of the exceeding of the reimbursement of medicinal products and medical
means prescribed in the reference period in the range of 105% to 110%.
3. If the average remuneration for medicinal products and medical devices
prescribed by the medical device in 1., or in the 2. quarter
2006, including medicinal products approved revision doctor, on
one registered insured, taking into account the age groups,
exceeds 110% of the average remuneration for medicinal products and medical
resources on one registered insured, taking into account the
age groups, in the reference period, including medicinal
products approved revision doctor, health insurance in the framework of the
the total reimbursement of the medical device does not pay the amount corresponding to
exceeding the reimbursement of medicinal products and medical devices
in the reference period prescribed above 110%.
4. The reference period for the purposes of the regulation, the corresponding calendar
quarter of last year.
5. If the total remuneration for the treated the insured exceeds 5 unregistered
% of the total remuneration for the insured person's registered in 1., or in the 2.
quarter of 2006, is entitled to health insurance within the overall
reimbursement of medical device neuhradit the amount corresponding to one
half of the crossing over 5% of the total remuneration for the registered
the insured person. This regulatory mechanism does not apply to care for
unregistered treated the insured person within the sound of the crowd and will not
in the case of payment of health care according to § 5 paragraph 1 (b). (c)).
6. If the average number of points in 1., or in the 2. quarter of 2006 for the
pull the care in the fields of medicine, 801, 802 222, 804, 805, 807, 812 to 819,
822 and 823 under the list of services on one of the policyholder, registered
taking into account the age groups, exceed the 106% of the average number of points in the
the reference period, health insurance in the context of the total remuneration
the medical device does not pay the amount corresponding to the excess.
7. If the average number of points in 1., or in the 2. quarter of 2006 for the
pull the care skill according to the list in the 809 performances, in addition to the performance
Screening Mammograms according to a list of performances, on one of the registered
insured persons, taking into account the age groups, will exceed 110% of the average
the number of points in the reference period, the health insurance company, within the overall
reimbursement of the medical device does not pay the amount corresponding to the excess.
8. If the average payment for health care provided on one
treated undocumented insured, taking into account age groups,
exceeds by more than 10% of the average remuneration in the reference period, and
at the same time by more than 20% of the specific part of the health care (i.e., either the payment of
for health, or for prescribed medicines and medical
resources, or for the requested care, including a particularly charged medicinal
products and material, particularly in the fields of medicine posted 222, 801, 802,
804, 805, 807, 809, 812 to 819, 822 and 823 under the list of performances), it is
health insurance in the context of the total payment of the medical equipment
authorized neuhradit amount corresponding to one quarter of the said
the excess.
9. the regulatory restrictions referred to in the previous paragraphs shall not apply if the
medical devices registered in the reference period or the investigational
50 and less competent health insurance policyholders, or provided
health care 50 and less non-relevant insurance policy holders
health insurance companies.
10. If the medical device proves that due to health
the status of insured person could use another method of treatment, or may prescribe other
medical device over 15 000 Czk approved revision doctor,
health insurance company the regulation does not apply, if the comparable
medicinal products or medical devices were not in a comparable
the range of medical device prescribed in the reference period.
(C)) table age indices
-----------------------------
age group Index
-----------------------------
0-4 years 3.80
5-9 years 1.65
10-14 years 1.30
15-19 years 1.00
20-24 years, 0.90
25-29 years 0.95
30-34 years, 1.00
35-39 years, 1.05
40-44 years, 1.05
45-49 years, 1.10
50-54 years 1.35
55-59 years 1.45
60-64 years 1.50
65-69 years, 1.70
70-74 years 2.00
75-79 years 2.40
80-84 years 2.90
85, and 3.40 more years
-----------------------------
Annex 5
The amount of remuneration and regulatory restrictions pursuant to § 6 paragraph 5
And the level of remuneration)
1. the maximum reimbursement for medical devices will be determined after their
half of the sum of the maximum rated as payment for the
medical devices for all the expertise of the contractually agreed that
medical device with the appropriate health insurance.
2. the maximum remuneration for proficiency shall be determined as follows:
Muo = POPzpo x [(PBPo x CB) x 1.05 + PUZUMo + PUZULPo]
where:
Muo maximum payment for the appropriate expertise
POPzpo number of unique policy holders of the relevant health
insurance companies treated in the expertise of the medical
equipment in the half-year
PBPo average number of medical facilities declared and
health insurance company recognized points on one
unique competent health insurance policyholders
treated in the expertise of the medical
the device in the reference period
CB price point according to § 6 paragraph 4
PUZUMo the average remuneration for the separately posted material on the
one of the unique insured the relevant health
insurance companies in the expertise in the healthcare
the device in the reference period
PUZULPo the average remuneration of a particularly charged medicinal products
one of the unique insured the relevant health
insurance companies in the expertise in the healthcare
the device in the reference period
3. the maximum remuneration referred to in paragraphs 1 and 2 shall be increased by a factor of change
income and expenditure of health insurance in the context of migration
policy holders. The calculation and application of the coefficient changes in revenue and expenditure
health insurance is set out in annex 7 to this Decree.
4. data on the average number of points and the average payment for a particularly
posted material and medicinal products on a single post
the unique expertise of the policyholder in accordance with formal medical facility
in the reference period and the number of unique policy holders in the treated
proficiency in the reference period, notify the health insurance
medical facilities by 30. 4.2006.
5. limitation of the maximum remuneration referred to in paragraph 1 shall not apply in the event that, in the
the reference period, the medical facility health care in some of the
expertise did.
6. Beyond the maximum remuneration referred to in paragraph 1 shall be reimbursed by health insurance company
volume of specially charged to medicinal products provided by health
an insurance company medical devices 2. half-year 2005, calculated on the
unique insured and treated the diagnosis in 2. first half of 2005 and
multiplied by the number of unique treated insured persons with appropriate
diagnosis in the period.
B) regulatory restrictions
1. If the average remuneration for medicinal products and medical devices
prescribed by the medical device on one unique insured in
1. half-year 2006, including medicinal products approved review
doctor, will exceed the average remuneration for medicinal products and medical
means prescribed in the reference period, including medicinal products
approved review by a doctor, in the range of 101% to 105%, health
the insurance company within the total payment of the medical device does not pay
the amount corresponding to 20% of the exceeding of the average remuneration for medicinal products
and medical devices prescribed in the reference period in the range of 101
% to 105%.
2. If the average remuneration for medicinal products and medical devices
prescribed by the medical device on one unique insured in
1. half-year 2006, including medicinal products approved review
doctor, will exceed the average remuneration for medicinal products and medical
means prescribed in the reference period, including medicinal products
approved review by a doctor, in the span of 105% to 110%, health
the insurance company within the total payment of the medical device does not pay
the amount corresponding to 40% of the exceeding of the reimbursement of medicinal products and
medical devices prescribed in the reference period in the range of 105%
up to 110%.
3. If the average remuneration for medicinal products and medical devices
prescribed by the medical device on one unique insured in
1. half-year 2006, including medicinal products approved review
doctor, exceed 110% of the average remuneration for medicinal products and
medical devices prescribed in the reference period, including
medicinal products approved revision doctor, health insurance in
the total amount of remuneration does not pay medical facility
corresponding to the overrun remuneration for medicinal products and medical
means prescribed in the reference period, over 110%.
4. the total amount of remuneration for medicinal products and medical devices
prescribed in the reference period shall be increased by the amount corresponding to
prescribed and health insurance medical devices
medicines provided in the 2. first half of 2005, on přepočtenou
unique insured and treated the diagnosis in 2. first half of 2005,
multiplied by the number of unique treated insured persons with appropriate
diagnosis in the period.
5. If the average number of points for the requested care in the fields of medicine, 801, 222
802, 804, 805, 807, 812 to 819, 822 and 823 by list, on the
one of the unique insured persons in 1. half of 2006, will exceed 106%
the average number of points in the reference period, the health insurance company in
the total amount of remuneration does not pay medical facility
corresponding to the overrun. 6. If the average number of points for the requested care
in 809, according to the list of skills, in addition to the performance of the screening
mammography, according to a list of performances, the one unique policyholder in the 1.
half of 2006, will exceed 110% of the average number of points in the reference
period, health insurance in the context of the overall payment of medical
the device does not pay the amount corresponding to the excess.
7. Regulatory restrictions referred to in the previous paragraphs shall not apply if the
medical device provided in the reference period or the investigational
health care and insurance policy holders less 50 unique relevant health
the insurance company.
8. If the medical device proves that due to health
the status of insured person could use another method of treatment, or may prescribe other
medical device over 15 000 Czk approved revision doctor,
health insurance company the regulation does not apply, if the comparable
medicinal products or medical devices were not in a comparable
the range of medical device prescribed in the reference period.
Annex 6
Procedure for determining the flat-rate, level of remuneration and regulatory restrictions
§ 7 paragraph 4
And the procedure for determining the flat-rate) for the expertise of the 222, 801, 802, 804,
805, 807, 812 to 819, 822 and 823 under the list of performances
The quarterly rate is determined according to the formula:
PS = (CÚref x Kpv) + ÚZÚLMref
where:
PS the flat rate for the quarter
CÚref total remuneration medical facility for health
care provided, declared and health insurance company
recognized in the reference period, which is the corresponding
calendar quarter last year after the settlement
contractually agreed regulations after deducting all
separately charged to medicinal products, including
separately charged to medicinal products authorised
the review by a doctor, and especially of the posted material,
granted in the reference period, the reported
and recognised health insurance
ÚZÚLMref the volume of payment all separately charged of medicinal
preparations, including a particularly charged medicinal
products approved by a physician, and review
the posted material, provided by the reference
the period declared and recognised health insurance
Kpv coefficient changes to the revenue and expenditure of the health
insurance companies in connection with migration policy holders.
The calculation and application of the coefficient is determined
in annex 7 to this Decree.
(B)) procedure for determining the flat-rate for the expertise of 809 by list
performance
The quarterly rate is determined according to the formula:
PS = (CÚref x 1.03 x Kpv) + ÚZÚLMref
where:
PS the flat rate for the quarter
CÚref total reimbursement of medical facilities for health care
granted, the area and the health insurance company recognized in the reference
period, which is the corresponding calendar quarter last year, after
the settlement contractually agreed regulations, in addition to the performance of the screening
mammograms according to a list of performances, after deduction of any particular
posted in medicinal products, including an especially charged of medicinal
products approved by the doctor, and the review of the posted material,
granted in the reference period, declared and recognised health
the insurance company
ÚZÚLMref the volume of payment all separately charged to medicinal products,
including specially charged to medicinal products approved review
doctor, and especially of the posted material, provided by the reference
the period declared and recognised health insurance
Kpv coefficient changes to the revenue and expenditure of health insurance in the context of
with migration policy holders. The calculation and application of the coefficient provided for in
Annex No. 7 of this Decree.
C) regulatory restrictions
1. After the evaluation of the total volume of provided care in the
the quarter will be between individual health insurance adjustment
flat rate according to the following rules:
and if the medical device reports) and health insurance
recognized in the quarter, the number of points corresponding to a margin of 98% to
105% of the number of points, the amount of the flat rate does not change. To
the reference to the number of points counted performance screening
mammograms according to a list of performances.
(b)) if the health care facility reports and health insurance
recognized in the quarter, the number of points is less than 98% of the reference
the number of points, shall be adjusted by multiplying the amount of the flat-rate coefficient
changes to performance. This coefficient is determined by the proportion of declared and recognized
the number of points in the quarter and the number of points of reference. If
medical device reports and is recognized by the health insurance company in
the assessment of the quarter the number of points higher than 105% of the reference number
points above the flat-rate does not change. In reference to the number of points
not according to the performance of screening mammography.
2. The reference points for these purposes means the number of declared,
recognised and paid points in the reference period.
3. Health insurance companies shall notify the medical facilities of
comparison of the volume of payment and the reference to the number of points to 30. 4.2006.
Annex 7
The calculation and application of the coefficient changes to the revenue and expenditure of the health
insurance companies in connection with migration policy holders in accordance with § 4 paragraph 5, section 5 of the
paragraph 8, section 8 paragraph 3, section 9, paragraph 4, section 11, paragraph 3, of the annex No.
1 part A), of Annex No. 2), annex, part A, no. 5) point 3 and
Annex 6, part A)
The factor changes to the revenue and expenditure of health insurance companies in connection with the
migration of insured persons shall be calculated in the following way:
Kpv = (P/E)-0.05
where:
P the sum of the data set out in rows B. II. 1 and B II. 2 of the statement of
Basic health insurance fund pursuant to Decree No.
274/2005 Coll., on how to provide information on the management of
health insurance companies and their range to 30
after subtracting the returnable financial assistance from the State budget
under section 12, paragraph. 2 Act No. 592/1992 Coll., on insurance
on health insurance, as amended
VD the indication referred to in the line of URA.III. 1 of the statement of the basic Fund
health insurance in accordance with Decree No. 274/2005 Coll. on
How to provide information on the management of health
insurance companies and their range, 2006
The coefficient will be applied only if political prisoners for the health
the insurance company will pay in the period, that ratio P/E is greater than the
1.05.
Selected provisions of the novel
Article II of the Decree No. 101/2006 Sb.
Transitional provisions
1. for the calculation of the total remuneration 1. half of 2006 under section 4, 5, 8, 9,
11, for the calculation of flat-rate basis in accordance with Annex 1, annex 2, for
calculation of the maximum remuneration referred to in the annex No 5 and for the calculation of flat-rate
the rates referred to in annex 6, the coefficient of income and expenditure
health insurance in connection with migration policy holders provided for this
by Decree.
2. For the calculation of flat-rate and the monthly payments referred to in annex 1,
apply the stabilisation coefficient determined by this Decree.
3. Another way of payment of health care. half of 2006, than
established by Decree No. 550/2005 Coll., as amended by this Decree, it is possible,
If this method of payment, health insurance
medical facilities and medical equipment if it proves
that the use of the method of payment provided for by Decree No. 550/2005 Coll., in
the text of this Ordinance, would reduce the range and availability of it provided by the
health care. The procedure referred to in the first sentence cannot be used if the
non-compliance has occurred, health insurance plan health insurance.
1) Decree No. 134/1998 Coll. issuing the list of health interventions
with point values, as amended by Decree No. 493/2005 Sb.
2) Article. (II) Act No. 459/2000 Coll., amending Act No. 48/1997 Coll.,
about the public health insurance and amending and supplementing certain
related laws, as amended.
Annex 1, point (B) of regulation of the Government No. 487/2000 Coll., laying down
the value of the item and the amount of reimbursement of health care paid for by the public
health insurance for 1. half of 2001.
section 17, paragraph 3). 11 (a). and Act No. 48)/1997.
4) § 40 paragraph. 2 of Act No. 48/1997 Coll.
