Reimbursement Of Health Care Costs. Insurance For 1. Pol 2006

Original Language Title: úhrady zdravotní péče hrazené ze zdrav. pojištění pro 1. pol. 2006

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$20 per month, or Get a Day Pass for only USD$4.99.
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.

Related Laws