428/2013 Sb.
DECREE
of 13 October. December 2013
on the determination of the values of the point, the amount of the reimbursement paid services and regulatory
limits for the year 2014
The Ministry of health shall lay down pursuant to § 17 para. 5 of law No 48/1997
Coll., on public health insurance and amending and supplementing certain
related laws, as amended by Act No. 117/2006 Coll., Act No.
245/2006 Coll., Act No. 261/2007 Coll., Act No. 298/2011 Coll. and act
No 369/2011:
§ 1
This Decree sets out the point values for the year 2014, the amount of the reimbursement paid by the
services provided to the insured under section 2 (2). 1 of law No 48/1997
Coll., on public health insurance and amending and supplementing certain
related laws, as amended by later regulations (hereinafter referred to as the "Act"),
and paid services provided by insurance policy holders from other Member
States of the European Union, European economic area and the Swiss
the Confederation by the directly applicable European Union legislation
governing the coordination of social security systems ^ 1) and the insured
other States with which it has concluded international Czech Republic
agreement on social security and related to the area covered by the
^ 2), services (hereinafter referred to as "foreign insured person"), and regulatory constraints for
methods of payment referred to in § 3 to 15, provided these terms and
health care services provider ("provider"):
and bed care providers) and providers of special inpatient care
According to § 22a of the Act,
(b)) in the field of General providers practical medicine and providers
in the field of practical medicine for children and adolescents,
(c) specialized outpatient care providers), ISP
hemodialysis health care and service providers in the fields of medicine, 903, 905
919 and 927 under the Decree issuing the list of medical procedures with
point values, as amended ^ 3) (hereinafter referred to as "list
performance "),
d) providers of out-patient care in the fields of medicine and 603 604 by list
performance,
e) providers in the field of dentistry,
(f)) in the fields of medicine outpatient care providers 222, 801, 802, 804,
805, 806, 807, 808, 809, 810, 812-819, 820, 822 and 823 by list
performances (hereinafter referred to as "listed expertise"),
g) providers of outpatient care in the fields of medicine, 911 914, 916, 921 and
925 by list of performances
h) ambulatory care providers in 902 and 917 according to skill list
performance,
I) providers of emergency medical services, transportation providers
patients, health care providers of transport services,
medical emergency services providers and providers of emergency
services in the field of dentistry and
j) providers of rehabilitation care and Spa Clinic ozdravovnami.
§ 2
(1) the reference period means for the purposes of annexes 1, 3 and 8 of this
Ordinance of the year 2012.
(2) the Rated period shall mean for the purposes of annexes 1, 3 and 8 of this
Notice the year 2014.
(3) Unique insured for the purposes of this order shall mean the insured person
health insurance companies treated by the provider in a specific expertise in
investigational or reference period, at least once, with the fact that it is not
applicable, whether it is a treatment within their own health services
or health services on-demand. If the insured person
provider in a specific expertise in the treatment period, or
the reference period several times, includes the number of unique policy holders
the health insurance companies treated in the skill only
once. In the event of a merger of health insurance companies, the number of unique
insured means the sum of unique policy holders of health insurance companies,
that have merged. If the insured person in the reference period
the insured more than one health insurance company, the number of unique
the treated insured persons are counted only once.
(4) when calculating the total number of declared and health provider
insurance company approved for medical procedures (hereinafter referred to as "the power")
the reference period according to annexes 3, 5 and 8 of this Decree, the following
points means the points calculated according to the list in the version in force on 1 January.
January 2014, that have not been paid at a reduced value of the point to which
they are not counted for points paid for services provided to foreign
insurance policy holders.
(5) if in the reference period to merge two health
insurance companies, used for calculation of the sum of the remittance information for the reference
the period of the merged health insurance companies.
§ 3
In the case of the provision of paid services to foreign persons with
provides for the payment of the same amount as in the case of Czech policy holders.
§ 4
(1) for the paid services provided by providers of inpatient care, with
except for covered services provided by providers of subsequent bed
care, providers of long-term care beds and special providers
bed care, the point value, the amount of the reimbursement paid services and regulatory
limit fixed in annexes no. 1, 9, 10, 12 to 14 of this Ordinance.
(2) for the paid services provided by providers of subsequent bed care,
providers of long-term care and the providers of special inpatient beds
care paid a flat rate per day of hospitalization, or by
list of performances with the point value, the amount of the reimbursement paid services and regulatory
the restrictions set out in annex 1 to this notice.
§ 5
For paid services supplied by providers in the field of General
practical medicine and providers in the field of practical medicine for
children and adolescents paid a combined kapitačně power payment
combined kapitačně power payment with calling kapitace or
According to the list of performances with the point value, the amount of the reimbursement paid by the services and
regulatory restrictions set out in annex 2 to this Decree.
§ 6
For specialized out-patient care provided by your ISP
outpatient health care expenses paid in accordance with the list of services and service providers
in the fields of medicine, 903, 905 919 and 927 by list of performances with the value of the
point, the amount of the reimbursement paid services and regulatory restrictions set out in annex
No. 3 to this notice.
§ 7
For out-patient care provided by providers of out-patient
care in the fields of medicine and 603 604 paid according to performance list
list of performances with the point value, the amount of the reimbursement paid services and regulatory
the restrictions set out in annex 4 to this notice.
§ 8
(1) for the paid for services supplied by providers in the field of dental
medicine paid for by list of performances with the point value shall be
0.95 €.
(2) the amount of the reimbursement paid by the services supplied by providers in the industry
Dentistry which are not fully provided for in paragraph 1 and the relevant regulatory
the restrictions are set out in annex 11 to this Decree.
(3) the health insurance fund shall limit the amount of payment to providers in the field of dental
medicine so that the sum of the cost of health insurance
spent on paid services supplied by providers in the field of dental
medicine in 2014, does not exceed the total amount of these costs
disability insurance plan provided for in the health insurance companies. If
overrunning of the total amount of remuneration paid for services provided by the
providers in the field of dentistry, provided for in the health insurance
health insurance plan for these services was caused by the employers '
by providing a greater volume of urgent care compared to the year 2012, health
the insurance company will pay this higher volume.
§ 9
For the paid services provided by providers of ambulatory health care
in the listed fields of medicine paid for by the value of the performance list
point and the amount of the reimbursement paid services set out in annex 5 to this
the Decree.
§ 10
For the paid services provided by providers of ambulatory health care
in the fields of medicine, 911 914, 916, 921 and 925, according to the list of procedures paid for by
According to the list of performances with the point value and the amount of the reimbursement paid services
down in annex 6 to this Ordinance.
§ 11
For the paid services provided by providers of ambulatory health care
in the fields of medicine and 902 917 according to the list of procedures paid for by list
performance point value and the amount of the reimbursement paid services set out in annex
# 7 of this Decree.
§ 12
For the paid services provided by emergency medical providers
services paid for by list of performance shall be in the amount of point value
1.10 Eur and for paid services provided by transport providers
urgent care patients paid according to the list of performances is determined
point value in the amount of $1.10.
section 13 of the
For the paid services provided by providers of medical transport
services paid for by list of performances with the point value and the amount of the payments and
regulatory restrictions covered services set out in annex 8 to this
the Decree.
§ 14
For the paid services provided by providers within the medical
emergency services or emergency services in the branch of dental medicine
paid by list of performances is fixed point value of 0.95 €.
§ 15
(1) for the complete spa sanatorium rehabilitation care for adults
provided by the Spa provider in healthcare facilities
hospital rehabilitation care down payment for one day stay in the
the amount which has been negotiated to 31. December 2013, plus $100.
If the payment for one day stay at 31. December 2013 negotiated
the remuneration in the amount of $950.
(2) for the complete spa sanatorium rehabilitation care for children and
youth under 18 years of age provided in healthcare facilities
Spa sanatorium rehabilitation care provider shall be the remuneration for the
one day stay at a level which has been negotiated to 31. December 2013
plus a $200. If the payment for one day stay at 31. December
2013 agreed, the remuneration in the amount of 1 050 CZK.
(3) For contributory Spa sanatorium rehabilitation care for adults
provided by the Spa provider in healthcare facilities
hospital rehabilitation care down payment for one day stay in the
the amount which has been negotiated to 31. December 2013, plus $100.
If the payment for one day stay at 31. December 2013 negotiated
the remuneration in the amount of $380.
(4) for contributory Spa sanatorium rehabilitation care for children and
youth under 18 years of age provided in healthcare facilities
Spa sanatorium rehabilitation care provider shall be the remuneration for the
one day stay at a level which has been negotiated to 31. December 2013
plus a $200. If the payment for one day stay at 31. December
2013 agreed, the remuneration in the amount of $480.
(5) for the paid for services provided in the Sanatorium schools shall be the remuneration for the
one day stay at a level which has been negotiated to 31. December 2013
plus $100. If the payment for one day stay at 31. December
2013 agreed, the remuneration in the amount of $640.
section 16 of the
This Decree shall enter into force on 1 January 2000. January 2014.
Minister:
Mudr. Holcat, MBA, in r.
Annex 1
The value of the item, the amount of the reimbursement paid services and regulatory restrictions pursuant to § 4
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 2
The value of the item, the amount of the reimbursement of health care and regulatory restrictions pursuant to § 5
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 3
The value of the item, the amount of the reimbursement and regulatory restrictions in accordance with § 6
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
*) Note. ASPI: the annex fixed communication about correcting typographical errors, which reads as follows:
In annex No. 3 on the side under A) 7196 point value and the amount of the remittances have instead of words
"For covered services provider", the words "be properly 2. For covered services provider "
Annex 4
The value of the item, the amount of the reimbursement and regulatory restrictions pursuant to § 7
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 5
Point value and the amount of the reimbursement in accordance with § 9
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 6
Point value and the amount of the reimbursement in accordance with § 10
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 7
Point value and the amount of the reimbursement in accordance with § 11
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 8
Point value and the amount of payments under section 13 of the
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 9
The group related to the diagnosis according to the classification with the indexes of these groups
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 10
The group related to the diagnosis according to the classification with the indexes of these groups
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 11
The amount of the reimbursement paid by the services according to § 8 para. 2
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 12
The coefficients of a weighted number of policy holders of health insurance changes according to the
regions of the Czech Republic for acute in-patient care
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 13
The coefficients of a weighted number of policy holders of health insurance changes according to the
regions of the Czech Republic for outpatient care
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
Annex 14
Medicines extracted from the payment of the second lump sum
_________________
*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2013.html#castka_167.
1) European Parliament and Council Regulation (EC) No 883/2004, on the coordination of
systems of social security, as subsequently amended.
European Parliament and Council Regulation (EC) no 987/2009, which
down detailed rules for the application of Regulation (EC) No 883/2004, on the coordination of
of social security systems.
European Parliament and Council Regulation (EU) no 1231/2010 laying
extends the scope of Regulation (EC) No 883/2004 and Regulation (EC) No.
987/2009 to nationals of third countries, to which this regulation
do not yet apply only because of their nationality.
2) for example, the communication from the Ministry of Foreign Affairs No. 130/2002 Coll. m.
with the negotiation of the Treaty, between the Czech Republic and the Federal Republic of
Yugoslavia on social security, the communication of the Ministry of foreign
things no. 135/2004 Coll. m. s., on the negotiation of a Treaty between the Czech Republic and
The Turkish Republic on social security, the Ministry of communication
Foreign Affairs No. 2/2007 Coll. m. s., the negotiation of the agreement between the Czech
Republic and the Republic of Macedonia concerning social security.
3) Decree No. 134/1998 Coll. issuing the list of medical procedures
with point values, as amended.