The Point Values, Payment Of Health Care Covered By The Insurance For The Year 2014

Original Language Title: Hodnoty bodu, úhrady zdravotní péče hrazené z pojištění pro r.2014

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now

Read the untranslated law here: https://portal.gov.cz/app/zakony/download?idBiblio=81144&nr=428~2F2013~20Sb.&ft=txt

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.