Change On Public Health Insurance, And The Change Of Related.

Original Language Title: změna z. o veřejném zdravotním pojištění a změna souvisejících z.

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Read the untranslated law here: https://portal.gov.cz/app/zakony/download?idBiblio=81910&nr=60~2F2014~20Sb.&ft=txt

60/2014 Sb.



LAW



of 19 December 2003. March 2014,



amending Act No. 48/1997 Coll., on public health insurance, and

on the change and the addition of some related laws, as amended

regulations, and other related laws



Change: 267/2014 Sb.



Parliament has passed the following Act of the Czech Republic:



PART THE FIRST



Amendment of the Act on public health insurance



Article. (I)



Act No. 48/1997 Coll., on public health insurance and amending and

supplementing certain related laws, as amended by Act No. 242/1997

Coll., Act No. 2/1998 Coll., Act No. 127/1998 Coll., Act No. 225/1999

Coll., Act No. 363/1999 Coll., Act No. 18/2000 Coll., Act No. 132/2000

Coll., Act No. 155/2000 Coll., the finding of the Constitutional Court, declared under no.

167/2000 Coll., Act No. 220/2000 Coll., Act No. 258/2000 Coll., Act No.

459/2000 Coll., Act No. 176/2002 Coll., Act No. 198/2002 Coll., Act No.

285/2002 Coll., Act No. 309/2002 Coll., Act No. 320/2002 Coll., Act No.

222/2003 Coll., Act No. 274/2003 Coll., Act No. 362/2003 Coll., Act No.

424/2003 Coll., Act No. 425/2003 Coll., Act No. 455/2003 Coll., Act No.

85/2004 Coll., Act No. 359/2004 Coll., Act No. 422/2004 Coll., Act No.

436/2004 Coll., Act No. 438/2004 Coll., Act No. 123/2005 Coll., Act No.

168/2005 Coll., Act No. 253/2005 Coll., Act No. 350/2005 Coll., Act No.

361/2005 Coll., Act No. 47/2006 Coll., Act No. 109/2006 Coll., Act No.

112/2006 Coll., Act No. 117/2006 Coll., Act No. 165/2006 Coll., Act No.

189/2006 Coll., Act No. 214/2006 Coll., Act No. 245/2006 Coll., Act No.

264/2006 Coll., Act No. 340/2006 Coll., the finding of the Constitutional Court

declared under the No 57/2007 Coll., Act No. 181/2007 Coll., Act No.

261/2007 Coll., Act No. 296/2007 Coll., Act No. 129/2008 Coll., Act No.

137/2008 Coll., Act No. 270/2008 Coll., Act No. 274/2008 Coll., Act No.

306/2008 Coll., Act No. 59/2009 Coll., Act No. 158/2009 Coll., Act No.

227/2009 Coll., Act No. 281/2009 Coll., Act No. 362/2009 Coll., Act No.

298/2011 Coll., Act No. 365/2011 Coll., Act No. 369/2011 Coll., Act No.

458/2011 Coll., Act No. 1/2012 Coll., Act No. 275/2012 Coll., Act No.

401/2012 Coll., Act No. 403/2012 Coll., Act No. 44/2013 Coll. and award

The Constitutional Court declared under no 238/2013 Coll., is hereby amended as follows:



1. In article 1 (1). 1, the words "European Community" shall be replaced by the words

"The European Union ^ 1), at the same time follows on directly applicable provisions of

The European Union ^ 51) ".



Footnote No. 1 and 51 shall be added:



"1) of Council Directive 89/105/EEC of 21 December 1989. December 1988 relating to the transparency

of measures regulating the pricing of medicinal products and the

their inclusion in the scope of national systems

health insurance.



Directive of the European Parliament and of the Council of 2011/24/EU of 9 June. March 2011

on the application of patients ' rights in cross-border health care.



The implementing Commission directive 2012/52/EU of 20 December. December 2012, which

for measures to facilitate the recognition of medical prescriptions

issued in another Member State.



51) European Parliament and Council Regulation (EC) No 883/2004 of 29 April 2004.

April 2004 on the coordination of social security systems, as

the text of the.



Regulation of the European Parliament and of the Council (EC) no 987/2009 of 16 January. September

2009 laying down detailed rules for the application of Regulation (EC) No 883/2004

on the coordination of social security systems, as amended.



Regulation of the European Parliament and of the Council (EU) no 1231/2010 of 24 March.

November 2010, extending the scope of Regulation (EC) No 883/2004

and Regulation (EC) no 987/2009 to nationals of third countries on the

which are not yet covered by this regulation only by reason of their State

jurisdiction. ".



2. In article 1 (1). 2 the words "in the field of coordination of social

Security "is replaced by" governing the coordination of social

Security (hereinafter referred to as "coordination regulation").



3. In section 11 (1). 1 (a). (b)), the word "services", the words "on

the territory of the Czech Republic. "



4. In section 11 is at the end of paragraph 1, the period is replaced by a comma and the following

the letter l) to (n)) are added:



"l) to pay the costs, which are expended on emergency care

pumped abroad, and only up to the amount provided for the reimbursement of such care,

If it has been granted on the territory of the Czech Republic,



m) to pay the costs, which are expended on health services, pumped in the

another Member State of the European Union, with regard to health services, which

It would have been when the provision to the territory of the Czech Republic covered by health

insurance (hereinafter referred to as "paid for by cross-border services"), and only in the amount of

laid down for the payment of such services if they were made on the territory of the

The Czech Republic,



n) to information about options to draw health services in other

the Member States of the European Union. ".



5. section 14 reads:



"section 14



(1) the health insurance covers medical services provided on

the territory of the Czech Republic.



(2) the health insurance Of the insured persons on the basis of its application

provide reimbursement of costs incurred for emergency care,

whose need has arisen during his stay abroad, and only in the amount of

laid down for the payment of such services if they were made on the territory of the

Of the Czech Republic.



(3) the health insurance Of the insured persons on the basis of its application

will provide a refund of the cost paid for by cross-border services, and

It's only up to the amount established for the payment of such paid services, if

would have been granted on the territory of the Czech Republic. If the refund is

the cost of cross-border services subject to the grant paid by the previous

consent under section 14b, provide him cost recovery only

If prior consent has been granted.



(4) with respect to the provision of cross-border services when covered by a necessary

care paid under coordination of regulation and costs associated with its

drawing on the coordination regulation are covered only partly,

apply for reimbursement of the costs incurred by the beneficiary and nehrazených

According to the coordination regulation the first sentence of paragraph 3. In this case,

the insured persons shall provide the refund of the costs incurred by it in the amount of

calculated as the difference between the total amount of the remuneration of such health

the service, which would provide in the territory of the Czech Republic was covered

of health insurance, and the total amount of the amount for such

health service paid for by the coordinating regulation. If the calculated

the amount is higher than the amount the beneficiary, provide him

refund only the amount spent.



(5) If this Act or decision of the State Institute for the control of

of medicinal products (hereinafter referred to as "the Institute") issued by the sixth section of the conditions

for payment of covered services, the following conditions must be met for

compensation paid to cross-border services; for such a condition is

does not consider the conclusion of a contract for the provision and payment of covered services. ".



6. in article 14, the following new section 14a to 14 c, which including the following title:



"§ 14a



The amount of reimbursement of costs pursuant to § 14 paragraph. 2 to 4 shall be determined on the basis of the

This law, Decree issued pursuant to § 17 paragraph. 4, price regulation,

measures of a general nature under section 15(2). 5 and the decision of the Institute by the

effective on the date of the sixth copy of the accounting document on which

the basis of the refund is carried out; the same applies, mutatis mutandis, for the reimbursement of the costs

that policyholders have arisen in connection with the drawing of the health services in the

another Member State of the European Union, the European economic area

or the Swiss Confederation, to which the authorisation was granted by the

coordination of regulation to ensure the coverage of health services

(hereinafter referred to as "the authorisation under the coordination regulation").



section 14b



Prior consent of the



(1) the Government may by regulation define the chargeable cross-border services, which

is the grant of a refund of costs pursuant to § 14 paragraph. 3 subject to the granting of an

the prior consent. As paid for by cross-border services, which is

refund of costs subject to prior consent, can be defined

only



and the planned paid services), for which the regulation of the local government and

availability of health services stated time

availability and which at the same time require hospitalization or highly

specialized instrumentation or medical equipment, or



(b)) paid services, which include treatment, which is a special

the risk for the patient or the population.



(2) the Ministry of health shall notify the European Commission, which

paid services is conditional on the prior consent of the reimbursement of costs.



(3) on the granting of prior consent shall be decided by the relevant health

the insurance company at the request of the insured person. The request must be made before the

the start of pumping paid cross-border services.



(4) the health insurance company can refuse to grant prior approval only,

If



and) would be the beneficiary due to its state of health when drawing

financed by the cross-border service is exposed to the risk that cannot be

acceptable, taking into account the possible contribution of drawing these covered

cross-border services,
(b)) is a reasonable concern that the drawdown would be covered by the cross-border services

could result in substantial danger to public health,



(c)) regarding who is paid to provide cross-border services,

There is a reasonable concern, as regards compliance with the standards and guidelines

relating to the quality of health services provided and on the safe

the insured person, or



(d)) can be required to provide health services to insured persons on the territory of the Czech

Republic within the time fixed by regulation of the Government of the availability

the local and temporal availability of health services.



(5) the health insurance policyholder when a claim for the award of

prior consent must also consider whether in the present case are not

the conditions for the issue of a permit by the coordinating regulation.

If these conditions are met, the health insurance company will issue the policyholder

authorization under the coordination of the regulation; This does not apply if the insured person in

the request stated that asks only about the granting of prior informed consent and

grant requests, even after he was informed of the health insurance company

the advantages of that bringing the issue of permits under the coordination of regulation

as opposed to the granting of prior consent.



§ 14 c



(1) Information concerning the drawing of health services in the Member

States of the European Union provides a national contact point, which is

the body, which was intended for a range of health insurance as a liaison

in accordance with the coordination regulation (hereinafter referred to as the "focal point").

The Health Ministry says the name and contact details of the contact

the place of the European Commission and published on the official notice board and is in the journal of the

The Ministry of health. The name and contact information of the focal point

published on their website and the health insurance companies.



(2) point of contact provides, in particular, information about the



and drawing options) of health services in the Member States of the European

of the Union,



(b)), providers



(c)) contact information national contact points in the other

the Member States of the European Union,



(d)) the legislation of the Czech Republic concerning the standards and guidelines

on the quality and safety of delivery of health services, including

provisions on the supervision and evaluation of providers, and providers, the

that these standards and guidelines apply,



e) patients ' rights, the procedures for submission of complaints and mechanizmech

to rectify the situation, and about how to resolve disputes in the Czech Republic,



f) terms, which are to be in accordance with the legislation of the Czech

Republic listed on medical regulations, which are displayed on the

the request of the patient who is going to use in another Member State of the European

the Union.



(3) the focal point further on request provides information about



and provide a specific provider) health services or

any limitations of its permissions,



(b) the accessibility of specific medical devices) in the Czech Republic

for persons with disabilities,



(c) draw health services) options under the coordination of regulation,



(d) the insured's rights) in connection with the drawing of the health services in the

other Member States of the European Union, and in particular on the rules and

conditions of reimbursement of costs and procedures for their application,



(e)) the rights of the patient from another Member State of the European Union on the territory of the

The Czech Republic in connection with the drawing of the health services, in particular on the

How to appeal and the remedy, if the patient has for it, that was damaged on

their rights, including in cases where the injury occurs as a result of the pumping

health services.



(4) in providing information concerning the drawing of health services

in another Member State of the European Union contact point shall communicate which rights

result of the coordination regulation and resulting from this Act.

The information referred to in paragraph 2 of point of contact type exposes on their

website. The information referred to in paragraphs 2 and 3 shall, at the request

shall provide, in a form which allows you to make with the following information in

extent necessary to meet persons with disabilities.



(5) the contact point works in order to exchange the necessary information

and examples of good practice with the national contact points of the other

the Member States of the European Union, European Commission, health

insurance companies and associations operating in the field of the protection of patients ' rights

These persons.



(6) Providers, the authorities competent to issue permissions to provide

health services and health insurance are required to contact

a place to provide information on his application, in accordance with paragraphs 2 and 3

without delay and free of charge, if you have this information available. ".



7. In section 15(2). 5, the words "State Institute for drug control (hereinafter referred to as

"The Institute") ' shall be replaced by the word "Institute".



8. In article 16a, paragraph. 2, in the introductory part of the provisions, the words "and to (f)))"

replaced by the words "and to (e)))".



9. In article 16a, paragraph 4 shall be deleted.



Paragraphs 5 to 11 shall become paragraphs 4 to 10.



10. In section 16a, paragraph. 5 the second sentence be deleted.



11. In section 16a, paragraph. 8, the words "2-4" is replaced by "2 and 3".



12. In article 16a, paragraph. 10 the words "9 and 10" is replaced by "8 and 9".



13. In section 16b of paragraph 1. 2 the first and second sentence, the words "7 and 8" shall be replaced by the words

"6 and 7".



14. In article 40, paragraph 2, the following paragraphs 3 and 4, including

footnote No. 52:



"(3) the health insurance companies decide on the applications of their insured persons about

the issue of a permit by the coordinating regulation. The request must be

shows what kind of health services to the beneficiary intends to draw instead of their

drawing and estimated time of their drawing. Health insurance company

authorization under the coordination of regulation will only issue in the case, for

his release conditions) set ^ 52 coordination regulations.

If there is reason to fear that the required health service cannot be

the policyholder due to its state of health and the probable course of the

the disease is granted on the territory of the Czech Republic in time and there is a danger of

delay, must issue a permit pursuant to the health insurance coordination

regulation without delay.



(4) health insurance will provide reimbursement of insured persons on request

costs pursuant to § 14 paragraph. 2 to 5 not later than the last day of the month

following the date of entry into force of the decision referred to in section 53, paragraph. 1.



52) article 20 regulation of the European Parliament and of the Council (EC) No 883/2004 of the

29 April. April 2004 on the coordination of social security systems, in

as amended. ".



Paragraphs 3 to 10 shall be renumbered as paragraphs 5 to 12.



15. In section 40 paragraph. 12 the words "7 and 8" shall be replaced by "10 and 11".



16. In section 40, the following paragraph 13 and 14 indents are added:



"(13) health insurance companies collect data relating to the administrative

proceedings in matters relating to compensation of the costs for health services, pumped

insured persons in other Member States of the European Union, in particular the data on the



and) proceedings initiated on the reimbursement of costs pursuant to § 14 paragraph. 2 to 4, of the

their number, place of their drawing and about how it was in the individual

proceedings decided



(b)) for the grant proceedings initiated prior consent, their number of

and, as was decided in the individual procedures,



(c)) the amounts that were in accordance with § 14 paragraph. 2 to 4 are replaced by the insured.



(14) the data collected in accordance with paragraph 13 shall communicate the health insurance

in the form at the request of disidentified Ministry of health.

The Ministry of health provides this information to the European Commission in the

her deadlines. ".



17. In section 53, paragraph. 1, the first sentence after the words "relating to" the following

the words "the grant of prior informed consent under section 14, the issue of the permit referred to in

the co-ordination regulation, the refund of the costs pursuant to § 14 paragraph. 2 to 4.0 "and

the third and fourth sentences are replaced by the phrases "health insurance decisions

in matters of price increases to premiums, fines, and the probable amount of insurance premiums

and in disputed cases in matters of paying insurance premiums and penalties

payment acreage. The appeal against the payment of the assessment does not have suspensory

effect. ".



PART THE SECOND



Amendment of the Act on general health insurance company in the Czech Republic



Article. (II)



Law No. 551/1991 Coll., on the Czech General health insurance company

Republic, as amended by Act No. 592/1992 Coll., Act No. 10/1993 Coll.

Act No. 60/1995 Coll., Act No. 145/1996 Coll., Act No. 48/1997 Coll.,

Act No. 305/1997 Coll., Act No. 93/1998 Coll., Act No. 127/1998 Coll.

Law No. 69/2000 Coll., Act No. 132/2000 Coll., Act No. 220/2000 Coll.

Act No. 49/2002 Coll., Act No. 420/2003 Coll., Act No. 455/2003 Coll.

Law No 438/2004 Coll., the Act No. 117/2006 Coll., the Act No. 261/2007 Coll.

Act No. 296/2007 Coll., Act No. 362/2009 Coll., Act No. 188/2011 Sb.

Act No. 298/2011 Coll., Act No. 369/2011 Coll. and Act No. 458/2011

Coll., is hereby amended as follows:



1. In section 5 (c)), including footnotes, no 1a is added:



"(c)) costs had pumped emergency care

abroad and the reimbursement of costs for medical services, pumped the policyholder in

another Member State of the European Union, pursuant to section 14 of the Act on public

health insurance ^ 1a),
1A) Act No. 48/1997 Coll., on public health insurance and amending and

addition of related laws, as amended

regulations. ".



2. In section 5) at the end of paragraph (e) is replaced by a comma and dot is added

subparagraph (f)), which read:



"(f)) for health services and the reimbursement of costs incurred by the policyholder

on health services pumped in European Union Member States,

The European economic area or the Swiss Confederation pursuant to

the directly applicable European Union legislation governing the coordination of

of social security systems and in accordance with the international treaties in the field of

social security. ".



PART THE THIRD



The amendment to the law on departmental, sectoral, Enterprise and other health

insurance companies



Article. (III)



Law No. 280/1992 Coll., on departmental, industry, corporate, and other

health insurance, as amended by Act No. 10/1993 Coll., Act No.

15/1993 Coll., Act No. 60/1995 Coll., Act No. 145/1996 Coll., Act No.

48/1997 Coll., Act No. 93/1998 Coll., Act No. 127/1998 Coll., Act No.

225/1999 Coll., Act No. 220/2000 Coll., Act No. 49/2002 Coll., Act No.

420/2003 Coll., Act No. 438/2004 Coll., the Act No. 117/2006 Coll., Act No.

267/2006 Coll., the Act No. 261/2007 Coll., Act No. 296/2007 Coll., Act No.

351/2009 Coll., Act No. 362/2009 Coll., Act No. 188/2011 Coll., Act No.

298/2011 Coll., Act No. 369/2011 Coll. and Act No. 458/2011 Coll., amended

as follows:



1. In section 13 (c)), including footnotes, No 23:



"(c)) costs had pumped emergency care

abroad and the reimbursement of costs for medical services, pumped the policyholder in

another Member State of the European Union, pursuant to section 14 of the Act on public

health insurance ^ 23),



23) Act No. 48/1997 Coll., on public health insurance and amending and

addition of related laws, as amended

regulations. ".



2. Section 13 is at the end of subparagraph (e)) is replaced by a comma and dot is added

subparagraph (f)), which read:



"(f)) for health services and the reimbursement of costs incurred by the policyholder

on health services pumped in European Union Member States,

The European economic area or the Swiss Confederation pursuant to

the directly applicable European Union legislation governing the coordination of

of social security systems and in accordance with the international treaties in the field of

social security. ".



PART THE FOURTH



The amendment to the law on health services



Article. (IV)



In section 45 of Act No. 372/2011 Coll. on health services and conditions

their provision (law on health services), as amended by Act No.

303/2013 Coll., is at the end of paragraph 2 is replaced by a comma and the following dot

the letter o), including footnotes, no 50:



") to provide information to the national focal point on its

the request pursuant to the Act on public health insurance ^ 50).



50) section 14 of Act No. 48/1997 Coll., on public health insurance, and about

change and the addition of some related laws, as amended

regulations. ".



PART THE FIFTH



The EFFECTIVENESS of the



Article. In



This law shall enter into force on the fifteenth day following its publication.



In r. hamáček.



Zeman in r.



Sobotka in r.