Reimbursement Of Health Care By Health. Insurance For 1. Mid-2006

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

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Read the untranslated law here: https://portal.gov.cz/app/zakony/download?idBiblio=62313&nr=101~2F2006~20Sb.&ft=txt

101/2006 Sb.



DECREE



of 20 December. March 2006,



amending Decree No. 550/2005 Coll., laying down the remuneration

health care paid for by public health insurance, including

regulatory restrictions, for 1. half-year 2006



The Ministry of health shall lay down pursuant to § 17 para. 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. 458/2000 Coll., (hereinafter referred to

"the Act"):



Article. (I)



Decree No. 550/2005 Coll., which sets the amount of the reimbursement of health care

paid for by public health insurance, including regulatory restrictions,

for the 1. half of 2006, shall be amended as follows:



1. In paragraph 1 (b). and section 5), the words "in the fields of medicine, 801 to 222 807, 809

and 812-823 "are replaced by the words" in the fields of medicine, 801, 802 222, 804, 805,

807, 809, 812-819, 822 and 823 ".



2. In article 2 (2). 2, "small number of insured persons" shall be replaced by

"100 and less to the insured" and the last sentence shall be deleted.



3. in article 3 paragraph 3 is added:



"(3) the health insurance fund shall provide monthly medical facility

remuneration of 105% of one sixth of the remuneration payable to a healthcare

the device in the reference period. ".



4. In section 3, the following paragraphs 4 and 5 are added:



"(4) If a health care facility shall provide health care for 50 and less

the health insurance the insured hospitalized, paragraph 1

shall not apply, and provided health care to be paid in accordance with 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-year 20062). ".



5. In section 4, paragraph 4. 4, the word "preliminary" is deleted.



6. In section 4, paragraph 4. 5 is the number "103" is replaced by "105" and at the end of

paragraph, the following phrase "restriction on the payment shall not apply if

medical device provided in the reference period or

health care 50 and less unique respective health insurance policy holders

the insurance company. ".



7. in paragraph 4, the following paragraph 7 is added:



"(7) beyond the total remuneration referred to in paragraph 5, the health insurance company

will pay the amount charged separately for medicinal products supplied by

health insurance medical facility in 2. first half of 2005,

calculated on the unique and diagnosis in treated 2.

first half of 2005, and multiplied by the number of unique treated insured persons with

the diagnosis in the period. ".



8. in § 5 para. 2, after the words "insured" the words

"with the appropriate age index according to annex No 4 to this part C)

the Decree ".



9. in section 5, paragraph 3:



"(3) the performances not included in kapitační payments, in addition to performance, which is

exhibit preventive examinations in accordance with the Decree No. 56/1997 Coll., which

the content and time range of preventive examinations, as amended by

amended, (hereinafter referred to as "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 to be unregistered insured person pursuant to paragraph 1. and) and (b)),

are to be paid according to the list of performances, while the price agreed for point 2.

first half of 2005 and published in the journal of the Department of health

shall remain in force for 1. half of 20063). ".



10. In section 5, paragraph 3, the following paragraph 4 is added:



"(4) performances, which are recognised by the Decree on preventive examinations

preventive examinations and vaccinations, according to the Decree on vaccination,

not included in the kapitační of the payment referred to in paragraph 1 (b). and) and (b)), to be paid

According to a list provided by the performance remuneration for medical procedures with the constraint

the maximum reimbursement to the insured's unique treated. Price point

agreed to 2. first half of 2005 and published in the journal of the Department of

health care remains in force for 1. half of 20063). Maximum

the remuneration of an insured person is treated on the unique for the specific

medical facility provides, as a proportion of the total remuneration for these performances

in the reference period, which is the corresponding half last year, and

number of unique treated policyholders, those performances

declared. The calculated percentage is multiplied by the number of unique treated

insured persons and by the factor 1.05. The maximum payment limit does not apply

in the event that, in the reference period or has been treated with 50 and

less unique treated policyholders the competent health insurance company. ".



Paragraphs 4 to 7 shall become paragraphs 5 through 8.



11. in § 5 para. 5, the words "2 and 3 ' shall be replaced by" 2-4 ".



12. in section 5 paragraph 8 reads as follows:



"(8) the total remuneration for the performance, not included in kapitační payments, in addition to

the performances, which are recognised by the Decree on preventive examinations

preventive examinations and vaccinations, according to the Decree on vaccination, performance

for non-registered insured persons referred to in paragraph 3, which will not exceed

105% of the total remuneration for the performance outside the kapitační payment and performance for

unregistered client in the reference period, which is the corresponding

calendar semester last year, will be increased by a factor of changes to income

and expenditure of health insurance in the context of migration policy holders.

Calculation and application of the coefficient changes to the revenue and expenditure of the health

the insurance company is set out in Appendix 7 to this Decree. Restriction on the payment

shall not apply if a medical facility shall provide the reference or

period health care 50 and less relevant to insurance policy holders

health insurance companies. ".



13. in section 6 (1). 4, after the words "paragraph 1", the words "and

pursuant to paragraph 7 ".



14. In paragraph 6, the following paragraph 7 is added:



"(7) if the medical facility shall provide health care for 50 and less

unique to the insured, the competent health insurance company, paragraph 1 shall

not apply, and provided health care to be paid in accordance with the list of procedures. ".



15. in section 7 (2). 1 the words "222, 801-807, 809 to 812 and 823"

replaced by the words "222, 801, 802, 804, 805, 807, 809, 812-819, 822 and

823 ".



16. in section 7 paragraph 2 reads as follows:



"(2) in the case of medical devices, where as a result of fluctuating considerably

the volume of provided health care paid for by public health

insurance, when medical equipment provided in the reference period,

which is the corresponding calendar quarter last year, the care of 50 and

less unique to the insured the health insurance company, and when it is not

possible to objectively provide for flat-rate individual health insurance

rate referred to in paragraph 1 (b). and), provided health care shall be borne by

According to the list. The price point for the expertise of 222, 801, 802, 804, 805,

807, 809, 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 the 1. half of 20063). ".



17. in § 8 para. 3 the number "103" is replaced by "105" and at the end of

paragraph, the following phrase "restriction on the payment shall not apply if

medical device provided in the reference period or

health care 50 and less unique respective health insurance policy holders

the insurance company. ".



18. in § 9 para. 4 is the number "103" is replaced by "105" and at the end of

paragraph, the following phrase "restriction on the payment shall not apply if

medical device provided in the reference period or

health care 50 and less unique respective health insurance policy holders

the insurance company. ".



19. in paragraph 11 (1) 3 the number "103" is replaced by "105" and at the end of

paragraph, the following phrase "restriction on the payment shall not apply if

medical device provided in the reference period or

health care 50 and less unique respective health insurance policy holders

the insurance company. ".



20. in annex 1, part A), the text "PS = {[(CÚref-ÚZÚLMref) + 0.98 x

ÚZÚLMref] x 1.03} x DC x Kpv + MNP + PCN "is replaced by the text" (PS = CÚref

x 1.05 x DC x Kpv) + ÚZÚLMref + MNP + PCN ".



21. in annex 1, part A), the text "CÚref-the total payment due

establishments of institutional care for health care provided, and declared

health insurance company recognized in the reference period, which is

the corresponding calendar half-year, last year, after the settlement contractually

the agreed regulations, with the exception of the volume adjuster

prescribed medicinal products and medical devices. Into this

reimbursement shall include the care that has been the medical establishment in the reference

period granted, reported by billing for the month of November

2005 and health insurance company recognized. "is replaced by the text" CÚref-total

the remuneration payable to establishments of institutional care for health care provided,

declared and recognised by the health insurance company in the reference period, which

the corresponding calendar half-year, last year, after the settlement

contractually agreed payment regulation, with the exception of the regulatory mechanism on

the volume of the prescribed medicinal products and medical devices,

deduction reported and recognized separately charged the health insurance company

medicinal products, including an especially charged of medicinal products,

approved the review by a doctor, and especially of the posted material,

granted in the reference period [part B) points 1. and 6.]. Into this


reimbursement shall include the care that has been the medical establishment in the reference

period granted, reported by billing for the month of November

2005 and health insurance company recognized. ".



22. in annex 1, part A) is in the symbol ÚZÚLMref the words "paragraph (B))"

replaced by the words "part B)" and the text "SC = 1 + ((ZZF-ZM)/VD) x 0.3"

replaced by "Dc = 1 + [(ZZF-ZM)/VD] x 0.3".



23. in annex 1, part A) is in the symbol, the words "and their ZZF range, to

30.9. 2005 "shall be replaced by the words" and their extent to 31.12.2005 ".



24. in annex 1, part A) to the symbol "PCN" after the words "health

insurance company "deleted" in the reference period "and the words

"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

insured persons with the appropriate diagnosis in the period ".



25. in annex 1, part A), the text "MOO = {[(CÚref-ÚZÚLMref) + 0.98 x

ÚZÚLMref] x 1.03 x Dc + PCN}/6 "is replaced by the text" MOO = [(CÚref x 1.05 x

SC) + ÚZÚLMref]/6 ".



26. in annex 1, part A), the words "medical symbol MOO

device to 15. 1.2006 "is replaced by" medical device to

30.4. 2006 ".



27. In annex 1, part B) points 1 and 4, the words "point A)" are replaced by

the words "part A)".



28. in annex 1, part B) point 6 is added:



"6. If the total remuneration for medicinal products and medical devices

prescribed by the medical facility in the 1. half of 2006, including

products approved revision doctor, will exceed 100% of remuneration for medicinal

medicinal products and medical devices prescribed in the reference period,

including medicinal products approved revision doctor, nurse

the insurance company within the overall remuneration to pay medical facility

the amount corresponding to the overrun the reimbursement of 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 facility in addition

provided by the medicinal products during the reference period, which is in this

case 2. first half of 2005, equivalent to a unique treated

the insured person and the diagnosis in 2. first half of 2005, multiplied by the number of

unique treated insured persons with the appropriate diagnosis in

period. ".



29. in annex 1, part B) point 7 is added:



"7. where the total number of points for the requested care in another health care

the device, in the fields of medicine, 801, 802 222, 804, 805, 807, 812-819, 822

and 823 by 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 fund in the context of the overall

reimbursement of medical device fails to pay the amount corresponding to

excess. ".



30. In annex 1, part B), the following new paragraphs 8, 9 and 10, which

shall be added:



"8. where the total number of points for the requested care in another health care

the device, according to the list in the expertise of 809 performances, in addition to performances

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, health

the insurance company within the overall remuneration to pay medical facility

the amount corresponding to the excess.



9. in the event that the medical facilities provided in 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 preceding paragraphs.



10. If the medical device proves that due to a medical

the status of an insured person could not prescribe a different medical device over 15

EUR approved the review by a 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. ".



31. Appendix 2 is added:



"Annex 2 to the Decree No. 550/2005 Sb.



Procedure for the calculation of flat rates and regulatory restrictions pursuant to § 3 paragraph 2



And the flat-rate method of calculation)



The flat rate shall be fixed at 105% of the total payment due

medical facility in 1. first half of 2005 for health care

granted, the area declared and recognised by the health insurance company in the reference

period, which is the relevant calendar half-year last year, after

the settlement agreed regulations, with the exception of the regulatory

mechanism on the amount of the prescribed medicinal products and medical

resources, multiplied by the coefficient changes to the revenue and expenditure of the health

insurance companies in connection with migration policy holders. Calculation and application of the

the coefficient changes to the revenue and expenditure of health insurance is set out in

Appendix 7 to this Decree. In the total remuneration includes care that

was 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. payment in the amount set out in section A) belongs to the medical facility,

provide at least 100% of the volume of health care 1. half of 2006,

reported by medical institutions and recognized by the health insurance company in

comparison with the reference period, in terms of the number of points for 100%

treatment days according to the list.



2. The number of points over 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 a 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 the contractually agreed upon.



4. in the case of a lower volume of reported and recognized by health care, than is

stated in paragraph 1, the amount of remuneration referred to in part A) shall be reduced by the same

the percentage by which the lower volume of health care in terms of points

According to the list.



5. If the total remuneration for medicinal products and medical devices

prescribed by the medical facility in the 1. half of 2006, including

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 overall payment of medical devices

fails to pay the amount corresponding to the overrun the reimbursement of medicinal products and

medical devices prescribed in the reference period over 100%.



6. If the total number of points for the requested care in another health care

the device, in the fields of medicine, 801, 802 222, 804, 805, 807, 812-819, 822

and 823, according to the list of services in the 1. half of 2006 exceed the 106% of the total

the number of points in the reference period, the health insurance fund in the context of the overall

reimbursement of medical device fails to pay the amount corresponding to the excess.



7. If the total number of points for the requested care in another health care

the device, according to the list in the expertise of 809 performances, at 1. half-year 2006

exceeds 110% of the total number of points in the reference period, health

the insurance company within the overall remuneration to pay medical facility

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 health care

50 and less competent health insurance company insured hospitalized.



9. If a medical device proves that due to a medical

the status of an insured person could not prescribe a different medical device over 15

EUR approved the review by a 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. ".



32. Annex 3:



"Appendix No. 3 to Decree No. 550/2005 Sb.



Regulatory restrictions pursuant to § 4 paragraph 6



1. If the average remuneration for medicinal products and medical devices

prescribed to one unique client in 1. half of 2006, including

medicinal products approved revision doctor, exceed the average

remuneration for medicinal products and medical devices prescribed in

the reference period, including medicinal products approved review

the doctor, in the range of 101% to 105% of the health insurance company within the overall

payment of the amount corresponding to the medical facility to pay 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 to one unique client in 1. half of 2006, including

medicinal products approved revision doctor, exceed the average

remuneration for medicinal products and medical devices prescribed in

the reference period, including medicinal products approved review

the doctor, in the range of 105% to 110%, health insurance company, within the overall

reimbursement of medical device fails to 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 to one unique client in 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 reference period, including medicinal products approved review

doctor, health insurance in the context of the overall payment of medical

the device fails to pay the amount corresponding to the overrun remuneration for medicinal

medicinal products and medical devices prescribed in the reference period over

110%.



4. If the average number of points per pull care in the fields of medicine, 801, 222

802, 804, 805, 807, 812-819, 822 and 823 by list of performances on

one of the unique client in 1. half of 2006, exceed the 106%

the average number of points in the reference period, the health insurance company in

the total payment of the medical facility fails to pay the amount

corresponding to the overrun.



5. If the average number of points per pull care in 809 by skill

the list of services on one of the unique client in 1. half of 2006,

exceeds 110% of the average number of points in the reference period, health

the insurance company within the overall remuneration to pay medical facility

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 health care 50 and less

unique to the insured the insurance companies. ".



33. the title of Annex No. 4: "how to call kapitace and regulatory

limitation under § 5 paragraph 7 and table age indices according to § 5

paragraph 2 ".



34. in annex 4, part B):



"(B)) regulatory restrictions



1. If the average remuneration for medicinal products and medical devices

prescribed medical facility in 1., or in the 2. quarter

2006, including medicinal products approved the review by a doctor, the

one registered insured, taking into account the age groups,

exceed the average remuneration for medicinal products and medical devices

on one of the registered persons, taking into account age groups,

prescribed in the reference period, including medicinal products authorised

the review by a doctor, in the range of 101% to 105% of the health insurance company in

the total payment of the medical facility fails to pay the amount

corresponding to 20% of the exceeding of the payment 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 medical facility in 1., or in the 2. quarter

2006, including medicinal products approved the review by a doctor, the

one registered insured, taking into account the age groups,

exceed the average remuneration for medicinal products and medical devices

on one of the registered persons, taking into account age groups,

prescribed in the reference period, including medicinal products authorised

the review by a doctor, in the range of 105% to 110% of the health insurance company in

the total payment of the medical facility fails to pay the amount

corresponding to 40% of the exceeding of the payment for 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 medical facility in 1., or in the 2. quarter

2006, including medicinal products approved the review by a doctor, the

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, prescribed in the reference period, including medicinal

products approved the review by a doctor, the health insurance fund in the framework of the

the total payment of the medical facility to 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 person exceeds 5 unregistered

% of the total remuneration for the registered client 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

of the insured person. This regulatory mechanism does not apply to care for

unregistered treated the insured person under the ordinary crowd and will not

applied 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, 812-819,

822 and 823 by list of performances on one of the registered person

taking into account the age groups exceed the 106% of the average number of points in

the reference period, the health insurance fund in the context of the total remuneration

medical device fails to 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 performances

Screening Mammograms according to a list of services on one of the registered

the insured person, taking into account the age groups exceeds 110% of the average

the number of points in the reference period, the health insurance fund in the context of the overall

reimbursement of medical device fails to pay the amount corresponding to the excess.



8. If the average payment for health care provided on one

treated an unauthorised persons, 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 healthcare (i.e. either the payment of

for medical procedures, or for prescribed medicines and medical

resources, or for the requested care, including a particularly charged to medicinal

products and separately charged material in the fields of medicine, 801, 802 222,

804, 805, 807, 809, 812-819, 822 and 823 by list of performances), it is

health insurance in the context of the overall payment of medical devices

authorized neuhradit amount corresponding to one quarter of the said

the excess.



9. the regulatory restrictions referred to in the preceding paragraphs shall not apply where

medical devices registered in the reference period or

50 and less competent health insurance company policyholders, or provided

health care 50 and less relevant to the insured to unregistered

health insurance companies.



10. If the medical device proves that due to a medical

the status of an insured person could use another method of treatment or prescribe a

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 scope of medical facility prescribed in the reference period. ".



35. in annex 4) shall be added to part (C) is added:



"(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 years and over 3.40 ".

-----------------------------



36. In the title of annex 5, the words "remuneration", the words "and

regulatory restrictions. "



37. In annex 5, part A, point 2 of the text) "= POPzpo x [MUo PBPo x CB +

(PUZUMo + PUZULPo) x 0.98 x 1.03] "is replaced by the text" MUo = POPzpo x

[(PBPo x CB) x 1.05 + PUZUMo + PUZULPo]. "



38. In annex 5, point 4 of part A), the words "by 31 December 2006. 01.

2006 ' is replaced by ' not later than 30 June 2003. 4.2006. ".



39. In annex 5, part A) point 5 is added:



"5. the restriction 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

Unfortunately, the skill ".



40. in annex 5, part A), the following point 6 is added:



"6. In excess of the maximum remuneration referred to in point 1 of the health insurance fund shall pay the

volume of specially charged to medicinal products provided by the medical

an insurance company medical devices in 2. first half of 2005, calculated on the

unique and treated diagnosis in 2. first half of 2005 and

multiplied by the number of unique treated insured persons with appropriate

diagnosis in the period. ".



41. in annex No 5 (B)):



"(B)) regulatory restrictions



1. If the average remuneration for medicinal products and medical devices

prescribed by the medical device on one of the unique client 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 the review by a doctor, in the range of 101% to 105%, health

the insurance company within the overall remuneration to pay medical facility

an 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 of the unique client 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 the review by a doctor, in the range of 105% to 110%, health

the insurance company within the overall remuneration to pay medical facility

the amount corresponding to 40% of the exceeding of the payment for 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 of the unique client 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 the review by a doctor, health insurance company in

the total payment of the medical facility fails to pay the amount

corresponding to the overrun remuneration for medicinal products and medical

means prescribed in the reference period above the 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 facility in addition

provided by medicinal products. first half of 2005, equivalent to

unique and treated 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 per pull care in the fields of medicine, 801, 222

802, 804, 805, 807, 812-819, 822 and 823 by list of performances on

one of the unique client in 1. half of 2006, exceed the 106%

the average number of points in the reference period, the health insurance company in

the total payment of the medical facility fails to pay the amount

corresponding to the overrun. 6. If the average number of points per pull care

in 809, according to list of performance skills, in addition to the performance of the screening

mammography, according to a list of services on one of the unique client in 1.

half of 2006, will exceed 110% of the average number of points in the reference

period, the health insurance fund in the context of the overall payment of medical

the device fails to pay the amount corresponding to the excess.



7. regulating the restrictions referred to in the preceding paragraphs shall not apply where

medical device provided in the reference period or

health care 50 and less unique respective health insurance policy holders

the insurance company.



8. If the medical device proves that due to a medical

the status of an insured person could use another method of treatment or prescribe a

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 scope of medical facility prescribed in the reference period. "



42. in annex 6, part A), the text ", and the procedure for determining the flat-rate)

rates "is replaced by the text") and the procedure for determining the flat-rate for

expertise of 222, 801, 802, 804, 805, 807, 812-819, 822 and 823 by

list of performances ".



43. in annex 6, part A, point 1, the text) "PS = [(CÚref-ÚZÚLMref) +

0.98 x ÚZÚLMref] x Kpv "is replaced by the text" PS = (CÚref x Kpv) +

ÚZÚLMref ".



44. in annex 6, part A) point 1 is in the symbol CÚref the words

"the settlement of the agreed regulation", the words "after the deduction of

all separately charged to medicinal products, including especially

posted in medicinal products approved the review by a doctor, and especially

the posted material, provided in the reference period, reported and

recognised health insurance ".



45. in annex 6, part A), point 2 shall be deleted and shall be deleted at the same time

marking point 1 of part A).



46. in annex No 6 is a part and a new part B)), which read as follows:



"(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 remuneration medical facility for health care

granted, the area declared and recognised by the health insurance company in the reference

period, which is the corresponding calendar quarter last year, after

the settlement agreed regulations, in addition to the performance of the screening

mammography, according to a list of performances, after deduction of any particular

charged to medicinal products, including an especially charged of medicinal

products approved the review by a doctor, and especially 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 separately charged of 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

with the migration of insured persons. Calculation and application of the coefficient provided for in

Appendix 7 to this Ordinance. ".



Part B) shall become part C).



47. in annex 6, part C, point 1 (a)). and) the words "margin of 97 up

103% "shall be replaced by" margin of 98% to 105% "at the end of the text of the letter

and dot), and the phrase "in reference to the number of points is

do not count the screening mammograms according to a list of performance procedures. ".



48. in annex 6) in part C, point 1 (b). (b)) is replaced by the number "97"

the number "98" and the number "103" "105" and at the end of the text of subparagraph (b))

the following sentence "in reference to the number of points will not count towards performance

Screening Mammograms according to a list of performances. "



49. in annex 6, part C) in point 3 shall be replaced by the words "until 31 December 2007. 1.

2006. "the words" to 30. 4.2006. ".



50. the title of Appendix No. 7 is "the calculation and application of the coefficient changes

revenue and expenditure of health insurance in the context of migration policy holders

According to § 4 paragraph 5, section 5 paragraph 8, section 8 paragraph 3, section 9, paragraph 4, section

11 paragraph 3, annex 1, part A), annex 2), annex.

5, part A) section 3 and annex 6, part A) ".



51. In annex 7, the text "Kpv = (P/VD)-0.03" is replaced by the text "Kpv

= (P/VD)-0.05 ".



52. in annex No. 7 in the symbol P, after the words "to 30. 6.2006 "

a comma and the words "after deduction of returnable financial assistance from the State

budget pursuant to § 12 para. 2 Act No. 586/1992 Coll., on

universal health insurance, as amended ".



53. in annex No. 7, in the last sentence number "1.03 ' is replaced by

"1.05".



Article II



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 annex 5, and for the calculation of flat-rate

rates referred to in annex 6 to the coefficient of income and expenditure

health insurance in the context of migration policy holders as determined by the

by Decree.



2. For the calculation of flat-rate and monthly payment according to annex No 1

It's the stabilization factor as determined by the Decree.



3. Another way of payment of health care 1. half of 2006, than the

established by Decree No. 550/2005 Coll., as amended by this Decree, it is possible,

If this method of payment of health insurance is

medical institutions shall agree and if the medical facility proves

that the use of the method of payment provided for by Decree No. 550/2005 Coll. on

the text of this Ordinance, would reduce the range and availability of it provided by the

health care. The procedure under the first sentence cannot be used if the

There has been a failure to comply with health insurance plan health insurance company.



Article. (III)



This Decree shall enter into force on 1 January 2000. April 2006.



Minister:



Mudr. Rath v. r.