50/2005 Sb.
DECREE
of 20 December. January 25, 2005
laying down the amount of reimbursement of health care covered by the public
health insurance, including regulatory restrictions for 1. first half of 2005
The Ministry of health shall lay down pursuant to § 17 para. 7 (b). (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"):
§ 1
This Decree lays down, in cases where it is not the result of the conciliation
management agreement pursuant to § 17 para. 8 of the Act, the amount of remittances
and health care paid for by) from public health insurance, including
regulatory restrictions for health care in health facilities
in institutional care, including specialised therapeutic institutes, hospitals in the long term
patients and medical device reporting treatment day no.
00005 pursuant to Decree issuing the list of medical procedures with
point values in "^ 1") (hereinafter referred to as "the list of performance"),
b) out-patient specialists
(c)) in the provision of emergency care in non-Contracting
health-care facilities.
§ 2
(1) the amount of reimbursement of health care in health establishments of the constitutional
care, with the exception of health care in specialised therapeutic institutes,
institutes for long-term patients and in medical devices
returning the treatment day no. 00005 according to the list of performances (hereinafter referred to as
"institutional care"), for 1. half of 2005 shall be
at least 103% of the total remuneration (including especially the posted material,
separately charged and reimbursement of medicinal products in excess of the flat-rate,
If they have been agreed upon) this health care pertaining to establishments of institutional care
in the 1. half of 2004.
(2) the remuneration of the condition laid down in paragraph 1 is to provide
at least 90% of the volume of reported health care medical facilities and
recognized by the health insurance, compared with 1. half of 2004, expressed
the number of points according to the list. In the case of a lower volume of reported and
recognised health care than is stated in the first sentence, the amount of the remuneration
referred to in paragraph 1 shall be reduced by the same percentage, which is the lower volume
health care.
(3) if the establishments of institutional care and the health insurance fund shall conclude an addendum
to the Treaty, or to agree on a new Treaty, containing the new health
performances, provided by residential care facilities, health insurance new
agreed to pay health care beyond the remuneration as defined in paragraphs
1 and 2 in the manner of payment of the agreed in the contract; If there is no
agreement on the method of payment and the amount of, shall be reimbursed by health insurance new
medical procedures according to the list of performances with the price point set for 1.
half of 2001 in the amount of $0.89. ^ 2)
(4) the increase in the volume of health care provided to the insured, for which
the costs of healthcare provided in 1. half of 2005 exceeded 300
EUR, shall be reimbursed by health insurance establishments of institutional care above and beyond
remuneration as defined in paragraphs 1 and 2 of the manner of payment of the agreed
in the contract; If there is no agreement on the method of payment and the amount to pay
health insurance company health care costs over the financial volume for these
the insured person 1. half of 2004, according to the list of performances with the price point
set for 1. half of 2001 in the amount of $0.89. ^ 2)
(5) if the establishments of institutional care provides health care for a small number of
insured persons the competent health insurance company, paragraphs 1 and 2 shall not apply
and provided health care to be paid in the manner of payment of the agreed
in the contract; If there is no agreement on the method of payment and the amount to pay
This health insurance company health care according to the list of performances with the price
provided for in point 1. half of 2001 in the amount of $0.89. ^ 2) a small number of
the insured shall mean 50 and less of insured persons (regardless of the number of
treatment).
(6) if the establishments of institutional care in the 1. first half of 2005 will provide bed
care more than 105% of the treated insured persons (regardless of
the number of treatments) compared to their number in the 1. half-year 2004
total remuneration of health care provided for in paragraph 1 shall be increased by the same
the percentage by which the number of treated policyholders higher than 105%.
(7) the health insurance fund shall provide the medical facility per month
a preliminary payment of at least one-sixth of the reimbursement of health care
laid down in § 2 (2). 1. The Bill for the whole semester health
the insurance company performs and passes the establishments of institutional care within 60 days after
the end of the half.
(8) health insurance and medical facilities may agree on
payment of health care in the form of payments for diagnosis; in this case,
paragraphs 1 to 7 shall not apply.
§ 3
The amount of the reimbursement of health care in specialised therapeutic institutes, hospitals
for long-term patients and in medical devices, returning
treatment day no. 00005 according to the list of performances for the 1. first half of 2005
fixed at a flat rate per treatment day (point value of the treatment
the day, scoring a patient category, the value of the overhead associated with
spot the value of treatment delivery and a lump sum, which is to be paid
medicinal products according to the list of performances) so that the total amount of remuneration
belonging to a medical facility for treatment day (point value
the treatment of the day, scoring a patient category, the value of the overhead
assigned to the point value of the treatment of the day and the flat-rate amount
are reimbursed medicinal products covered by the list of performances) in the 1. half-year 2004
increase index 1.13.
§ 4
(1) Specialized out-patient care provided in out-patient
medical facilities are reimbursed under a contractual arrangement between
health insurance and medical facilities, according to a list of performances
remuneration for provided medical procedures to limit the time the wearer's performance
12 hours per calendar day with the maximum payment restrictions following the
the number of insured persons treated in the clinic. The amount of the
the remuneration shall be laid down in the annex to this Decree.
(2) price point for the payment of health care referred to in paragraph 1 is agreed to in the 2.
half of 2004, and proclaimed in the journal of the Department of health under the
§ 17 para. 9 of the Act shall remain in force for 1. first half of 2005.
(3) a different payment method than the one referred to in paragraph 1, it is possible, if
medical facilities and health insurance fund on the proposal for a medical
device on this method of payment, the total amount of the remuneration agreed between the
higher than the remuneration provided for in paragraph 1 and the method of payment is not
contrary to the laws and regulations governing public health insurance.
§ 5
(1) the reimbursement of emergency health care, if there is no contract between the
medical facilities and health insurance must be carried out
provided by the medical procedures as follows:
and) dental out-patient care are reimbursed according to the rates applicable to
healthcare provided by dentists in the 1. first half of 2005,
(b)) other health care are to be paid according to the list of performance and health
the undertaking may, on the basis of the law ^ 3) apply regulatory measures
as with the contracted medical facilities.
(2) price point for the payment of health care referred to in paragraph 1 (b). (b))
set for 1. half of 2001 remains in force for 1. half-year
2005. ^ 4)
§ 6
This Decree shall take effect on the date of publication.
Minister:
doc. MUDr. Emmerova, CSc. v. r.
XIII.
The amount of remuneration referred to in section 4, paragraph 4. 1
1. the maximum payment to the competent ambulantnímu medical facility
(hereinafter referred to as "medical devices"). and 2. quarter (hereinafter referred to as
"the quarter") 1. first half of 2005, is calculated as the product of
the total number of unique treated policyholders the relevant health
insurance companies treated the medical establishment in the quarter and
the value of the maximum payment per unique treated the insured person
the health insurance companies treated the medical establishment.
2. the value of the maximum payment per unique treated the insured person
the health insurance companies treated the medical establishment for
each quarter is calculated as the product of the values of the maximum remuneration to the
one of the unique treated insured persons the competent health insurance company
treated medical institutions in the corresponding quarter of the previous
the year, multiplied by the coefficient 1.03. The value of the maximum payment per
unique competent health insurance company insured person treated
treated in the relevant quarter of the previous year shall be determined as the value
the proportion of the total number of points declared medical facilities and
the recognized sickness insurance fund in the corresponding quarter of the previous year
divided by the number of unique treated policyholders the treated
the medical establishment in the corresponding quarter of the previous year.
2.1. If the value is the maximum payment per unique treated
the insured person's sickness insurance fund in the relevant expertise in
medical equipment is lower than the national average
the maximum reimbursement per insured person treated the unique
expertise on the relevant health insurance, it shall apply for the calculation of the
the maximum payment per unique treated the insured person
medical device value national average maximum payment
one of the unique expertise of an insured person in that treated the
health insurance, multiplied by the coefficient 1.03.
2.2. the insured person shall mean the Unique treated one insured person without the
regardless of how many times a medical facility reported on this
the insured person within a specified time period of health care.
2.3. the value of the national average, the maximum payment per
a unique skill for the insured person treated the
health insurance shall be determined as a proportion of all Contracting
health facilities, appropriate expertise and declared the
health insurance company recognized in the relevant quarter and points total
number of unique treated insured persons treated by devices
the health insurance fund in the relevant expertise.
2.4. appropriate health insurance For the insured person treated in the
expertise of the insured person are calculated both in their own care, so the insured person in
care requested. The value of the national average, the maximum payment per
the unique expertise of an insured person under treated for each
quarter of the previous year shall notify each health insurance company
medical equipment and publish on the Internet no later than 273 days
After the end of the quarter the previous year.
2.5. In the case that a medical facility in the reference period
the previous year did not exist, or a medical facility treating less
than 150 insured persons the competent health insurance company, limiting the maximum
payment shall not apply.
3. the maximum reimbursement for medical devices is the sum of the maximum
remittances to one unique treated the insured in each skill
specified in the contract concluded between that medical facilities and
health insurance company.
4. in the case of medical devices, where compared to the reference period
the previous year the capacity has changed the scope of health care
stipulated in the contract, health insurance companies the final amount to be paid
into account in the amendment to the contract.
5. payment for prescribed medicines, medical devices and for
pull the care shall be as follows:
5.1. If the total remuneration for the prescribed medicines and medical
resources, with the exception of medicinal products and medical devices
approved the review by a doctor over the reference period and volume for the
pull the care in the fields of medicine, 801-805 222, 809, 812-823, according
list of performances exceed by more than 15% of the average of this medical
devices in the respective quarter of the previous year, the health
insurance against medical device regulatory reduction of 25% of the
such a crossing, and ways in the contract concluded between the
medical facilities and health insurance.
5.2. If the total remuneration for the prescribed medicines and medical
resources, with the exception of medicinal products and medical devices
approved the review by a doctor over the reference period and volume for the
pull the care in the fields of medicine, 801-805 222, 809, 812-823, according
list of performance exceeds by more than 20% of the national average on one
unique to doctors that treated the insured person, the kind of skill
medical equipment (in terms of scope of performance contained in the
the contract) and the type of health care provided, taking into account age
groups in the relevant calendar quarter, the health insurance company
against medical device regulatory reduction of 25% of such
exceeded, and ways in the contract concluded between the
medical facilities and health insurance.
5.3. The values of the national averages of payments for prescribed medicines
and medical devices, with the exception of medicinal products and
medical devices approved by the review by a doctor on one
unique treated the insured's each quarter the previous
year shall be published on the Internet on health insurance to 273 days since the end of
the corresponding quarter of the previous year.
5.4. the health insurance company may apply to medical devices
the regulation of payments for prescribed pharmaceuticals and medical devices and for
pull the care referred to in point 5.1. or according to section 5.2., and
that represents medical device is less a deduction.
5.5. If the total payment in the quarter for medicinal products and
medical devices prescribed by the medical establishment, with the exception of
medicinal products and medical devices approved by the review
doctor and medical facility for taking care to pull in the fields of medicine
222, 801-805, 809 812-823, according to the list of performances is lower than
the total remuneration for medicinal products and medical devices prescribed by
the medical establishment, with the exception of medicinal products and medical
the funds approved a revision doctor, and for the care of a requested
medical facilities in the fields of medicine, 801-805 222, 809, 812-823
According to the list of performances in the quarter the previous year, shall pay the
health insurance medical facility a bonus of 30%
savings, and no later than 60 calendar days after the last
day of the quarter.
1) Decree No. 134/1998 Coll. issuing the list of medical procedures
with point values, as amended by Decree No 55/2000 Coll., Decree No.
135/2000 Coll., Act No. 458/2000 Coll., Decree No. 101/2002 Coll. and the
Decree No 291/2002 Coll.
2) Article. (II) Act No. 458/2000 Coll., amending Act No. 48/1997 Coll.,
on public health insurance and amending and supplementing certain
related laws, as amended. Annex 1, point (B)
1 Government Regulation No. 484/2000 Coll., laying down the point values and above
reimbursement of health care paid for by public health insurance for 1.
half of 2001.
3) § 40 paragraph 2. 2 of Act No. 48/1997 Coll.
4) Article. (II) Act No. 458/2000 Coll.
section 6 (a). (b)) Government Regulation No. 484/2000 Sb.