The Point Values, The Amount Of Remittance Services And Regulatory Constraints For The Year 2017

Original Language Title: hodnoty bodu, výše úhrad služeb a regulační omezení pro rok 2017

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348/2016 Sb.



DECREE



of 19 December 2003. October 2016



on the determination of the values of the point, the amount of the reimbursement paid services and regulatory

limits for the year 2017



The Ministry of health shall lay down pursuant to § 17 para. 5 of Act 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. 298/2007 Coll., Act No.

369/2011 Coll. and Act No. 200/2015:



§ 1



This Decree provides for the year 2017, the point values, the amount of the reimbursement paid by the

services provided to the insured under section 2 (2). 1 of Act No. 48/1997

Coll., on public health insurance and amending and supplementing certain

related laws, as amended, (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

the remuneration referred to in § 3 to 19, provided by these Contracting providers

health services (hereinafter referred to as "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, and 919 905

927 pursuant to Decree issuing the list of medical procedures with

point values of ^ 3) (hereinafter referred to as "the list of 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, 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 the fields of medicine and 902 917 by 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,



j) providers of rehabilitation care and Spa Clinic ozdravovnami and



to care providers).



§ 2



(1) the reference period means for the purposes of this order the year 2015.



(2) the Rated period shall mean for the purposes of this order the year 2017.



(3) In the reference period are included with all paid services

in 2015, provided the provider reported to 31. March 2016 and

health insurance recognised until 31 March 2006. may 2016. The rating period

included are all paid for services provided in the year 2017,

the provider reported to 31. March 2018 and health insurance company

recognised until 31 March 2006. may 2018.



(4) a 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 requested, if it is not stipulated otherwise.

If the insured person by the provider in a specific expertise

treated in the period or the period of reference more than once, includes

the number of unique insured persons the competent health insurance company

treated in the skill only once. In the case of merge

health insurance companies, the number of unique policy holders make it as

the sum of the unique policy holders of health insurance companies that have merged.

If the insured person during the reference period the insured more than one

health insurance companies, the number of unique treated insured persons are

counted only once.



(5) the global unique by the insured person for the purposes of this Ordinance means

the insured person health insurance companies treated bed care provider in

any expertise within custom or requested health care services

in the reference period or at least once, if not further

unless otherwise provided for. If the insured person by the provider, regardless of

on it, in which expertise, treated in the period or reference

period more than once, includes the number of global unique insured persons

the health insurance companies treated the only provider

once. In the event of a merger of health insurance companies, the number of global

unique counts as the sum insured global unique

policy holders of health insurance companies that have merged. If it has been

the insured person during the reference period the insured more than one health

insurance companies, the number of global unique treated insured persons are

counted only once.



(6) when calculating the total number of declared and health provider

insurance company approved for medical procedures (hereinafter referred to as "the power")

the reference periods referred to in annexes 5 and 8 of this Decree, the following points

means points calculated according to the list of performances, in the version in force on 1 January.

January 2017, which aren't counted points for paid services

granted to foreign insurance policy holders.



(7) if in the 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, 13 and 14 of this Ordinance.



(2) for the paid services provided by providers of subsequent bed care,


providers of long-term care beds, special out-patient care

provided under section 22 (b). (c)) and e) of the Act and the specific provider

inpatient care, paid a flat rate per day of hospitalisation 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 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 care paid for by list of performances with the point value, the amount of

reimbursement covered services and regulatory restrictions set out in annex 3 to the

This Decree.



§ 7



For out-patient care provided by providers of outpatient care in

603 and 604 specializations according to the list of performances by the score from the list

performance point value, the amount of the reimbursement paid services and regulatory constraints

down 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 the year 2017 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 from 2015, health

the insurance company will pay this higher volume.



§ 9



For the paid services provided by providers of outpatient care in

According to the list of specified fields of medicine paid for by the performance, the value of point

and the amount of the reimbursement paid services set out in annex 5 to this Decree.



§ 10



For the paid services provided by providers of outpatient care in

proficiency 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 outpatient care in

fields of medicine and, according to the list of 902 917 performances paid by list

performance point value and the amount of the reimbursement paid services set out in annex

# 7 of this Decree.



§ 12



(1) for the paid services provided by emergency medical providers

services paid for by list of performance shall be in the amount of point value

1.13 Eur, with the exception of contracts of transport, according to the list of codes

performances, for which the value of the point of 1.12 Eur, and with the exception of

performance no 06714 according to the list of performances for which the value of the point

in the amount of CZK 1. The maximum reimbursement to the provider for the reported performance of no.

06714 according to the list of performances in the period does not exceed the limit of payment

for these performances in 2016.



(2) for the paid services provided by transport providers

urgent care paid for by list of performance shall be the value of point in the

EUR 1.12 Eur, with the exception of contracts of transport, according to the list of codes

performances, for which the value of the item in the amount of $1.11, and with the exception of

performance no 06714 according to the list of performances for which the value of the point

in the amount of CZK 1. The maximum reimbursement to the provider for the reported performance of no.

06714 according to the list of performances in the period does not exceed the limit of payment

for these performances in 2016.



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 reimbursement

covered services set out in annex 8 to this Ordinance.



§ 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 performance shall be the value of the item in the amount of CZK 1.



§ 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

When piece measures 104% of the contractually agreed remuneration for one day stay for 2016.

If the payment for one day stay for 2016 negotiated to 31.

December 2016, the remuneration in the amount of Czk 1 092. Payment for accommodation

and diet Guide to the insured shall be at the same level as remuneration for the

These folders for insured persons, which is provided by the comprehensive Spa

hospital rehabilitation care.



(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 of 104% of the contractually agreed remuneration for one day

stay in the year 2016. If the payment for one day stay for 2016

negotiated to 31. December 2016, the remuneration in the amount of Czk 1 404.

Remuneration for the Board and lodging Guide to the insured shall be at the same

amount as remuneration for these folders for insured persons, which is provided by the

comprehensive Spa sanatorium rehabilitation care.



(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

When piece measures 104% of the contractually agreed remuneration for one day stay for 2016.

If the payment for one day stay for 2016 negotiated to 31.

December 2016, the remuneration in the amount of $395.



(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 of 104% of the contractually agreed remuneration for one day


stay in the year 2016. If the payment for one day stay for 2016

negotiated to 31. December 2016, the remuneration in the amount of $499.



(5) For contributory Spa sanatorium rehabilitation care shall be

payment of 30 € for the reported performance no 09543 according to the list. This

the performance of an insurance company may be banned up to three times during a single

treatment of the insured person.



(6) for the paid services provided in Sanatorium schools shall be the remuneration for the

one day stay in the amount of $839.



section 16 of the



(1) for each provider reported and recognized by the health insurance company

performance no 09543 according to the list of performance shall be the remuneration in the amount of CZK 30.

The maximum reimbursement to the provider for the reported feats no 09543 according

list of performances in the period does not exceed the amount equal to the

the victim's number of performances no 09543 according to the list of services, as amended by

effective in 2014, declared to the health insurance company in 2014.



(2) in the case of a provider that did not exist in 2014, arose during a

2014 or did not have a contract with a health insurance company,

It's the health insurance numbers of performances no 09543 comparable

providers in 2014.



(3) the remuneration referred to in paragraphs 1 and 2 shall not count towards the maximum remuneration for

paid services.



(4) the provisions of paragraphs 1 and 2 shall not apply to the provider

Spa sanatorium rehabilitation care in the provision of subsidised

Spa sanatorium rehabilitation care.



§ 17



(1) for each provider reported and recognized by the health insurance company

performance no 09552 according to the list of performance shall be the remuneration in the amount of $13.

The maximum reimbursement to the provider for the reported feats no 09552 according

list of performances in the period does not exceed the amount equal to the

třináctinásobku number of the recipes in 2014, on the basis of which it was issued

a medicine partly or fully paid from public health

insurance.



(2) in the case of a provider that did not exist in 2014, arose during a

2014 or did not have a contract with a health insurance company,

It's the health insurance numbers of recipes comparable providers

in 2014.



section 18



Reported for each provider and health insurance company recognized performance

No 78890 according to the list of performance shall be the remuneration in the amount of $10,000. This

reimbursement is not included in the amount of the remuneration paid for services provided for under the

section 2.1.1, and 3.5, 4, and 6 of annex 1 to this notice.



§ 19



For paid services supplied by providers in expertise 005-

hospital pharmacy paid according to performance point value list

down in the amount of CZK 1.



section 20



This Decree shall enter into force on 1 January 2000. January 2017.



Minister:



Mudr. Němeček, MBA, in r.



Č. 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/2016.html#castka_137.



Č. 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/2016.html#castka_137.



Č. 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/2016.html#castka_137.



Č. 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/2016.html#castka_137.



Č. 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/2016.html#castka_137.



Č. 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/2016.html#castka_137.



Č. 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/2016.html#castka_137.



Č. 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/2016.html#castka_137.



Č. 9



The contractually agreed remuneration individually-Group related to the

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/2016.html#castka_137.



Č. 10



Remuneration in the form of flat-rate case-the group related to the diagnosis according to the

Classification indexes of these groups



_________________

*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2016.html#castka_137.



Č. 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/2016.html#castka_137.



Č. 12



Medicines extracted from the payment of the second lump sum



_________________

*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2016.html#castka_137.



Č. 13



The payment order of the payment in the form of flat-rate case-related Group

to the diagnosis according to the classification of the second lump sum payment exempt



_________________

*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2016.html#castka_137.



Č. 14



Popměru the number of insured persons that factor health insurers in a given

the District of



_________________

*) Note. ASPI: the attachment is available on the website http://ftp.aspi.cz/opispdf/2016.html#castka_137.



1) European Parliament and Council Regulation (EC) No 883/2004 on the coordination

systems of social security, as amended.



European Parliament and Council Regulation (EC) no 987/2009

down detailed rules for the application of Regulation (EC) No 883/2004 on the coordination

of social security systems.



The European Parliament and of the Council Regulation (EU) no 1231/2010, which

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., the negotiation of the Treaty between the Czech Republic and


The Turkish Republic on social security, the Ministry of communication

Foreign Affairs No 2/2007 Sb. 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.

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