Hospital network: Ministry of Health will change the lump sum settlement mechanism

In the opinion of the Ministry of Health, it is necessary to adjust the mechanism of determining the lump sum for the basic hospital provision of healthcare services, hereinafter referred to as the "lump sum", in such a way that the amounts transferred to healthcare providers under this lump sum take into account the increased implementation of healthcare services in connection with the provision of assistance medical persons entitled under the Act of 12 March 2022 on assistance to Ukrainian citizens in connection with an armed conflict in the territory of that country (Journal of Laws, item 583, as amended), hereinafter referred to as the "Assistance Act".

The need to introduce regulations that will enable the use of coefficients correcting the value of the lump sum due to the fact that the service provider has an accreditation certificate referred to in the regulations issued on the basis of Art. 5 of the Act of November 6, 2008 on accreditation in health care (Journal of Laws of 2016, item 2135), also in relation to those entities in which the validity of such a certificate has expired and which were unable to obtain new certificates valid in the current billing period, despite all due diligence, due to the extension of the assessment process during the COVID-19 pandemic.

The amended regulation proposes to introduce regulations establishing a mechanism for an appropriate increase in the lump sum by the amounts from the subsidy allocated to financing the costs of medical care for persons entitled under the Act on Assistance . This mechanism is based on the assumption that the basis for increasing the lump sum for a given service provider will be the value of the lump sum excess achieved in a given period, regardless of whether it results from increased performance of benefits for beneficiaries or persons entitled under the Act on assistance. The amount of the lump sum increase for a specific service provider will be the product of the value of its excess and the quotient of the total amount of the subsidy used in a given period and the total value of the excess in the voivodeship.

In addition, the proposed regulation includes a provision that will allow the application of coefficients correcting the value of the lump sum due to the fact that the service provider has an accreditation certificate also in relation to entities for which the validity of such a certificate has expired, but not earlier than 12 months before the beginning of the current billing period, and at the same time the assessment procedure conducted in relation to the application for renewal of accreditation has not been completed. The condition for using this option will be the delivery to the director of the provincial branch of the National Health Fund, not later than within 7 days from the entry into force of the regulation, an accreditation certificate regarding the security system profiles owned, the validity of which expired not earlier than 12 months before the beginning of the planning period, along with a declaration of the head of the medical entity that despite the submission of the application for accreditation for the next period, not later than 6 months before the expiry of the accreditation certificate, the assessment procedure has not been completed.

Project: HERE

Source: MZ