Change the list of indications for spa treatment rehabilitation care for adults and children

Ministry of Health issued on 27 July 2012 Decree No. 267/2012 Coll. establishing a list of indications for spa treatment rehabilitation care for adults, children and adolescents (hereafter referred to as New Indicators List "). This Decree shall take effect from 1 10th 2012th Existing Decree No. 58/1997 Coll. Establishing a list of indications for spa care for adults, children and adolescents (hereafter referred to as the old Indication 'list) , that date is repealed.

Differences in new indication list

It should be underlined that in the new indicator list are used to describe therapeutic groups and individual indications of the same symbols as in the old indicator list, but the content and meaning for most indications, the new indicator list changes. Some indication disappeared, some indications are new, some indications are merged, some have changed professional criteria.

New Indication list differs from the old also in the general instructions. New Indication list distinguishes between primary and repeated stay and regulates the conditions and criteria for issuance.

In assessing whether it is a primary or recurrent treatment stay and whether it is possible to repeat stay will proceed according to § 2, paragraph 2, which states that the last treatment stay insured carried out according to the existing legislation in the period from 1 October 2009 to the date of entry into force of the new indication list is considered the treatment stay in the new indication list. Other therapeutic stay relevant indication, based on which stay was carried out according to the previous sentence shall be deemed repeated stay in the new indication list.

Length of stay per basic treatment, unlike the old list of indications established for 21 days, in children and adolescents to 28 days. If the spa treatment rehabilitation care is provided as complex, the Head of physician of the medical equipment provider spa treatment rehabilitation care for marked indications according to the specific condition of the insured exceptionally propose its extension. Extension and its length is subject to approval by the insurance physician reviewer.

Length of stay in the form of repeated treatment of complex spa treatment rehabilitation care for adults is set at 21 days, in children and adolescents for 28 days. Extension and its length are subject to review consent of the doctor.

Length of of stay in the form of repeated treatment contributory spa care medical rehabilitation in adults is determined by design doctor who recommended treatment, at 14 or 21 days. If the spa treatment rehabilitation care is provided 14 days in length, the head physician of the medical equipment provider spa treatment rehabilitation care according to the specific situation of the insured exceptionally propose to extend it to 21 days, with the extension subject to review consent of a doctor.

The transition period

New Indication list in § 2 paragraph 1 sets the transition period, after which the spa treatment rehabilitation care, the provision of which the proposal has been issued under the old list of indications (that is the proposal issued before 1 10th 2012), made ​​according to the old list of indications.

Proposals exposed to 30 9th 2012, issued in accordance with the old indicator list will be performed and billed according to the old list of indications.

Proposals issued from 1 10th 2012, issued in accordance with the new indicator list will be performed and billed according to the new list of indications.

This means that in the transitional period will have to be providing care and billing of care provided in parallel with the old and new indication list.

The transitional period is determined by the validity of confirmed proposals, the length of treatment and the time needed for billing. Expected duration of the transitional period in August 2013.

Due to the transition period, and given that a new indicator list, indicator groups, and individual indication marked by the same symbols as in the old list of indications, while the content, meaning, respectively. the conditions for a new indication for some indication list changes, will be a transitional period for the same price different label indications for treatment according to the content and meaning of the indication. Will be determined by whether the proposal is issued under the old or the new list of indications (eg indication II / 1, represented by the old list of indications,, Medical educational stay ", according to a new indication list is an indication of II / 1 designation for,, symptomatic coronary artery disease heart ").

The insurance company will therefore after medical rehabilitation care providers ask for billing label indications in order to establish that the law was treating the indications given. We assume that the document VZP - 16/2004,, Bill spa care "providers will display when the new list of indications mentioned before marking indication symbol, n", and in accordance with the label in the appropriate dial, which is in this spirit modified. This solution will be necessary to ensure fair processing statement. The details of the technical solution providers will be informed in detail by the relevant regional offices VZP.

Proposals on health care

To provide spa treatment rehabilitation care continues, the spa treatment rehabilitation care is according to § 33 of Act No. 48/1997 Coll., On public health insurance, as amended by Act No. 369/2011 Coll., Paid service, if provided as a necessary part of the healing process, when its provision recommended treating physician and confirmed by physician review. The proposal serves to continue the form / document VZP - 15/2004,, proposal on health care "physician authorizing provider, thus registering a general practitioner or a doctor during hospitalization.

We would like to appeal to doctors who exhibit Proposals on health care, to pay increased attention to the new Decree No. 267/2012 Coll. Establishing indication list for spa treatment rehabilitation care for adults, children and adolescents, and that this legislation from first 10th 2012 consistently followed in their design activities.

Source: Infoservis 20/2012