The National Health Fund (NFZ) wants to recruit new employees, and the ministry is easing restrictions. The project is now open for consultation.
- The draft amendment to the Act on health services financed from public funds has been submitted for consultation.
- The proposed provisions are intended to enable the National Health Fund to "acquire employees with the required high competences, in particular with medical education"
- The project also changes the provisions regarding the allowance for AOTMiT for data acquisition, tightens the provisions on cross-border care, and proposes new provisions regarding the nomination of Expert Centres for Rare Diseases.
- New regulations regarding the provision of healthcare to patients at the Gostynin centre were also proposed.
On Monday, November 3, a draft amendment to the Act on health services financed from public funds was published on the website of the Government Legislation Centre .
The project, which has been submitted for public consultation, includes proposals for solutions concerning the creation of legal mechanisms enabling the National Health Fund to recruit employees with the required high competences , changes in the deduction for the Agency for Healthcare and Treatment (AOTMiT), but also, among other things, tightening cross-border care and adding provisions regarding the establishment of Expert Centres for Rare Diseases , as well as new provisions regarding healthcare for patients at the centre in Gostynin.
As regards improving the work of the National Health Fund, it is planned to "loosen" the restrictions in this area, which currently affect the implementation of control tasks carried out by the National Health Fund.
The amendment therefore covers the provisions regarding the issuance of consent from the President of the National Health Fund (NFZ) to conduct business activity. The draft proposes limiting the requirement to obtain such consent only to cases where the business activity being undertaken is related to the tasks performed by the NFZ.
"The introduction of the above changes will enable NFZ employees, including those with medical education, to take up additional employment or business activity within a scope that does not conflict with the tasks performed by the NFZ . Creating the opportunity to work for the NFZ and simultaneously earn income on the labor market as part of other professional activities will contribute to increasing the competitiveness of the NFZ as an employer," we read in the OSR.
Additionally - as indicated by the Ministry of Health - the removal of the ban on employment in the founding entity and in local government units (...) will allow the National Health Fund to acquire qualified employees whose scope of tasks performed by another employer does not conflict with the scope of tasks performed by the National Health Fund.
"The physicians currently employed by the National Health Fund (NFZ) in carrying out inspection tasks are already of advanced age, often reaching retirement age. The problem resulting from the limited ability to recruit new medically trained staff is a real problem that the NFZ grapples with on a daily basis when carrying out its tasks. This problem will worsen in the coming years, consequently leading to the inability of this entity to properly carry out its tasks," the Ministry of Health explains in its justification for the proposed changes to the regulations.
Further changes proposed in the draft concern the deduction for the Agency for Health Technology Assessment and Tariff System .
As the Ministry of Health explains, determining the deduction for the Agency based, among other things, on the Agency's draft tariff plan for a given year was justified before the amendment to the Act on Benefits of May 25, 2017, came into force. "The purpose of this solution was to secure financial resources for the costs of obtaining data necessary to establish the tariff of benefits," the Ministry of Health reminds.
At the same time, it points out that the above-mentioned amendment repealed the obligation for the Agency to pay medical facilities for the preparation and transfer of data, imposing the obligation to make this information available free of charge at the request of the President of the Agency.
"Therefore, taking into account the Agency's draft tariff plan in determining the amount of the deduction has become unjustified. Currently, the costs incurred in implementing the tariff plan are primarily fixed costs, primarily the salaries of Agency employees. The draft tariff plan is constructed so that its implementation does not require a significant increase in staffing levels. Additional, but insignificant, costs include the salaries of members of the Tariff Council and potential fees for clinical experts," explains the Ministry of Health.
Therefore, it is not justified - as we read in the OSR - to leave in the Agency's cost catalogue the costs of obtaining data necessary to establish the tariff of benefits.
The Ministry of Health emphasizes that "changes concerning the Agency will not affect the amount of the deduction for the Agency for a given year" and reminds that "in accordance with applicable regulations, the amount of the deduction for the Agency is no more than 0.06% of the planned revenues due from health insurance contributions for that year specified in the National Health Fund financial plan."
The project also includes regulations related to the establishment of Rare Disease Expert Centres.
As the Ministry reminds us, the primary task of the OECR is to ensure that patients with a specific rare disease or group of rare diseases have access to modern diagnostics and highly specialized, coordinated medical care . In accordance with Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients' rights in cross-border healthcare, the European Union Committee of Experts on Rare Diseases (EUCERD) has developed uniform guidelines and recommendations for the establishment of OECRs in Member States. According to EUCERD recommendations, OECRs should be nominated by the Minister of Health.
In Poland, the OECR has been established so far through the so-called recognition of competence procedure. The Ministry of Health reminds that on March 28, 2023, the Minister of Health issued a letter of nomination to all centers participating in the European Reference Networks for Rare Diseases , officially recognizing them as OECRs.
"Taking into account the existence of many other centers that have been conducting diagnostics for years and providing treatment and care to beneficiaries with suspected or diagnosed rare diseases, which have extensive scientific achievements and conduct well-established cooperation with foreign institutions, it is necessary to introduce legal regulations that will enable the minister responsible for health matters to grant the status of OECR," we read in the OSR.
The project also aims to ensure that the National Health Fund finances healthcare services provided in publicly accessible healthcare facilities to persons placed in the National Centre for the Prevention of Dissocial Behaviour in Gostynin , regardless of their health insurance entitlements.
"The indicated change will ensure consistency with the applicable principles of financing services for persons insured by the National Health Fund," argues the Ministry of Health.
Moreover, the aim of the draft amendment is to "tighten the health insurance system for persons in cross-border situations related to the application of EU regulations on the coordination of social security systems. This refers to situations where the regulations on cross-border health care are inconsistent with the requirements of EU law and where there are so-called legal loopholes in the legal regulations concerning the collection of health insurance contributions from pensions and annuities transferred to bank accounts from other European Union (EU) Member States or European Free Trade Agreement (EFTA) Member States and the United Kingdom of Great Britain and Northern Ireland (UK).
According to the Ministry of Health, there is a need to tighten the regulations on collecting health insurance contributions from pensions and disability pensions from other EU, EFTA and UK countries and to create provisions obliging persons receiving pensions or disability pensions who are or have been in cross-border situations related to the application of EU regulations on the coordination of social security systems to inform ZUS or KRUS about the circumstances determining the coverage of health insurance in respect of receiving a "Polish" pension or disability pension, as well as to create a legal basis for deducting overdue health insurance contributions from persons who were subject to compulsory insurance in a given period but were not registered for it due to a lack of appropriate knowledge on the part of the competent pension authority.
Hence the proposal to add provisions that will oblige:
- persons who, on the date of acquisition of the right to a pension or disability pension, reside in the territory of another EU, EFTA or UK Member State and are not entitled to healthcare benefits under the regulations of such a country to inform the competent pension authority of this fact within 14 days from the date of acquisition of the right to a pension or disability pension,
- persons who, after acquiring the right to a pension or disability pension, were deregistered from health insurance due to taking up gainful activity in the territory of another EU, EFTA or UK Member State or were not registered for health insurance for this reason, to inform the competent pension authority about the termination of such activity within 14 days of its termination, which will allow the pension authorities to establish that the persons obliged to transfer it are subject to the health insurance obligation due to receiving a Polish pension or disability pension and, consequently, to register these persons for health insurance;
- Adding a provision authorizing ZUS to deduct unpaid health insurance contributions from a pension or disability pension if the arrears in paying these contributions arose as a result of the person receiving the pension or disability pension failing to fulfill the obligation specified in the added provisions of Article 75 of the Act on Benefits.
The project also provides for:
- introducing changes to the provisions governing the rules for applying for the consent of the President of the National Health Fund to obtain planned services under the principles applicable in the EU regulations on the coordination of social security systems or the rules for obtaining reimbursement of cross-border healthcare costs in order to adapt Polish law to the requirements of EU law, which are necessary in the light of the rulings of the Court of Justice of the European Union.
- introducing provisions regulating the procedure for reimbursement of necessary services provided in another EU, EFTA or UK country, in accordance with EU coordination regulations, in the event of an application for reimbursement of such costs to the National Health Fund (NHF) (currently, such a procedure is regulated only at the level of an order of the President of the National Health Fund);
- introducing minor adjustments and clarifications to the provisions governing the reimbursement of cross-border healthcare costs.
Additionally, the project introduces the possibility of concluding contracts for the provision of services—the supply of medical devices—for an indefinite period. This is intended to reduce the bureaucratic burden on the National Health Fund (NFZ) by reducing the number of documents required by bidders when submitting applications solely for the purpose of contract continuation. Such contracts are now concluded for a maximum of five years.
Furthermore, the bill also envisages changes to the annual settlement of health insurance contributions by entrepreneurs by adding a provision under which entrepreneurs will not be able to receive a refund from the Social Insurance Institution (ZUS) for overpaid contributions whose value does not exceed ten times the amount of the reminder costs in administrative enforcement proceedings (i.e., PLN 160). These funds will be credited towards future contribution arrears.
At the same time, it is expected that ZUS will ex officio refund the overpaid amount after the contribution payer submits their annual return, without the entrepreneur's legally required application. If the refund amount does not exceed the above amount (i.e., PLN 160), the funds will be credited to the contribution payer's account and, according to general rules, may be refunded or credited towards current or future contributions.
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