The Constitutional Court “overruled“ the provision of the Health Insurance Act (HILA), which from 2019 prohibits hospitals from paying for over-the-limit activity, lex.bg wrote.
It is about Art. 55a, para. 2 of the Health Insurance Act, which reads: “The National Health Insurance Fund does not pay for medical and dental care provided by medical facilities in violation of the terms specified in their contracts under Art. 59, para. 1 volumes and values“.
The problem with hospital limits has been around for years, and when the judicial practice stabilized in the sense that the health insurance fund should reimburse the costs of the medical facilities for medical activities actually performed, which, for objective reasons, exceeded the volumes introduced in the framework contract, it was amended HCW and the ban on payment was introduced.
Last year, a panel of the Supreme Administrative Court (SAC) contested it by describing the result of its action as follows – “getting sick later and in an inappropriate place”. And he pointed out that it leads to a practical ban on hospitals treating patients after they have exceeded the limits in the National Framework Agreement with the health fund.
Now the prohibition in Art. 55a, para. 2 PPE is declared unconstitutional.
The court only reports that it was taken unanimously with the participation of 10 constitutional judges, and Yanaki Stoilov has an opinion on the reasons.