Notice (1) for submission of documentation for determining the contractual compensation for 2024 - SUPPLEMENT

[01.11.2023]

All public healthcare institutions (PHIs), private healthcare institutions (PHIs) that provide hospital healthcare and healthcare institutions that provide specialised medical rehabilitation as extended hospital treatment (spas), which have a contract with the Health Insurance Fund of the Republic of North Macedonia, for the purpose of determining the contractual compensation for providing healthcare services to insured persons in 2024, need to submit the following documentation:

• Request for determining the contractual compensation for 2024 with a detailed explanation if compensation higher than that determined for 2023 is requested;
• Draft Plan for the type and volume of healthcare services for 2024 by activities - form (1-5);
• Summary recapitulation of total planned healthcare services for 2024 by levels of healthcare protection - form 6,
• List of activities - form 9 and changes that occurred in 2023 (only for PHIs);
• List of employees by structure - form 8 and plan for employing new staff (only for PHIs).

[SUPPLEMENT 07.11.2023]

• Data on calculated and collected co-payment for healthcare services in 2023 - total amounts
• Claims from the Ministry of Health on the basis of programmes (only for PHIs)
• Data on the number of engaged persons with a service contract by structure

If compensation is requested for new equipment and new diagnostic procedures the following should also be submitted:

• Overview of planned new equipment and new diagnostic procedures for 2024 - form 7 with an attached study on the purposes of introducing the equipment, the staff who will be involved in operating and maintaining the equipment, the necessary funds for current maintenance of the equipment and market research with three offers.

If a PHI requests compensation for reconstruction and/or renovation the following should also be submitted:

• Survey/calculation by an authorised construction company.

If a PHI requests conditional compensation the following should also be submitted:

• Detailed explanation; 
• Draft Plan for a specific type and volume of healthcare services, if the request for conditional compensation relates to a specific type and volume with precisely defined healthcare services (including medicines) that the healthcare institution needs to perform during the year on Form (Annex 1); 
• Draft Plan for individual costs from current operations necessary for providing healthcare services if the request for conditional compensation relates to covering individual costs from current operations necessary for providing healthcare services on Form (Annex 3);
• For approval of conditional compensation for medicines, attached to the request submitted by the healthcare institution, in addition to the Draft Plan for a specific type and volume of healthcare services (Form from Annex 1), the following is also submitted guideline/protocol for evidence-based medicine, in accordance with Article 27 of the Law on Healthcare Protection, which covers the use of the medicine for which conditional compensation is requested. A guideline/protocol for evidence-based medicine is not submitted only if these are:
  • medicines that are on the List of medicines covered by the Fund or
  • medicines for which there was already an active public procurement on 05.09.2023.

The documentation submitted should be in accordance with the prescribed forms by the Fund, published on the website www.fzo.org.mk in the Healthcare section -> Templates of required documentation for 2024.

The request for contractual compensation with the attachments, verified by the director of the healthcare institution, is submitted to the Fund's archive marked "for the Financial Affairs Sector". At the same time, the healthcare institution should also submit the request with the attachments in electronic form to the email address [email protected], and the name of the healthcare institution needs to appear in the name of the email address, while the content should specify a contact person, contact telephone and their email address.

The deadline for submitting the required documentation to the Fund is up to and including 09.11.2023.

The Fund may also request other documentation related to the Request. 

Respectfully,

Health Insurance Fund of the Republic of North Macedonia