Mental Health Centers. Extension of pilot almost a done deal, but what about financing?

The Mental Health Centers pilot was supposed to end in the middle of this year. However, a decision was made to extend it by another six months. Work is currently underway to amend the pilot regulation. This is to enable its smooth completion, because, as indicated by representatives of the Ministry of Health, at the stage of its creation, no thought was given to how to exit it - the pilot regulation lacked appropriate provisions regarding financing.

As Maciej Karaszewski, director of the Department of Healthcare at the Ministry of Health, explained, if the pilot were to end as planned at the end of June, the National Health Fund should have issued corrective invoices by 31 March, reducing the payments twice, which would mean that entities implementing the pilot would be left without money for current operations for three months.

The proposed regulations will, among other things, extend the settlement period for the last period of the contract concluded with the Fund, enabling its proper settlement. This solution is to ensure financial liquidity for institutions in the last settlement period, in connection with the inclusion of the reduction of this last period in the costs of implementing the contract. This change is to reduce the risk of negative financial consequences resulting from the current double reductions made by the Fund.

However , the Ministry of Finance has reservations about the plans for another extension. - The argument that the extension of the program is for the purpose of its settlement seems incorrect. The pilot program in mental health centers has been operating since 2018 and the date of its completion was known, which is why it was possible to properly prepare for the completion and settlement of the program - indicated Deputy Minister Hanna Majszczyk in her comments on the draft amendment to the pilot regulation.

Moreover, she considered that the programme should first be evaluated for the period in which it was in force and only then any decisions should be made.

Hanna Majszczyk also questioned the possibility of financing the planned changes by the National Health Fund. She pointed out that, according to the Regulatory Impact Assessment, the financial consequences resulting from the entry into force of the regulation are to be covered within the financial resources of the Fund, without the need to increase them or to activate the reserve fund. The costs of the pilot program are to be financed from the item concerning pilot programs in the financial plan of the National Health Fund.

According to the deputy head of the Ministry of Finance, this statement "seems doubtful" in view of the fact that the costs of healthcare services under pilot programs in Mental Health Centers according to the National Health Fund's financial plan for 2024 amount to PLN 2 billion 78 million 470 thousand, and the implementation - according to the preliminary annual report - amounted to PLN 2 billion 37 million 256.7 thousand.

Hanna Majszczyk pointed out that the funds planned so far, taking into account the implementation of the program until 30 June 2025, amount to PLN 1 billion 284 million 740 thousand. Therefore, in her opinion, it should be clarified whether the amount planned in the National Health Fund plan for this year, lower by PLN 793 million 730 thousand compared to the previous year, will be sufficient to extend the implementation of the pilot program.

- According to the Minister of Finance, this is at least doubtful - Majszczyk emphasized.

- It should be noted that the costs related to the extension of the pilot program were not indicated. In view of the above, the statement about securing funds under the draft NFZ plan for 2025 raises doubts - she added.

The issue of financing the planned changes was addressed in the comments to the project by the vice-president of the National Health Fund, Jakub Szulc. He admitted that at the stage of developing the financial plan of the National Health Fund for 2025, the planned regulations were not known and were not taken into account when developing the structure of the costs of services. Nevertheless, as he assured, the value of the secured funds allows for financing the costs of the planned regulation in 2025.

At the same time, he informed that according to the data of the National Health Fund IT system, the value of contracts for the implementation of the pilot program in Mental Health Centers in the period from January 1 to June 30, 2025, as of May 14 this year, amounts to PLN 1 billion 65 million 221 thousand 688.41.

Let us recall that last week the Ministry of Health informed that the plan to extend the pilot was consulted with the National Health Fund Headquarters, in particular in the financial scope . The Ministry also noted that the rate, which is PLN 75.74 per half year (per resident), remains unchanged.

- However, the issue of the budget held by the National Health Fund remains within the competence of the fund - the Ministry of Health stressed at the time.

The comments also raised the question of what about the indexation of rates for CZP in connection with the July increases for employees. The extension of the pilot means that the centers will "catch up" on the annual salary increase.

Let us recall that according to the so-called pay rise act, the salaries of employees of medical facilities are increased every year, from 1 July, because they cannot be lower than the minimum wages specified in the regulations. These, in turn, are calculated as the product of the base amount, equal to the average salary in the economy, and the coefficient assigned to a given professional group.

The Mazowiecki Szpital Bródnowski drew attention to this issue during the consultations. It pointed out that the proposed amendment does not contain any provisions on the indexation of the flat rate for the second half of this year.

- The lack of indexation of the flat rate in the second half of the year, with simultaneous increases for medical staff, will lead to a deterioration of the financial situation of many entities that run CZP. In centers where a significant percentage of employees are employed under an employment contract, the last indexation of the flat rate did not cover the July increases for medical staff - indicated the hospital.

Therefore, he proposed a provision providing for the indexation of the lump sum rate to the population from 1 July this year, at a higher rate than the annual indexation rate announced by the Central Statistical Office.

Wrocławskie Centrum Zdrowia SP ZOZ drew attention to yet another problem. - The planned changes extend the settlement period of the last period of the agreement concluded with the Fund for the implementation of the pilot program, allowing the entity to settle it properly, however , the investment works already started regarding the construction of specialist centers within the mental health centers will not be able to be continued (financed) within the framework of the funds received for financing construction, expansion and modernization of the infrastructure necessary for the proper functioning of the centers. The inability to finance the construction investments started from the funds from the pilot program may result in a threat to the financial liquidity of the entity - indicated the facility.

For this reason, in her opinion, it would be justified to secure the financial resources of the healthcare entity by indicating that the settlement of money for investments with a positive opinion in the IOWISZ system (assessment of the justification for investments in the health sector), included in the investment plan, is not subject to refund until the completion of said investment (however, no longer than 3 years).

The Ministry of Health has not yet responded to the comments submitted during the agreements and consultations.

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