Text consolidated by Valsts valodas centrs (State Language Centre) with amending regulations of: 18 December 2018 [shall come into force from 1 January 2019]; 26 March 2019 [shall come into force from 29 March 2019]; 7 May 2019 [shall come into force from 17 May 2019]; 10 December 2019 [shall come into force from 1 January 2020]; 9 June 2020 [shall come into force from 10 June 2020]; 14 July 2020 [shall come into force from 16 July 2020]; 27 April 2021 [shall come into force from 1 May 2021]; 27 May 2021 [shall come into force from 3 June 2021]; 29 June 2021 [shall come into force from 1 July 2021]; 28 September 2021 [shall come into force from 1 October 2021]; 8 October 2021 [shall come into force from 10 October 2021]; 2 November 2021 [shall come into force from 5 November 2021]; 29 December 2021 [shall come into force from 1 January 2022]; 1 February 2022 [shall come into force from 4 February 2022]; 31 May 2022 [shall come into force from 3 June 2022]; 14 July 2022 [shall come into force from 20 July 2022]; 15 November 2022 [shall come into force from 18 November 2022]; 10 January 2023 [shall come into force from 19 January 2023]; 31 January 2023 [shall come into force from 7 February 2023]; 28 March 2023 [shall come into force from 1 April 2023]; 4 April 2023 [shall come into force from 13 April 2023]; 9 May 2023 [shall come into force from 13 May 2023]; 5 September 2023 [shall come into force from 12 September 2023]; 19 December 2023 [shall come into force from 1 January 2023]; 16 January 2024 [shall come into force from 1 February 2024]; 30 April 2024 [shall come into force from 3 May 2023]; 21 May 2024 [shall come into force from 1 June2023]; 18 June 2024 [shall come into force from 21 June 2023]; 3 September 2024 [shall come into force from 6 September 2023]; 19 November 2024 [shall come into force from 22 November 2023]; 26 November 2024 [shall come into force from 1 January 2025]; 10 December 2024 [shall come into force from 1 January 2025]; 25 June 2025 [shall come into force from 1 July 2025]; 8 July 2025 [shall come into force from 11 July 2025]. If a whole or part of a paragraph has been amended, the date of the amending regulation appears in square brackets at the end of the paragraph. If a whole paragraph or sub-paragraph has been deleted, the date of the deletion appears in square brackets beside the deleted paragraph or sub-paragraph.

Republic of Latvia Cabinet Regulation No. 555 Adopted 28 August 2018

Procedures for the Organisation of and Payment for Health Care Services

Issued pursuant to Section 5, Paragraphs two and three, Section 6,
Paragraph two, Clauses 7 and 14 and Paragraph four, Section 7,
Section 8, Paragraph two, and Section 10, Paragraph three of the
Health Care Financing Law, Section 3, Paragraph two and Section 9,
Paragraph five of the Medical Treatment Law, Section 11, Clause 2
of the Disability Law, and Section 14 of the law On Social Protection
of the Participants in the Liquidation of the Consequences of the
Accident at the Chernobyl Atomic Power Plant and Persons who
Suffered due to the Accident at the Chernobyl Atomic Power Plant

[19 December 2023]

1. General Provision

1. The Regulation prescribes:

1.1. the health care services included in the State paid medical assistance minimum and State mandatory health insurance, the procedures for organising the provision of these services and making payment for them, and also the amount of payment for the abovementioned services;

1.2. the procedures for the receipt of emergency medical assistance;

1.3. the health care services not financed from the State budget subsidy from the general revenue granted to the programme of the Ministry of Health for ensuring health care (hereinafter - the State budget);

1.4. the procedures by which a patient shall make a co-payment for a State paid health care service, the amount of the co-payment, and also the total amount of co-payments for the health care services received;

1.5. the procedures for the formation of queues for the receipt of health care services;

1.6. the health care services financed from the State budget subsidy from the general revenue granted to the programmes of the Ministry of Justice, the Ministry of Defence, and the Ministry of the Interior for ensuring health care, the groups of persons which have the right to receive the abovementioned health care services, and also the groups of persons for which the patient co-payment shall be covered from such resources;

1.7. the infectious diseases and the services of palliative care when a person is exempted from the patient co-payment;

1.8. the procedures by which health care of pregnant women, persons up to 18 years of age (hereinafter - the child), and persons with a predictable disability shall be organised and financed, and also ensuring of human resources for such care shall be performed;

1.9. the procedures by which the persons specified in Section 14 of the law On Social Protection of the Participants in the Liquidation of the Consequences of the Accident at the Chernobyl Atomic Power Plant and Persons who Suffered due to the Accident at the Chernobyl Atomic Power Plant shall receive free-of-charge services or healthcare allowances in dentistry and dental prosthetics;

1.10. the procedures for organising, financing, and receiving palliative care.

[19 December 2023]

2. Health Care Services not Financed from the State Budget Funds, Health Care Services Included in the State Paid Medical Assistance Minimum and State Mandatory Health Insurance

2. The following health care services shall not be financed from the State budget:

2.1. homeopathic medical treatment and medical treatment using methods of unconventional medicine;

2.2. aesthetic surgeries and cosmetology services, including plastic surgeries of external genitalia, vagina, and cervix for the purposes of aesthetics;

2.3. abortions, except for abortions due to medical indications;

2.4. sexological treatment and sex reassignment;

2.5. maintaining of a stem cell bank and germinative cell bank, except for the case referred to in Sub-paragraph 4.3.3¹ of this Regulation;

2.6. consultations, clinical and paraclinical diagnostic examinations which are conducted for victims of unlawful offences upon assignment from a forensic medical expert;

2.7. health examinations which are necessary for work or for the receipt of special permits, as well as health examinations for drivers of vehicles and preventive examinations which are not referred to in Annex 1 to this Regulation;

2.8. laboratory testing performed on an outpatient basis, except for the testing referred to in Sub-paragraphs 3.8, 3.11, and 4.4 of this Regulation;

2.9. surgical assistance in the following cases:

2.9.1. correction of prolapses, except for second-degree to fourth-degree incomplete vaginal prolapse and complete uterovaginal prolapse;

2.9.2. [7 May 2019];

2.9.3. myomectomy, except for the cases when bleeding is detected or the functioning of adjacent organs is impaired, or there are complaints of pain, or if the myoma is the reason for infertility;

2.9.4. urinary incontinence surgeries if urodynamic testing confirming stress or mixed incontinence has not been performed;

2.9.5. [10 December 2019];

2.10. health care services provided by an art therapist, except for medical rehabilitation services provided within the scope of a multiprofessional team and also services provided on an outpatient basis in the mood disorder consulting room for children and in the consulting room of functional specialists upon providing psychiatric assistance;

2.11. health care services provided by a nutritionist on an outpatient basis, except for medical rehabilitation services provided within the scope of a multiprofessional team, health care services provided to inflammatory bowel disease patients on an outpatient basis, and also health care services provided on an outpatient basis in the consulting room of rare diseases, in the consulting room for enteral or parenteral nutrition patients, in the consulting room of psychoemotional support for oncology patients, or in the consulting room of functional specialists, ensuring psychiatric assistance;

2.12. determination of exposure to alcohol, narcotic, psychotropic, or toxic substances, except for the cases when it is necessary for ensuring the medical process;

2.13. dentistry, except for the cases referred to in Sub-paragraph 4.1 of this Regulation;

2.14. other health care services which are not referred to in Paragraphs 3 and 4 of this Regulation or are provided without conforming to the procedures laid down in this Regulation or to the conditions of the contract entered into by and between the National Health Service (hereinafter - the Service) and the medical treatment institution, including without conforming to the list of manipulations to be paid for from the State resources approved by the Service and published on the website and the conditions of payment for manipulations included therein (hereinafter - the list of manipulations).

[7 May 2019; 14 July 2020; 14 July 2022; 28 March 2023; 4 April 2023; 19 December 2023; 26 November 2024]

3. A person who has the right to receive the State paid medical assistance minimum shall be ensured with the following in accordance with the procedures laid down in this Regulation:

3.1. emergency medical assistance provided by a team of the State Emergency Medical Service;

3.2. the provision of emergency medical assistance in the reception wards of inpatient medical treatment institutions and at emergency rooms, including in cases of traumas as well as in cases when removal of an ectoparasite is necessary;

3.3. the provision of emergency medical assistance in an inpatient medical treatment institution for persons whose health condition in accordance with Annex 2 to this Regulation has been assessed as the condition where:

3.3.1. there are disorders of the vital functions;

3.3.2. without the provision of immediate medical assistance, disorders of the vital functions may set in for the patient;

3.3.3. the health condition of the patient has deteriorated without the provision of immediate medical assistance, there are potential threats to life or serious consequences for the health of the patient;

3.4. birth assistance, including care for pregnant women, and also postnatal care for a woman who has recently given birth and for a newborn in accordance with the laws and regulations regarding the procedures for ensuring birth assistance;

3.5. forensic psychological and forensic psychiatric expert-examination;

3.6. health care provided by a general practitioner and the medical practitioners employed at his or her practice, including:

3.6.1. preventive examinations, and also determination of the risk of cardiovascular diseases in accordance with Annex 1 to this Regulation;

3.6.2. vaccination with the vaccines procured in centralised form by the Service in accordance with the procedures laid down in the laws and regulations regarding vaccination rules or the laws and regulations regarding epidemiological safety measures for the containment of the spread of COVID-19 infection and with the vaccines in accordance with the laws and regulations regarding the procedures for the reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for outpatient medical treatment;

3.6.3. house visits of a general practitioner to the following groups of persons:

3.6.3.1. children;

3.6.3.2. persons for whom Group I disability has been determined;

3.6.3.3. persons who are more than 80 years old;

3.6.3.4. persons who require palliative care (patients who are incurable (in accordance with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (hereinafter - ISC-10), principal diagnosis codes B20-B24, C00-C97, D37-D48, G05, G12, G13, G35, G54.6, G55.0, G60.0, G61.0, G63.1, G70, G95.1, G95.2, G99.2, I50, I69, K22.2, L89, or T91.3 and additional diagnosis code in all cases - Z51.5 (hereinafter - the palliative care));

3.6.3.5. persons who have died in domestic environment in order to establish the fact of death;

3.6.3.6. persons who require continuous mechanical ventilation of lungs;

3.6.3.7. persons who receive house care in accordance with the procedures laid down in this Regulation;

3.6.3.8. persons who are sick with influenza during the period of influenza epidemic;

3.6.3.9. persons to whom an emergency medical assistance team has gone in response to a call and the general practitioner has agreed on a house visit in accordance with the procedures laid down in this Regulation;

3.6.3.10. persons with mental disorders (in accordance with the ICD-10, principal diagnosis codes F01, F20, and F73);

3.6.3.11. persons who are in a long-term social care and social rehabilitation institution;

3.6.3.12. persons who have COVID-19 infection if the general practitioner has agreed with the Service on the provision of this service;

3.6.4. manipulations have been performed at the practice of the general practitioner according to the competence of medical practitioners in conformity with the conditions specified in the list of manipulations;

3.7. measures of cancer screening organised by the State (hereinafter - the State organised screening) in accordance with the procedures laid down in this Regulation;

3.8. laboratory testing and other diagnostic examinations performed:

3.8.1. upon referral of a general practitioner in conformity with the conditions specified in the list of manipulations;

3.8.2. at a laboratory which has been granted the status of a national reference laboratory in the issue of epidemiological safety;

3.9. renal replacement therapy procedures and specialist consultations related to such procedures;

3.10. continuous mechanical ventilation of lungs, including house visits of a specialist and medical rehabilitation for persons who require continuous mechanical ventilation of lungs;

3.11. health care services for making a diagnosis, for medical treatment, and medical rehabilitation for a person:

3.11.1. with mental and behavioural disorders (in accordance with the ICD-10, diagnosis codes F00-F99), including house visits of a psychiatrist to psychiatric patients who are not able to visit a medical treatment institution due to the health condition;

3.11.2. with malignant neoplasms and neoplasms of uncertain or unknown behaviour (in accordance with the ICD-10, diagnosis codes C00-C97, D00-D09, D37-D48), including positron emission tomography examinations with computer tomography, in conformity with the payment conditions for the health care services laid down in the contract with the medical treatment institution if a doctors' council, which shall include at least one radiologist, has decided on the necessity of the service, or a haematologist, oncologist-chemotherapist, or paediatric haemato-oncologist in the case of the ICD-10 diagnosis with codes C43, C62, C81-C86.6. The requirement for the participation of a radiologist in the composition of the council shall not apply to the council of haematologists or paediatric haemato-oncologists;

3.11.3. with diabetes mellitus (in accordance with the ICD-10, diagnosis codes E10-E14);

3.11.4. with any of the infectious diseases referred to in Annex 3 to this Regulation;

3.11.¹ the palliative care service of a mobile team at the place of residence of the patient (hereinafter - the mobile palliative care team service) if a doctors' council has decided on the necessity of the service;

3.11.² health care services provided by a nurse or a certified doctor's assistant (feldsher) and also by a certified physiotherapist, including the health care services provided at home as referred to in Sub-paragraph 4.2 of this Regulation, in a long-term social care and social rehabilitation institution;

3.12. intradermal, subcutaneous, intramuscular, and intravenous injections to be administered on an outpatient basis upon providing:

3.12.1. emergency medical assistance;

3.12.2. medical assistance to pregnant women and women during the period following childbirth of up to 70 days, and also to persons with diabetes mellitus, tuberculosis, oncological diseases or mental illnesses, and persons who are receiving continuous mechanical ventilation of lungs at home;

3.13. medicinal products and medical devices, including parenteral medicinal products which are acquired by the Service in a centralised manner, and also the medicinal products and medical devices to be compensated in accordance with the regulatory enactment regarding the procedures for reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for the outpatient medical treatment in the cases referred to in Sub-paragraph 3.11 of this Regulation.

[7 May 2019; 10 December 2019; 17 December 2020; 29 December 2021; 10 January 2023; 28 March 2023; 4 April 2023; 5 September 2023; 19 December 2023; 26 November 2024]

4. A person who has the right to receive health care services within the scope of the State mandatory health insurance (hereinafter - the insured person) shall be ensured, in accordance with the procedures laid down in this Regulation, with the following in addition to the health care services referred to in Paragraph 3 of this Regulation:

4.1. dental services in the following cases:

4.1.1. dental services to children;

4.1.2. initial orthodontic consultation to children and also orthodontic treatment in case of hereditary orofacial clefts, including in cases of severe maxillo-facial deformities, for persons up to 25 years of age if the treatment was commenced before the age of 18;

4.1.3. dental assistance to asylum seekers in an urgent case;

4.1.4. dental prosthetics to the persons specified in Section 14 of the Law on Social Protection of the Participants of Liquidation of Consequences of the Accident at the Chernobyl Nuclear Power Plant and the Victims of the Accident at the Chernobyl Nuclear Power Plant for whom expenses for dental services shall be covered in the amount of 50 %, but expenses for dental prosthetics with removable plastic prosthesis - in full amount;

4.1.5. tooth extractions in urgent cases under general anaesthesia for patients with Group I disability which has been determined due to mental and behavioural disorders;

4.1.6. dental services for patients who receive long-term psychiatric treatment in an inpatient medical treatment institution, including in accordance with a court decision;

4.2. the following health care services at home:

4.2.1. administration of medicinal products (intradermal, subcutaneous, and intravenous injections);

4.2.2. care for skin lesions;

4.2.3. change of and care for a long-term urinary catheter, care for an artificial opening (stoma), including education and training of the patients and their relatives regarding care for an artificial opening (stoma) to be financed by the Service not more than five times per person, except for care for tracheostomy, gastrostomy, nephrostomy, cystostomy to be financed by the Service according to the number of the services actually provided;

4.2.4. enteral feeding through a tube or an artificially created opening and parenteral feeding;

4.2.5. rehabilitation services to persons with sequelae of injury of the spinal cord (in accordance with the ICD-10, diagnosis code T91.3), persons with a cerebrovascular disease (in accordance with the ICD-10, diagnosis codes I60, I61, I63, I64, I69), and children who are registered with the palliative care consulting room of valsts sabiedrība ar ierobežotu atbildību "Bērnu klīniskā universitātes slimnīca" [State limited liability company Children's Clinical University Hospital];

4.2.6. [14 July 2020];

4.2.7. if a person receives the health care services referred to in Sub-paragraph 4.2.2, 4.2.3, 4.2.4, or 4.2.5 of this Regulation, the following shall be ensured additionally, if necessary:

4.2.7.1. testing and delivery of the materials obtained as a result of testing to the laboratory;

4.2.7.2. control of vital signs;

4.2.7.3. education and training of the patient and his or her relatives regarding health promotion measures and patient care;

4.2.7.4. giving of the enema;

4.2.7.5. intradermal, subcutaneous, intramuscular, and intravenous injections;

4.3. health care which is provided by a midwife or a doctor specialising in a specific speciality, except for a general practitioner (hereinafter - the specialist), other medical practitioners and medical treatment support persons in accordance with Annex 4 to this Regulation, including:

4.3.1. the health care services provided by a sports doctor to athletes up to 18 years of age and children with an increased physical load in accordance with the regulatory enactment determining the procedures for the health care and medical supervision of athletes and children with an increased physical load;

4.3.2. house visit of specialists in conformity with the following conditions:

4.3.2.1. house visits of a doctor of rehabilitation and physical medicine to children who are registered with the palliative care consulting room of the State limited liability company Children's Clinical University Hospital and are receiving health care at home, and also to persons with sequelae of injury of the spinal cord (in accordance with the ICD-10, diagnosis code T91.3), persons with a cerebrovascular disease (in accordance with the ICD-10, diagnosis codes I60, I61, I63, I64, or I69) who are receiving health care at home;

4.3.2.2. house visits of a specialist of the palliative care consulting room to children who are registered with the palliative care consulting room of the State limited liability company Children's Clinical University Hospital;

4.3.3. medically assisted insemination, except for the cases when two unsuccessful procedures of medically assisted insemination (clinically confirmed pregnancy has not set in after the transfer of the embryo) have been financed from the State budget funds, for women up to 40 years of age, and also after attaining this age if the stimulation of ovary cells with medicinal products commenced up to the age of 40 years has been successful and medically assisted insemination is continued until transfer of the embryo without freezing it;

4.3.3.¹ collection, freezing, and storage of germ cells (for not longer than 10 years from the moment of freezing) for patients with oncological diseases if the germ cells are collected and frozen before commencing chemotherapy and a doctors' council has decided on the necessity of the service;

4.3.4. prescribing of optical products correcting visual acuity for children;

4.4. laboratory testing performed on an outpatient basis which have been performed:

4.4.1. upon referral of specialists in conformity with the conditions specified in the list of manipulations;

4.4.2. in the consulting room of rare diseases according to the conditions specified in the contract with the Service;

4.4.3. in accordance with the procedures laid down in this Regulation, in another European Union (hereinafter - EU) Member State and a European Economic Area (hereinafter - EEA) country, the Swiss Confederation (hereinafter - Switzerland) or the United Kingdom of Great Britain and Northern Ireland (hereinafter - the United Kingdom) if it is necessary to prevent irreversible deterioration of the life functions or health condition of a person and:

4.4.3.1. the examinations are required for a child according to the opinion of the council of the State limited liability company Children's Clinical University Hospital;

4.4.3.2. the examinations are required for a person according to the opinion of the council of sabiedrība ar ierobežotu atbildību "Rīgas Austrumu klīniskā universitātes slimnīca" [limited liability company Riga East University Hospital] if hymerism monitoring must be performed after allogeneic stem cell transplantation from a non-related donor or control of minimal residual disease must be performed according to the method - real-time polymerase chain reaction on bone marrow aspirate - in case if there are indications for allogeneic stem cell transplantation for a person for whom molecular genetic changes have been detected and search for a non-related donor is required, and also in the case if molecular genetic changes have been detected after allogeneic stem cell transplantation from a non-related donor;

4.5. diagnostic imaging performed upon referral of specialists on an outpatient basis in conformity with the conditions specified in the list of manipulations, including positron emission tomography examinations with computer tomography if a doctors' council, which shall include at least one radiologist, has decided on the necessity for the service, or a haematologist, oncologist-chemotherapist, or paediatric haemato-oncologist in the case of the ICD-10 diagnosis with codes C43, C62, C81-C86.6 in conformity with the payment conditions for the health care services laid down in the contract with the medical treatment institution. The requirement for the participation of a radiologist in the composition of the council shall not apply to the council of haematologists or paediatric haemato-oncologists;

4.6. the health care services provided at a day hospital in accordance with Annex 5 to this Regulation, including intradermal, subcutaneous, intramuscular, and intravenous injections to be administered on an outpatient basis;

4.7. psychotherapeutic and psychological assistance in the following cases:

4.7.1. if assistance is provided in psychiatric inpatient medical treatment institutions or units;

4.7.2. if it is necessary upon ensuring outpatient psychiatric assistance or palliative care;

4.7.3. if assistance is provided by a multiprofessional team within the scope of a medical rehabilitation programme;

4.7.4. if a forensic psychological expert-examination is performed;

4.7.5. if the necessity for such assistance has been specified by a psychiatrist in order to prevent committing of criminal offences against morality and sexual inviolability of a child;

4.7.6. if a health care service in the consulting room of rare diseases is provided;

4.7.7. if a health care service in the consulting room of methadone maintenance treatment is provided;

4.7.8. if the necessity for psychotherapeutic and psychological support for a person has been determined by a general practitioner - up to 10 times during the calendar year;

4.7.9. if psychoemotional support is provided within the scope of a consultative telephone service;

4.8. inpatient health care in accordance with Annex 6 to this Regulation, including:

4.8.1. the following health care services in traumatology and orthopaedics:

4.8.1.1. medical treatment of trauma sequelae, bone and joint diseases if a council of traumatologists and orthopaedists has decided on the necessity of the service;

4.8.1.2. medical treatment of osteomyelitis, septic arthritis, and soft tissue inflammations, including spine surgery;

4.8.1.3. endoprosthetic surgeries;

4.8.1.4. reconstructive arthroscopy if it is performed at level IV and V hospitals;

4.8.1.5. repeated spine surgeries if relapse occurs within a year from the moment of performing the surgery or if a doctors' council of spine surgery has decided on the necessity of the service;

4.8.1.6. medical treatment of degenerative-dystrophic diseases of spine for persons with progressive spine deformity if a doctors' council of spine surgery has decided on the necessity of the service, or with symptoms of spinal cord or cauda equina compression;

4.8.1.7. planned surgeries for a person with a predictable disability according to the individual rehabilitation plan approved by the State Medical Commission for the Assessment of Health Condition and Working Ability or for persons who have been ill for a protracted period of time and who are of the working age;

4.8.1.8. surgeries for the elimination of intervertebral disc damages - microdiscectomy and microfenestration if a doctors' council of spine surgery has decided thereon;

4.8.2. organ and tissue transplantation in the following amount:

4.8.2.1. autologous and allogeneic stem cells, including search for the donor;

4.8.2.2. kidneys, liver, heart, and heart valves;

4.8.2.3. bones and connective tissues, fascia, skin, tendons, and cartilaginous tissue;

4.8.2.4. corneas;

4.8.2.5. lungs for persons with a rare disease if a doctors' council has decided on the necessity of the service;

4.8.3. pulmonary endarterectomy for persons with a rare disease if a doctors' council has decided on the necessity of the service;

4.9. medical rehabilitation in accordance with Sub-chapter 3.11 and Chapter 4 of this Regulation;

4.10. health care services in the following amount shall be ensured, in the priority order specified in this Regulation, to persons who have been ill for a protracted period of time and who are of the working age for the prevention of setting in of disability or for the prevention of its progress if the person has received a decision of the doctors' council in which the disease has been recognised as endangering the capacity for work and the methods for medical treatment have been indicated, justifying their choice:

4.10.1. surgical, traumatological, or rehabilitation services to persons with traumas, polytraumas, dorsopathies, nerve, nerve root and plexus damages, decubitus ulcers, burns and corrosions, frostbites, and orthopaedic diseases;

4.10.2. invasive cardiology services to persons after an infarction;

4.10.3. surgical services to persons with imminent blindness (cataract, glaucoma, and other eye and adnexa diseases);

4.10.4. implantation of the cochlear implant;

4.10.5. medical rehabilitation service according to the rehabilitation plan developed by a doctor of rehabilitation and physical medicine after a stroke, cardiac surgeries, and endoprosthetic replacement of large joints;

4.11. means of medical treatment and foods for specific groups in the following amount:

4.11.1. means of medical treatment and foods for specific groups procured in centralised form by the Service, including:

4.11.1.1. spectacle lenses, spectacle frames, and contact lenses for children who have been diagnosed with a high-degree congenital myopia (above 5.0 Dsph), high-degree hypermetropia (above 4.0 Dsph), high-degree astigmatism (above 1.0 D), high-degree anisometropia (above 2.0 D), aphakia in case of congenital cataract or aphakia in case of acquired cataract for one eye or both eyes, acquired short-sightedness (above 7.0 Dsph), keratoconus, accommodative esotropia, paresis (bifocal spectacle lenses), albinism, congenital retinal cone dystrophy with photophobia (photochromic spectacle lenses) proved with objective examination techniques, retinal scarring, opacities (prosthetic contact lenses), low vision of 3rd-4th degree regardless of the degree of refraction anomaly;

4.11.1.2. medical nutritional supplements, enteral and parenteral nutrition mixtures and the medical devices necessary for their administration:

4.11.1.2.1. for adult patients who are included in the records of the enteral or parenteral nutrition patient care consulting room of the limited liability company Riga East University Hospital in accordance with the indications specified in the contract with the Service and published on the website of the Service;

4.11.1.2.2. for patients of the State limited liability company Children's Clinical University Hospital in accordance with the indications specified in the contract with the Service and published on the website of the Service;

4.11.2. the reimbursable medicinal products and medical devices in accordance with the laws and regulations regarding the procedures for reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for the outpatient medical treatment;

4.11.3. [29 December 2021];

4.11.4. hearing implants for children or persons with a predictable disability and for persons who have been ill for a protracted period of time and who are of the working age;

4.11.5. the medicinal products indicated in Annex 7 to this Regulation, and also the medicinal products and medical devices which have been included in the list of manipulations;

4.11.6. spectacle lenses and spectacle frames for patients who receive long-term psychiatric treatment in an inpatient medical treatment institution, including in accordance with a court decision;

4.12. State paid health care services in another EU Member State, EEA country, Switzerland, and the United Kingdom in accordance with the procedures laid down in this Regulation and the conditions of Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems (hereinafter - Regulation No 883/2004), Regulation (EC) No 987/2009 of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation No 883/2004 on the coordination of social security systems (hereinafter - Regulation No 987/2009), and the Protocol on Social Security Coordination of the Trade and Cooperation Agreement concluded between the EU and the United Kingdom on 26 December 2020 (hereinafter - the EU and UK Protocol);

4.13. reimbursement of expenses for health care services received in another EU Member State, EEA country, Switzerland, or the United Kingdom in accordance with the procedures laid down in this Regulation (cross-border healthcare).

[7 May 2019; 10 December 2019; 14 July 2020; 17 December 2020; 29 December 2021; 28 March 2023; 4 April 2023; 5 September 2023; 19 December 2023; 19 November 2024; 8 July 2025]

3. Organisation of the Health Care Services Included in the State Paid Medical Assistance Minimum and State Mandatory Health Insurance

3.1. General Principles

5. Health care services financed from the State budget according to the by-laws shall be provided by State administration institutions, and also the medical treatment institutions which have entered into a contract with the Service for:

5.1. provision of primary health care services - the Service shall select service providers from the waiting list of primary health care service providers (general practitioners, medical treatment institutions providing dental services, medical treatment institutions ensuring health care at home) to be created and maintained by the Service;

5.2. provision of secondary outpatient health care services - the Service shall select service providers on the basis of a selection procedure of health care service providers developed by the Service, except for the following cases:

5.2.1. for ensuring of the functions of the national reference laboratory - with a medical treatment institution which has acquired the relevant status in accordance with a regulatory enactment determining the procedures for granting and cancellation of the status of the national reference laboratory in the field of epidemiological safety or suspension of its operation, and also regarding the rights and obligations of the national reference laboratory;

5.2.2. for ensuring of post-exposure prophylaxis (PEP) to medical practitioners, for ensuring of vertical prophylaxis of human immunodeficiency virus infection, for ensuring of therapy of opportunistic infections of human immunodeficiency virus, for storage of immunobiological preparations, and also for distribution of medicinal products for tuberculosis the contract shall be entered into with limited liability company Riga East University Hospital;

5.2.3. if it is possible to agree with a secondary outpatient health care service provider which already is in contractual relations with the Service on the provision of secondary outpatient health care services of other types if:

5.2.3.1. the secondary outpatient health care service provider has submitted an appropriate offer;

5.2.3.2. sufficient accessibility of such health care services has not been ensured;

5.2.3.3. financial resources for payment for such health care services are available;

5.2.3.4. the resources available to the secondary outpatient health care service providers who are providing such health care services are fully stretched;

5.2.4. if the contract for the provision of health care services is entered into with medical treatment institutions of other countries;

5.2.5. for ensuring birth assistance provided by a midwife during pregnancy and the postpartum period in accordance with the laws and regulations regarding the procedures for providing birth assistance, the contract shall be entered into with the medical treatment institution which employs a certified midwife if a written application for the provision of the service has been received by the Service;

5.3. provision of inpatient health care services. A contract shall be entered into with the medical treatment institutions referred to in Annex 6 to this Regulation according to the level of the relevant medical treatment institution and the payment conditions for programmes of inpatient health care services referred to in Annex 6 to this Regulation, except for the following cases:

5.3.1. for ensuring of birth assistance the contract shall be entered into with the medical treatment institution which has provided State paid birth assistance in at least 200 cases in the previous year;

5.3.2. for inpatient health care services for the provision of which the Service has announced a procedure for selecting service providers the contract shall be entered into with the medical treatment institutions which have applied to the relevant selection of health care service providers and conform to the criteria brought forward therein;

5.3.3. if a contract for the provision of health care services is entered into with medical treatment institutions of other states;

5.4. ensuring of organisational and methodological work. The contract shall be entered into with a medical treatment institution which has specialised in the provision of the relevant health care services.

[19 November 2024]

5.¹ For the accessibility of the services referred to in Sub-paragraph 4.7.8 of this Regulation, the Service shall enter into contracts with legal persons for the provision of the services of a clinical and health psychologist, psychotherapy specialist, or psychotherapist by organising the procedure for the selection of service providers.

[19 November 2024]

5.² The Service shall conduct a procurement for providing the service referred to in Sub-paragraph 4.7.9 of this Regulation.

[29 December 2021]

5.³ The service referred to in Paragraph 3.11¹ of this Regulation shall be provided by medical treatment institutions which have entered into a contract with the Service for the mobile palliative care team service at the place of residence of the patient (hereinafter - the provider of the mobile palliative care team service). For the provision of services, the Service shall announce the procedure for selecting service providers and shall enter into a contract with the medical treatment institutions which have applied to the relevant selection of health care service providers and conform to the criteria set out therein.

[19 December 2023]

5.⁴ The service referred to in Sub-paragraph 3.11² shall be provided by long-term social care and social rehabilitation institutions which have entered into the contract for the provision of health care services at a long-term social care and social rehabilitation institution in conformity with the following conditions:

5.⁴1. the Service has received a written application for the provision of services;

5.⁴2. the relevant long-term social care and social rehabilitation institution has more than 149 places for customers from 18 years of age;

5.⁴3. a unit for the provision of health care services, which has been registered in the register of medical treatment institutions, has been established at the relevant long-term social care and social rehabilitation institution.

[26 November 2024]

6. Upon creating the waiting list of primary health care service providers referred to in Sub-paragraph 5.1 of this Regulation, the Service shall conform to the following conditions:

6.1. within a year after completion of the State paid residency a general practitioner has the right to request to register him or her in the waiting list of general practitioners on a priority basis. If there are several such general practitioners in the waiting list, they shall be registered in the order of submitting the submission before other doctors who are in the waiting list of general practitioners;

6.2. if a general practitioner discontinues the contractual relations with the Service, the Service shall, without conforming to the chronological order of the waiting list, offer the opportunity to take over the relevant practice to a general practitioner who:

6.2.1. in accordance with the procedures laid down in this Regulation has continuously substituted the relevant general practitioner for more than six months;

6.2.2. has received a scholarship from the local government on the basis of an agreement entered into regarding provision of services of a general practitioner in the territory of the local government after receipt of the certificate of a general practitioner;

6.2.3. has agreed with the relevant general practitioner on taking over of the practice (except for the case if, as a result of the planned taking over, the practice would be acquired by a medical treatment institution providing secondary outpatient health care services and the general practitioner becomes an employee), and also has received information regarding the work organisation, liabilities, cooperation institutions of such practice and the different health care and prevention programmes of patient groups;

6.3. the Service shall refuse to register a health care service provider in the waiting list if a dentist is not employed and does not provide health care services in a medical treatment institution providing dental services.

[7 May 2019]

7. The Service shall organise the State organised screening on the basis of the contracts entered into for:

7.1. cervical cancer screening examinations - with primary health care service providers, with secondary outpatient health care service providers which have the type of service "Gynaecology" included in the contract, and also with laboratory service providers which have been selected based on the procedure established by the Service for selecting service providers;

7.2. colorectal cancer screening examinations - with primary health care service providers, and also with service providers with which a contract for the performance of outpatient laboratory testing has been entered into and which ensure fecal occult blood tests in accordance with the procedures laid down in this Regulation;

7.3. mammography screening examinations - with the service providers with which a contract for the provision of secondary outpatient health care services has been entered into and which ensure mammography examinations of breast cancer screening;

7.4. prostate cancer screening examinations - with outpatient laboratory service providers which have the type of service "Laboratory testing" included in the contract.

[27 April 2021; 14 July 2022]

8. State paid health care services may be provided only by such health care service providers which meet the following conditions:

8.1. have registered in the register of medical treatment institutions;

8.2. conform to the mandatory requirements which have been laid down for medical treatment institutions and their units in the laws and regulations;

8.3. the health care service provider has the medical staff necessary for the provision of services and, where necessary, the medical support staff or drivers of an ambulance emergency response vehicle;

8.4. the health care service provider has appropriate materials and technical facilities;

8.5. are able to ensure complete, accurate, and timely exchange of information with the system for the settlement of payments for health care services "Management Information System" (hereinafter - the management information system);

8.6. have entered into a contract with the Service for the use of the unified electronic information system of health sector (hereinafter - the health information system) and fulfil the obligations specified in the laws and regulations governing the operation of the health information system;

8.7. an internal control system has been implemented for the prevention of the risk of corruption and a conflict of interest.

[10 December 2019 / Sub-paragraph 8.7 shall come into force on 1 January 2022. See Paragraph 237]

9. The conditions referred to in Sub-paragraphs 8.5 and 8.6 of this Regulation shall not be applicable to the State Emergency Medical Service.

9.¹ Sub-paragraph 8.7 of this Regulation shall apply to outpatient medical treatment institutions which provide State paid health care services in at least five types of services.

[10 December 2019 / Paragraph shall come into force on 1 January 2022. See Paragraph 237]

10. The Service shall enter into a contract with health care service providers, except for a contract for the ensuring of methodological work, for a time period which is not less than three years and does not exceed 10 years. The Service has the right to terminate contractual relations with a health care service provider which does not conform to the conditions referred to in this Regulation or in the contract entered into with the Service.

11. The Service shall, in accordance with the conditions referred to in Annex 8 of this Regulation, perform centralised procurements for ensuring the means of medical treatment and foods for specific groups referred to in Sub-paragraph 4.11.1 of this Regulation. Information on the conditions of the centralised procurement shall be published on the website of the Service.

[14 July 2020]

12. The Service shall post the following on its website in a language that is easy to understand as well as provide upon request:

12.1. information on the physicians who are providing State paid health care services and the physicians who have the right to refer persons for the receipt of State paid health care services or to prescribe medicinal products or medical devices to be reimbursed by the State on the basis of the conditions of a memorandum of understanding, indicating the medical treatment institution, the given name, surname, speciality of the physician and whether the physician is entitled to refer for the receipt of State paid health care services and is entitled to prescribe medicinal products and medical devices to be reimbursed from the State budget funds and intended for outpatient medical treatment;

12.2. information on the health care system in the Republic of Latvia:

12.2.1. the rights of patients;

12.2.2. organisation of and payment for health care (also the Plan of Patient Hospitalisation Sites);

12.2.3. health care service providers;

12.2.4. the mandatory requirements for medical treatment institutions and their units, including the requirement to ensure accessibility of the environment for persons with functional disorders;

12.2.5. operation of the Medical Treatment Risk Fund;

12.2.6. the procedures for submitting a complaint regarding the quality of a health care service;

12.3. information on the procedures by which it is possible to receive health care services in foreign states, and also on the procedures by which it is possible to receive a reimbursement of expenditure for the health care services received in foreign states;

12.4. the amount of information to be included in the prescription;

12.5. data on the performance indicators of health care service providers.

13. The following persons have the right to refer a person for the receipt of State paid health care services or to prescribe medicinal products and medical devices to be reimbursed from the State budget funds and intended for outpatient medical treatment:

13.1. the doctors for whom such rights have been specified in the contract entered into by and between the Service and the medical treatment institution for the provision of health care services and financing from the State budget funds;

13.2. the doctors who work at medical treatment institutions of places of imprisonment and to whom such rights have been specified according to a memorandum of understanding regarding cooperation entered into by and between the Service and the Prisons Administration;

13.3. the doctors who work at long-term social care and social rehabilitation institutions providing State or local government financed long-term social care and social rehabilitation services and to whom such rights have been specified according to the contract entered into by and between the Service and the long-term social care or social rehabilitation institution;

13.4. the doctors who are employed at medical treatment institutions of the National Armed Forces and to whom such rights have been specified according to a memorandum of understanding regarding cooperation entered into by and between the Service and the National Armed Forces;

13.5. the doctors who are providing health care services at an accommodation centre for asylum seekers and to whom such rights have been specified according to a memorandum of understanding regarding cooperation entered into by and between the Service and the Office of Citizenship and Migration Affairs;

13.6. the doctors who are providing health care services at an accommodation centre for detained foreigners and to whom such rights have been specified according to a memorandum of understanding regarding cooperation entered into by and between the Service and the State Border Guard.

[7 May 2019; 4 April 2023]

14. In addition to the conditions referred to in Paragraph 13 of this Regulation:

14.1. a midwife has the right to refer a person for the receipt of a State paid birth assistance and also to prescribe the List M medicinal products and medical devices to be reimbursed from the State budget funds and intended for outpatient medical treatment for ensuring birth assistance provided by a midwife during pregnancy and the postpartum period in accordance with the laws and regulations regarding the procedures for the provision of birth assistance if such rights have been specified in the contract entered into by and between the Service and the medical treatment institution for the provision of health care services and payment from the State budget funds;

14.2. doctor's assistants (feldshers) and nurses employed at a medical treatment institution have the right to prescribe the medicinal products and medical devices to be reimbursed from the State budget funds and intended for outpatient medical treatment in accordance with the procedures laid down in the laws and regulations regarding writing out prescriptions if such rights have been specified in the contract entered into by and between the Service and the medical treatment institution for the provision of health care services and payment from the State budget funds;

14.3. doctor's assistants and nurses working at a medical treatment institution of the Prison Administration have the right to prescribe the medicinal products and medical devices to be reimbursed from the State budget funds and intended for outpatient medical treatment in accordance with the procedures laid down in the laws and regulations regarding writing out prescriptions if it is determined by the contract entered into by and between the Service and the Prison Administration.

[25 June 2025]

15. A person with an E 106, E 109, E 121, or S 1 form issued by another EU Member State, EEA country, or Switzerland shall obtain the right to receive health care services in a medical treatment institution of Latvia after registration of the relevant form with the Service.

3.2. Organisation of Primary Health Care

16. Primary health care is an aggregate of outpatient health care services which are provided to a person at a medical treatment institution or his or her place of residence by:

16.1. a general practitioner and medical practitioners employed at his or her practice:

16.1.1. a doctor's assistant (feldsher);

16.1.2. a nurse;

16.1.3. a midwife;

16.2. medical practitioners employed at a medical treatment institution providing dental services:

16.2.1. a dentist, including a paediatric dentist;

16.2.2. a dentist's assistant;

16.2.3. [17 December 2020];

16.2.4. a dental technician;

16.2.5. a dental hygienist;

16.3. medical practitioners ensuring health care at home;

16.4. the provider of the mobile palliative care team service;

16.5. the medical practitioners who provide health care services at a long-term social care and social rehabilitation institution.

[19 December 2023; 26 November 2024]

17. A person shall receive primary health care services:

17.1. upon his or her initiative by turning to a primary health care service provider, except for health care at home;

17.2. upon an invitation of a general practitioner, including for the performance of preventive examination or State organised screening measures;

17.3. at home in accordance with Sub-paragraphs 3.11¹ and 4.2 of this Regulation and also Sub-chapters 3.4 and 3.4¹ of this Regulation;

17.4. at a long-term social care and social rehabilitation institution in accordance with Sub-paragraph 3.11² and Paragraph 5⁴ of this Regulation.

[19 December 2023; 26 November 2024]

18. The boundaries of the area within which a general practitioner together with medical practitioners employed at the practice of the general practitioner provides primary health care services shall be determined by the Service upon agreement with the relevant local government (hereinafter - the basic area of operation of the general practitioner).

[17 December 2020]

19. In areas with insufficient provision of services provided by general practitioners and with more difficult access to health care services the Service may, in an exceptional case, enter into a contract with the local government for the operation of a feldsher station (in which a certified doctor's assistant (feldsher) is working) for ensuring primary health care services if one of the following conditions is in effect:

19.1. there is no practice of a general practitioner registered in the municipality parish where the feldsher station is located or the distance from the feldsher station to the closest practice of a general practitioner exceeds 10 km;

19.2. not less than 400 inhabitants are declared in the service area of the feldsher station (in the area the inhabitants of which are receiving the health care services provided by the doctor's assistant (feldsher));

19.3. there is no practice of a general practitioner registered in the area and the Service has received a certification from the relevant local government or from a general practitioner - resident that the general practitioner - resident will ensure the services of a general practitioner in the particular area after receipt of the certificate.

[7 May 2019]

3.3. Organisation of Health Care Provided by a General Practitioner

20. Each person has the right to choose a general practitioner and to register in the list of patients of the general practitioner in conformity with the following conditions:

20.1. the person may be registered only with one general practitioner;

20.2. only children shall be registered with a paediatrician;

20.3. the person registered in the list of patients of the general practitioner has the right to choose another general practitioner and to perform re-registration.

21. In order to register in the list of patients of a general practitioner or to re-register a person shall use the unified electronic information system of health sector or the State administration service portal www.latvija.lv. If the person does not have the opportunity of registering electronically, the person shall turn to the selected general practitioner and enter into an agreement.

22. An agreement regarding registration in the list of patients of a general practitioner, except for electronic registration, shall be prepared in two copies, and each copy shall be signed by the person and the general practitioner. One copy of the agreement is issued to the person, and the second copy remains with the general practitioner who stores it while the person is registered in the list of his or her patients.

23. The practice of the general practitioner shall, within five working days after entering into the agreement, enter information in the management information system of the Service on the agreement to register the person in the list of patients of the general practitioner.

[17 December 2020]

24. The general practitioner has the option of not agreeing to registration of the person in the list of his or her patients if:

24.1. the declared place of residence of the person is located outside the basic area of operation of the general practitioner;

24.2. the number of patients registered in the list of patients of the general practitioner forms a full practice, except for:

24.2.1. first-degree relatives in ascending or descending order or spouse of an already registered person;

24.2.2. persons living in the basic area of operation of the general practitioner (declared place of residence).

25. The Service shall post information on its website regarding general practitioners the number of patients registered in their list of patients forms a full practice. A full practice shall be formed by the following number of patients registered in the list of patients of a general practitioner:

25.1. if children are not registered in the list of patients of a general practitioner - 1800 persons;

25.2. if only children are registered in the list of a general practitioner - 800 persons;

25.3. if both adults and children are registered in the practice of a general practitioner, the Service shall determine the proportion of the number of children and adults registered in the practice against to the total number of patients and assess it against the number of patients indicated in Sub-paragraphs 25.1 and 25.2 of this Regulation.

26. Upon request of a person, the Service shall provide information regarding general practitioners with whom it is possible to register, the location of practices of such general practitioners, and the procedures for registration, and also shall post information on the website of the Service regarding practices of general practitioners, indicating the name of the medical treatment institution, the given name, surname of the general practitioner, the address, telephone number (which has been submitted to the Service for publishing on the website) of the medical treatment institution, electronic mail address for communication with patients (if the institution has indicated such), the area of basic operation, the working hours of the practice, and the reception hours of the general practitioner.

27. The Service shall block registration of a person with a general practitioner:

27.1. for patients of psychiatric inpatient medical treatment institutions who are continuously undergoing medical treatment for more than three months;

27.2. imprisoned persons;

27.3. for persons regarding whom the Service has received information from the Register of Natural Persons on the place of residence indicated outside the Republic of Latvia.

[14 July 2022]

28. Blocking of registration of a person with a general practitioner shall suspend the existing registration and preclude re-registration of the person with another general practitioner, but the person shall not lose the right to receive State paid health care services according to his or her status - insured person or person who has the right to receive the State paid medical assistance minimum.

29. If the grounds for blocking registration of a person with a general practitioner have ceased to exist, the Service shall unblock registration of the person and renew registration of the patient in the list of patients of a general practitioner.

30. A person shall be excluded from the list of patients of a general practitioner:

30.1. if the general practitioner has terminated contractual relations with the Service - within five working days from the moment of termination of the contract;

30.2. in the cases specified in Section 42 of the Medical Treatment Law, on the basis of a submission of the general practitioner and the opinion of the examination by the Health Inspectorate regarding the particular case (not applicable if the patient is a child), and the Service shall inform the person thereof;

30.3. if the person has attained 18 years of age and the relevant general practitioner is a paediatrician. The relevant paediatrician shall inform the person of such fact;

30.4. the person has lost the right to receive State paid health care services;

30.5. if according to the information included in the Register of Natural Persons the person has died;

30.6. on the basis of a submission of the patient - within five working days after receipt thereof.

[14 July 2022; 4 April 2023]

31. If a general practitioner terminates contractual relations with the Service, the Service shall re-register the persons registered in the list of his or her patients to the list of the general practitioner taking over the practice or basic area of operation (also its part) of the general practitioner who has terminated the contractual relations.

[17 December 2020]

32. The Service shall publish the information regarding exclusion of patients from the list of patients of a general practitioner and re-registration with the general practitioner taking over the practice or basic area of operation (also its part) of the general practitioner on the website of the Service and send it to the local government.

[7 May 2019]

33. A general practitioner who enters into a contract with the Service for the provision of health care services in the basic area where services were previously provided by a general practitioner the contractual relations with whom have ended due to his or her death or due to other previously unforeseen circumstances (for example, a prohibition to provide State paid health care services has been imposed in accordance with the procedures laid down in the laws and regulations) shall take over the medical documentation of such patients who were registered with the previous general practitioner.

34. The general practitioner shall receive a full list of his or her registered patients and information on the changes in the list, using the management information system of the Service.

35. A patient of a general practitioner shall be:

35.1. a person who is registered in the list of patients of the general practitioner;

35.2. a person whose registration with the general practitioner has been blocked;

35.3. a person who has not registered in the list of patients of the general practitioner (hereinafter - the temporary patient) and who:

35.3.1. has fallen ill during temporary stay (for example, official travel, visit) and has turned for assistance at the practice of the general practitioner which is nearest to the place of stay;

35.3.2. is periodically under care of relatives or guardians in the basic area of operation of the relevant general practitioner;

35.3.3. has never been registered with the general practitioner but has turned for assistance to the general practitioner;

35.3.4. is a patient registered with another general practitioner who has turned to the general practitioner as the substitute of the general practitioner of the patient (in case of temporary substitution).

36. Each general practitioner, together with the medical practitioners employed at the practice of a general practitioner, shall, according to the contract with the Service, provide health care services in the basic area of his or her operation, ensuring health care for the patients registered in his or her list of patients, and also shall:

36.1. provide health care services to a patient registered in his or her list of patients also outside the basic area of his or her operation, agreeing thereupon with the relevant person;

36.2. provide the necessary health care services to the temporary patients, including perform vaccination according to the calendar of vaccination;

36.3. regularly assess the health condition of the persons registered in his or her list of patients, ensuring that during the calendar year the health condition is assessed for not less than half of all the patients registered in the list of patients of the general practitioner;

36.4. issue a statement on the health condition of a child;

36.5. ensure primary diagnostics of malignant neoplasms and, in accordance with the procedures laid down in Annex 1 to this Regulation, perform determination of the risk of cardiovascular diseases and subsequent care for patients according to the determined risk in conformity with the conditions specified in the contract with the Service;

36.6. ensure that not later than during the following working day the general practitioner or a medical practitioner employed at his or her practice contacts the person in order to agree on subsequent health care if the general practitioner has received information regarding a visit by an emergency medical assistance team to the person registered in the list of patients of the general practitioner and such person has not been admitted;

36.7. establish the fact of death of a person registered with him or her or under his or her care, or a person who has died in domestic environment in his or her basic area of operation, and also issue the documents specified in the laws and regulations regarding the procedures for keeping medical records if the cause of death is known to the general practitioner;

36.8. in accordance with the laws and regulations regarding the procedures for the determination of the fact of brain death and biological death and the transferring of a deceased person for burial, send the deceased person for pathological-anatomical examination;

36.9. inform the territorial institution of the State Police if the general practitioner suspects violent death;

36.10. perform other obligations specified in laws and regulations or the contract with the Service.

[17 December 2020]

37. Upon assessing the health condition of a person and taking into account the amount of the rights of the person for the receipt of State paid services (insured person or person who has the right to receive the State paid medical assistance minimum), the general practitioner may refer the person for receipt of secondary health care services.

38. The general practitioner shall perform health care for patients jointly with medical practitioners employed at the practice of the general practitioner in conformity with the following conditions:

38.1. an appropriate workplace has been arranged for the medical practitioners employed at the practice;

38.2. if the number of patients registered with the general practitioner exceeds the number of patients forming a full practice, it is ensured that at the practice of the general practitioner:

38.2.1. at least two medical practitioners (nurse, doctor's assistant (feldsher), or midwife) are employed in addition to the general practitioner;

38.2.2. the independent reception hours of patients for the employed medical practitioners (nurse, doctor's assistant (feldsher), or midwife) are not less than 10 hours a week;

38.3. the general practitioner who has more than 2400 persons registered with him or her ensures that:

38.3.1. at least one of the medical practitioners employed at the practice of the general practitioner is a doctor's assistant (feldsher), except for the case when the resident is trained at the practice of the general practitioner and functions of the receptionist are carried out by another person;

38.3.2. there is a room that is separated from the workplace of the general practitioner at the practice of the general practitioner where the medical practitioners employed at the practice of the general practitioner can provide health care services according to their competence.

[14 July 2020]

39. The general practitioner shall, jointly with medical practitioners employed at the practice of the general practitioner, ensure health care for patients at the place of practice of the general practitioner (or workplace if the general practitioner is an employee in a medical treatment institution) and at the places of residence of patients in accordance with the following procedures:

39.1. the reception hours of patients of the general practitioner shall be determined (the total working hours shall be added up if the general practitioner has several places of reception):

39.1.1. not less than 20 hours a week if the number of persons registered in the practice is up to 2000, including not less than 15 hours a week at the principal practice if the general practitioner has several places of reception;

39.1.2. not less than 25 hours a week if the number of persons registered in the practice is more than 2000, including not less than 19 hours a week at the principal practice if the general practitioner has several places of reception;

39.1.3. according to the conditions regarding other reception hours at the principal practice if the general practitioner has agreed thereupon with the Service in the following cases:

39.1.3.1. the number of patients registered in the practice is less than 500 patients;

39.1.3.2. the general practitioner has more than two additional places of reception;

39.1.3.3. similar number of registered patients live in each administrative territory which is part of the basic area of operation of the general practitioner;

39.2. the working hours of the practice shall be determined as not less than 40 hours a week, ensuring the availability of the general practitioner or a medical practitioner employed at the practice of the general practitioner at the place of principal practice of the general practitioner during these hours;

39.3. the reception hours of the general practitioner shall be determined in a way that at least once a week the reception of patients is ensured from 8.00 and at least once a week - until 19.00, except for the case when the general practitioner has agreed upon other procedures with the Service;

39.4. the reception hours for persons without a prior appointment (for acute patients) shall be determined as not less than one hour each day, ensuring the availability of the general practitioner for such persons on the same day when the person has turned to the practice of the general practitioner or on the following working day if the person has turned to the practice of the general practitioner after the end of the reception hours of the general practitioner;

39.5. the time of reception shall be determined for persons with a prior appointment;

39.6. the primary health care services shall be ensured within five working days. In order to ensure the service within five working days, the general practitioner shall, if necessary, extend the reception hours of patients;

39.7. patients shall be provided with an opportunity to apply for house visits on working days at least until 15.00.

40. The general practitioner may organise an external reception at a feldsher station located in the basic area of operation of the general practitioner, coordinating the schedule of external visits with the Service.

41. If the absence of the general practitioner exceeds:

41.1. five days but does not exceed two months - the general practitioner shall inform the Service of the time of his or her absence and submit information accepted by the substitute regarding substitution and its conditions in writing;

41.2. two months - the Service shall suspend the contract with such general practitioner and shall enter into a fixed-term contract with his or her substitute if the general practitioner submits a document to the Service justifying his or her absence, certifying that:

41.2.1. the general practitioner is on a parental leave;

41.2.2. the general practitioner is incapacitated for work, and such incapacity for work is lasting for more than two months;

41.2.3. training related to health care and lasting not more than six months is planned, provided that the general practitioner may participate in the training not more than once every three years.

42. Outside the working hours of general practitioners:

42.1. the health care services provided by the general practitioner (except for house visits) and the determination of the fact of death of a person who has died in domestic environment in a city may be ensured by a doctor on duty who receives patients on working days after 15.00 and on weekends according to the schedule of working hours of the doctor on duty specified in the contract with the Service;

42.1.¹ the health care services provided by the general practitioner (except for house visits) may be ensured by a doctor on duty working at a level V medical treatment institution (except for specialised medical treatment institutions) who receives patients according to the schedule of working hours of the doctor on duty specified in the contract with the Service;

42.2. on working days during the hours from 17.00 to 8.00 and on weekends throughout day and night persons may receive medical consultations and recommendations for action in case of exacerbation of acute or chronic diseases also using the general practitioner's consultative telephone number.

[7 May 2019; 8 July 2025]

43. The general practitioner shall ensure information to the patient regarding the procedures for the receipt of primary health care services provided by the general practitioner during working hours, outside working hours, and in case of substitution, and also information regarding the possibilities of receiving other health care services. The general practitioner shall ensure that information regarding substitution is publicly available at his or her workplace.

44. The general practitioner shall ensure substitution of the medical practitioners employed at his or her practice during their absence, taking into account the amount of obligations to be performed by such medical practitioners and the competence of medical practitioners specified in laws and regulations.

45. If the general practitioner is an employee in a medical treatment institution, substitution of the general practitioner and the medical practitioners employed by the general practitioner shall be ensured by the medical treatment institution.

3.4. Health Care at Home

46. If a person requires an outpatient health care service but he or she is unable to arrive to a medical treatment institution for the receipt of such service due to medical indications, such service shall be provided to the person at home if:

46.1. the person has a chronic disease and movement disorders due to medical indications;

46.2. the person has been discharged from an inpatient medical treatment institution or from a day hospital after a surgical intervention;

46.3. the person with a cerebrovascular disease (according to the ICD-10, diagnosis codes I60, I61, I63, I64, or I69) requires medical rehabilitation services and their provision has been commenced within three months after the beginning of the disease;

46.4. medical rehabilitation services are necessary to such children who are registered with the palliative care consulting room of the State limited liability company Children's Clinical University Hospital;

46.5. the person with sequelae of injury of the spinal cord (in accordance with the ICD-10, diagnosis code T91.3) which manifests as tetraplegia or paraplegia and for the majority of muscles under the damage the strength is less than three points requires medical rehabilitation services after receipt of the primary medical rehabilitation in the programme of inpatient services "Rehabilitation for Patients with Cross-sectional Injury of the Spinal Cord (Spinal Patients)" if a doctor of rehabilitation and physical medicine employed at valsts sabiedrība ar ierobežotu atbildību "Nacionālais rehabilitācijas centrs "Vaivari"" [State limited liability company National Rehabilitation Centre Vaivari] refers to such services.

47. A person shall receive health care services at home in conformity with the following conditions:

47.1. if there is a referral of the general practitioner or a referral of the medical treatment institution after discharging from the inpatient medical treatment institution or day hospital (except for medical rehabilitation services) and the following information has been indicated in the referral:

47.1.1. diagnosis due to which health care at home is necessary;

47.1.2. diagnosis due to which there are movement disorders;

47.1.3. instructions of the attending physician for health care at home, including for administration of medicinal products;

47.1.4. the time period during which health care at home must be ensured;

47.2. in order to receive medical rehabilitation services, there must be a referral of a doctor of rehabilitation and physical medicine to which a medical rehabilitation plan developed in accordance with the procedures laid down in this Regulation has been appended.

48. Health care services at home shall be provided by a nurse or a certified doctor's assistant (feldsher) but medical rehabilitation services at home - by a certified physiotherapist, occupational therapist, or audio speech therapist. Health care services at home shall be provided only by such persons referred to in this Paragraph who work at a medical treatment institution which has entered into a contract with the Service for the provision of health care services at home and payment for them.

[4 April 2023]

49. [19 November 2024]

50. A medical treatment institution which provides health care services at home shall ensure:

50.1. the possibility for persons to apply health care services at home on working days from 9.00 to 16.00, on weekends and holidays from 9.00 to 13.00;

50.2. the provision of the service is commenced not later than within 24 hours from the moment of receipt of the application;

50.3. the provision of such services on working days, weekends, and holidays.

51. A health care service provider which provides health care services at home shall, within three working days, inform the general practitioner of the person (if the person is not registered with a general practitioner - the general practitioner of the basic area according to the actual place of residence of the person) regarding commencement of the relevant service, making a note thereon in the medical card of the person.

52. The duration of one episode for health care services at home for a person with a chronic disease and movement disorders due to medical indications shall be up to 30 calendar days, except for medical rehabilitation, continuous mechanical ventilation of lungs, and parenteral feeding of children. If it is necessary to receive health care services at home for a longer period of time, the general practitioner shall visit the person within two working days before the end of the abovementioned time period and provide an opinion to the service provider on the necessity to continue the provision of the relevant service or to discontinue it.

53. After discharging from an inpatient medical treatment institution or day hospital due to a surgical intervention the duration of provision of health care services at home shall be up to 10 calendar days. If the health care service at home is required for a longer period of time, the general practitioner shall, upon request of the relevant service provider, visit the person and provide an opinion on the necessity to continue the provision of the relevant service or to discontinue it.

54. Health care services at home shall be provided for a person who requires medical rehabilitation services until the time indicated in the referral and in the medical rehabilitation plan, but not longer than for 60 calendar days. If the health care service at home is necessary for a longer period of time, the doctor of rehabilitation and physical medicine shall visit the person within two working days before the end of the abovementioned time period and provide an opinion to the service provider on the necessity to continue the provision of the relevant service or to discontinue it. The total period of medical rehabilitation provided at home for persons with sequelae of injury of the spinal cord who receive medical rehabilitation service at home as a continuation of the receipt of primary medical rehabilitation at an inpatient medical treatment institution may not exceed six months.

55. The service provider, after it has terminated the provision of health care services at home, shall submit to the general practitioner of the person or to the general practitioner of the basic area according to the actual place of residence of the person, and also to the person an opinion on the health care service provided.

3.4.¹ Mobile Palliative Care Team Service

[19 December 2023]

55.¹ The provider of the mobile palliative care team service shall ensure services in accordance with the laws and regulations regarding the procedures for organising, financing, and receiving palliative care and also shall ensure the following:

55.¹1. the possibility to apply for the palliative care service at the place of residence of the patient 24 hours a day, including on weekends and public holidays;

55.¹2. patient assessment and preparation of an individual palliative care plan and implementation thereof;

55.¹3. provision of information to the general practitioner of the person (if the person is not registered with a general practitioner, then the general practitioner for the basic area of operation according to the actual place of residence of the person) on the commencement of the relevant service no later than within three working days from the moment the service is commenced.

[19 December 2023]

55.² Health care services provided by the mobile palliative care team at the place of residence of the patient shall be provided by medical practitioners in accordance with the procedures laid down in the contract with the Service.

[19 December 2023]

55.³ After terminating the provision of the mobile palliative care team service, the service provider shall prepare a report on the examination/treatment of the outpatient in accordance with the laws and regulations regarding a unified electronic information system of the health sector and shall enter it into the health information system.

[19 December 2023]

3.5. Secondary Health Care

56. A person shall receive State paid secondary health care services:

56.1. upon referral of a general practitioner or a specialist, except for positron emission tomography examinations with computer tomography for the receipt of which a decision of the doctors' council is necessary or, in the case of the ICD-10 diagnosis with codes C43, C62, C81-C86.6, a referral of a haematologist, oncologist chemotherapist, or paediatric haemato-oncologist;

56.2. by turning to the following direct access specialists upon his or her own initiative:

56.2.1. a psychiatrist or paediatric psychiatrist if the person is suffering from a mental illness (in accordance with the ICD-10, diagnosis codes F00-F09, F20-F62, F63.1-F99);

56.2.2. a narcologist;

56.2.3. a pneumonologist if the person is ill with tuberculosis (in accordance with the ICD-10, diagnosis codes A15-A19, B90, J65, P37.0, R76.1, Y58.0, Y60.3, Z03.0, Z20.1, Z22.7);

56.2.4. a dermatovenerologist if the person is ill with a sexually transmitted disease (in accordance with the ICD-10, diagnosis codes A50-A64, B35.0,4,8, B37.3,4, B86, L01.1, L08.0, L24.4, L30.2, Z11.3,4, Z20.2,6, Z22.4, Z29.2, Z86.1);

56.2.5. an endocrinologist if the person is ill with diabetes mellitus (in accordance with the ICD-10, diagnosis codes E10-E11.8; E12-E14.9);

56.2.6. an oncologist chemotherapist if the person is ill with an oncological disease (in accordance with the ICD-10, diagnosis codes C00-C97, D00-D09, D37-D48);

56.2.7. a gynaecologist;

56.2.8. an ophthalmologist;

56.2.9. a paediatric surgeon;

56.2.10. a paediatrician;

56.2.11. an infectologist if:

56.2.11.1. a person is ill with human immunodeficiency virus (hereinafter - HIV) infection (in accordance with the ICD-10, diagnosis codes B20-B24, Z21) or hepatitis C infection (in accordance with the ICD-10, diagnosis codes B17.1, B18.2);

56.2.11.2. a person has undergone an HIV rapid test using capillary blood or saliva with a positive result (in accordance with the ICD-10, diagnosis code Z20.6) or a hepatitis C rapid test with a positive result (in accordance with the ICD-10, diagnosis code Z20.5), or a hepatitis B rapid test with a positive result (in accordance with the ICD-10, diagnosis code Z20.5) at an HIV prevention point which has a cooperation contract with the Centre for Disease Prevention and Control;

56.2.11.3. he or she is a contact person (in accordance with the ICD-10, diagnosis code Z20.6) for a person with diagnosed HIV infection who receives medical treatment at an inpatient medical treatment institution;

56.2.12. a sports doctor in the State limited liability company Children's Clinical University Hospital;

56.2.13. specialists who provide services in the mood disorder consulting room for children;

56.2.14. a midwife for receiving birth assistance during pregnancy and the postnatal period in accordance with the laws and regulations regarding the procedures for providing birth assistance;

56.3. by turning to medical treatment institutions upon his or her own initiative, including to emergency room in order to receive emergency medical assistance;

56.4. upon referral of an emergency medical assistance team;

56.5. within the scope of the State organised screening of breast and cervical cancer, by turning to a medical treatment institution implementing the screening programme upon her own initiative (if there is a valid letter of invitation in the management information system of the Service) or with the letter of invitation sent by the Service;

56.6. with the letter of invitation sent by the Service for the receipt of medically assisted insemination service.

[10 December 2019; 14 July 2020; 17 December 2020; 4 April 2023; 5 September 2023; 19 November 2024]

57. The general practitioner or specialist shall draw up the referral for the receipt of secondary health care services in accordance with the laws and regulations regarding the unified electronic information system of health sector. In exceptional case, if a special form of referral is necessary for outpatient laboratory services as well as other services, the conditions for the drawing up of the referral are specified in the contract of the Service with the medical treatment institution.

[10 December 2019]

58. The medical treatment institution shall inform the general practitioner or specialist who issued the referral of the secondary health care service provided and:

58.1. if the person requires further examinations or consultations, issue a referral to the person for the receipt of such services;

58.2. if necessary, prescribe the reimbursable medicinal products and medical devices in accordance with the laws and regulations regarding the procedures for reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for the outpatient medical treatment.

59. The medical treatment institution shall ensure the issuance of the results of examinations to the patient or medical practitioner who referred the patient for the performance of an examination not later than within five working days after performance of the examination or in other time if an agreement with the patient has been reached thereupon.

60. Medical treatment institutions shall mutually recognise the results of the performed examinations within a month from the day of performing the examination.

3.6. Conditions for the Formation of Queues for the Receipt of Health Care Services

61. A medical treatment institution shall form queues for the receipt of health care services in conformity with the following conditions:

61.1. the medical treatment institution shall provide health care services to children and pregnant women on a priority basis;

61.2. the medical treatment institution shall plan the provision of State paid health care services in a way to ensure the availability of health care services throughout the calendar year;

61.3. the medical treatment institution shall ensure the secondary outpatient health care service necessary to the person not later than within 10 working days in the following cases and according to the following procedures:

61.3.1. if the person requires the first consultation with an oncologist chemotherapist, haematologist, paediatric haemato-oncologist, or oncological gynaecologist - from the day when the person has turned to the medical treatment institution for the receipt of the service;

61.3.2. if the person has been referred to the primary diagnostic examination of malignant neoplasms or the primary diagnostic examination of malignant neoplasm recurrences in accordance with the conditions published on the website of the Service - from the day when the person has turned to the medical treatment institution for the receipt of the service;

61.3.3. if the person requires a consultation of such specialist who ensures secondary diagnostics of malignant neoplasms or secondary diagnostics of malignant neoplasm recurrences at a medical treatment institution indicated on the website of the Service - from the day when the person has been applied for the receipt of such service by a general practitioner, gynaecologist, or prison doctor, or by another specialist in cases where diagnostics of recurrences is necessary;

61.3.4. if a pregnant woman or a woman in the postnatal period up to 70 days requires a specialist consultation or an examination due to a sudden illness or exacerbation of a chronic disease that may endanger the health of the person or the course of pregnancy - from the day when the person has turned to the medical treatment institution for the receipt of the service;

61.4. the medical treatment institution shall, within the following time period counting from the day when the patient had turned to the medical treatment institution, ensure the provision of the necessary service to a patient with the diagnosis code Z03.5 who has been referred by the general practitioner for determination of the risk of cardiovascular diseases according to the procedures indicated on the website of the Service:

61.4.1. electrocardiogram - within three months or within one month if the general practitioner has made a note in the referral regarding high or very high risk of cardiovascular diseases;

61.4.2. echocardiogram - within six months or within three months if the general practitioner has made a note in the referral regarding high or very high risk of cardiovascular diseases;

61.4.3. carotid ultrasound - within six months or within three months if the general practitioner has made a note in the referral regarding high or very high risk of cardiovascular diseases;

61.4.4. cycle ergometry - within three months;

61.4.5. consultation of a specialist (cardiologist, vascular surgeon) - within a month if the general practitioner has made a note in the referral regarding high or very high risk of cardiovascular diseases.

[7 May 2019; 29 December 2021; 14 July 2022; 19 December 2023]

62. The medical treatment institution which according to the contract with the Service ensures the post-screening examinations referred to in this Regulation shall perform them within 30 days from the day when a person has turned to the medical treatment institution for the receipt of the service.

63. For a person with a predictable disability the medical treatment institution shall commence the provision of the State paid planned health care services which are included in the individual rehabilitation plan approved by the State Medical Commission for the Assessment of Health Condition and Working Ability within the following time periods:

63.1. outpatient health care services - within 15 working days;

63.2. planned outpatient and inpatient medical rehabilitation services - within 15 working days;

63.3. planned surgeries - within five months.

64. Medical treatment institutions which perform planned endoprosthetic replacement of large joints shall form and maintain the following queues of applicants for the receipt of State paid planned health care services:

64.1. endoprosthetic replacement as a matter of urgency according to the criteria specified in the contract with the Service;

64.2. endoprosthetic replacement according to general procedures;

64.3. dynamic observation programme.

[17 December 2020]

65. If a person who is in the queue for endoprosthetic replacement of large joints refuses the time offered for performing the surgery of endoprosthetic replacement of large joints or does not provide an answer within two months from the day of sending the offer, he or she shall be deleted from the abovementioned queue.

66. An inpatient medical treatment institution which provides surgical assistance shall plan the provision of inpatient health care services in the following priority order:

66.1. emergency medical assistance;

66.2. planned surgical assistance in the following cases:

66.2.1. surgical treatment for children;

66.2.2. surgical treatment in case of inflammatory bowel diseases;

66.2.3. surgical treatment of hormonally active endocrine glands;

66.2.4. planned surgeries for persons who have been ill for a protracted period of time and who are of the working age to the extent specified in Sub-paragraph 4.10 of this Regulation;

66.2.5. for persons with a predictable disability according to the individual rehabilitation plan approved by the State Medical Commission for the Assessment of Health Condition and Working Ability;

66.2.6. surgical treatment in the programmes of health care services indicated in Paragraph 2 of Annex 6 to this Regulation;

66.3. other planned surgeries performed at the inpatient medical treatment institution which, in accordance with this Regulation, are included in the amount of the State paid health care services.

67. The Service shall form a centralised queue of applicants for the receipt of State paid health care services of medically assisted insemination (hereinafter - the register of queues) in conformity with the following conditions:

67.1. the procedures by which medical treatment institutions ensuring State paid services of medically assisted insemination shall provide information to the Service regarding persons who require health care services of medically assisted insemination for the receipt of which the Service maintains the register of queues shall be determined in the contract with the Service;

67.2. the following information shall be included in the register of queues:

67.2.1. the given name, surname, personal identity number, electronic mail address, telephone number of the person;

67.2.2. the date when the person was accepted into the queue and the medical treatment institution in which the person has been accepted into the queue;

67.2.3. the sequence number of the person in the queue;

67.2.4. the date when the invitation regarding the possibility to receive a State paid service was sent;

67.2.5. information regarding the process and result of provision of the service;

67.3. the Service shall send the invitation to the patient to receive the service at any medical treatment institution providing State paid services of medically assisted insemination to the electronic mail address indicated in the register of queues (official electronic address if an e-address account has been activated for the patient);

67.4. the Service shall determine the number of invitation letters to be sent to persons according to the financial resources available.

68. A person shall be excluded from the queue referred to in Paragraph 67 of this Regulation if:

68.1. receipt of health care service is not necessary for the person or is not possible due to medical indications;

68.2. the person does not meet the criteria for the receipt of the health care service of medically assisted insemination anymore;

68.3. the person has refused to receive a State paid health care service of medically assisted insemination;

68.4. within six months since sending of the invitation the person has not turned to the medical treatment institution for receipt of the health care service of medically assisted insemination;

68.5. the person has died or has lost the right to receive a State paid service of medically assisted insemination.

3.7. Secondary Outpatient Health Care

69. In order for a person to receive a secondary outpatient health care service, a general practitioner or specialist shall jointly with the person choose the place of receipt of the health care service, assessing the urgency of receipt of the service, and shall inform the person of the necessity to apply to the relevant medical treatment institution for the receipt of the health care service, except for the case if the person needs a consultation of such specialist after primary diagnostics of malignant neoplasms who ensures secondary diagnostics of malignant neoplasms. In such case the general practitioner, the prison doctor, or the gynaecologist shall apply the person for the receipt of the consultation and inform him or her of the planned time for the receipt of the service.

69.¹ When organising the provision of outpatient psychiatric assistance, the initial assessment of the patient shall be performed by the general practitioner, psychiatrist, or paediatric psychiatrist who shall refer the patient to a clinical and health psychologist or psychotherapist for the receipt of the service, specifying the required number of visits in the referral, except for cases when the patient is referred to the service provider specified in Paragraph 5.¹ of this Regulation. In such cases, assistance shall be provided without exceeding the number of visits referred to in Sub-paragraph 4.7.8 of this Regulation.

[19 November 2024]

70. Types of State paid secondary outpatient health care services which are provided by each medical treatment institution shall be determined in the contract with the Service and published on the website of the Service.

71. In order to detect precancerous diseases and cancer at early stages, the Service shall organise and supervise the State organised screening which is a health care programme based on the data of the Register of Natural Persons involving sending of centralised invitations and continuous monitoring of results. The State organised screening shall include the following screening and post-screening examinations for the following target groups:

71.1. cervical cancer screening which shall be performed:

71.1.1. using the liquid-based cytology method for women at the age of 25 and 28;

71.1.2. using the human papillomavirus testing method once every five years for women from 30 to 70 years of age;

71.2. colorectal cancer screening which shall be performed once every two years for patients 50 to 74 years of age as a screening test for colorectal cancer;

71.3. breast cancer screening with the mammography method which is performed once in two years for women from 50 to 69 years of age;

71.4. prostate cancer screening which shall be performed once every two years for men from 50 to 75 years of age and for men from 45 years of age if there is a family history of prostate cancer.

[14 July 2002]

72. State organised screening shall be performed in conformity with the following conditions:

72.1. the Service shall send an invitation letter for cervical cancer screening to women at the age and within the period referred to in Sub-paragraph 71.1 of this Regulation, except for the following cases:

72.1.1. if according to the information in the management information system of the Service the woman has undergone the following:

72.1.1.1. cervical amputation;

72.1.1.2. extirpation of the uterus with removal of Fallopian tubes or without removal of Fallopian tubes;

72.1.1.3. vaginal extirpation of the uterus;

72.1.1.4. extirpation of the uterus during childbirth or in early period following childbirth with removal of appendages or without removal of appendages;

72.1.1.5. the Wertheim's operation;

72.1.1.6. extirpation of the uterus with lymphadenectomy of true pelvis or deomentisation;

72.1.1.7. laparoscopic hysterectomy with or without appendages;

72.1.2. if according to the information in the management information system of the Service the woman has undergone a cytological examination of cervix within a year until the date of preparation of the invitation letter;

72.1.3. if the diagnosis C53, C54, C56, or C57 (in accordance with ICD-10) has been indicated for the woman in the register of patients suffering from certain diseases;

72.1.4. if at the time of preparation of the invitation letter the woman did not have a declared place of residence in the Republic of Latvia;

72.2. the Service shall, once in two years, send an invitation letter regarding the organised breast cancer screening to the women of the target group, except for the following cases:

72.2.1. if the diagnosis C50 (in accordance with ICD-10) has been indicated for the woman in the register of patients suffering from certain diseases;

72.2.2. if according to the information in the management information system of the Service the woman has undergone a mammography examination within a year until the date of preparation of the invitation letter;

72.2.3. if at the time of preparation of the invitation letter the woman did not have a declared place of residence in the Republic of Latvia;

72.3. the practice of a general practitioner shall, once every two years, provide information on the organised colorectal cancer screening to the patients of the target group registered at the respective practice of the general practitioner and also shall invite to perform the fecal occult blood test and ensure the performance of such test, except for the following cases:

72.3.1. if the practice of a general practitioner has information that the patient has been morphologically diagnosed with diagnosis C18, C19, C20 or C21 (in accordance with the ICD-10);

72.3.2. if the practice of a general practitioner has information that the person has undergone a colonoscopy examination during the previous calendar year;

72.4. information on the prostate cancer screening shall be provided to target group patients registered at the practice of a general practitioner by the practice of a general practitioner, and a referral for the examination shall be issued once every two years.

[17 December 2020; 27 April 2021; 14 July 2022]

73. The conditions for the performance of primary and secondary diagnostics of malignant neoplasms and primary and secondary diagnostics of malignant neoplasm recurrences at medical treatment institutions shall be published on the website of the Service, providing for preconditions in order to ensure taking of a decision on the tactic of medical treatment of a patient within one month from the moment when secondary diagnostics of a malignant neoplasm or secondary diagnostics of a recurrence has been commenced for the person.

[29 December 2021]

74. The Coordination Centre of Rare Diseases which has been established by the State limited liability company Children's Clinical University Hospital and which, on the basis of a mutual agreement, cooperates with valsts sabiedrība ar ierobežotu atbildību "Paula Stradiņa klīniskā universitātes slimnīca" [State limited liability company Pauls Stradiņš Clinical University Hospital] and limited liability company Riga East University Hospital shall ensure:

74.1. coordination of the flow of patients with rare diseases, referring the patient with a rare disease for further medical treatment to the State limited liability company Children's Clinical University Hospital, the State limited liability company Pauls Stradiņš Clinical University Hospital, or the limited liability company Riga East University Hospital accordingly;

74.2. a doctors' council for the determination of the specific treatment with medicinal products of rare diseases for the diagnoses indicated in the laws and regulations regarding the procedures for the reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for outpatient medical treatment and for further monitoring or genetic diagnostics;

74.3. a doctors' council for the determination of pulmonary transplantation;

74.4. the methodological management of rare diseases, forming a uniform approach in medical treatment of rare diseases;

74.5. issuance of the patient card for a patient with a rare disease.

[29 December 2021]

75. For patients with rare diseases:

75.1. a decision on the provision of the pulmonary endarterectomy service shall be taken by a doctors' council organised by the State limited liability company Pauls Stradiņš Clinical University Hospital or the limited liability company Riga East University Hospital in the composition of not less than three doctors, with the participation of a vascular surgeon and a cardiologist;

75.2. after taking of the decision on the specific treatment with medicinal products of rare diseases and upon commencing the administration of the medicinal products by the patient, the Coordination Centre of Rare Diseases shall monitor whether the administration of medicinal products achieves the initially intended result of medical treatment. If the initially intended result of medical treatment is not achieved, the doctors' council organised at the Coordination Centre of Rare Diseases has the right to repeatedly decide on the necessity of the specific treatment with medicinal products, revoking or changing the assigned medical treatment and informing the patient with the rare disease of the decision taken.

76. The conditions for the health care services provided at consulting rooms of health care services shall be determined in the contract with the Service.

77. Pain control and control of other symptoms shall be performed on a priority basis within the scope of palliative care, ensuring the needs necessary for the patient regardless of the place where he or she is located - at home or in an inpatient medical treatment institution - and retaining the best possible quality of life until the moment when death sets in.

78. A medical treatment institution which receives a monthly fixed payment for the work of specialists or units of medical treatment institutions (except for the payment for the work of the emergency room) shall ensure that the working hours of the relevant specialist or consulting room has been specified according to the following conditions:

78.1. for one load of a doctor - reception of patients for not less than 30 hours a week;

78.2. for one load of a nurse - work for not less than 40 hours a week.

79. Tertiary health care shall be organised and financed from the State budget funds in accordance with the procedures by which secondary health care is organised and financed.

3.8. Health Care Provided at a Day Hospital

80. Such health care services shall be provided at a day hospital which cannot be provided on an outpatient basis due to their complexity, risk, or them being time-consuming, but due to which admission of a patient into an inpatient hospital for ensuring day-and-night monitoring by medical practitioners is not necessary.

81. The health care services to be provided at a day hospital shall be medical treatment or diagnostic services during the provision of which medical treatment and health care is ensured to the person at the medical treatment institution for partial day-and-night (not earlier than from 6.00 and not later than until 22.00), manipulations are performed for not less than three hours, or observation of the person is ensured after performance of manipulations, and they display the following characteristic signs:

81.1. admission one or several times;

81.2. the time period between two consecutive admissions is at least six hours;

81.3. the duration of one admission is up to 16 hours.

82. The State paid services to be provided at a day hospital are indicated in Annex 5 to this Regulation.

83. Examinations, medical treatment procedures, and surgeries which are not directly related to the services to be provided at the day hospital and which, in accordance with the laws and regulations regarding the mandatory requirements for medical treatment institutions or their units, may be performed at the day hospital in an equipped consulting room of a specialist or procedures shall not be performed in a day hospital.

84. The health care services of the day hospital according to their potential risk of complications shall be as follows:

84.1. first level health care service of the day hospital - shall be provided by the medical treatment institution which has an intensive care unit, an anaesthesiology unit, and a blood transfusion room;

84.2. second level health care service of the day hospital - the medical treatment institution does not require an intensive care unit, an anaesthesiology unit, or a blood transfusion room for the provision of such service.

85. If it is intended to provide an invasive cardiology, interventional radiology, or surgical service (hereinafter - the surgical operation) to a person at the day hospital, prior to the issuance of a referral the general practitioner or specialist shall assess the following:

85.1. the age, health condition of the person and, according to the medical indications, shall refer the person for the performance of such examinations which are necessary to assess whether the surgical operation could be performed at a day hospital;

85.2. the risk of complications of the necessary surgical operation;

85.3. the communication abilities of the person (the ability to understand and comply with the recommendations regarding further care after performance of the surgical operation);

85.4. the possibilities of the person to receive medical assistance after the surgical operation if it is going to be necessary, also ascertain whether a phone is available to the person;

85.5. whether pain control after the surgical operation may be ensured, using oral analgesics or regional anaesthetic.

86. The medical treatment institution which performs the surgical operation at a day hospital shall ensure that:

86.1. the patient is admitted once for the performance of the surgical operation at the day hospital;

86.2. prior to the surgical operation the attending physician informs the patient of the planned operation, and also of movement of the patient to an inpatient medical treatment institution if complications are to arise for the patient and monitoring by medical practitioners will be necessary outside the working hours of the day hospital (after 22.00);

86.3. after the surgical operation the attending physician assesses the health condition of the patient;

86.4. the patient is transferred to an inpatient medical treatment institution which ensures day-and-night emergency medical assistance if due to medical reasons he or she requires monitoring of medical practitioners outside the working hours of the day hospital (after 22:00), except for the case if the medical treatment institution concurrently meets the following conditions:

86.4.1. the medical treatment institution has the staff resources and it ensures monitoring of the patient in the necessary amount;

86.4.2. the patient is discharged from the day hospital not later than on the following day after admission into the day hospital;

86.4.3. the medical treatment institution provides first level health care services of a day hospital;

86.5. upon discharging the patient from the day hospital to home, the attending physician provides recommendations to the patient for postoperative care, and also informs of the visiting hours of the specialist for repeated assessment of the health condition, if necessary.

87. If a person requires laboratory testing which is directly related to the health care service to be provided in the day hospital, the specialist which sends the sample of the material to be examined for laboratory testing shall indicate in the referral that the person is a patient of a day hospital.

3.9. Health Care Provided at an Emergency Room and in the Reception Ward

88. If a person has a trauma, an acute disease, or exacerbation of a chronic disease and requires urgent intervention by medical practitioners, and also if the necessary assistance is beyond the competence of the primary health care practitioner, the person may receive the necessary health care services:

88.1. at an emergency room which has been established in the medical treatment institutions referred to in Annex 10 to this Regulation;

88.2. in the reception ward of an inpatient medical treatment institution.

89. If a person who has turned to an emergency room, according to the health condition, requires emergency medical treatment at an inpatient medical treatment institution, the medical treatment institution shall call an emergency medical assistance team to deliver the person to the nearest corresponding inpatient medical treatment institution, taking into account the health condition of the person and the conditions referred to in the contracts of the Service with medical treatment institutions.

90. If a person has turned to the reception ward of an inpatient medical treatment institution and it is not necessary to admit the person, outpatient health care services are provided to the person at the reception ward of the inpatient medical treatment institution.

90.¹ If health care has been provided to a child in the reception ward of the State limited liability company Children's Clinical University Hospital and this child has not been hospitalised, the hospital shall inform the general practitioner of the person of the health care services provided and shall provide recommendations for further health care.

[19 November 2024 / Paragraph shall come into force on 1 January 2025. See Paragraph 280.¹]

91. If incapacity for work has been detected for a person who has turned to an emergency room or the reception ward of an inpatient medical treatment institution, the medical treatment institution shall ensure the issuance of a sick-leave certificate to a person in accordance with the regulatory enactment determining the procedures by which temporary incapacity for work of a person is certified.

92. The medical treatment institution which provides health care services at an emergency room shall ensure that:

92.1. the urgent medical assistance is available at least 12 hours a day and shall agree with the Service regarding specific working hours in the contract in conformity with the following conditions:

92.1.1. working hours on working days are primarily specified in the time period from 16.00 to 8.00, working hours outside this time period are determined only in case if the emergency room is open for more than 12 hours;

92.1.2. working hours on weekends and holidays may be specified within the scope of the whole 24 hours;

92.2. the urgent medical assistance is provided by at least one doctor and at least one doctor's assistant (feldsher) or a nurse, except for the case when the Service has agreed with the medical treatment institution on other procedures.

[7 May 2019]

3.10. Inpatient Health Care

93. In order for a person who requires 24-hour monitoring by a medical practitioner to receive an inpatient health care service, the general practitioner or specialist shall issue a referral to the person in conformity with the following conditions:

93.1. jointly with the person (except for a person who is in a place of imprisonment) choose the inpatient medical treatment institution, assessing the urgency of receipt of the service;

93.2. indicate in the referral or append to the referral an extract with the results of examination which justify the particular objective of referral and the health condition of the person.

94. In order for a person who is in a place of imprisonment to receive a planned inpatient health care service, the prison doctor shall, on the basis of the medical indications and urgency, agree on the time of provision of the service with the inpatient medical treatment institution where it is possible to receive the relevant service.

95. State paid inpatient health care services shall be provided to a person by the inpatient medical treatment institutions referred to in Annex 6 to this Regulation according to the level specified for each medical treatment institution (the level of services to be ensured) in conformity with the payment conditions of inpatient health care services specified in Annex 6 to this Regulation and in the contract with the medical treatment institution.

[7 May 2019]

96. If an admitted person has medical indications for the receipt of such inpatient health care services which are provided by an inpatient medical treatment institution of higher level, the inpatient medical treatment institution shall ensure movement of the person for admission to the inpatient medical treatment institution of the corresponding level.

97. If an admitted person has medical indications for the receipt of such health care services which are not provided by the inpatient medical treatment institution, the inpatient medical treatment institution shall ensure the delivering of the person to another medical treatment institution for the receipt of the necessary medical manipulations and back to the inpatient medical treatment institution. In such case the Service shall cover the expenses for the manipulations for such inpatient medical treatment institution in which the person is admitted. The relevant inpatient medical treatment institution shall settle the accounts with the performer of manipulations.

98. If the medical treatment institution temporarily discontinues any inpatient health care service which has been specified in the contract entered into with the Service, the former shall cover expenses for the inpatient health care services provided to the patient in another medical treatment institution during this period of time and reach an agreement regarding the payment procedures with the medical treatment institution which has actually provided the relevant health care service.

99. The inpatient medical treatment institution has the right to reach an agreement (by entering into a relevant agreement) with another medical treatment institution regarding delivering of the patients to such medical treatment institution for the receipt of the necessary health care services also in other cases not referred to in this Regulation, including reaching an agreement regarding the procedures for mutual settlement of accounts and other issues, informing the Service thereof.

100. The medical treatment institution shall ensure that a doctor of rehabilitation and physical medicine evaluates the person who is discharged from the inpatient medical treatment institution after medical treatment of a cerebrovascular disease (in accordance with the ICD-10, diagnosis codes I60, I61, I63, and I64). If the relevant person requires medical rehabilitation services, he or she shall be issued a referral of a doctor of rehabilitation and physical medicine and a rehabilitation plan for the receipt of medical rehabilitation prepared in accordance with the procedures laid down in this Regulation. The medical treatment institution shall ensure the following to other persons with functional restrictions for whose medical treatment medical rehabilitation is required and who are discharged from the inpatient medical treatment institution:

100.1. the preparation of a referral of a doctor of rehabilitation and physical medicine and a rehabilitation plan if a doctor of rehabilitation and physical medicine is employed at the medical treatment institution;

100.2. the preparation of recommendations of the attending physician regarding the necessity of further medical rehabilitation, describing the rehabilitation commenced at the inpatient institution, if a doctor of rehabilitation and physical medicine is not employed at the medical treatment institution.

[7 May 2019]

3.11. Medical Rehabilitation

[7 May 2019]

101. The objective of medical rehabilitation services is to ensure the reduction or elimination of functional restrictions for persons with specific functional restrictions, and also the assessment and reduction of the risk of complications.

[7 May 2019]

102. The medical rehabilitation services shall be as follows:

102.1. services of acute rehabilitation which are provided concurrently with medical treatment of an acute disease or an exacerbation of a disease up to three months from the beginning of the disease or the moment of commencing medical treatment of the exacerbation of the disease;

102.2. services of subacute rehabilitation which are provided up to six months from the beginning of the disease or the moment of commencing medical treatment of the exacerbation of the disease;

102.3. long-term rehabilitation services in case of chronic functional restrictions which are provided for more than six months from the beginning of the disease or the moment of commencing medical treatment of the exacerbation of the disease, or in case of perinatal development disorders by including the patient in dynamic observation of medical rehabilitation.

[7 May 2019]

103. Medical rehabilitation services shall be organised in conformity with the following conditions:

103.1. by inpatient medical treatment institutions according to the profiles of medical treatment institutions and programmes of inpatient health care services specified in Annex 6 to this Regulation;

103.2. at a day hospital - acute (only for children), subacute, and long-term medical rehabilitation services;

103.3. on an outpatient basis - acute, subacute, and long-term medical rehabilitation services.

[7 May 2019]

104. Selection of persons (including persons with oncological diseases) for the receipt of State paid medical rehabilitation services shall be performed:

104.1. by a doctor of rehabilitation and physical medicine who, upon a person undergoing medical treatment at an inpatient medical treatment institution or being discharged from an inpatient medical treatment institution in the cases referred to in Paragraph 100 of this Regulation, or upon consulting a person on an outpatient basis, shall examine the person or assess the referral of another doctor or medical documentation prepared by the functional specialist;

104.2. in case of psychiatric assistance - by a psychiatrist or paediatric psychiatrist;

104.3. in case of narcological assistance - by a narcologist;

104.4. by a general practitioner or specialist if rehabilitation services provided by the functional specialist up to five visits are required for a patient whose functional restrictions in one type of functioning conform to the International Classification of Functioning, Disability and Health.

[7 May 2019]

105. Upon performing the selection of persons for the receipt of rehabilitation services, a doctor of rehabilitation and physical medicine (or a psychiatrist, paediatric psychiatrist, or narcologist accordingly) shall evaluate:

105.1. the health condition of the person and the functional restrictions related thereto;

105.2. the potential of medical rehabilitation;

105.3. the motivation of the person and his or her relatives;

105.4. the stability of the health condition for the receipt of rehabilitation services;

105.5. the type of receipt of medical rehabilitation services which is the most optimal for the person, taking into account that medical rehabilitation services can be received at an outpatient medical treatment institution, including at a day hospital, at an inpatient medical treatment institution, and at home.

[7 May 2019]

106. A medical treatment institution shall provide medical rehabilitation services in the following priority order, taking into account that children up to three years of age with high risk for the development of functional disorders, children from three to six years of age with moderately severe and severe functional restrictions, and employees of emergency service who have suffered damage to health in rescue operations in disasters with more than five victims, shall be the first to receive rehabilitation services in the indicated groups of persons:

106.1. persons with acute and subacute functional disorders manifesting as restrictions of communication, cognitive abilities, movement, self-care, instrumental activity of daily living;

106.2. persons with subacute functional restrictions which restrict the capacity for work of the person and may cause disability;

106.3. persons with chronic functional restrictions at the intervals specified in the rehabilitation plan if the person is under dynamic observation;

106.4. other persons with functional restrictions.

[7 May 2019]

107. Medical rehabilitation services shall be provided by a doctor of rehabilitation and physical medicine (or a psychiatrist, paediatric psychiatrist, or narcologist accordingly) and functional specialists in the form of consultations, multiprofessional or monoprofessional medical rehabilitation services in conformity with the procedures indicated in Paragraphs 108 and 109 of this Regulation.

[7 May 2019]

108. A monoprofessional medical rehabilitation service is an individual rehabilitation service provided by a doctor of rehabilitation and physical medicine (or a psychiatrist, paediatric psychiatrist, or narcologist accordingly) or a functional specialist for the provision of which other medical practitioners and medical support persons may be attracted and which is provided on an outpatient or inpatient basis within the scope of acute rehabilitation.

[7 May 2019]

109. A multiprofessional medical rehabilitation service is a specialised form of organising a medical rehabilitation service which is implemented by a multiprofessional medical rehabilitation team at a day hospital or inpatient medical treatment institution in conformity with the following conditions:

109.1. the service is provided by a doctor of rehabilitation and physical medicine (or a psychiatrist, paediatric psychiatrist, or narcologist accordingly) and functional specialists with the participation of medical practitioners and medical support persons as well as clinical or health psychologists;

109.2. the specialists to be involved in ensuring of a multiprofessional medical rehabilitation service are determined by a doctor of rehabilitation and physical medicine (or a psychiatrist, paediatric psychiatrist, or narcologist accordingly) who coordinates the work of the multiprofessional team;

109.3. a multiprofessional medical rehabilitation service is provided:

109.3.1. as the base service which lasts two to three hours and includes individual work of functional specialists with the person, using at least three different medical technologies;

109.3.2. as the intensive rehabilitation course which lasts three to four hours and includes individual work of functional specialists with the person, using at least three different medical technologies;

109.4. meetings of the multiprofessional medical rehabilitation team take place at least once a week, and the decisions taken during meetings are recorded in the medical documentation of the patient.

[7 May 2019]

110. In case of chronic functional restrictions, if rehabilitation is required for more than six months, a psychiatrist, a paediatric psychiatrist, a narcologist, or a doctor of rehabilitation and physical medicine may include the person in dynamic observation of medical rehabilitation. A doctor of rehabilitation and physical medicine (or a psychiatrist, paediatric psychiatrist, or narcologist accordingly), upon implementing dynamic observation of medical rehabilitation, shall:

110.1. determine the intervals of control of the health condition and functioning of the person, organise the preparation or revision of the rehabilitation plan (not less than once a year), and organise the implementation thereof;

110.2. prescribe the necessary technologies, medicinal products, examinations, and consultations of medical rehabilitation;

110.3. send the person to receive State paid medical rehabilitation services;

110.4. if necessary, coordinate the developed medical treatment and rehabilitation plan with the general practitioner and the local government social service office and coordinate the execution thereof.

[7 May 2019]

111. A medical treatment institution which has included a person in dynamic observation of medical rehabilitation shall ensure:

111.1. the record-keeping of the persons included in dynamic observation of medical rehabilitation;

111.2. the aggregation of the results of evaluation of health and functional condition and rehabilitation of the person.

[7 May 2019]

112. A doctor of rehabilitation and physical medicine (or a psychiatrist, a paediatric psychiatrist, or a narcologist accordingly) shall develop a medical rehabilitation plan for persons who receive medical rehabilitation services on an inpatient basis or at a day hospital or who require more than five outpatient visits to the functional specialist, persons who receive rehabilitation services at home in accordance with Paragraph 46 of this Regulation, and persons who are included in dynamic observation of medical rehabilitation. One copy of the plan shall be issued to the patient and the other shall be appended to the outpatient or inpatient medical card. The following shall be included in the plan:

112.1. the evaluation of the patient, determining the restrictions of functioning and the restrictions of activities;

112.2. the objective of medical rehabilitation;

112.3. the type of the planned medical rehabilitation services;

112.4. the specialists to be involved and the objectives of medical rehabilitation to be achieved;

112.5. the necessary technical aids;

112.6. the planned intensity of medical rehabilitation.

[19 November 2024]

113. After completion of the medical rehabilitation course, a medical practitioner shall evaluate the result of medical rehabilitation, determining whether the objective of medical rehabilitation has been achieved, partially achieved, or has not been achieved, and assess the necessity for the person to continue receipt of medical rehabilitation services hereinafter.

[7 May 2019]

114. If the condition of the person becomes stable (according to the opinion of the doctor of rehabilitation and physical medicine or the psychiatrist, paediatric psychiatrist, or narcologist), the dynamic observation of medical rehabilitation may be revoked upon initiative of the person or upon person moving to a long-term social care and social rehabilitation institution.

[7 May 2019]

3.12. Emergency Medical Assistance

115. Emergency medical assistance shall be provided to a person:

115.1. by a medical treatment institution;

115.2. by the State Emergency Medical Service.

116. Medical treatment institutions which ensure the operation of the reception ward in accordance with Annex 6 to this Regulation shall provide emergency medical assistance throughout the day and night. Other medical treatment institutions shall ensure the provision of emergency medical assistance during the working hours of the institution.

117. If a person requires emergency medical assistance or it is necessary to determine or clarify a diagnosis, the team of the State Emergency Medical Service shall deliver the person to the nearest corresponding medical treatment institution, taking into account the health condition of the person and the conditions referred to in the contracts of the Service with medical treatment institutions.

117.¹ The team of the State Emergency Medical Service shall initially transport a patient who has been medically transported from a foreign medical treatment institution for treatment in Latvia to a level III, IV, or V medical treatment institution of the corresponding profile that is in closer proximity to the address of the declared place of residence (or the address of the last known place of residence) of the patient, taking into account the health condition of the person and the conditions specified in the contracts entered into by and between the Service and the medical treatment institutions.

[17 December 2020]

118. The team of the State Emergency Medical Service shall provide emergency medical assistance to a victim (sick person) who is in a condition that is critical to life and health on-scene as well as during transportation to a medical treatment institution in the following cases:

118.1. accidents, traffic accidents, disasters, severe mechanical, thermal, chemical, and combined injuries, electrical injuries, foreign bodies in airways, drowning, choking, poisoning;

118.2. sudden disease or exacerbation of chronic diseases which endangers the life of the person:

118.2.1. a cardiovascular disease characterised by pain, choking fits or shortness of breath, cold sweat, irregular heartbeat, loss of consciousness;

118.2.2. peripheral vascular disease characterised by sudden pain in arms or legs, coldness of arms or legs, pallor;

118.2.3. diseases of the central or peripheral nervous system characterised by sudden cognitive loss, cramps, fainting fit, headache or backache, disorders of sensation or movement;

118.2.4. a gastrointestinal disease characterised by sudden pain in the stomach, vomiting, cold sweat, continuous diarrhoea;

118.2.5. a urologic disease characterised by sudden pain in the lumbar and sacral region or acute urinary disorders;

118.2.6. acute mental disorders characterised by aggressive behaviour or an attempted suicide;

118.2.7. bleeding of any origin that endangers life;

118.2.8. allergic reactions of any origin that endanger life;

118.2.9. a seizure of bronchial asthma;

118.3. emergency movement of the victim (sick person) (the person shall be transported with the ambulance emergency response vehicle under supervision of the team of the State Emergency Medical Service according to the referral issued by the attending physician) as well as delivery of a woman giving birth according to the health condition:

118.3.1. from the location of the person to the nearest corresponding medical treatment institution;

118.3.2. from a medical treatment institution to an inpatient medical treatment institution or an inpatient medical treatment institution of higher level.

119. The medical practitioner who applies movement has an obligation to ensure the provision of emergency medical assistance or health care of another type to the victim (sick person) until the moment of arrival of the team of the State Emergency Medical Service.

120. The State Emergency Medical Service shall provide specialised emergency medical assistance:

120.1. during disasters or in emergency medical situations upon request of rescue services or a medical practitioner authorised by the head of the medical treatment institution;

120.2. upon request of a medical practitioner authorised by the head of an inpatient medical treatment institution if the necessary amount of medical assistance exceeds the possibilities of the available medical assistance at the medical treatment institution in the following cases:

120.2.1. severe head traumas and spontaneous intracranial haemorrhage;

120.2.2. trauma to the spine with damages to spinal cord;

120.2.3. severe polytraumas;

120.2.4. severe or extensive burn and corrosion, frostbite;

120.2.5. injury to or acute closure of the major blood vessels;

120.2.6. traumatic amputations where replantation is possible;

120.2.7. serious acute surgical diseases or serious complications of a surgical operation;

120.2.8. severe internal bleeding;

120.2.9. severe myocardial infarction, acute irregular heartbeat;

120.2.10. severe, complex obstruction of upper airways;

120.2.11. severe poisoning;

120.2.12. unclear contagious disease or massive outbreak of infectious disease in a short period of time as well as justified suspicions regarding an especially dangerous infectious disease;

120.2.13. the victim (sick person) is in a condition that is critical to health and life and he or she requires a consultation (council), medical transportation or medical evacuation by air transport to an inpatient medical treatment institution of the corresponding profile in the territory of Latvia;

120.3. upon request of a medical practitioner authorised by the head of the medical treatment institution, if it is necessary to transport a child who is in a condition critical to life and who has received, in accordance with the procedures laid down in this Regulation, the S2 form "Authorisation to Obtain Planned Health Treatment" to a medical treatment institution of an EU Member State, EEA country, Switzerland, or the United Kingdom or to transport such child from a medical treatment institution of an EU Member State, EEA country, Switzerland, or the United Kingdom if medical transportation is required according to his or her health condition.

[19 November 2024]

121. The medical practitioner on duty of the State Emergency Medical Service shall register all calls for emergency medical assistance, including emergency movement applications, and, where necessary, inform the caller for emergency assistance that a visit will possibly be a paid service, and also provide information regarding other possibilities of receipt of health care services.

122. Teams of the State Emergency Medical Service shall be placed in the relevant territory, taking into account the density of inhabitants and the size of the zone to be serviced, and also other factors influencing the time of provision of assistance (for example, poor quality of roads) so that in 75 % of cases emergency medical assistance is provided within the following period of time after receipt of emergency call:

122.1. in State cities - not later than within 12 minutes from the time of receipt of the call;

122.2. in municipality towns - not later than within 15 minutes from the time of receipt of the call;

122.3. in other territories - not later than within 25 minutes from the time of receipt of the call.

[17 December 2020 / Amendment to Sub-paragraph 122.1 regarding the replacement of the words "in republic cities" with the words "in State cities" shall come into force on 1 July 2021. See Paragraph 4 of Amendments]

3.13. Receipt of Health Care Services in Another EU Member State, EEA Country, Switzerland, and the United Kingdom

[19 November 2024]

123. The Service shall cooperate with the cross-border healthcare contact points of EU Member States, EEA countries, and Switzerland in issues regarding the receipt of health care services in foreign states and the compensation of expenses for health care services received in foreign states, and also, upon request of a person, shall provide the contact details of the contact points of the EU, EEA, and Switzerland.

124. The Service shall, in accordance with the conditions of Regulation No 883/2004, Regulation No 987/2009, and the EU and UK Protocol, issue the following documents certifying the right of the person to receive State paid health care services in another EU Member State, EEA country, Switzerland, or the United Kingdom:

124.1. S1 form "Certificate of Entitlement to Health Care" (hereinafter - the S1 form) ensuring the person with the right to receive the health care services in the state indicated in the form which are guaranteed in the relevant state;

124.2. S2 form "Authorisation to Obtain Planned Health Treatment" (hereinafter - the S2 form) ensuring the right to receive the planned health care service indicated in the form in the state and within the time period indicated in the form;

124.3. S3 form "Certificate of Entitlement to Health Care to a Retired Cross-border Employee in the Former Country of Employment" (hereinafter - the S3 form) ensuring a retired cross-border employee with the right to complete the medical treatment indicated in the form in the country indicated in the form;

124.4. the European health insurance card (hereinafter - the insurance card) or a copy of the certificate replacing the European health insurance card (hereinafter - the certificate replacing the insurance card) which ensures the right to receive emergency medical assistance or the necessary medical assistance during temporary stay in a EU Member State, EEA country, or Switzerland;

124.5. form E104 and its equivalent form S041 certifying the periods of insurance, employment, or stay of a person in the Republic of Latvia.

[19 November 2024]

125. The Service shall evaluate the right of a person to receive an S form, the insurance card, or the certificate replacing the insurance card if a submission of the person or a request of the competent authority for the issue of the relevant document has been received.

126. The State Revenue Service and the State Social Insurance Agency shall provide the information necessary to the Service for the coordination of the social security system in online mode in conformity with the following procedures:

126.1. the State Revenue Service shall provide the current information regarding the employment status of the person;

126.2. the State Social Insurance Agency shall provide information:

126.2.1. on the social insurance periods of the person in Latvia since 1996;

126.2.2. on the pension granted, including information on the type of pension, length of period of insurance, and restriction on the time period for disbursement of pension if such has been specified;

126.2.3. on the term of validity of the A1 form "Statement of Social Security Legislation Applicable to the Recipient of the Certificate" and U2 form "Authorisation to Continue Receiving Unemployment Benefits" issued to the person.

[10 December 2019]

127. The S1 form shall be issued to an insured person who complies with any of the following criteria:

127.1. the person is registered in Latvia in the status of an employed person or a self-employed person but his or her place of residence is in another EU Member State, EEA country, Switzerland, or the United Kingdom, and the person regularly returns there;

127.2. the person is sent to the country of residence, i.e. another EU Member State, EEA country, Switzerland, or the United Kingdom, for work on a temporary basis (for not more than 24 months), and he or she holds a valid A1 form "Statement of Social Security Legislation Applicable to the Recipient of the Certificate";

127.3. the person is going to the country of residence, i.e. another EU Member State, EEA country, Switzerland, or the United Kingdom, on a temporary basis (for not more than 24 months) in order to perform activity in the status of a self-employed person, and he or she holds a valid A1 form "Statement of Social Security Legislation Applicable to the Recipient of the Certificate";

127.4. the person is receiving a pension of the Republic of Latvia and is not employed but his or her place of residence is in another EU Member State, EEA country, Switzerland, or the United Kingdom;

127.5. the person is an unemployed person who, for the purpose of finding a job, wishes to go to the country of residence, i.e. another EU Member State, EEA country, Switzerland, or the United Kingdom, and who holds a valid U2 form "Authorisation to Continue Receiving Unemployment Benefits".

[7 May 2019; 17 December 2020; 19 November 2024]

128. In order for the Service to assess the right of a person to receive the S1 form, the person shall submit an application to the Service for the receipt of S1 (E106, E109, E121) form. The following shall be indicated in the application:

128.1. basic information on the person:

128.1.1. the given name, surname, nationality, date of birth, personal identity number of Latvia or the taxpayer registration number assigned by the State Revenue Service if the person is not registered in the Register of Natural Persons, and telephone number or electronic mail address;

128.1.2. information as to whether the person is insured in the social security system of another EU Member State, EEA country, Switzerland, or the United Kingdom;

128.1.3. information as to whether the person is registered in the status of an employed person or a self-employed person in another EU Member State, EEA country, Switzerland, or the United Kingdom;

128.1.4. if the person is registered in the status of an employed person in Latvia, the name, registration number, and legal address of the workplace shall be indicated;

128.1.5. if the person is registered in the status of a self-employed person in Latvia, the registration number, address of the performance of activity, and type of occupation shall be indicated;

128.1.6. if the person is receiving pension from Latvia, the type of pension (old-age, loss of provider, disability, service) shall be indicated, including regarding pension from another EU Member State, EEA country, Switzerland, or the United Kingdom;

128.2. additional information on the person according to the criteria on the basis of which the person wishes to receive the S1 form:

128.2.1. if the person is going to or has been sent to the country of residence, i.e. an EU Member State, EEA country, Switzerland, or the United Kingdom, the address in Latvia and the address in the country to which the person is going shall be indicated;

128.2.2. if the status of an unemployed person has been granted to the person, the address of stay in the state to which he or she wishes to go for the purpose of finding a job shall be indicated;

128.2.3. if the place of residence of the person is located in another EU Member State, EEA country, Switzerland, or the United Kingdom, the identification number assigned in the country of the place of residence and the registered address of the place of residence for which the S1 form is being requested shall be indicated.

[14 July 2022; 19 November 2024]

129. In order for a family member dependent on the insured person (spouse, person under guardianship or trusteeship) to receive the S1 form, information according to the conditions applying to the insured person shall be submitted to the Service.

130. In order for the Service to assess the right of the person to receive the insurance card, the person shall submit an application to the Service for the receipt of the insurance card. The following information shall be indicated in the application:

130.1. the given name, surname, date of birth, personal identity number of Latvia or the taxpayer registration number assigned by the State Revenue Service and the identification number assigned in another state if such has been assigned, and telephone number or electronic mail address;

130.2. address (if the person wishes to receive the insurance card by post);

130.3. information on the state of citizenship and place of residence;

130.4. information as to whether the person is insured in the social security system of another EU Member State, EEA country, Switzerland, or the United Kingdom.

[19 November 2024]

131. If an application for the receipt of the insurance card is submitted in the unified electronic information system of health sector, the person shall fill in the form posted therein.

132. If the person has the right to receive the insurance card, the Service shall issue it or send it by post to the address indicated by the person or to the address of the declared place of residence of the person.

133. The insurance card shall be issued for a period of three years or a shorter period of time conforming to the period during which it is possible to establish that the person has the right to receive health care services paid from the State budget funds.

134. The Service shall issue the insurance card to the person on the day of receipt of the application or send it by post, except for the case if the Service establishes that the person does not have the right to receive the insurance card. In such case the Service shall prepare a written decision on refusal to issue the insurance card and shall notify the abovementioned decision to the person in accordance with the procedures laid down in the Law on Notification.

135. The person shall pay according to the price list of paid services of the Service for making of the insurance card if it has been requested more than a month before expiry of the term of validity of the valid card.

136. If a person, while temporarily staying in any EU Member State, EEA country, Switzerland, or the United Kingdom, wishes to receive emergency or necessary medical assistance and the person cannot present the insurance card, the Service shall, on the basis of the application from the person for the issuance of the certificate replacing the insurance card or upon request of the competent authority of the country where the person is located, issue the certificate replacing the insurance card to the person or the competent authority of the relevant country.

[19 November 2024]

137. The Service shall issue the S2 form to an insured person who wishes to receive a planned health care service in another EU Member State, EEA country, Switzerland, or the United Kingdom if the following conditions are met concurrently:

137.1. the health care service is part of the range of State paid health care services;

137.2. during examination of the application there is no medical treatment institution providing State paid health care services which could ensure the necessary health care service to the person, and a justified opinion of the medical treatment institution has been received thereon;

137.3. the person requires the service in order to prevent irreversible deterioration of vital functions or health condition, taking into account the health condition of the person at the moment of assessment and the predictable development of the disease.

[19 November 2024]

138. The Service shall not issue the S2 form if health care services are provided within the scope of clinical trials or an experimental technology of medical treatment is used for them.

139. In order for the Service to assess the right of a person to receive the S2 form, the person shall submit the following documents to the Service:

139.1. an application for the receipt of S2 (E112) form. The following information shall be indicated in the application:

139.1.1. the given name, surname, date of birth, personal identity number of Latvia or the taxpayer registration number assigned by the State Revenue Service if the person is not registered in the Register of Natural Persons, address, telephone number or electronic mail address;

139.1.2. the health care service necessary for the person according to an opinion of the doctors' council;

139.1.3. the state of receipt of the health care service and the service provider;

139.1.4. the time period of receipt of the health care service (period from/to);

139.1.5. [17 December 2020];

139.1.6. [17 December 2020];

139.1.7. information as to whether the person is insured in the social security system of another EU Member State, EEA country, Switzerland, or the United Kingdom;

139.2. an opinion of the doctors' council of the relevant field of medical treatment of a medical treatment institution providing State paid health care services in which the necessary service is indicated, and also a justification whether such service is necessary for the person in order to prevent irreversible deterioration of vital functions or health condition, taking into account the health condition of the person at the moment of assessment and the predictable development of the disease, and medically justified reasons due to which the person needs to receive the relevant health care service in another state, and also information whether the relevant health care service is to be provided within the scope of clinical trials or an experimental technology of medical treatment will be used for it.

[14 July 2022; 19 November 2024]

140. The Service has the right to request that the person submits a confirmation of the medical treatment institution that the health care service planned to be received at the relevant medical treatment institution will be ensured on the basis of the S2 form.

141. The Service has the right to request the following opinions from medical treatment institutions:

141.1. on whether the medical treatment institution can ensure the necessary health care service to the person and whether the health care service can be provided within a time period that is medically justified, taking into account the health condition of the person at the moment of assessment and the predictable development of the disease;

141.2. on the possibilities of providing the necessary health care service in Latvia by inviting a medical practitioner of another country in the relevant field of medical treatment, and the costs of providing such health care service in Latvia, comparing them to the costs arising if the person would be sent to another EU Member State, EEA country, Switzerland, or the United Kingdom for the receipt of the necessary health care service, and also indicating whether the medical technology which must be used for the provision of the health care service has been approved in the country of the medical practitioner invited.

[19 November 2024]

142. If the Service receives an opinion of a medical treatment institution that it is possible to provide the necessary health care service to the person in Latvia by inviting a medical practitioner of another state in the relevant field of medical treatment, the Service shall, upon assessment of the considerations of economic viability and other circumstances which might affect the health condition of the person, take the decision to issue the S2 form or to refuse to issue it, indicating that the person may receive the necessary health care service in Latvia, and enter into a contract with the relevant medical treatment institution, providing for the procedures by which the necessary health care service will be provided and payment for it shall be made.

143. Upon taking the decision to issue the S2 form, the Service has the right to specify the Member State and the health care service provider, taking into account the considerations of economic viability, if the Service has such information at its disposal. If the person refuses to receive services with the service provider selected by the Service, the Service has the right to take the decision to refuse to issue the S2 form.

144. The Service has the right to take a decision in the cases specified in Regulation No 883/2004, Regulation No 987/2009, and the EU and UK Protocol on behalf of the competent authority of another EU Member State, EEA country, Switzerland, or the United Kingdom to issue the S2 form to a person who is subject to the social security system of another EU Member State, EEA country, Switzerland, or the United Kingdom.

[19 November 2024]

145. If the person has not exercised the right granted by the decision of the Service within one calendar year after the day of entering into effect of the decision to issue the S2 form, the decision to issue the S2 form shall cease to be in effect.

146. In order to receive the S3 form, the person shall submit the following documents to the Service:

146.1. an application for the receipt of the S3 form. The following information shall be indicated in the application:

146.1.1. the given name, surname, date of birth, personal identity number or the taxpayer registration number assigned by the State Revenue Service if the person is not registered in the Register of Natural Persons, address, telephone number or electronic mail address;

146.1.2. the previously commenced health care service;

146.1.3. the provider of the health care service;

146.2. an opinion of the doctors' council of the relevant sector of medical treatment on the health care service necessary for the person which must be completed. The health care service, medically justified reasons due to which the relevant health care service should be considered a continuation of a previously commenced health care service shall be indicated in the opinion.

[14 July 2022]

147. The person is not entitled to receive and use the S form, the insurance card, or the certificate replacing the insurance card issued by the Service in order to receive health care services paid from the State budget funds in another EU Member State, EEA country, Switzerland, or the United Kingdom if the person is considered insured:

147.1. within the scope of another social security system in accordance with Regulation No 883/2004 and the EU and UK Protocol;

147.2. within the scope of the social security system of any institution of the European Union or within the scope of the health insurance scheme in accordance with Regulation (EEC, Euratom, ECSC) No 259/68 of the Council of 29 February 1968 laying down the Staff Regulations of Officials and the Conditions of Employment of Other Servants of the European Communities, except for the case referred to in Article 15 of Regulation No 883/2004;

147.3. within the scope of the social security system of an international organisation;

147.4. within the scope of the social security system of students.

[19 November 2024]

148. A person who has been issued any of the S forms, the insurance card or the certificate replacing the insurance card has an obligation, without delay but not later than within five working days, to inform the Service in writing if:

148.1. the person becomes an insured person within the scope of another social security system;

148.2. information submitted by the person to the Service within the scope of the administrative case changes.

149. The Service shall take the decision to cancel the S form, the insurance card or the certificate replacing the insurance card issued if it establishes that, upon application of Regulation No 883/2004, Regulation No 987/2009, and the EU and UK Protocol, the person is not entitled to receive health care services paid from the State budget funds in another EU Member State, EEA country, Switzerland, or the United Kingdom.

[19 November 2024]

149.¹ The data referred to in this Sub-chapter which are necessary to specify the right of the person to receive health care in the EU, EEA, Switzerland, and the United Kingdom are processed in the international cooperation information system under management of the Service, and such data shall be exchanged between the competent authorities of the EU Member States and the United Kingdom using the access point referred to in Article 4 of Regulation No 987/2009.

[19 November 2024]

4. Payment for the Health Care Services Included in the State Paid Medical Assistance Minimum and State Mandatory Health Insurance

4.1. General Provisions

150. It shall not be paid from the State budget funds intended for payment for health care services:

150.1. for services other than health care services, including it shall not be paid for transport and residence expenses of the person or the person accompanying him or her which are related to movement in order to receive a health care service, except for the following cases:

150.1.1. as specified in Sub-paragraph 120.3 of this Regulation;

150.1.2. when lung transplantation services are required;

150.1.3. [19 November 2024];

150.1.4. when transporting a patient from a higher-level inpatient medical treatment institution to a lower-level inpatient medical treatment institution if the health condition of the patient has improved and allows for continued treatment in a lower-level inpatient facility, and if the higher-level inpatient medical treatment institution needs to free up inpatient beds for acute patients requiring emergency inpatient treatment;

150.2. for health care services which have been received without the referral of such doctor who has the right to refer for the receipt of State paid health care services, except for emergency medical assistance provided by a medical treatment institution which is in contractual relations with the Service and other cases referred to in this Regulation;

150.3. for secondary health care services if the person has refused in writing from waiting for a planned health care service and he himself or she herself or a third person has made payments for the relevant health care service;

150.4. for medical treatment on an inpatient basis of such persons whose disease or trauma may be treated on an outpatient basis;

150.5. for similar examinations or examinations equivalent on an information basis in secondary health care which have been performed repeatedly within a month from the day when an examination with a referral of a general practitioner or specialist was performed, except for cases if the person is provided emergency medical assistance at a medical treatment institution which is in contractual relations with the Service or control of therapy results is ensured;

150.6. for ensuring of medical assistance at public events.

[14 July 2020; 10 January 2023 / See Paragraph 277]

151.¹ The estimate of fixed payments and tariffs for bed days shall include a payment for work during night, on weekends, on holidays, and for overtime work.

[7 May 2019]

151. The Service shall pay, in accordance with the procedures laid down in this Regulation, to medical treatment institutions for the health care services included in the list of State paid health care services using the following types of payment:

151.1. a fixed payment;

151.2. an estimate payment;

151.3. actual costs according to invoices;

151.4. a payment of capitation;

151.5. a tariff for a care episode;

151.6. a tariff for a manipulation;

151.7. a tariff for a bed day;

151.8. a tariff for medical treatment of one patient.

152. Tariffs for health care services, including tariffs for the manipulations included in the list of manipulations, shall be calculated using the following formula:

TC = VC (D + S + M + E) + FC (U + A + N) where

TC - tariff for a health care service;

VC - variable costs (direct costs):

D - work remuneration;

S - mandatory State social insurance contributions;

M - means of medical treatment;

E - expenses related to the catering of patients;

FC - fixed costs (indirect costs):

U - indirect manufacturing costs to be added (expenses related to the maintenance of patients for payment for services, for making of risk payments, for purchase of materials, energy resources, water, and inventory);

A - administrative expenses;

N - depreciation.

[14 July 2020]

153. The work remuneration (D) referred to in Paragraph 152 of this Regulation, and also other payments for a health care service shall be calculated taking into account that the average work remuneration per month is specified in the following amount:

153.1. for doctors and functional specialists - EUR 2 304.00;

153.2. for medical practitioners, patient care persons, and assistants of functional specialists - EUR 1,388.00;

153.3. for support persons of medical treatment and patient care - EUR 925.00.

[19 December 2023]

153.¹ When calculating the manipulation tariff, the Service may apply the remuneration specified in Sub-paragraphs 153.1 and 153.2 of this Regulation for work performed by a medical physicist, pharmacist, or bioinformatician if the working time of the medical physicist, pharmacist, or bioinformatician in providing the relevant service exceeds 30 % of the working time specified for the service.

[4 April 2023]

153.² Work remuneration (D) shall include all expenses provided for by the laws and regulations governing employment legal relationships.

[17 December 2020]

153.³ The total funding that a medical treatment institution allocates for the remuneration of the personnel involved in providing State paid health care services shall not be less than the total funding received from the Service intended for work remuneration (D).

[17 December 2020]

153.⁴ A medical treatment institution shall direct the State budget funding granted additionally for increasing work remuneration for medical practitioners who provide State paid inpatient health care services in accordance with the following conditions:

153.⁴ 1. funding for increasing work remuneration without additional conditions shall be directed for medical practitioners whose average monthly work remuneration for the provision of inpatient health care services in the previous 12 calendar months does not exceed two average monthly work remunerations for workforce in the State for the previous year, rounding to full euros (on the basis of the information published in the official statistical notification of the Central Statistical Bureau);

153.⁴ 2. funding for increasing work remuneration in proportion to the funding granted in accordance with the increase in work remuneration of the groups of medical practitioners referred to in Paragraph 153 of this Regulation shall be directed for medical practitioners whose average monthly work remuneration for the provision of inpatient health care services in the previous 12 calendar months exceeds two but does not exceed three average monthly work remunerations for workforce in the State of the previous year, rounding to full euros (on the basis of the information published in the official statistical notification of the Central Statistical Bureau).

[25 June 2025]

153.⁵ If the Service establishes that a medical treatment institution has not complied with the conditions referred to in Paragraph 153.⁴ of this Regulation, it shall assign the medical treatment institution to ensure the directing of the additionally granted State budget funding to medical practitioners in compliance with the conditions referred to in Paragraph 153.⁴ of this Regulation, and also to repay such part of the funding which was granted without complying with Paragraph 153.⁴ of this Regulation in the period for which an inspection was carried out.

[25 June 2025]

154. The amount of payment for health care services referred to in this Regulation shall be determined taking into account:

154.1. the amount of the tariff for a care episode referred to in Annex 4 to this Regulation;

154.2. the amount of capitation referred to in Annex 11 to this Regulation;

154.3. the amount of the fixed monthly payment (supplement) for consulting rooms of medical specialists and units referred to in Annex 10 to this Regulation;

154.4. the services of emergency medical assistance and the health care services provided at the reception ward of an inpatient medical treatment institution in accordance with Annexes 6 and 10 to this Regulation;

154.5. the conditions referred to in Annex 6 to this Regulation for observation of patients for up to 24 hours;

154.6. the medical treatment of patients at a hospital in conformity with the conditions referred to in Annex 6 to this Regulation;

154.7. the manipulations of health care services specified in the list of manipulations and the payment conditions for such manipulations;

154.8. the planning territories of secondary outpatient health care services specified in Annex 12 to this Regulation.

[14 July 2022; 18 June 2024]

155. Prior to introduction of a new health care service payment model, in order to check the operation of the planned payment model, the Service is entitled, after coordination with the Ministry of Health and the relevant health care service provider, to specify in the contract the financing procedures corresponding to the conditions of the planned payment model.

156. Upon receipt of health care services paid from the State budget, a person shall make the patient co-payment in the amount specified in Annex 13 to this Regulation in conformity with the conditions referred to in the list of manipulations in relation to the patient co-payment.

157. Upon providing inpatient health care services, a medical treatment institution may collect additional fee in the amount of not more than EUR 31.00 for surgical operations performed in the operating room per admission which have been indicated as major surgical operations in the list of manipulations. This additional fee shall not be collected from persons who are exempted from co-payments and from persons who present the statement referred to in Paragraph 162 of this Regulation.

[10 December 2019]

158. The additional fee of a patient for the surgical operations performed in the operating room per admission shall not be covered from the State budget funds, except for the case if the surgery has been performed for a poor person who has been recognised as such in accordance with the laws and regulations regarding the procedures by which a family or a person living separately shall be recognised as poor, or for an employee of the State Medical Emergency Service, or in case if a person has requested a statement from the Service certifying that the amount of co-payment for the outpatient and inpatient health care services received in the calendar year has reached the maximum amount.

[10 December 2019]

159. A person may pay the patient co-payment and additional charge for the performed major surgical operations within 15 days after receipt of the health care service or at another time if a written agreement thereon has been reached with the medical treatment institution.

[17 December 2020]

160. The total amount of the patient co-payment for each time of admission in one inpatient medical treatment institution may not exceed EUR 355.00.

161. The amount of the patient co-payment for the outpatient and inpatient health care services received in the calendar year may not exceed EUR 570.00.

162. A statement that the person has received health care services during the calendar year and made the patient co-payment (including that covered by the insurer or another person) in the amount of EUR 570.00 shall be issued by the Service according to the payment documents presented by the person.

163. The Service shall cover the patient co-payment for a medical treatment institution from the State budget funds:

163.1. for persons who are exempted from it;

163.2. for persons whose patient co-payment has reached the maximum amount in one case of admission;

163.3. for persons who have received a statement regarding the maximum amount of annual co-payment reached;

163.4. in case of death of a patient at a medical treatment institution or in case if the general practitioner establishes the fact of death of a person who has died in domestic environment;

163.5. the difference forming between the amount of co-payment specified in Sub-paragraph 5.1 of Annex 13 to this Regulation for medical treatment at a day and night hospital and the amount of co-payment specified in Sub-paragraph 5.3 of Annex 13 to this Regulation for persons with specific diagnoses;

163.6. the difference forming between the amount of co-payment specified in Sub-paragraph 5.1 of Annex 13 to this Regulation for medical treatment at a day and night hospital and the amount of co-payment specified in Sub-paragraph 5.4 of Annex 13 to this Regulation upon undergoing medical treatment in beds of rehabilitation profile.

[7 May 2019]

164. The infectious diseases in case of which a person is exempted from the patient co-payment are indicated in Annex 3 to this Regulation.

165. Persons who, in accordance with the conditions referred to in Annex 6 to this Regulation, receive inpatient health care services within the scope of the programme of inpatient health care services "Palliative Care" shall be exempted from the patient co-payment.

166. The Ministry of Defence, the Ministry of Justice, and the Ministry of the Interior shall cover the fee for the following health care services for the following persons:

166.1. the Ministry of Defence:

166.1.1. for soldiers of professional service and soldiers of national defence service who are performing military service, and also national guardsmen - the patient co-payment, including the patient co-payment for the reimbursable medicinal products and medical devices in accordance with the laws and regulations regarding the procedures for the reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for outpatient medical treatment, and also the fee for health care services which such persons have the right to receive in accordance with the laws and regulations regarding the conditions for the receipt of health care and social rehabilitation services, the types of services to be paid, and the procedures for the payment of expenses;

166.1.2. for retired soldiers and former national guardsmen - health care services in accordance with the laws and regulations regarding health care services to be paid, and also the amount of expenses and payment procedures;

166.1.3. for soldiers of the armed forces of member states to the North Atlantic Treaty Organisation and the states participating in the programme "Partnership for Peace" - for health care services in accordance with the Status of Forces Agreement of member states to the National Atlantic Treaty Organisation;

166.1.4. for candidates of professional service, conscripts of the national defence service, reserve soldiers, and reservists which are conscripted in the active service, for citizens of Latvia who have voluntarily enlisted for the service into reserve, and for candidates for national guardsmen - expenses for the medical examinations performed within the scope of a medical examination with an appointment of the medical commission and for the opinions of doctors (including expenses for paid services of health care) in accordance with the laws and regulations regarding the conditions for the receipt of health care and social rehabilitation services, the types of services to be paid, and the procedures for the payment of expenses;

166.1.5. for the participants of the movement "Youth Guard" - expenses for health care services in accordance with the Cabinet regulations determining health care services to be paid for youth guards, the conditions for the receipt thereof, and the payment procedures;

166.2. the Ministry of Justice shall cover the health care services provided by a medical practitioner working at a place of imprisonment, and also the patient co-payment for prisoners who are receiving health care outside the place of imprisonment and the patient co-payment for the reimbursable medicinal products and medical devices in accordance with the laws and regulations regarding the procedures for reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for the outpatient medical treatment;

166.3. the Ministry of the Interior shall cover the fee for health care services and the patient co-payment in the following amount:

166.3.1. for foreigners who have been detained in accordance with the procedures laid down in the Immigration Law - for health care services which are necessary during and at the place of their accommodation and are guaranteed to such persons in accordance with the laws and regulations (except for emergency assistance, birth assistance, and the cases specified in the Epidemiological Safety Law, and also the medicinal products necessary for medical treatment of tuberculosis which are paid from the State budget resources intended for health care). If health care of such persons is insured, the health care expenses shall be covered by the insurer;

166.3.2. for outpatient health care services which are provided to persons placed in the temporary place of detention of the State Police (except for emergency medical assistance and the cases specified in the Epidemiological Safety Law if health care services are paid from the State budget resources intended for health care);

166.3.3. for the initial health examination performed for asylum seekers at a general practitioner which has been provided in the premises of an accommodation centre for asylum seekers and at a psychiatrist, for rapid tests for determination of HIV and Hepatitis B;

166.3.4. for asylum seekers who have been detained in accordance with the procedures laid down in the Asylum Law - for examinations of the health condition and sanitary treatment, and also for such health care services which are necessary during and at the place of their accommodation and have been specified in the laws and regulations governing the field of health care and the interior;

166.3.5. for officials with special service ranks of the institutions of the system of the Ministry of the Interior and the Prisons Administration of the Ministry of Justice, and also for officials retired from service who, in accordance with the laws and regulations, have been granted the right to receive paid health care, the fee for health care services and the patient co-payment shall be covered in accordance with the laws and regulations governing the field of the interior and the field of remuneration of the State administration.

[9 May 2023]

167. The requester of a forensic medical expert-examination shall pay for consultations, clinical and paraclinical diagnostic examinations which are conducted for victims of unlawful offences upon assignment from a forensic medical expert.

168. The Service shall make payment for the health care services specified in this Regulation on the basis of the contracts referred to in Paragraph 5 of this Regulation and in conformity with the conditions referred to in Annex 14 to this Regulation.

168.¹ When making payment for inpatient and outpatient health care services provided by the medical treatment institution, the Service shall, in accordance with the procedures laid down in the contract with the medical treatment institution, apply a coefficient of 0.9 to the entire volume of services provided in the respective month if the medical treatment institution receives payment for the digitisation of health care services in accordance with Paragraph 1 of Annex 6 to this Regulation, but fails to ensure the preparation and entry of the following documents in the health information system in accordance with the laws and regulations regarding a unified electronic information system of the health sector:

168.¹1. referral for the receipt of an outpatient/inpatient service;

168.¹2. discharge - epicrisis;

168.¹3. laboratory test result.

[30 April 2024; 1 May 2024 / Paragraph shall come into force on 1 April 2025. See Paragraph 281]

4.2. Payment for Primary Health Care

169. The Service shall plan the resources for payment for primary health care services in accordance with Annex 11 to this Regulation.

170. The Service shall cover the following for a general practitioner for the provision of State paid health care services in accordance with the conditions referred to in Annex 11 to this Regulation:

170.1. the payment (including payment for carrying out of the functions of a receptionist) which is calculated taking into account the number of persons registered in the list of patients of the general practitioner (capitation);

170.2. expenses for the manipulations carried out at the practice of the general practitioner which have been indicated in the list of manipulations as the manipulations to be paid additionally to the general practitioner in accordance with the conditions of payment for such manipulations;

170.3. the fixed payments and supplements;

170.4. the average work remuneration of a nurse, a doctor's assistant (feldsher), and a midwife per month specified in this Regulation (Paragraph 153 of this Regulation);

170.5. the payment for substitution of another general practitioner if he or she is substituted for a time period exceeding two months - according to the estimate of monthly revenue of the practice to be substituted;

170.6. the compensation of the patient co-payment for persons who have been exempted from the patient co-payment.

[10 December 2019]

171. The Service, upon calculating the capitation, fixed payments, and supplements of the general practitioner as well as the work remuneration of a nurse and a doctor's assistant (feldsher), shall not take into account the information on such persons whose registration with the general practitioner has been blocked. The Service shall pay for the health care services provided to such persons as for temporary patient care.

172. The general practitioner shall be paid for the care for a temporary patient according to the tariffs for care episodes of a general practitioner and the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations. If the temporary patient is registered with the general practitioner, then the care episode shall be paid from the monetary funds of such general practitioner with whom the person is registered but in the amount of not more than 50 % from the payment of the monthly capitation of such general practitioner calculated in accordance with the procedures laid down in this Regulation.

173. The primary health care services provided to a person who has registered with a general practitioner but is receiving health care services with another general practitioner and does not meet the criteria of a temporary patient referred to in this Regulation shall be paid services.

174. The number of medical practitioners necessary for ensuring patient care at a practice of a general practitioner and the conditions for financing such persons shall be included in the contract entered into by the general practitioner with the Service. The general practitioner has an obligation to pay the payment made by the Service for the work of the medical practitioners employed at the practice of the general practitioner to such persons in full amount, making the tax payments specified in the laws and regulations.

175. In case of death of a general practitioner or in case if a court judgment or a decision precluding a general practitioner from providing primary health care services has entered into effect, the Service may, for a time period not exceeding one month, enter into a contract with the medical treatment institution in which the general practitioner had been working or with the medical practitioner employed at the practice of the general practitioner and, in accordance with the procedures laid down in Annex 11 to this Regulation, cover expenses related to the performance of the following activities:

175.1. arranging of the medical documentation at the practice, carrying out complete accounting thereof;

175.2. issuing of the information accumulated in the medical documentation regarding the patient upon request of the patient;

175.3. handing over of the medical documentation to the subsequent general practitioner chosen by the patient;

175.4. maintaining of the premises leased by the general practitioner;

175.5. handing over of the medical documentation to the general practitioner who enters into a contract with the Service for the provision of health care services in the basic area of operation of the previous (deceased) general practitioner.

176. If a general practitioner terminates the contractual relations with the Service in relation to retirement of the general practitioner, the Service shall disburse a compensation payment calculated in accordance with the procedures laid down in Annex 11 to this Regulation to the practice of the general practitioner for the redundancy benefit disbursed to the medical practitioners employed at the practice, in conformity with the following conditions:

176.1. the general practitioner has attained the age when old-age pension is granted in accordance with the laws and regulations;

176.2. a general practitioner who is in the waiting list of general practitioners or a general practitioner who is taking over the practice of the general practitioner in another case in accordance with the procedures laid down in this Regulation has agreed to enter into a contract for the provision of health care services in the basic area of operation of the general practitioner.

[7 May 2019]

177. The general practitioner has the right to receive a payment of the performance evaluation of a general practitioner which is calculated on the basis of the evaluation of performance indicators of the general practitioner in accordance with Annex 15 to this Regulation.

178. A monthly fixed payment shall be disbursed to the newly opened practices of general practitioners until the moment when the number of persons registered in the list of patients of the general practitioner reaches 600 but not longer than for nine months after entering into the contract with the Service and to the practices of general practitioners where at least 90 % of the patients cared for in a month are persons without a specified place of residence or whose place of residence is declared at a shelter, and such payment shall consist of the following:

178.1. the average work remuneration specified in this Regulation for a doctor per month (Paragraph 153 of this Regulation) and State social insurance contributions;

178.2. the average work remuneration specified in this Regulation for medical practitioners and patient care persons per month (Paragraph 153 of this Regulation) and State social insurance contributions;

178.3. the monthly fixed payment indicated in Paragraph 8 of Annex 11 to this Regulation to the practice of the general practitioner;

178.4. the fee for the manipulations performed at the practice of the general practitioner according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations;

178.5. the compensation of the patient co-payment for persons who have been exempted from the patient co-payment.

[19 November 2024]

179. The Service shall evaluate the number of persons registered in the list of patients of the newly opened practice of general practitioners once a month.

180. A doctor on duty who is providing services outside the working hours of general practitioners shall be paid for work according to the monthly fixed payment indicated in Annex 11 to this Regulation.

181. Medical treatment institutions which are providing State paid dental services shall be paid for work according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations.

182. The Service shall pay to medical practitioners who are carrying out health care at home in accordance with Sub-chapter 3.4 of this Regulation according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations.

182.¹ Medical treatment institutions providing the mobile palliative care team service shall be remunerated according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations.

[19 December 2023]

182.² Long-term social care and social rehabilitation institutions which provide health care services in accordance with Sub-paragraph 3.11.² and Paragraph 5⁴ of this Regulation shall receive the remuneration for work from the Service in the form of a monthly fixed payment. The calculation of the fixed payment shall include the following:

182.²1. the average work remuneration specified in this Regulation for a functional specialist per month (Paragraph 153 of this Regulation) and State social insurance contributions;

182.²2. the average work remuneration specified in this Regulation for medical practitioners and patient care persons per month (Paragraph 153 of this Regulation) and State social insurance contributions;

182.²3. the monthly fixed payment indicated in Annex 10 to this Regulation.

[26 November 2024]

183. The Service shall pay to doctor's assistants (feldshers) who are employed at the feldsher station owned by the local government with which the Service has entered into a contract, in accordance with Annex 11 to this Regulation.

4.3. Payment for Secondary Outpatient Health Care

184. The Service shall make a payment for the secondary outpatient health care services provided by specialists, except for the health care services provided at a day hospital:

184.1. according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations and the tariffs for care episodes indicated in Annex 4 to this Regulation;

184.2. by performing a fixed monthly payment the calculation of which shall include:

184.2.1. the average work remuneration of doctors and nurses specified in this Regulation per month (Paragraph 153 of this Regulation);

184.2.2. the mandatory social insurance contributions of the employer;

184.2.3. the resources necessary for ensuring the operation in accordance with the conditions indicated in Annex 10 to this Regulation;

184.3. by covering expenses for individual secondary outpatient health care services which are referred to in Annex 7 to this Regulation - on the basis of the invoices of the medical treatment institution.

185. The fixed monthly payment shall be performed for the following specialists or units of medical treatment institutions:

185.1. for a pneumonologist who is providing health care services to persons suffering from tuberculosis (in accordance with the ICD-10, diagnosis codes A15-A19, B90, J65, P37.0, R76.1, Y58.0, Y60.3, Z03.0, Z20.1);

185.2. for the consulting room of diabetic foot care;

185.3. for the palliative care consulting room;

185.4. for the consulting room of chronic obstructive pulmonary diseases which is providing health care services to persons suffering from asthma or another chronic obstructive pulmonary diseases (in accordance with the ICD-10, diagnosis codes J44-J45);

185.5. for the stoma consulting room;

185.6. for the consulting room of a psychologist/psychotherapist;

185.7. for the consulting room of methadone maintenance treatment;

185.8. for the consulting room of rare diseases at the State limited liability company Children's Clinical University Hospital which provides health care services:

185.8.1. to patients with metabolic disorders (in accordance with the ICD-10, diagnosis codes E70-E90) or rare diseases (ORPHA codes);

185.8.2. to patients with congenital anomalies;

185.8.3. to pregnant women for whom a congenital developmental anomaly of the foetus has been detected;

185.8.4. to children who are registered with the palliative care consulting room of the State limited liability company Children's Clinical University Hospital and who require a consultation of a dietician;

185.9. for the training room of diabetes mellitus patients upon providing health care services to persons with diabetes mellitus (in accordance with the ICD-10, diagnosis codes E10-E14, O24);

185.10. for the HIV compliance room;

185.11. for the consulting room of a psychiatrist;

185.12. for the consulting room of functional specialists upon providing psychiatric assistance;

185.13. for the consulting room of a nurse upon providing psychiatric assistance;

185.14. for the consulting room of a paediatrician upon providing health care services to children in case of acute diseases at inpatient medical treatment institutions of Level III, IV, and V;

185.15. for the consulting room of an arrhythmologist;

185.16. for the enteral and parenteral nutrition patient care consulting room at limited liability company Riga East University Hospital;

185.17. for the psychoemotional support room for oncology patients at limited liability company Riga East University Hospital;

185.18. for the mood disorder consulting room for children at sabiedrība ar ierobežotu atbildību "Bērnu un pusaudžu resursu centrs" [limited liability company Child and Adolescent Resource Centre].

[7 May 2019; 10 December 2019; 14 July 2020; 17 December 2020; 29 June 2021 / Amendment shall come into force on 2 July 2021. See Paragraph 3 of Amendments]

186. [8 July 2025]

187. The Service shall make the monthly fixed payment for the operation of the training room of diabetes mellitus patients to university hospitals, regional multi-functional hospitals, and medical treatment institutions which ensure the largest volume of endocrinology services to inhabitants in planning units and in which the service may be ensured by a nurse who has been trained in the patient training method at a nursing practice.

[4 April 2023]

4.4. Payment for the Health Care Services Provided at a Day Hospital

188. The Service shall make a payment for the secondary outpatient health care services provided at a day hospital according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations.

189. The Service shall not pay for medical treatment at a day hospital if any of the surgical operations which, according to the payment conditions indicated in the list of manipulations has been referred to as the major surgical operation, has been performed during such medical treatment, except for the surgical operations referred to in Annex 5 to this Regulation.

4.5. Payment for the Health Care Services Provided at an Emergency Room and the Reception Ward

190. The Service shall pay for the services provided at an emergency room:

190.1. by performing the fixed monthly payment the calculation of which shall include:

190.1.1. the average work remuneration of doctors and doctor's assistants (feldshers)/nurses specified in this Regulation (Paragraph 153 of this Regulation);

190.1.2. the mandatory social insurance contributions of the employer;

190.1.3. the resources necessary for ensuring the operation in accordance with the conditions indicated in Annex 10 to this Regulation;

190.2. according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations - for the diagnostic examinations performed for the person.

191. The Service shall pay for the outpatient health care services provided at the reception ward of an inpatient medical treatment institution:

191.1. by performing the fixed monthly supplement for the operation of the reception ward;

191.2. according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations and the tariffs for care episodes indicated in Annex 4 to this Regulation if the medical treatment institution does not receive the fixed monthly supplement for the operation of the reception ward;

191.3. by covering expenses for the performed diagnostic examinations according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations.

192. The fixed monthly supplement for the operation of the reception ward of a hospital shall include expenses for ensuring the being on 24-hour duty of the specialists referred to in Paragraph 1 of Annex 6 to this Regulation. The medical treatment institutions which receive the fixed monthly supplement for the operation of the reception ward have an obligation to ensure that the necessary specialists are on a 24-hour duty. If the medical treatment institution fails to ensure that specialists are on a 24-hour duty in accordance with the procedures laid down in this Regulation, the Service may reduce the fixed monthly supplement for the operation of the reception ward of a hospital as well as agree with the medical treatment institution which has been granted the first level regarding another time for ensuring a surgeon being on duty.

193. If a person has turned to the reception ward of an inpatient medical treatment institution and the person does have a trauma, acute disease, or exacerbation of a chronic disease when urgent intervention of medical practitioners is required or the necessary assistance does not exceed the competence of the primary health care practitioner, the person shall pay for the outpatient health care services received according to the price list of paid services of the medical treatment institution.

4.6. Financing of Outpatient Laboratory Services

194. The Service shall, in accordance with the procedures laid down in Annex 16 to this Regulation, plan the amount of resources intended for a general practitioner and a specialist of secondary outpatient health care within the scope of which the general practitioner and the specialist of secondary outpatient health care shall appoint a person for the receipt of outpatient laboratory services, and also the amount of payment for the providers of outpatient laboratory services.

195. The general practitioner and the specialist of secondary outpatient health care have an obligation, upon referring a person for the receipt of outpatient laboratory services, to supervise the utilisation of the amount of resources intended for payment for outpatient laboratory services.

196. A doctor of a medical treatment institution of a place of imprisonment, a long-term social care and social rehabilitation institution, or a medical treatment institution of the National Armed Forces shall, upon referring a person for the receipt of outpatient laboratory services, conform to the amount of financial resources stipulated by the Service regarding which the relevant medical treatment institution is informed according to the procedures specified in the memorandum of understanding.

197. The Service shall, each month, post information on the website regarding the utilisation of the financial resources intended for payment for laboratory services in the previous month, indicating how they have been utilised:

197.1. by general practitioners with whom patients are registered;

197.2. by medical treatment institutions with which the Service has entered into a contract for the payment for secondary outpatient health care services;

197.3. at medical treatment institutions of a place of imprisonment;

197.4. by the bodies of a long-term social care and social rehabilitation institution;

197.5. by medical treatment institutions of the National Armed Forces.

198. If a general practitioner or a medical treatment institution providing outpatient health care services has turned to the Service in the first half of the relevant year regarding increase in the amount of the resources intended for payment for outpatient laboratory services, the Service shall increase the amount of the resources to such general practitioner or medical treatment institution intended for payment for outpatient laboratory services calculated for the second half of the relevant year if resources are available to the Service and if:

198.1. the number of persons registered with the general practitioner in the first half of the relevant year has increased by more than 25 %;

198.2. the general practitioner receives, in the first half of the relevant year, the supplement specified in this Regulation for care for chronic patients in such amount which exceeds the supplement for care for chronic patients calculated on average per general practitioner by more than 25 %;

198.3. the total number of episodes in the medical treatment institution in which a specialist of secondary outpatient health care is employed has increased, in the first half of the relevant year, by more than 25 % from the planned number of episodes.

199. The Service shall perform payment for the outpatient laboratory services according to the tariffs for manipulations indicated in the list of manipulations and the payment conditions for manipulations.

200. If the provider of outpatient laboratory services has performed examinations in a given month to an extent exceeding EUR 7114.36 of the amount of resources intended for payment (excluding from the calculation the payment for the performance of histological examinations, identification of mutations in neoplasm cells, examinations pertaining to transplantation services, laboratory diagnostics of rare diseases, COVID-19 laboratory services, laboratory testing for patients with malignant neoplasms and performance of laboratory services in reception wards), then, when settling the payment for outpatient laboratory services to such service provider, the Service shall apply the coefficient 0.9 to the entire volume of services provided in the relevant month.

[8 July 2025]

4.7. Financing of Inpatient Health Care

201. The following shall be included in the payment made by the Service for inpatient health care services:

201.1. the payment for the services included in the programmes of inpatient health care services for which the tariff of medical treatment of one patient (hereinafter - the marked services) has been specified in accordance with Paragraph 2 of Annex 6 to this Regulation - according to the relevant tariff of medical treatment of one patient;

201.2. the fixed monthly payment for the services included in the programmes of inpatient health care services which are included in the calculation of the Diagnosis Related Groups (hereinafter - the DRG services);

201.3. the fixed monthly supplement for the operation of the reception ward to inpatient medical treatment institutions providing emergency medical assistance 24 hours a day;

201.4. the fixed monthly supplement for the observation of patients up to 24 hours;

201.5. the fixed monthly payment for the DRG services and the marked services to the State limited liability company Children's Clinical University Hospital according to the conditions specified in the contract with the Service;

201.6. the payment according to the number of actual bed days and the tariff for a bed day to care for a patient who requires long-term mechanical ventilation of lungs;

201.7. the payment according to the estimate financing determined in the contract with the medical treatment institution, forecasting the number of patients who will receive the necessary medical treatment within the scope of the estimate in the following cases:

201.7.1. for involuntary psychiatric medical treatment at an inpatient medical treatment institution with security guard;

201.7.2. for long-term psychiatric medical treatment of children or adults at an inpatient medical treatment institution, including according to a court decision;

201.8. the payment according to the number of actual bed days, the tariff for a bed day of the relevant medical treatment institution, and tariffs for the performed manipulations for manipulations which have been marked with an asterisk (*) in the list in the following cases:

201.8.1. for the health care services provided to the persons insured within the scope of the social security system of the EU Member States, EEA countries, Switzerland, or the United Kingdom with the insurance card or the certificate replacing the insurance card in accordance with the requirements laid down in the international agreements governing the field of health care;

201.8.2. [8 July 2025];

201.8.3. [8 July 2025];

201.8.4. the payment for surgery to repair intervertebral disc damage, i.e. microdiscectomy and microfenestration, if such procedures have been approved by a council of neurosurgeons or spinal surgeons;

201.9. the payment according to the tariffs for manipulations for the manipulations which are marked in the list with two asterisks (**);

201.10. the payment for individual inpatient health care services referred to in Annex 7 to this Regulation - on the basis of invoices of the medical treatment institution;

201.11. the payment for the subacute rehabilitation, long-term rehabilitation/dynamic observation, and rehabilitation of the conditions which had occurred during perinatal period according to the number of actual bed days, the tariff for bed days specified for the relevant programme, and the tariffs for the performed manipulations for the manipulations which have been indicated in the contract with the medical treatment institution in the payment conditions as the manipulations binding for the programme;

201.12. the payment for the digitisation of health care services in accordance with Paragraph 1 of Annex 6 to this Regulation which shall be made by the Service once a year by 1 July of the current year.

[7 May 2019; 14 July 2020; 30 April 2024; 19 November 2024]

202. Upon calculating the number of bed days spent in a hospital (the duration of medical treatment), the day of entering and the day of discharging a person shall be considered one day.

203. The Service shall not pay for the secondary outpatient health care services received at an inpatient medical treatment institution during admission of a person, except for the following:

203.1. the State organised screening examinations;

203.2. the microbiological examinations for the determination of tuberculosis if the sample was taken prior to the placement of the person in the inpatient medical treatment institution;

203.3. the rental of a State paid oxygen concentrator if an oxygen concentrator has been issued to the patient for use at home.

[4 April 2023]

204. The Service shall not pay for the medical treatment of a person on an inpatient basis if the person has stayed at the inpatient medical treatment institution for one day, except for the case if death of the person has set in during the period of medical treatment, the person has received birth assistance, the person has received renal replacement therapy, the person has been transported to another inpatient medical treatment institution, or services have been provided to a person who has been brought for medical treatment from a place of imprisonment. If the person leaves the inpatient medical treatment institution on the first day disregarding the instructions of a medical practitioner, the medical treatment institution is entitled to request payment from the person for the inpatient health care services provided on the first day by applying the types of payment for State paid health care services referred to in Sub-paragraphs 201.8 and 201.9 of this Regulation.

[19 November 2024]

4.8. Procedures for the Reimbursement of Expenses for the Health Care Services Received in Another EU Member State, EEA Country, Switzerland, and the United Kingdom and International Settlement of Accounts

[19 November 2024]

205. The Service shall reimburse the expenses to an insured person covered from personal funds for the following:

205.1. for the health care services received in another EU Member State, EEA country, Switzerland, or the United Kingdom in accordance with the conditions for the costs of health care services of the country in which health care services were provided to the person according to the information provided by the competent authority of the EU Member State, EEA country, Switzerland, or the United Kingdom on the amount to be reimbursed to the person if:

205.1.1. during temporary stay the person has received emergency medical assistance or the necessary medical assistance and the relevant health care services are part of the range of State paid health care services in the state in which they were received;

205.1.2. the Service has taken a decision to issue the S2 form to the person but the person has paid for the received health care service from personal funds;

205.2. for the health care services received in another EU Member State or EEA country according to the tariffs for health care services in force in the Republic of Latvia at the moment of receipt of the health care service or according to the amount of compensation specified in the laws and regulations regarding the procedures for the reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for outpatient medical treatment at the moment when the medicinal products and medical devices were acquired if:

205.2.1. the person has received a planned health care service, except for the case referred to in Sub-paragraph 205.1.2 of this Regulation, and such health care service is paid in the Republic of Latvia from the State budget funds in accordance with the procedures laid down in this Regulation;

205.2.2. the person has received emergency or necessary health care and it was ensured by a health care service provider which does not participate in the social security system of such state, and such health care service is paid in the Republic of Latvia from the State budget funds;

205.2.3. the person has not received a planned health care service for the provision of which the Service has issued the S2 form in the state or with the health care service provider indicated in the S2 form issued by the Service.

[19 November 2024]

206. In order to receive the reimbursement of expenses for the health care services received in another EU Member State, EEA country, Switzerland, or the United Kingdom, the person shall, within a year from the day when he or she has stopped receiving health care services, submit the following documents to the Service:

206.1. an application for the reimbursement of expenses. The following information shall be indicated in the application:

206.1.1. the given name, surname, date of birth, personal identity number of Latvia or the taxpayer registration number assigned by the State Revenue Service if the person is not registered in the Register of Natural Persons, telephone number or electronic mail address;

206.1.2. the country in which health care services have been received;

206.1.3. the description of the reason for receipt of the health care service in another EU Member State, EEA country, Switzerland, or the United Kingdom;

206.1.4. the details of the settlement account of the person;

206.2. a document certifying the payment in which information identifying the recipient of the service is indicated;

206.3. the document of the provider of the health care service in which the following information is indicated:

206.3.1. the health care services provided to the person;

206.3.2. the period of provision of the health care services;

206.3.3. the price of the health care services provided to the person for each service individually;

206.3.4. a certification regarding payment for the health care services provided;

206.3.5. the diagnosis on the basis of which the health care service was provided to the person;

206.4. if the person is requesting to perform reimbursement of expenses in accordance with Sub-paragraph 205.2.1 of this Regulation - a prescription or a referral issued by a general practitioner or specialist for the receipt of the relevant health care service or information regarding the number, date of issuance of the prescription or referral, the medical treatment institution, and the medical practitioner who issued the prescription or referral, if the person does not have the prescription or referral at his or her disposal anymore, except for the case if, in accordance with the procedures laid down in this Regulation, a referral is not necessary for the receipt of the relevant health care service, and also other documents certifying that the requirements for the receipt of health care services laid down in the laws and regulations governing the field of health care have been met;

206.5. information as to whether the person was not considered insured within the scope of another social security system at the time of receipt of the health care service.

[19 November 2024]

207. Upon settlement of the reimbursement of expenses for the health care services received in another EU Member State, EEA country, Switzerland, or the United Kingdom, the amount of the reimbursement of expenses in euros shall be determined on the basis of the currency rate published by the European Central Bank which was specified in accordance with Regulation No 987/2009 and the EU and UK Protocol on the day when the Service received the application for the reimbursement of expenses from the person.

[19 November 2024]

208. The Service shall perform mutual settlement of accounts with EU Member States, EEA countries, Switzerland, and the United Kingdom for the persons insured within the scope of the social security system of such countries in conformity with the following conditions:

208.1. for the outpatient health care services provided by State administration institutions and medical treatment institutions - according to the tariffs for health care services indicated in the list of manipulations and the tariffs for care episodes indicated in Annex 4 to this Regulation;

208.2. for a call of a team of emergency medical assistance - according to the price of the call in accordance with the price list of paid services of the State Emergency Medical Service;

208.3. for inpatient health care services - by including the following in the calculations:

208.3.1. the payment for State paid health care services according to the actual number of bed days to be paid for, the types of payment for State paid health care services referred to in Sub-paragraphs 151.6 and 151.7 of this Regulation, and the list of manipulations;

208.3.2. the patient co-payment reimbursed by the State;

208.3.3. the average cost of treatment for one patient in the reception ward of the medical treatment institution;

208.3.4. the average cost of treatment for observation of one patient (to be included if such service has been provided);

208.3.5. the amount of the invoice paid (to be included if the payment for the service provided has been made to the medical treatment institution in accordance with Annex 7 to this Regulation).

[19 November 2024]

5. Closing Provisions

209. The following are repealed:

209.1. Cabinet Regulation No. 113 of 27 February 2018, Procedures for the Provision of Health Care Services at a Day Hospital (Latvijas Vēstnesis, 2018, Nos. 42, 66);

209.2. Cabinet Regulation No. 311 of 29 May 2018, Regulations Regarding Health Care Services in the Field of Rare Diseases (Latvijas Vēstnesis, 2018, No. 107);

209.3. Cabinet Regulation No. 450 of 24 July 2018, Procedures for the Provision of Health Care Services to Patients with Chronic Diseases at an Inpatient Medical Treatment Institution (Latvijas Vēstnesis, 2018, No. 150);

209.4. Cabinet Regulation No. 452 of 24 July 2018, Procedures for the Provision of Health Care Services for the Prevention of Cardiovascular Diseases (Latvijas Vēstnesis, 2018, No. 150).

210. Sub-paragraph 6.3 of this Regulation shall come into force on 1 July 2019.

211. The requirement referred to in Sub-paragraph 185.10 of this Regulation in relation to the HIV compliance room and Sub-paragraph 3.15 of Annex 10 shall come into force on 1 April 2019.

212. The institutions referred to in Paragraph 126 of this Regulation shall hand over the data necessary to the Service in online mode starting with 1 January 2020.

213. The Service shall perform reimbursement of expenses for the health care services referred to in Sub-paragraph 205.2.1 of this Regulation if the health care services were received after 25 October 2013.

214. The Service shall pay the fixed supplement for the operation of the reception ward to the medical treatment institutions referred to in Sub-paragraphs 1.7.9, 1.5, 1.7.5, 1.7.6, and 1.7.7 of Annex 6 to this Regulation from 1 April 2019 if the medical treatment institutions ensure that the relevant specialists are on 24-hour duty in the reception wards.

[7 May 2019]

215. The Service shall apply the procedures laid down in Annex 14 to this Regulation for the determination of the amount of finances for the provision of inpatient health care services from 1 January 2019.

216. The Service shall, by way of subrogation, recover the expenses for inpatient health care services, which have been paid from the State budget funds and, until 31 December 2013, provided to a person upon whose health harm has been inflicted as a result of illegal act, failure to act or criminal offence, in accordance with the tariff for bed days, the tariffs for the performed manipulations, and the number of actual bed days specified in the laws and regulations regarding the procedures for the organisation and financing of health care in force at the time of receipt of the health care service.

217. The functions of a general practitioner referred to in this Regulation shall also be carried out by primary health care paediatricians and primary health care internists with whom the Service has a contract entered into as on the day of coming into force of this Regulation for the provision of and payment for primary health care services.

218. If the Service has entered into a contract with the local government regarding the operation of a feldsher station but the relevant area does not conform to the condition referred to in Paragraph 19 of this Regulation anymore, the Service may continue the contractual relations with the local government for not more than three years from the day when a non-conformity with any of the abovementioned conditions has been detected.

219. Medical treatment institutions which until 31 August 2018 have been specified the right, in the contract with the Service, to provide State paid health care services at emergency rooms shall provide such services according to the conditions indicated in the contract until 31 March 2019. From 1 April 2019 such medical treatment institutions shall provide State paid services at emergency rooms or in the reception wards in accordance with the procedures laid down in Paragraph 92 of, Annex 6 and Annex 10 to this Regulation.

220. The Service shall include the profiles indicated in Paragraph 1 and the programmes of inpatient services indicated in Paragraph 2 of Annex 6 to this Regulation in contracts with medical treatment institutions in conformity with the following conditions:

220.1. sabiedrība ar ierobežotu atbildību "Jēkabpils slimnīca" [limited liability company Jēkabpils Hospital] shall commence the provision of inpatient health care services in the profile "Stroke Unit" and in the programme of inpatient services "Neurology (Stroke Unit)" indicated in Sub-paragraph 2.7.1 of Annex 6 to this Regulation from 1 April 2019;

220.2. sabiedrība ar ierobežotu atbildību "Siguldas slimnīca" [limited liability company Sigulda Hospital] shall commence the provision of inpatient health care services in the profile of therapy, surgery, gynaecology, paediatrics, and traumatology from 1 April 2019;

220.3. the State limited liability company Pauls Stradiņš Clinical University Hospital shall commence the provision of inpatient health care services in the programme of inpatient services "Palliative Care" indicated in Sub-paragraph 2.17.2 of Annex 6 to this Regulation from 1 April 2019;

220.4. the first level inpatient medical treatment institutions shall commence the provision of inpatient health care services in the programme of inpatient services "Other Therapeutic Services" indicated in Sub-paragraph 2.21 of Annex 6 to this Regulation from 1 April 2019.

221. The Service is entitled, until 31 December 2018 on the basis of an application of a medical treatment institution, to make changes in the amount of financing specified in the contract which is intended for payment for the surgical operations performed at a day hospital and for the services that are part of the programme of inpatient services "Planned Temporary Surgery", without taking into account the restrictions referred to in Annex 14 to this Regulation for the amount of the financial resources to be diverted.

222. Medical treatment institutions shall ensure the use of parenteral medicinal products purchased in accordance with the procedures laid down in this Regulation for medical treatment of oncological diseases and the Service shall pay for them from 1 January 2019.

223. The E106, E109, E120, and E121 forms, the insurance cards issued for the use in the EU Member States and by 15 August 2010 shall be valid until expiry of the term of validity of such document, except for the cases when the relevant document has been cancelled.

224. Contracts for the provision of State paid health care services which have been entered into by and between the health care service provider and the Service prior to coming into force of this Regulation shall be in effect until expiry of the time period specified in the contract.

225. The Regulation shall be applied from 1 September 2018.

226. The condition referred to in Sub-paragraph 4.1.3 of this Regulation regarding payment for dental assistance from the State budget funds for asylum seekers who have attained 18 years of age and are more than 18 years old shall be in force until 31 December 2018.

227. [7 May 2019]

228. The Service shall, in accordance with the conditions referred to in Sub-chapter 4.8 of this Regulation, reimburse expenses for health care services which have been received in the United Kingdom of Great Britain and Northern Ireland or their receipt has been commenced until the day when the United Kingdom of Great Britain and Northern Ireland has withdrawn from the European Union in accordance with Article 50 of the Treaty on the European Union.

[26 March 2019]

229. The medicinal products referred to in Sub-paragraph 4.4 of Annex 7 to this Regulation for medical treatment of children with oncological and oncohaematological diseases in case of invasive mycoses after chemotherapy shall be paid as for medical treatment performed on an inpatient basis also if medical treatment was performed in the time period from 1 September 2018 to 1 April 2019.

[7 May 2019]

230. The payment indicated in Paragraph 8.¹ of Annex 11 to this Regulation shall be EUR 142.29 until 30 June 2019.

[7 May 2019]

231. The Service shall disburse the payment referred to in Paragraph 16 of Annex 11 to this Regulation in the amount of EUR 75.00 to general practitioners for cancer discovered in a timely manner in 2018 until 1 September 2019.

[7 May 2019]

232. The rights specified in Paragraph 13 of this Regulation for the doctors working at long-term social care and social rehabilitation institutions which provide long-term social care and social rehabilitation services financed by the local government shall be applied from 1 January 2020.

[7 May 2019]

233. In 2019 and 2020 the Service shall, in addition to the payment referred to in Sub-paragraph 201.2 of this Regulation, pay a compensation payment for introduction of the programmes of DRG services, determining it in the amount of the previous year and additionally taking into account the financing necessary for ensuring the planned increase in remuneration for such medical treatment institutions the total contractual amount of which is less than the contractual amount of the previous year.

[10 December 2019]

234. The compensation payment referred to in Paragraph 233 of this Regulation for the introduction of the programmes of DRG services for medical treatment institutions of Level V is made in addition to the payment referred to in Sub-paragraph 201.2 of this Regulation by 31 March 2019, but starting from 1 April 2019 the compensation payment is covered by applying the base coefficient in the calculation of the payment of DRG services in accordance with Sub-paragraph 3.3.1 of Annex 14 to this Regulation.

[7 May 2019; 14 July 2020]

235. The tariffs for medical treatment of one patient specified in Sub-paragraph 2.4 of Annex 6 to this Regulation shall be as follows until 30 June 2019:

235.1. for the programme "Birth in Case of Birth Pathology" - EUR 667.11;

235.2. for the programme "Physiological Birth" - EUR 476.29;

235.3. for the programme "Caesarean Section" - EUR 866.53.

[7 May 2019]

236. The requirement referred to in Sub-paragraph 1.1.1.4 of Annex 1 to this Regulation for enzymatic determination of biotinidase activity in a newborn, for the determination of 17-OF-progesterone with the fluorescence enzyme immunoassay (FEIA) in a newborn, for the quantitative fluorometric determination of the total galactose in a newborn, for the determination of immunoreactive trypsinogen (IRT) with the fluorescence enzyme immunoassay (FEIA) shall come into force on 1 July 2019.

[7 May 2019]

237. Sub-paragraph 8.7 and Paragraph 9.¹ of this Regulation shall come into force on 1 January 2022.

[10 December 2019]

238. The coefficients to be included in the calculation of work remuneration referred to in Note 2 of Annex 10 to this Regulation shall be applied from 2020 to the average work remuneration which was in force until 31 December 2019 (for doctors and functional specialists - EUR 1 350.00, for medical practitioners, patient care persons, and assistants of functional specialists - EUR 810.00).

[10 December 2019]

239. The Service shall apply the evaluation of the execution of the quality indicators specified in Sub-paragraph 3.1.1 of Annex 14 to this Regulation from 1 January 2026.

[19 December 2023]

240. The Service shall disburse the payment referred to in Paragraph 16 of Annex 11 to this Regulation in the amount of EUR 75.00 to general practitioners for cancer discovered in a timely manner in 2019 until 1 September 2020.

[9 June 2020]

241. The annual performance evaluation of general practitioners according to the evaluation criteria specified in Annex 15 to this Regulation and the payment for the fulfilment of these criteria in 2020 and 2021 shall be applied according to the performance indicators in 2019 if the performance indicators in 2020 or 2021 are lower than those in 2019. For general practitioners who in 2020 entered into contractual relations with the Service, the payment for the fulfilment of these criteria in 2020 shall be applied according to the national average performance indicators in 2019. For general practitioners who in 2021 entered into contractual relations with the Service, the payment for the fulfilment of these criteria in 2020 shall be applied according to the national average performance indicators in 2019.

[29 December 2021]

242. In 2020, the Service shall not carry out the financial revision of the contractual amount in accordance with Paragraph 33.¹ of Annex 11 and the procedures referred to in Paragraphs 5 and 7 of Annex 14 to this Regulation. The Service shall carry out the financial revision of the contractual amount in 2020 by evaluating the actual execution of the amount of funding over eight months of the current year and shall reduce the total contractual amount if the contractual performance during these eight months is less than 90 % of the planned amount of funding for this period and if the Service and the medical treatment institution have agreed upon such reduction.

[9 June 2020]

243. [14 July 2022]

243.¹ [14 July 2022]

244. [14 July 2022]

245. [14 July 2022]

245.¹ Until 31 December 2021, the Service shall pay for:

245.¹1. psychotherapeutic and psychological support for a person who is entitled to receive health care services within the scope of mandatory State health insurance if the necessity for such assistance has been determined by a general practitioner - up to 10 sessions;

245.¹2. ensuring the operation of a consultative telephone service for residents to receive psychoemotional support.

[27 April 2021 / Sub-paragraph 245.¹2 shall come into force on 1 July 2021. See Paragraph 257]

245.² In order to ensure the availability of the services referred to in Sub-paragraph 245.¹1 of this Regulation, the Service shall enter into contracts with legal persons for the provision of services by clinical and health psychologists, psychotherapy specialists, or psychotherapists, using the type 7 care episode specified in Annex 4 to this Regulation for the accounting of the specialists' work, and in conformity with the following conditions:

245.²1. a written application for the provision of the service has been received by the Service;

245.²2. the service is provided by the person who is registered in the register of psychologists or the register of medical practitioners and medical treatment support persons;

245.²3. the legal person has the materials and technical facilities necessary for the provision of psychotherapeutic and psychological services.

[27 April 2021]

245.³ The Service shall make the payment to a practice of a general practitioner for the COVID-19 vaccination coverage indicators achieved in 2021 according to the following conditions:

245.³1. for the practice of a general practitioner that does not provide vaccination against COVID-19 in accordance with the procedures laid down in the contract with the Service, the payment shall be made for the COVID-19 vaccination coverage indicators achieved in the period from 1 January 2021 to 30 September 2021 for residents from 60 years of age and patients from 18 years of age with certain chronic diseases published on the website of the Centre for Disease Prevention and Control:

245.³1.1. EUR 1.00 for each person who has completed vaccination if the vaccination coverage is up to 60 %;

245.³1.2. EUR 2.00 for each person who has completed vaccination if the vaccination coverage is from 60 % to 80 %;

245.³1.3. EUR 3.00 for each person who has completed vaccination if the vaccination coverage is from 80 % to 100 %;

245.³2. for the practice of a general practitioner that provides vaccination against COVID-19 in accordance with the procedures laid down in the contract with the Service, the payment shall be made:

245.³2.1. for the COVID-19 vaccination coverage indicators achieved in the period from 1 January 2021 to 31 December 2021 for residents from 60 years of age and patients from 18 years of age with certain chronic diseases published on the website of the Centre for Disease Prevention and Control:

245.³2.1.1. EUR 2.00 for each person who has completed vaccination if the vaccination coverage is up to 60 %;

245.³2.1.2. EUR 4.00 for each person who has completed vaccination if the vaccination coverage is from 60 % to 80 %;

245.³2.1.3. EUR 6.00 for each person who has completed vaccination if the vaccination coverage is from 80 % to 100 %;

245.³2.2. for the COVID-19 vaccination coverage indicators achieved in the period from 1 January 2021 to 31 December 2021 for residents who are not referred to in Paragraph 245.³2.1 of this Regulation:

245.³2.2.1. EUR 1.00 for each person who has completed vaccination if the vaccination coverage is up to 50 %;

245.³2.2.2. EUR 3.00 for each person who has completed vaccination if the vaccination coverage is from 50 % to 70 %;

245.³2.2.3. EUR 5.00 for each person who has completed vaccination if the vaccination coverage is from 70 % to 100 %;

245.³2.3. for the practices of general practitioners referred to in Sub-paragraph 245.³2 of this Regulation, the Service shall carry out an additional assessment of vaccination coverage achievement for the period from 1 January 2021 to 30 September 2021 and shall make an interim payment by 31 December 2021 for the COVID-19 vaccination coverage indicators achieved in 2021.

[8 October 2021]

245.⁴ For the practice of a general practitioner that provides vaccination against COVID-19 at the practice:

245.⁴1. the Service shall make an additional payment of EUR 11.87 for each vaccine dose administered to a patient in the period from 1 October 2021 to 31 December 2021;

245.⁴2. in accordance with the procedures laid down in the contract with the Service, the practice has the right to receive the reimbursement of expenses up to the amount of EUR 440 for health promotion and rehabilitation measures intended for the persons employed at the practice of a general practitioner and received during the period from 1 October 2021 to 31 August 2022.

[8 October 2021; 2 November 2021]

245.⁵ [14 July 2022]

245.⁶ [14 July 2022]

246. [14 July 2022]

247. The age restrictions referred to in Sub-paragraphs 4.1.1, 4.1.2, and 4.3.3 of this Regulation for receiving of and payment for dental services and medically assisted insemination services shall not apply to patients who, during the emergency situation, reached the age after which the specific service is no longer covered if:

247.1. the appointment for a dental service had been made prior to the entry into force of the emergency situation, but the appointment was cancelled during the emergency situation declared due to COVID-19;

247.2. the medically assisted insemination service was due to commence in accordance with the centralised queue maintained by the Service, but commencement of the service was not possible during the emergency situation declared due to COVID-19;

247.3. the dental service is received or the medically assisted insemination service is commenced by 31 August 2020.

[9 June 2020]

248. [14 July 2022]

249. Sub-paragraph 4.11.1.2 of this Regulation and Sub-paragraph 1.2.10 of Annex 8 shall apply from 1 July 2020 to patients who, until 30 June 2020, have received enteral and parenteral feeding mixtures.

[14 July 2020]

250. The Service shall determine the payment amount for secondary outpatient health care and inpatient health care service providers for 2021 and 2022 according to the volume planned until 1 July 2020, taking into account the planned increase in remuneration for 2021 and 2022, except for:

250.1. the medical rehabilitation day hospital where planning is carried out according to the results of the procedure for selecting a service provider;

250.2. the cases where changes in planning the payment amount are necessary to ensure service availability and continuity, and either a written application for the necessity thereof has been received from the medical treatment institution or an agreement has been reached with the medical treatment institution on such changes, stipulating that the changes are made within the scope of the total funding provided for in the contract.

[29 December 2021]

251. [19 November 2024]

252. The Service shall apply the payments for screening response indicators referred to in Paragraph 16.¹ and 16.² of Annex 11 to this Regulation from 1 January 2021.

[17 December 2020 / See Paragraph 2 of Amendments]

253. Sub-paragraphs 185.17 and 185.18 of this Regulation, and Sub-paragraphs 2.22 and 2.23 of Annex 10 shall come into force on 1 July 2021.

[17 December 2020]

254. [14 July 2022]

255. Until 30 June 2022, the Service is entitled to make changes to the list of manipulations referred to in Sub-paragraph 154.7 of this Regulation more frequently than once per quarter if the changes are related to COVID-19. The Service shall inform the medical treatment institutions and the Ministry of Health of the changes made.

[29 December 2021]

256. [29 December 2021]

257. Sub-paragraph 245.¹2 of this Regulation shall come into force on 1 July 2021.

[27 April 2021]

258. The expenses related to the establishment of a mood disorder consulting room for children shall be reimbursed by the Service to the health care service provider referred to in Sub-paragraph 2.23 of Annex 10 to this Regulation for the provision of services in the regions from 1 July 2021.

[27 April 2021]

259. The Service shall disburse the payment referred to in Paragraph 16 of Annex 11 to this Regulation in the amount of EUR 75.00 to general practitioners for cancer discovered in a timely manner in 2020 until 1 September 2021.

[29 June 2021]

260. Until 31 December 2022, the Service shall make the payment for the provision of inpatient health care services to inpatient medical treatment institutions which provide health care services to Ukrainian civilians due to the armed conflict caused by the Russian Federation in accordance with the procedures laid down in the contract with the Service according to the actual costs for the following:

260.1. the medical transportation of patients from a foreign medical treatment institution to an inpatient medical treatment institution in Latvia;

260.2. the transfer of patients from one inpatient medical treatment institution to another inpatient medical treatment institution.

[31 May 2022]

261. During the period from 1 July 2022 to 30 June 2025, cervical cancer screening using the human papillomavirus testing method for women from 30 years of age shall be performed once every three years.

[14 July 2002]

262. Until 31 December 2022, the Service shall, in accordance with the procedures laid down in the contract with the medical treatment institution, make the payment for the following services provided for the containment of the spread of COVID-19 and prevention of the consequences thereof:

262.1. for performing laboratory testing for COVID-19 detection according to the COVID-19 testing algorithm published on the website of the Centre for Disease Prevention and Control;

262.2. according to the actual costs - for the transportation of COVID-19 patients from an inpatient medical treatment institution to their home if the health condition of the patient allows for continued treatment at home and the patient is unable to find a way to get home without endangering epidemiological safety and also for travel expenses for the medical practitioner who visits a COVID-19 patient;

262.3. according to the actual costs - for the transfer of a patient from a higher-level inpatient medical treatment institution to a lower-level inpatient medical treatment institution if the health condition of the patient has improved and allows for continued treatment in a lower-level inpatient institution and if the higher-level inpatient medical treatment institution needs to free inpatient beds for acute patients who require inpatient treatment as a matter of urgency;

262.4. for subacute rehabilitation and long-term rehabilitation for patients recovering from COVID-19 infection;

262.5. for ongoing monitoring of the health condition of patients recovering from COVID-19 infection;

262.6. for vaccination against COVID-19.

[14 July 2002]

263. Until 31 December 2022, the Service shall make the payment for the diagnosis and treatment of COVID-19 patients according to the volume of services actually provided. When making the payment for the treatment of COVID-19 patients at an inpatient medical treatment institution, an intensity coefficient shall be applied to the remuneration included in the tariff for bed days.

[14 July 2002]

264. Until 31 December 2022, the Service shall make the payment for laboratory services for COVID-19 detection according to the volume of services actually provided, without applying the coefficient referred to in Paragraph 200 of this Regulation or the procedures referred to in Annex 16 to this Regulation.

[14 July 2002]

265. Until 31 December 2022, the Service shall pay for the following:

265.1. in accordance with the procedures laid down in the contract with the Service - for ensuring the substitution of a general practitioner during leave and in the case of sick-leave certificate A if the availability of general practitioner services to patients is ensured during the absence of the general practitioner;

265.2. for the consultations provided remotely by general practitioners in accordance with the list of manipulations.

[14 July 2002]

266. Until 31 December 2022, the Service shall pay for the operation of a consultative telephone service providing psychoemotional support for adolescents. The Service shall conduct a procurement for the provision of this service.

[14 July 2002]

267. During the period from 1 January 2022 to 31 December 2022, the Service shall make the payment for the employment of an additional employee at the practice of a general practitioner that provides vaccination against COVID-19 in accordance with the procedures laid down in the contract with the practice of the general practitioner. The payment shall consist of the following:

267.1. the average monthly work remuneration referred to in Sub-paragraph 153.2 of this Regulation and the mandatory State social insurance contributions;

267.2. the supplement for providing a workplace in the amount of EUR 119.00.

[14 July 2002]

268. Until 31 December 2022, the Service shall make payments to medical treatment institutions according to the volume of services actually provided for the following:

268.1. the use of personal protective equipment and disinfectants in the provision of services in accordance with the list of manipulations or monthly fixed payment;

268.2. the secondary outpatient health care services provided to persons with an active confirmed COVID-19 infection or to a contact person recognised in accordance with the laws and regulations regarding epidemiological safety measures for the containment of the spread of COVID-19 infection during the period of medical observation in accordance with the list of manipulations.

[14 July 2002]

269. If the inpatient medical treatment institutions referred to in Annex 6 to this Regulation are unable to provide inpatient treatment for therapeutic profile patients and also for chronic patient care profile and COVID-19 patients due to the limited number of beds, the Service is entitled, until 31 December 2022, to enter into a contract for the inpatient care of such patients with other inpatient medical treatment institutions not referred to in Annex 6 to this Regulation.

[14 July 2002]

270. Until 31 December 2022, the Service shall make the following payments to inpatient health care service providers:

270.1. the supplement for the intensity and organisation of patient flow in the reception ward of the inpatient medical treatment institutions referred to in Sub-paragraphs 1.1 and 1.2 of Annex 6 to this Regulation (in addition to the supplement for the operation of the reception ward and patient observation for up to 24 hours specified in Annex 6 to this Regulation) in accordance with the procedures laid down in the contract with the medical treatment institution, calculating the payment according to the increase in the number of patients and applying an intensity coefficient to the remuneration;

270.2. the payment in accordance with the procedures laid down in the contract with the medical treatment institution for the treatment of COVID-19 patients in an intensive care bed or unit.

[14 July 2002]

271. From 1 July 2022, the Service shall pay for the services of an art therapist referred to in Sub-paragraph 2.10 of this Regulation and for the services of a functional specialist referred to in Annex 10 to this Regulation at a mood disorder consulting room for children, the health care services referred to in Paragraphs 262, 263, 264, 265, 268, 269, and 270 of this Regulation, and also for the operation of the consultative telephone service referred to in Paragraph 266 of this Regulation for adolescents to receive psychoemotional support.

[14 July 2002]

272. In 2022, the Service shall direct the funding obtained by carrying out the financial revision of the contractual amount in accordance with the procedures referred to in Paragraph 7 of Annex 14 to this Regulation to the providers of inpatient health care services for the compensation for the increase in energy source costs. The Service shall enter into a contract with the provider of inpatient health care services for the compensation for the increase in energy source costs.

[15 November 2022]

273. Until 31 December 2025, the Service shall make the payment for the provision of inpatient health care services to inpatient medical treatment institutions which provide health care services to Ukrainian civilians due to the armed conflict caused by the Russian Federation in accordance with the procedures laid down in the contract with the Service according to the actual costs for the following:

273.1. the medical transportation of patients from a medical treatment institution in Ukraine to an inpatient medical treatment institution in Latvia;

273.2. the transfer of patients from an inpatient medical treatment institution to another inpatient medical treatment institution.

[10 December 2024]

274. Until 31 December 2024, the Service shall make the payment for performing laboratory testing for COVID-19 detection according to the COVID-19 testing algorithm published on the website of the Centre for Disease Prevention and Control in accordance with the procedures laid down in the contract with the medical treatment institution.

[19 December 2023]

275. Until 31 December 2023, the Service shall make the payment for the use of personal protective equipment and disinfectants in the provision of services in accordance with the list of manipulations or monthly fixed payment to medical treatment institutions according to the volume of services actually provided.

[28 March 2023]

276. If the inpatient medical treatment institutions referred to in Annex 6 to this Regulation are unable to provide inpatient treatment for therapeutic profile patients and also for chronic patient care profile patients due to the limited number of beds, the Service is entitled, until 31 December 2023, to enter into a contract for the inpatient care of such patients with other inpatient medical treatment institutions not referred to in Annex 6 to this Regulation.

[10 January 2023 / See Paragraph 277]

277. The Service shall pay for the vaccination referred to in Sub-paragraph 3.6.2 of this Regulation, the transportation expenses referred to in Sub-paragraphs 150.1.3 and 150.1.4 and Paragraph 273, and also the health care services referred to in Paragraphs 274, 275, and 276 of this Regulation from 1 January 2023.

[10 January 2023]

278. During the period from 1 January 2023 to 31 January 2023, the Service shall make the payment for the employment of an additional employee at the practice of a general practitioner that provides vaccination against COVID-19 in accordance with the procedures laid down in the contract with the practice of the general practitioner. The payment shall consist of the following:

278.1. the average monthly work remuneration referred to in Sub-paragraph 153.2 of this Regulation and the mandatory State social insurance contributions;

278.2. the supplement for providing a workplace in the amount of EUR 119.00.

[31 January 2023]

279. Sub-paragraph 3.11.¹ of this Regulation shall come into force on 1 October 2023.

[28 March 2023]

280. During the period from 1 September 2023 to 31 December 2023, the amount of capitation, including the payment for performing the functions of a receptionist and providing telephone consultations during the working hours of the practice, shall be EUR 3.353868 per person per month.

[5 September 2023]

280.¹ Paragraph 90.¹ of this Regulation shall come into force on 1 January 2025.

[19 November 2024]

281. Paragraph 168.¹ of this Regulation shall come into force on 1 April 2025. During the period from 1 April 2025 to 30 September 2025, the Service shall withhold the difference between the full payment for the provided inpatient and outpatient health care services and the amount paid to the medical treatment institution, applying the coefficient referred to in Paragraph 168.¹ of this Regulation and shall pay it to the medical treatment institution at the moment when it commences the preparation of the medical documents referred to in Paragraph 168.¹ of this Regulation and their placement in the health information system in accordance with the laws and regulations regarding a unified electronic information system of the health sector. The difference shall not be paid to the medical treatment institution if the medical treatment institution fails to commence the preparation of the medical documents referred to in Paragraph 168.¹ of this Regulation and their placement in the health information system by 1 October 2025.

[30 April 2024]

282. In 2024, the Service shall pay the annual payment referred to in Paragraph 1 of Annex 6 to this Regulation for the digitisation of health care services to medical treatment institutions at a reduced amount, calculating the sum proportionally for the period from 1 May 2024 to 31 December 2024.

[30 April 2024]

283. The Service has the right to enter into a contract with sabiedrība ar ierobežotu atbildību "Sanare-KRC Jaunķemeri" [limited liability company Sanare-KRC Jaunķemeri] and sabiedrība ar ierobežotu atbildību "Rehabilitācijas centrs "Līgatne"" [limited liability company Rehabilitation Centre Līgatne] for the provision of inpatient medical rehabilitation services to the patients referred to in Sub-paragraph 273.1 of this Regulation until 31 December 2025, with payment made according to the tariffs for treatment of one patient as specified in Sub-paragraph 2.20.1, 2.20.2, or 2.20.4 of Annex 6 to this Regulation.

[10 December 2024]

284. Valsts sabiedrība ar ierobežotu atbildību "Piejūras slimnīca" [State limited liability company Seaside Hospital] shall provide the narcology profile referred to in Sub-paragraph 1.1.7.3 of Annex 6 to this Regulation and the programme "Narcology" referred to in Sub-paragraph 2.25.13.5 in accordance with the procedures laid down in the contract with the Service. Until the commencement of the aforementioned inpatient health care service profile and health care service programme at State limited liability company Seaside Hospital, these services shall continue to be provided by sabiedrība ar ierobežotu atbildību "Liepājas reģionālā slimnīca" [limited liability company Liepāja Regional Hospital].

[18 June 2024]

285. From 1 July 2025, the Service shall make the payment for the health care service referred to in Sub-paragraph 42.1.¹ of this Regulation, and also the payment referred to in Sub-paragraphs 2.10.8 and 2.10.26 of Annex 6 and Sub-paragraph 2.9 of Annex 10 to this Regulation, and the payment referred to in Paragraph 29 of Annex 11 to this Regulation in compliance with the condition referred to in Sub-paragraph 29.1 of Annex 11.

[8 July 2025]

Informative Reference to European Union Directives

This Regulation contains legal norms arising from:

1) 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;

2) Commission Implementing Directive 2012/52/EU of 20 December 2012 laying down measures to facilitate the recognition of medical prescriptions issued in another Member State;

3) Directive 2011/92/EU of the European Parliament and of the Council of 13 December 2011 on combating the sexual abuse and sexual exploitation of children and child pornography, and replacing Council Framework Decision 2004/68/JHA.

Prime Minister Māris Kučinskis

Minister for Health Anda Čakša

 

Annex 1
Cabinet Regulation No. 555
28 August 2018

[8 July 2025]

Preventive Examinations (Inspections) and Determination of the Risk of Cardiovascular Diseases

1. Preventive examinations of children

Early neonatal period

Neonatal period

Infant period

Toddler period

Pre-school period

School period

1.1. Age

48-78 h

3rd-6th day of life

7th-14th day of life

15th-21st day of life

22nd-28th day of life

1 month of age

2 months of age

3 months of age

4 months of age

5 months of age

6 months of age

7-8 months of age

9-11 months of age

12 months of age

13-18 months of age

19-24 months of age

2 years of age

3 years of age

4 years of age

5 years of age

6 years of age

7-18 years of age

1.2. Examination performed by a general practitioner:

1.2.1. at home

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1.2.2. at the practice of a general practitioner1

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Once a year

1.3. Examination performed by a midwife or a nurse or a doctor's assistant (feldsher) working at the practice of a general practitioner:

1.3.1. at home

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Once every 10 days

If a child does not arrive for the scheduled examination at the medical practice

1.3.2. at the practice of a general practitioner

1.4. Screening:

1.4.1. determination of phenylalanine in blood

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1.4.2. determination of thyrotropin-releasing hormone in blood

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1.4.3. enzymatic determination of biotinidase activity in a newborn

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1.4.4. determination of 17-OH-progesterone in a newborn's blood with the fluorescence enzyme immunoassay (FEIA)

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1.4.5. quantitative fluorometric determination of the total galactose in a newborn's blood

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1.4.6. determination of immunoreactive trypsinogen (IRT) with the fluorescence enzyme immunoassay (FEIA) and, in case of changes in the IRT result, of CFTR gene dF508 mutation

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1.4.7. determination of SMN1 gene deletion in a newborn's blood by extracting DNA

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1.4.8. determination of T and/or B cell receptor deficiency in a newborn's blood by extracting DNA

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1.4.9. newborn screening for galactosaemia by determining total galactose from dried blood spots and enzyme GALT activity in newborns whose blood sample was taken before 48 hours of life, in premature infants with a weight below 2000 g and/or gestational age ≤ 33 + 6 weeks, in newborns who have received blood product transfusion and/or parenteral feeding, or in newborns with primarily altered galactose indicators

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1.4.10. screening for metabolic diseases in blood by determining their characteristic metabolites using the liquid chromatography tandem mass spectrometry (LC-MS/MS) method: - newborn screening for glutaric aciduria (type 1) from dried blood spots; - newborn screening for glutaric aciduria (type 2) from dried blood spots; - newborn screening for medium-chain acyl-coenzyme A dehydrogenase deficiency from dried blood spots; - newborn screening for long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency from dried blood spots; - newborn screening for very long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency from dried blood spots; - newborn screening for primary carnitine deficiency from dried blood spots; - newborn screening for carnitine/acylcarnitine translocase deficiency from dried blood spots; - newborn screening for carnitine palmitoyltransferase deficiency (type Ia) from dried blood spots; - newborn screening for carnitine palmitoyltransferase deficiency (type II) from dried blood spots; - newborn screening for argininaemia from dried blood spots; - newborn screening for citrullinaemia (type I) from dried blood spots; - newborn screening for citrin deficiency (citrullinaemia type II) from dried blood spots; - newborn screening for argininosuccinate lyase deficiency from dried blood spots; - newborn screening for homocystinuria in a dried blood spot; - newborn screening for maternal and/or infant vitamin B12 deficiency in a dried blood spot

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1.4.11. hearing test using the otoacoustic emission method

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1.4.12. eyesight tests2

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1.5. Immunoprophylaxis

In accordance with the vaccination schedule

1.6. Neonatologist examination for children born up to the 34th week of gestation (provided by a neonatologist employed by State limited liability company Children's Clinical University Hospital, State limited liability company Pauls Stradiņš Clinical University Hospital, limited liability company Liepāja Regional Hospital, SIA "Daugavpils reģionālā slimnīca" [limited liability company Daugavpils Regional Hospital], SIA "Vidzemes slimnīca" [limited liability company Vidzeme Hospital], SIA "Jēkabpils reģionālā slimnīca" [limited liability company Jēkabpils Regional Hospital], or SIA "Rīgas Dzemdību nams" [limited liability company Riga Maternity Hospital])3

40th week of gestation, adjusted

44th week of gestation, adjusted

3 months of age, adjusted

6 months of age, adjusted

9 months of age, adjusted

12 months of age, adjusted

18 months of age, adjusted3

24 months of age, adjusted3

1.7. Dental hygienist visit

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Once a year, but for children at 7, 11, and 12 years of age - twice in the respective age group

1.8. Determination of fasting glucose level in venous blood plasma (mmol/l)

Once a year for patients in risk groups from 10 years of age4

Notes. 1 The general practitioner shall conduct an early childhood developmental assessment as part of the preventive examination in accordance with the conditions laid down in the contract with the Service; the assessment shall be conducted at four, six, nine, twelve, and eighteen months of age, and also at two and three years of age. 2 At 13-24 months of age: indicative assessment of visual ability, ocular misalignment angle with the prism cover test, extraocular movement, skiascopy after brief cycloplegia, dilated fundus examination. At 3 years of age: comparative visual acuity test using an E letter chart or picture chart, ocular misalignment angle with the prism cover test, extraocular movement, skiascopy after brief cycloplegia, dilated fundus examination. At 6-7 years of age: near and distance visual acuity, stereoscopic and binocular eyesight tests, eye movement test, convergence test, ocular misalignment angle with the prism cover test, extraocular movement, skiascopy after brief cycloplegia, dilated fundus examination. The aforementioned eyesight tests shall be performed by an ophthalmologist. 3 Neonatologist examinations shall be provided until the adjusted age of one year or, if an opinion has been received from a specialist on the necessity to continue observation until the adjusted age of two years. 4 Risk group patients include children whose body mass index (hereinafter - the BMI) is ≥ 85th percentile in relation to age, height, and gender and who have at least one of the following risk factors: family history of type 2 diabetes mellitus in a first-degree or second-degree relative; mother with diabetes mellitus or gestational diabetes mellitus during pregnancy with the specific child; belonging to a high-risk ethnic group (African American, Native American, Hispanic, Asian, or Pacific Islander); signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, arterial hypertension, dyslipidaemia, polycystic ovary syndrome, low birth weight for gestational age).

2. Preventive examinations of adults

2.1. Age of the person in full years

2.2. General health examination performed by a general practitioner

2.2.1. history of complaints

2.2.2. body weight and height, BMI

2.2.3. measure- ment of arterial blood pressure and pulse

2.2.4. condition of skin and mucous membranes, examination of the oral cavity

2.2.5. exami- nation and palpation of neck, axillary and inguinal lymph nodes

2.2.6. assess- ment of thyroid gland projection

2.2.7. appear- ance and palpation of breast tissue

2.2.8. aus- cultation of cardiac activity, carotid arteries and lungs

2.2.9. abdominal palpation

2.2.10. assessment of vision, hearing, mental state, sensation, movement, neurological disorders, and conse- quences of trauma

2.2.11. digital rectal examination

2.3. State organised screening1

2.3.1. cervical cancer screening

2.3.1.1. with liquid-based cytology method

2.3.1.2. with human papilloma- virus testing method

2.3.2. preventive exami- nation for breast cancer - mammo- graphy

2.3.3. preven- tive exami- nation for bowel cancer - fecal occult blood test

2.3.4. prostate cancer screening2

2.4. Cardio- vascular disease risk assessment using the SCORE method3

2.4.1. collection of medical history - family history (early (up to 50 years of age) athero- sclerotic cardio- vascular disease or sudden death), smoking

2.4.2. waist circum- ference

2.4.3. deter- mination of total cholesterol in blood

2.4.4. deter- mination of high-density cholesterol in blood

2.4.5. deter- mination of low-density cholesterol in blood

2.4.6. deter- mination of trigly- cerides in blood

2.4.7. electro- cardiogram

2.4.8. deter- mination of SCORE risk group

2.5. Deter- mination of fasting glucose level in venous blood plasma (mmol/l)4

2.6. Immuno- prophylaxis

18-24 years of age

Once a year

In accordance with the vaccination schedule

25 years of age

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26-27 years of age

Once a year

28 years of age

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29 years of age

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30 years of age

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31 years of age

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32-33 years of age

Once a year

34 years of age

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35 years of age

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36 years of age

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37 years of age

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38-39 years of age

Once a year

40 years of age

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41-42 years of age

Once a year

43 years of age

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44 years of age

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45 years of age

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46 years of age

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47 years of age

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48 years of age

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49 years of age

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50 years of age

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51 years of age

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52 years of age

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53 years of age

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54 years of age

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55 years of age

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56 years of age

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57 years of age

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58 years of age

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59 years of age

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60 years of age

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61 years of age

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62 years of age

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63 years of age

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64 years of age

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65 years of age

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66 years of age

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67 years of age

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68 years of age

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69 years of age

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70 years of age

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71 years of age

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72 years of age

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73 years of age

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Once a year

Notes. 1 Screening and post-screening examinations are laid down in the contract with the medical treatment institution and on the website of the Service. 2 Prostate cancer screening may be provided to men from the age of 45 if prostate cancer has been identified in the family medical history. 3 SCORE method - a method for determining the risk of fatal cardiovascular events within the next 10 years. 4 For patients in the risk group, fasting venous blood plasma glucose levels (mmol/l) shall be determined once a year. The risk group includes individuals with a BMI ≥ 25 (kg/m²) and at least one of the following risk factors: a first-degree relative diagnosed with diabetes mellitus, coronary heart disease and/or transient ischaemic attack, and/or history of stroke, arterial hypertension, high-density cholesterol < 0.90 mmol/l and/or triglycerides > 2.82 mmol/l, polycystic ovary syndrome, sedentary lifestyle (physical activity < 30 min/day or < 4 h/week), conditions associated with insulin resistance (abdominal obesity - waist circumference > 80 cm in women, > 94 cm in men, acanthosis nigricans, fatty liver).

3. Care for pregnant women and women who have recently given birth shall be provided in accordance with the laws and regulations regarding the provision of birth assistance.

4. Preventive and medical examinations performed by a sports doctor and a general practitioner for athletes up to 18 years of age and children with an increased physical load shall be conducted in accordance with the laws and regulations establishing the procedures for health care and medical supervision of athletes and children with an increased physical load.

5. During the examination performed within the scope of the preventive examination, the general practitioner shall evaluate the necessity for additional examinations and specialist consultations.

6. Health care services for the prevention of cardiovascular diseases shall be implemented by the practice of the general practitioner once for a specific age group. After determining the risk of cardiovascular diseases, the general practitioner shall recommend and prescribe further measures for the patient in compliance with the procedures laid down in the contract with the Service.

7. The procedures for the prevention of cardiovascular diseases specified in this Annex shall not apply to high and very high risk patients who have:

7.1. a cardiovascular disease with one of the following features:

7.1.1. a history of myocardial infarction or acute coronary syndrome;

7.1.2. a history of coronary revascularisation - percutaneous coronary intervention or coronary artery bypass grafting;

7.1.3. a history of revascularisation of other (non-coronary) arteries;

7.1.4. a history of arterial atherothrombotic stroke or transient ischaemic attack;

7.1.5. aortic aneurysm or peripheral arterial disease;

7.1.6. definitive atherosclerotic plaque in the coronary, carotid, or another artery detected by angiography, ultrasound, or another non-invasive diagnostic imaging examination, except for the cases where the thickness of the middle layer of the vascular wall (intima media thickness (IMT)) is up to 1.5 mm;

7.2. type 1 or type 2 diabetes mellitus with or without target organ damage, with or without one or more cardiovascular disease risk factors (smoking, hypercholesterolaemia or significant (second or third degree) arterial hypertension);

7.3. severe or moderate chronic kidney disease with a glomerular filtration rate lower than 59 ml/min/1.73 m²;

7.4. severe (third degree) arterial hypertension;

7.5. familial or primary hyperlipidaemia.

 

Annex 2
Cabinet Regulation No. 555
28 August 2018

Procedures for the Provision of Emergency Medical Assistance Included in the Basic Level of Medical Assistance

1. A medical practitioner in the reception ward of the institution shall assess the health condition of the person by evaluating whether it meets the following criteria:

No.	Level description	Description of the clinical condition
1.1.	Clinical condition with disorders of the vital functions	1. Cardiac arrest (asystole). 2. Respiratory arrest. 3. Possible respiratory arrest due to airway obstruction. 4. Respiratory rate < 8 breaths/min. 5. Systolic blood pressure < 80 mmHg. 6. Coma (unconsciousness), no response to pain or a Glasgow Coma Scale (hereinafter - the GCS) score < 9 points. 7. Generalised seizures, status epilepticus. 8. Severe intoxication. 9. Severe mental disorders with dangerous aggressive behaviour towards oneself and others. 10. Polytrauma. 11. Severe head trauma, intracranial haemorrhage. 12. Anaphylactic shock. 13. Acute coronary syndrome with acute rhythm disturbances, shock, collapse, pulmonary oedema. 14. Internal bleeding. 15. Acute cardiac arrhythmia with hypotension.
1.2.	Condition in which the patient may develop disorders of the vital functions if medical assistance is not provided immediately	1. Critical airway condition - stridor or pathological salivation. 2. Acute respiratory disorders. 3. Acute circulatory disorders: a) cold, moist skin, poor perfusion (capillary refill time > 5 s); b) heart rate (hereinafter - the HR) < 50 beats/min or > 150 beats/min; c) hypotension with impaired tissue perfusion. 4. Acute loss of a large volume of blood. 5. Very severe acute pain due to various causes, including acute cardiac pain, abdominal pain, or ectopic pregnancy, assessed as 9-10 points on a 10-point scale. 6. Hypoglycaemia, blood glucose level < 2 mmol/l. 7. Drowsiness, delayed reaction due to any cause (GCS < 10 points). 8. Fever or general body hypothermia with signs of lethargy. 9. Exposure of the eyes to acid or alkaline agents. 10. Polytrauma requiring urgent organised assistance by a medical team. 11. Acute localised trauma - fractures of major bones and/or vertebrae, amputations. 12. High-risk medical history: a) high consumption of sedatives or toxic substances of another origin; b) other life-threatening intoxication; c) exposure to life-threatening environmental factors (generalised allergic reaction). 13. Mental and behavioural disorders: a) aggression or violence that poses a threat to the patient and others; b) pronounced psychomotor agitation requiring physical restraint due to danger to the patient and/or others. 14. Acute neurological focal symptoms
1.3.	The health condition of the patient has deteriorated with potential life-threatening consequences or serious health implications if medical assistance is not provided immediately	1. Drowsiness, delayed reaction due to any cause (GCS < 13 points). 2. Oxygenation < 90 per cent. 3. Recurrent seizures recorded within the last 12 hours. 4. Persistent vomiting (lasting more than 30 minutes). 5. Acute dehydration. 6. Head injury with temporary loss of consciousness. 7. Moderate pain, assessed as 7-8 points on a 10-point scale, requiring immediate pain relief. 8. Acute abdominal pain without high-risk signs, assessed as at least 8 points on a 10-point scale, in patients > 65 years of age. 9. Acute neurological focal symptoms. 10. Moderate extremity injury with deformation, fracture or compartment syndrome. 11. Mental and behavioural disorders: a) suicide attempt or suicide threats; b) acute psychoses; c) disorganised behaviour; d) severe depression; e) acute psychomotor agitation. 12. Penetrating eye trauma. 13. Moderate bleeding from any cause. 14. Urinary retention, increased urinary output. 15. Head injuries without loss of consciousness. 16. Severe state of withdrawal which may be complicated by risk factors (history of psychoses, seizures, other acute illnesses). 17. Bites, lacerations, or salivary exposure from animals with rabies or suspected of having rabies. 18. Injuries and accidents

2. Emergency medical assistance shall be provided to a patient until the clinical condition of the patient meets the criteria specified in Paragraph 1 of this Annex, as assessed by the attending physician, including until the point when treatment, based on the decision of the attending physician or, if necessary, a doctors' council, continues as long-term maintenance of vital functions (for example, continuous mechanical ventilation of lungs). When providing emergency medical assistance, blood transfusion and administration of blood products shall be provided to the patient if necessary.

3. Services required by a patient for longer than one month to maintain vital functions shall not be considered emergency medical assistance.

4. Tissue and organ transplantation shall not be considered emergency medical assistance.

Minister for Health Anda Čakša

 

Annex 3
Cabinet Regulation No. 555
28 August 2018

[9 June 2020]

List of Infectious Diseases

No.	ICD-10 code*	Name
1.	A00	Cholera
2.	A01	Typhoid and paratyphoid fevers
3.	Z22.0-1	Carrier of typhoid; carrier of other intestinal infectious diseases
4.	A02	Other salmonella infections
5.	A03	Shigelloses
6.	A04; A08; A09	Other bacterial intestinal infections; viral and other specified intestinal infections; other gastroenteritis and colitis of infectious and unspecified origin
7.	A05	Other bacterial food-borne intoxications, not elsewhere classified
8.	A06	Amoebiasis
9.	A07.0; A07.1; A07.2; A07.8	Balantidiasis; giardiasis (lambliasis); cryptosporidiosis; other specified protozoal intestinal diseases
10.	A15-A19	Tuberculosis
11.	A20	Plague
12.	A21	Tularaemia
13.	A22	Splenic fever (Anthrax)
14.	A27	Leptospirosis
15.	A28.2	Extraintestinal yersiniosis
16.	A30	Leprosy (Hansen disease)
17.	A31	Infections due to other mycobacteria
18.	A32	Listeriosis
19.	A33-A35	Tetanus neonatorum; obstetrical tetanus; other tetanus
20.	A36	Diphtheria
21.	Z22.2	Carrier of diphtheria-causing bacteria
22.	A37	Pertussis
23.	A38	Scarlet fever
24.	A39	Meningococcal infection
25.	A48.1	Legionnaires disease
26.	A50-A53	Congenital syphilis; early syphilis; late syphilis; other types of syphilis and unspecified syphilis
27.	A54	Gonococcal infection
28.	A56	Other sexually transmitted chlamydial diseases
29.	A60	Anogenital herpes viral infection
30.	A68.0	Louse borne relapsing fever
31.	A69.2	Lyme disease
32.	A70	Chlamydia psittaci infections
33.	A71	Trachoma
34.	A75-A79	Rickettsioses
35.	A80	Acute poliomyelitis
36.	A81.0	Creutzfeldt-Jakob disease
37.	A82	Rabies
38.	Z20.3	Contact with and exposure to rabies
39.	A84; A85; A86; A87	Tick-borne viral encephalitis; other viral encephalitis, not elsewhere classified; unspecified viral encephalitis; viral meningitis
40.	A95; A96; A97; A98; A99	Yellow fever; arenaviral haemorrhagic fever; dengue; other viral haemorrhagic fevers, not elsewhere classified; unspecified viral haemorrhagic fever
41.	B01	Varicella
42.	B05	Measles (morbilli)
43.	B06	Rubella (German measles)
44.	B08.8	Other specified viral infections characterised by skin and mucous membrane lesions
45.	B15-B19	Viral hepatitis
46.	B20-B24	Human immunodeficiency virus (HIV) disease
47.	Z21	Asymptomatic human immunodeficiency virus (HIV) infection status
48.	B25	Cytomegaloviral diseases
49.	B26	Mumps
50.	B27	Infectious mononucleosis
51.	B35	Dermatophytosis
52.	B50-B54	Plasmodium falciparum malaria; Plasmodium vivax malaria; Plasmodium malariae malaria; other parasitologically confirmed malaria; unspecified malaria
53.	B58	Toxoplasmosis
54.	B75	Trichinellosis
55.	B86	Scabies
56.	B99	Other and unspecified infectious diseases
57.	G00; G01; G02	Bacterial meningitis, not elsewhere classified; meningitis due to bacterial diseases classified elsewhere; meningitis due to other infectious and parasitic diseases classified elsewhere
58.	J09; J10; J11	Influenza due to identified zoonotic or pandemic influenza virus**; influenza due to identified seasonal influenza virus**; influenza, virus not identified**
59.	J13	Pneumonia due to Streptococcus pneumoniae
60.	U07.1; U07.2	COVID-19, virus identified; COVID-19, virus not identified

Notes.

1. * If the "underlying condition" is subject to the dual classification system provided for in the ICD-10, both dagger and asterisk codes must be used.

2. ** The patient is exempt from co-payment if treated as an inpatient.

Minister for Health Anda Čakša

 

In the wording provided by the Ministry of Health

Annex 4
Cabinet Regulation No. 555
28 August 2018

[8 July 2025]

Care Episodes and Tariffs Thereof

1. For the purpose of organising the work accounting and payment for outpatient health care specialists, care episodes shall be classified as follows:

1.1. Type 1 - care episode related to an acute illness or injury;

1.2. Type 2 - care episode related to a chronic illness diagnosed for the first time;

1.3. Type 3 - care episode related to an exacerbation of a previously diagnosed disease;

1.4. Type 4 - care episode related to preventive examination, home visiting, or vaccination;

1.5. Type 5 - care episode related to dynamic monitoring of a chronic disease or health condition;

1.6. Type 6 - care episode related to reasons not classified in care episodes of Types 1, 2, 3, 4, and 5;

1.7. Type 7 - care episode related to health care services provided in auxiliary consulting rooms.

2. Care episodes of Types 1, 2, 3, 5, and 6 shall be used by the outpatient care specialists referred to in Paragraph 5 of this Annex.

3. Each medical practitioner shall complete an accounting document, i.e. the outpatient ticket, for the work performed within the care episode.

4. In order to receive payment for health care services provided to a person, if the care episode lasts more than 30 calendar days, the medical treatment institution shall close it after 30 calendar days, counting from the day when the care episode commenced, and shall initiate a new care episode with the next visit of the person.

5. Specialists and applicable tariffs for care episodes:

No.	Speciality	Tariff (EUR)
5.1.	Allergologist	17.49
5.2.	Algologist	17.49
5.3.	Anaesthetist, reanimatologist1	17.49
5.4.	Occupational health and occupational physician	22.36
5.5.	Vascular surgeon	27.29
5.6.	Doctor's assistant (feldsher)	7.30
5.7.	Paediatric allergologist	19.40
5.8.	Paediatric audiologist	19.40
5.9.	Paediatric endocrinologist	33.77
5.10.	Paediatric gastroenterologist	33.77
5.11.	Paediatric haemato-oncologist	33.77
5.12.	Paediatric infectologist	33.77
5.13.	Paediatric cardiologist	33.77
5.14.	Paediatric surgeon	16.64
5.15.	Paediatric nephrologist	33.77
5.16.	Paediatric neurologist	33.77
5.17.	Paediatric pneumonologist	19.40
5.18.	Paediatric psychiatrist	43.71
5.19.	Paediatric rheumatologist	33.77
5.20.	Dermatologist, venereologist	17.49
5.21.	Endocrinologist	26.76
5.22.	Doctor of rehabilitation and physical medicine	17.49
5.23.	Phlebologist	14.74
5.24.	Phoniatrician	17.49
5.25.	Gastroenterologist	26.87
5.26.	Gynaecologist, birth attendant	14.74
5.27.	Gynaecologist, birth attendant2	46.88
5.28.	Family doctor (general practitioner)	8.71
5.29.	Haematologist	27.32
5.30.	Hepatologist	28.94
5.31.	Immunologist	29.74
5.32.	Infectologist	28.50
5.33.	Internist	17.49
5.34.	Cardiologist	26.68
5.35.	Surgeon	14.74
5.36.	Medical geneticist	17.49
5.37.	Spinal surgeon	14.74
5.38.	Oral and maxillo-facial surgeon	14.74
5.39.	Narcologist	32.53
5.40.	Emergency medicine physician	17.49
5.41.	Nephrologist	17.49
5.42.	Neurosurgeon	28.26
5.43.	Neurologist	27.52
5.44.	Neonatologist	19.40
5.45.	Ophthalmologist	14.74
5.46.	Oncologist-chemotherapist	17.49
5.47.	Gynaecologic oncologist	27.98
5.48.	Otolaryngologist	14.74
5.49.	Palliative medicine specialist	23.80
5.50.	Paediatrician	33.77
5.51.	Plastic surgeon	14.74
5.52.	Pneumonologist	17.49
5.53.	Psychiatrist	32.53
5.54.	Radiation therapist	17.49
5.55.	Rheumatologist	26.79
5.56.	Hand surgeon	14.74
5.57.	Cardiac surgeon	14.74
5.58.	Sports doctor	28.13
5.59.	Thoracic surgeon	28.81
5.60.	Transplantologist	14.74
5.61.	Traumatologist, orthopedist	14.74
5.62.	Urologist	14.74

6. Type 7 care episode shall be used by the following specialists:

6.1. in primary health care:

No.	Speciality
6.1.1.	General practitioner
6.1.2.	Internist
6.1.3.	Paediatrician

6.2. in secondary outpatient health care:

No.	Speciality
6.2.1.	Anaesthetist, reanimatologist
6.2.2.	Audio speech therapist
6.2.3.	Paediatric gastroenterologist
6.2.4.	Paediatric cardiologist
6.2.5.	Paediatric nephrologist
6.2.6.	Paediatric psychiatrist
6.2.7.	Biologist
6.2.8.	Biomedical laboratory assistant
6.2.9.	Dermatologist, venereologist
6.2.10.	Dietitian
6.2.11.	Endoscopist (gastrointestinal endoscopy)
6.2.12.	Occupational therapist
6.2.13.	Doctor of rehabilitation and physical medicine
6.2.14.	Physiotherapist
6.2.15.	Gastroenterologist
6.2.16.	Gynaecologist, birth attendant
6.2.17.	Geneticist
6.2.18.	Haematologist
6.2.19.	Infectologist
6.2.20.	Immunologist
6.2.21.	Cardiologist
6.2.22.	Clinical microbiologist
6.2.23.	Clinical and health psychologist
6.2.24.	Laboratory physician
6.2.25.	Laboratory specialist
6.2.26.	Speech therapy specialist (speech teacher, speech therapist)
6.2.27.	Masseur
6.2.28.	Art therapist
6.2.29.	Nurse
6.2.30.	Medical geneticist
6.2.31.	Microbiologist
6.2.32.	Narcologist
6.2.33.	Nephrologist
6.2.34.	Neurologist
6.2.35.	Pathologist
6.2.36.	Pneumonologist
6.2.37.	Psychiatrist
6.2.38.	Psychotherapist
6.2.39.	Psychotherapy specialist
6.2.40.	Podiatrist
6.2.41.	Radiologist
6.2.42.	Radiation therapist
6.2.43.	Sports doctor3
6.2.44.	Technical orthopedist
6.2.45.	Forensic medicine expert
6.2.46.	Forensic psychiatric expert
6.2.47.	Transfusiologist
6.2.48.	Transplantologist
6.2.49.	Urologist
6.2.50.	Nutritionist
6.2.51.	Midwife
6.2.52.	Specialists who have mastered the following therapeutic and diagnostic methods:
6.2.52.1.	vascular ultrasound examination
6.2.52.2.	therapeutic and diagnostic percutaneous coronary and large vessel intervention
6.2.52.3.	paediatric massage technique
6.2.52.4.	bronchoscopy
6.2.52.5.	dermatoscopy
6.2.52.6.	diagnostic cardiac and large vessel catheterisation and angiography
6.2.52.7.	echocardiography
6.2.52.8.	electroencephalography
6.2.52.9.	electrocardiography
6.2.52.10.	cardiac pacing and invasive correction of rhythm disorders
6.2.52.11.	electromyography
6.2.52.12.	physical therapy technique
6.2.52.13.	physical and pharmacological stress tests with electrocardiography and imaging methods (including myocardial perfusion scanning)
6.2.52.14.	physical exercise test with electrocardiography
6.2.52.15.	gastrointestinal endoscopy
6.2.52.16.	hyperbaric oxygenation
6.2.52.17.	invasive correction of cardiac rhythm disorders
6.2.52.18.	comprehensive echocardiography
6.2.52.19.	colposcopy
6.2.52.20.	laser therapy
6.2.52.21.	massage technique
6.2.52.22.	non-invasive electrophysiological diagnostics and treatment in cardiology
6.2.52.23.	neurosonography for newborns and infants
6.2.52.24.	neurosonographic examination
6.2.52.25.	advanced electrocardiography
6.2.52.26.	implantation of permanent cardiac rhythm regulation and diagnostic devices
6.2.52.27.	screening echocardiography
6.2.52.28.	screening electrocardiography
6.2.52.29.	standard transthoracic echocardiography
6.2.52.30.	ultrasound examination in obstetrics and gynaecology
6.2.52.31.	general ultrasound examination
6.2.52.32.	functional diagnostic technique in nursing practice
6.2.52.33.	diabetes mellitus patient training technique in nursing practice

Note.

¹ When consulting patients prior to surgery and examinations.

² When admitting a previously examined patient to the waiting list for medically assisted insemination services and also when consulting the patient before and after receiving the service at a specialised medical institution.

³ A sports doctor shall use Type 7 care episode when performing an additional preventive medical examination.

 

Annex 5
Cabinet Regulation No. 555
28 August 2018

[26 November 2024]

Health Care Services Provided at Day Hospitals

No.	Type of the health care service	Mandatory (basic) manipulations1
		first level	second level
1.	Renal replacement therapy	60010 + 04171; 04177-04180; 19270; 19275-19277; 19282; 250212	60010 + 04171; 04177-04180; 19270; 19275-19277; 19282; 250212
2.	Invasive cardiology	60075 + 60071-60074
3.	Interventional radiology	60075 + 501203; 50122; 501243; 501303; 501343; 501383; 501443; 501463; 50720-50722
4.	Chemotherapy and haematology	60110 + 60008; 60110 + 60413; 60110 + 60555
5.	Radiotherapy	60110 + 50300-50303; 50340-50343; 50346; 50349; 50352; 50353; 50356; 50357; 50360; 50363; 50370-50374; 50390; 50391; 50393; 50396-50397; 50416; 50417; 50425-50434; 50438. For children - 601107
6.	Robotic stereotactic radiosurgery4	60110 + 50470; 50471; 50472
7.	Rehabilitation:
7.1.	adult rehabilitation	60110 + 55106; 55107; 55108; 55109	60110 + 55106; 55107; 55108; 55109
7.2.	paediatric rehabilitation	60110 + 55106; 55107; 55108; 55109	60110 + 55106; 55107; 55108; 55109
8.	Treatment of psychiatric patients in a psychiatric profile day hospital	60124	60124
9.	Treatment of addiction patients in a narcology profile day hospital	60110 + 13025; 13026; 60069	60110 + 13025; 13026; 60069
10.	Treatment of neurological and internal diseases9	60110 + 02124; 06062; 06125; 06130; 06131; 06136; 06137; 06141; 07045; 07072; 09182-09186; 10020-10026; 10033-10034; 10037-10038; 10041-10044; 11001; 11051-11052; 11058; 11060; 11065-11068; 11101-11103; 25008; 25014; 25020; 25022; 31186; 31187; 31252; 60413; 60507 For children: 02124; 06003 + 06004 + 06033 + 06015; 06041; 06004 + 06007 + 06015; 06004 + 06007 + 06041; 06003 + 06004 + 06033 + 06021; 06102; 07023; 07044; 07046; 06007 + 06004 + 06033 + 06021; 06102; 07023; 07044; 07046; 07072; 09182-09186; 11002; 5008710; 60420; 60507	60110 + 06062; 06125; 06130; 06131; 06136; 06137; 06141; 07045; 09182-09186; 10020-10026; 10033-10034; 10037-10038; 10041-10044; 11001; 11051-11052; 11058; 11060; 11065-11068; 11101-11103; 25008; 25014; 25020; 25022; 31186; 31187; 31252; 60413
11.	Treatment of patients with chronic pain	60110 + 29156-29160; 04103; 04106-04108; 04115-04118; 04121-04126; 04138-04139
12.	Surgical services:
12.1.	ophthalmology	60075 + 17097; 17120; 17122; 1712310; 1713510; 1713610; 17138-17143; 17151; 17153; 17156; 17157; 17165; 17166; 17170; 17172; 17180-17181; 17186-17189; 17195-17197; 17199; 17216; 17217; 17226; 17228; 17229; 17232; 17233; 17242; 17245; 17250-17257; 17270-17274; 17285; 17286; 17288; 17289; 17294; 17300; 17304; 17340; 17372	60075 + 17097; 17120; 17138; 17142; 17143; 17153; 17156; 17166; 17180; 17181; 17186-17189; 17199; 17226; 17250-17257; 17270-17272; 17285; 17286; 17288; 17289; 17340; 17372
12.2.	urology	60075 + 19019; 19021; 19030-19036; 19038; 19039; 19045; 1905210; 19057; 19059 + 19071; 19067-19070; 19075; 19077; 19079-19081; 19085; 19089; 19114; 19116; 19117; 19125; 19148; 19151; 19158; 19161; 19163, 19164, 19165, 19170; 19173; 19175; 19178; 19179; 19187; 19197	60075 + 19019; 19021; 19030-19036; 19038; 19045; 19057; 19067-19070; 19075; 19077; 19079-19081; 19085; 19116; 19117; 19125; 19148; 19151; 19158; 19161; 19173; 19175; 19178; 19179; 19187
12.3.	gastrointestinal endoscopy	60075 + 08053; 08058-08061; 08070-08072; 08077; 0808110; 08090; 08093; 08097; 08100; 08111; 08112; 08113; 08121-08122	60075 + 08053; 08058-08061; 08070-08072; 08077; 08090; 08093; 08097; 08100; 08111; 08113; 08121-08122
12.4.	Gynaecology	60075 + 16001; 16007-16009; 16011-16012; 16018-16021; 16026; 16029; 16032; 16040-16044; 16052-16054; 16080; 16082; 16087-16091; 20059	60075 + 16001; 16008; 16009; 16020; 16026; 16029; 16032; 20059
12.5.	otolaryngology:
12.5.1.	paediatric otolaryngology	60075 + 18071; 18014; 18022; 18023; 18034; 1804610; 18047; 18073; 18076; 18077; 18079; 18091; 18092; 18093; 18102; 18106; 18107; 18109; 18128; 18140; 18141; 18142; 18152; 181645; 18177	60075 + 18071; 18076; 18077; 18177
12.5.2.	adult otolaryngology	60075 + 18014; 18022; 18023; 18024; 18032; 18033; 18034; 18038; 18040; 18041; 18047; 18048; 18055; 18056; 18057; 18060; 18061; 18062; 18070; 18071; 18073; 18076; 18077; 18078; 18079; 18092; 18093; 18101; 18102; 18106; 18108; 18109; 18126; 18128; 18141; 18142; 18152; 18154; 18155; 18156; 18157; 18177; 18179; 18180; 18187; 18188; 18196; 18198; 18199; 18205; 18206; 18213; 18242; 18243; 18265	60075 + 18014; 18023; 18032; 18033; 18047; 18048; 18061; 18070; 18071; 18076; 18077; 18102; 18106; 18126; 18128; 18177; 18199; 18205; 18206
12.6.	traumatology, orthopaedics, hand and reconstructive microsurgery, plastic surgery	60075 + 03180; 20014; 20028; 20029; 20039; 20040; 20041; 20043; 20044; 20050; 20059-20060; 20070-20071; 20073; 20075; 20085; 20100; 20101; 20108; 20127; 20139; 20145-20147; 20159; 20200; 20203-20205; 20207; 20209-20210; 20212; 20217; 20218; 20222; 20224; 20229; 20249; 20281; 20282; 20284; 20285; 20288; 20290; 20292-20293; 20303; 22034; 23002; 23003; 23004; 23005; 23006; 23007; 23009; 23010; 23015-23016; 23021; 23022; 23036; 23037; 23052-23054; 23060-23061; 23063-23066; 23068-23070; 23075-23081; 23083; 23084; 23090-23094; 23096-23099; 23106; 23108-23112	60075 + 03180; 20014; 20028; 20029; 20039; 20040; 20041; 20043; 20044; 20050; 20059-20060; 20070-20071; 20073; 20100; 20101; 20108; 20127; 20139; 20145; 20146; 20200; 20203; 20205; 20207; 20209; 20212; 20217; 20222; 20249; 20281; 20282; 20284; 20285; 20288; 20290; 20292-20293; 22034; 23002; 23009; 23010; 23021; 23037; 23052-23053; 23063-23065; 23068-23070; 23076; 23078-23080; 23083; 23084; 23090-23094; 23096; 23098; 23099; 23106; 23108-23112
12.7.	general surgical services	60075 + 03180; 03183; 03184; 03187-03189; 04150-04152; 20014; 20029; 20039; 20041; 20044; 20050; 20059; 20060; 21022; 21024; 21026; 21027; 21067; 21100-21105; 21130; 21190; 22023; 22034; 28001; 28003; 28004; 28017-28026; 28036-28042; 29005; 29006; 29008; 29009; 29015; 29016; 29019; 29020; 29022; 29023; 29025; 29031-29037; 29039; 29040; 29045; 29046; 29050; 29070; 29084; 29087; 29089; 29090; 29095-29104; 29110-29113; 29119; 29126-29131; 29133; 29135; 29143-29151; 29165-29169; 29172; 29183; 29187-29190; 29196; 29197; 29199; 29202-29205; 29224; 29238; 29239; 29257; 29258; 31022; 31160; 31175; 31186; 31215; 31216; 31252	60075 + 03180; 03183; 03187; 03188; 03189; 20014; 20029; 20039; 20041; 20044; 20050; 20059; 20060; 21022; 21026; 21027; 21067; 22023; 22034; 28001; 28003; 28004; 28017; 28019; 28021-28025; 28036-28042; 29005; 29006; 29008; 29009; 29087; 29103; 29110; 29167; 29169; 29183; 29187; 29196; 29257; 29258; 31186; 31252
12.8.	paediatric surgery	60075 + 03180; 03188; 04150-04152; 19019; 19021; 19030; 19032-19035; 19037-19039; 19057; 19059; 19067; 19068; 19075; 19077; 19079; 19085-19086; 19089; 19114; 19116; 19145; 19150; 19151; 19158; 19161; 20014-20015; 20028; 20030; 20039; 20041; 20043; 20044; 20050; 20057; 20059-20060; 20070-20071; 20085; 20147; 20149; 20159; 20200; 20203-20205; 20207; 20209; 20212; 20218; 20249; 20281; 20300-20301; 20303; 20306; 20309; 21024; 21026; 21027; 21103; 21175; 23009; 23016; 23021; 23037; 23052; 23064-23066; 23068-23069; 23076-23081; 23096; 23098; 23099; 23109; 27002-27004; 27022-27025; 27037; 27040-27042; 29102; 29129; 29167-29169; 29171; 30027; 31209; 50118; 501203; 50122; 501243; 501303; 501343; 50722	60075 + 03180; 03188; 19019; 19021; 19030; 19032-19035; 19038; 19057; 19067; 19068; 19075; 19077; 19079; 19085; 19116; 19151; 19158; 19161; 20014; 20028; 20039; 20041; 20043; 20044; 20050; 20059; 20060; 20070; 20071; 20149; 20200; 20203; 20205; 20207; 20209; 20212; 20249; 20281; 21026; 21027; 23009; 23021; 23037; 23052; 23064; 23065; 23068; 23069; 23076; 23078-23081; 23096; 23098; 23099; 23109; 27004; 27022; 27024; 27037; 29167; 29169; 29171
13.	Dental treatment with general anaesthesia8	70917; 70918	70917; 70918
14.	Medically assisted insemination	16143-16147	16143-16147
15.	Examinations for long-term oxygen therapy	60110 + 60510; 60506-60507; 41086-41087	60110 + 60510; 60506-60507; 41086-41087

Notes.

¹ Only the binding (basic) manipulations to be performed in the specific day hospital and which are used for identifying the type of health care service provided in that specific day hospital are indicated. The Service shall, in accordance with this Regulation, additionally pay the service provider for other necessary manipulations required to prepare the patient for the binding manipulation and to ensure safe execution of the binding manipulation (including laboratory tests, necessary radiological examinations, anaesthesia services, and supplementary manipulations).

² Renal replacement therapy procedures in a day hospital shall be paid for dialysis patients with uraemic skin changes (ICD-10 diagnosis code L29.8 "Other pruritus").

³ The manipulation may also be performed by vascular surgeons employed by State limited liability company Pauls Stradiņš Clinical University Hospital or limited liability company Riga East Clinical University Hospital.

⁴ The manipulations shall be paid to limited liability company Sigulda Hospital if patients have been referred for the service by specialists from State limited liability company Pauls Stradiņš Clinical University Hospital or limited liability company Riga East Clinical University Hospital based on a decision by a doctors' council which includes at least one radiation therapist.

⁵ The payment for bone-anchored hearing aids (BAHA) shall be made to State limited liability company Children's Clinical University Hospital.

⁶ [10 December 2019]

⁷ The manipulation with code 60110 without binding manipulations shall be indicated if a patient of State limited liability company Children's Clinical University Hospital receives radiotherapy in another medical treatment institution.

⁸ When providing dental treatment with general anaesthesia to children and performing dental extractions under general anaesthesia for the patient group referred to in Sub-paragraph 4.1.5 of this Regulation, no referral is required for receiving the service.

⁹ For patients with rare diseases at State limited liability company Children's Clinical University Hospital, the day hospital service shall be paid if during a single visit at least three consultations by doctors of different specialities are provided and/or at least one functional diagnostic examination or at least two diagnostic examinations are performed.

¹⁰ The manipulations in a day hospital shall be paid only for children, including manipulations 08081, 17123, 17135, 17136, 18046, 19052, and 50087 in a day hospital shall be paid for children only if they have been performed under general anaesthesia or sedation.

 

In the wording provided by the Ministry of Health

Annex 6
Cabinet Regulation No. 555
28 August 2018

[8 July 2025]

Providers of Inpatient Health Care Services and Payment Conditions for Inpatient Health Care Services

1. The Service shall enter into contracts for inpatient health care with inpatient medical treatment institutions in conformity with the following conditions:

1.1. the levels, service profiles, and tariffs for bed days determined for medical treatment institutions:

Medical treatment institution

Profiles of inpatient health care services1

Tariff for bed days (EUR)

Payment for digitisation (EUR)

therapy

chronic patient care

care

surgery

gynaecology

pregnancy and childbirth care

paediatrics

traumatology

neurology

urology

otorhinolaryngology

stroke unit

infections

pregnancy pathology

psychiatry

rehabilitation

cardiology

nephrology

invasive cardiology

oncology

palliative care

pulmonology

gastro-enterology

neurosurgery

vascular surgery

endocrinology

thoracic surgery

ophthalmology

narcology

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

1.1.1. Level V medical treatment institutions

1.1.1.1. State limited liability company Pauls Stradiņš Clinical University Hospital

X

IP2

X

X

X

PAC3

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

156.43

357 837

1.1.1.2. limited liability company Riga East University Hospital

X

IP2

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

156.43

433 054

1.1.1.3. State limited liability company Children's Clinical University Hospital

Paediatric profile

X

IP2

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

276.56

134 224

1.1.2. Level IV medical treatment institutions

1.1.2.1. limited liability company Liepāja Regional Hospital

X

IP2

X

X

X

X

X + PAC3

X

X

X

X

X

X

IP2

IP2

X

X

IP2

IP2

IP2

IP2

IP2

IP2

IP2

IP2

142.57

76 450

1.1.2.2. limited liability company Daugavpils Regional Hospital

X

IP2

X

X

X

X

X

X

X

X

X

X

X

IP2

IP2

X

X

IP2

IP2

IP2

IP2

IP2

IP2

IP2

IP2

X

X

X

142.57

88 206

1.1.2.3. sabiedrība ar ierobežotu atbildību "Ziemeļkurzemes reģionālā slimnīca" [limited liability company Ziemeļkurzeme Regional Hospital]

X

IP2

X

X

X

X

X

X

X

X

X

X

X

IP2

IP2

X

X

IP2

IP2

IP2

IP2

IP2

IP2

IP2

IP2

X

X

142.57

43 546

1.1.2.4. sabiedrība ar ierobežotu atbildību "Jelgavas pilsētas slimnīca" [limited liability company Jelgava City Hospital]

X

IP2

X

X

X

X

X

X

X

X

X

X

IP2

IP2

X

X

IP2

IP2

IP2

IP2

IP2

IP2

IP2

IP2

142.57

41 714

1.1.2.5. limited liability company Vidzeme Hospital

X

IP2

X

X

X

X

X + PAC3

X

X

X

X

X

X

IP2

IP2

X

X

IP2

IP2

IP2

IP2

IP2

IP2

IP2

IP2

X

142.57

53 831

1.1.2.6. limited liability company Jēkabpils Regional Hospital

X

IP2

X

X

X

X + PAC3

X

X

X

X

X

X

IP2

IP2

X

X

IP2

IP2

IP2

IP2

IP2

IP2

IP2

IP2

X

142.57

36 779

1.1.2.7. sabiedrība ar ierobežotu atbildību "Rēzeknes slimnīca" [limited liability company Rēzekne Hospital]

X

IP2

X

X

X

X

X

X

X

X

X

X

X

IP2

IP2

X

X

IP2

IP2

IP2

IP2

IP2

IP2

IP2

IP2

X

142.57

42 357

1.1.3. Level III medical treatment institutions

1.1.3.1. Madonas novada pašvaldības sabiedrība ar ierobežotu atbildību "Madonas slimnīca" [Madona municipality limited liability company Madona Hospital]

X

IP2

X

X

X

X

IP2

IP2

AR4

108.47

24 755

1.1.3.2. sabiedrība ar ierobežotu atbildību "Cēsu klīnika" [limited liability company Cēsis Clinic]

X

IP2

X

X

X

IP2

IP2

AR4

108.47

15 254

1.1.3.3. sabiedrība ar ierobežotu atbildību "Dobeles un apkārtnes slimnīca" [limited liability company Dobele and Surrounding Area Hospital]

X

IP2

X

X

X

X

IP2

IP2

AR4

108.47

14 421

1.1.3.4. sabiedrība ar ierobežotu atbildību "Jūrmalas slimnīca" [limited liability company Jūrmala Hospital]

X

IP2

X

X

X

X

IP2

IP2

AR4

108.47

20 003

1.1.3.5. sabiedrība ar ierobežotu atbildību "Ogres rajona slimnīca" [limited liability company Ogre District Hospital]

X

IP2

X

X

X

X

X

IP2

IP2

AR4

108.47

24 331

1.1.3.6. sabiedrība ar ierobežotu atbildību "Balvu un Gulbenes slimnīcu apvienība" [limited liability company Balvi and Gulbene Hospital Association]

X

IP2

X

X

X

X

X

IP2

IP2

AR4

108.47

16 095

1.1.3.7. sabiedrība ar ierobežotu atbildību "Kuldīgas slimnīca" [limited liability company Kuldīga Hospital]

X

IP2

X

X

X

X

X

IP2

IP2

AR4

108.47

17 675

1.1.4. Level II medical treatment institutions

1.1.4.1. sabiedrība ar ierobežotu atbildību "Alūksnes slimnīca" [limited liability company Alūksne Hospital]

X

IP2

X

IP2

IP2

IP2

IP2

IP2

AR4

108.47

11 416

1.1.4.2. sabiedrība ar ierobežotu atbildību "Preiļu slimnīca" [limited liability company Preiļi Hospital]

X

IP2

X

X

IP2

X

IP2

IP2

AR4

108.47

10 000

1.1.4.3. sabiedrība ar ierobežotu atbildību "Tukuma slimnīca" [limited liability company Tukums Hospital]

X

IP2

X

IP2

IP2

IP2

IP2

IP2

AR4

108.47

11 597

1.1.4.4. sabiedrība ar ierobežotu atbildību "Krāslavas slimnīca" [limited liability company Krāslava Hospital]

X

IP2

X

X

IP2

IP2

IP2

IP2

IP2

AR4

108.47

10 000

1.1.5. Level I medical treatment institutions

1.1.5.1. Līvānu novada domes pašvaldības sabiedrība ar ierobežotu atbildību "Līvānu slimnīca" [Līvāni municipality limited liability company Līvāni Hospital]

X

IP2

X

AR4

62.64

10 000

1.1.5.2. sabiedrība ar ierobežotu atbildību "Aizkraukles slimnīca" [limited liability company Aizkraukle Hospital]

X

IP2

X

AR4

62.64

10 000

1.1.5.3. sabiedrība ar ierobežotu atbildību "Bauskas slimnīca" [limited liability company Bauska Hospital]

X

IP2

X

AR4

62.64

10 000

1.1.5.4. sabiedrība ar ierobežotu atbildību "Limbažu slimnīca" [limited liability company Limbaži Hospital]

X

IP2

AR4

62.64

10 000

1.1.5.5. sabiedrība ar ierobežotu atbildību "Ludzas medicīnas centrs" [limited liability company Ludza Medical Centre]

X

IP2

X

AR4

62.64

10 000

1.1.6. Level V specialised medical treatment institutions

1.1.6.1. valsts sabiedrība ar ierobežotu atbildību "Traumatoloģijas un ortopēdijas slimnīca" [State limited liability company Traumatology and Orthopaedics Hospital]

IP2

X

X

X

X

137.70

64 777

1.1.6.2. limited liability company Riga Maternity Hospital

X

X

X + PAC3

X

128.87

29 947

1.1.6.3. State limited liability company National Rehabilitation Centre Vaivari

IP2

X

118.07

36 796

1.1.6.4. State limited liability company National Psychiatric Health Centre

X

X

98.87

64 670

1.1.7. Specialised medical treatment institutions

1.1.7.1. sabiedrība ar ierobežotu atbildību "Rīgas 2. slimnīca" [limited liability company Rīga 2nd Hospital]

IP2

X

X

X

137.70

26 564

1.1.7.2. valsts sabiedrība ar ierobežotu atbildību "Bērnu psihoneiroloģiskā slimnīca "Ainaži"" [State limited liability company Children's Psychoneurological Hospital Ainaži]

X

X

0

10 000

1.1.7.3. State limited liability company Seaside Hospital

IP2

X

X

X

98.87

13 058

1.1.7.4. State limited liability company Daugavpils Psychoneurological Hospital

X

X

98.87

61 187

1.1.7.5. valsts sabiedrība ar ierobežotu atbildību "Slimnīca "Ģintermuiža"" [State limited liability company Hospital Ģintermuiža]

X

X

X

98.87

28 668

1.1.7.6. valsts sabiedrība ar ierobežotu atbildību "Strenču psihoneiroloģiskā slimnīca" [State limited liability company Strenči Psychoneurological Hospital]

X

X

98.87

29 841

1.1.7.7. limited liability company Sigulda Hospital

IP2

X

AR4

62.64

10 000

1.1.8. Other hospitals

1.1.8.1. sabiedrība ar ierobežotu atbildību "Saldus medicīnas centrs" [limited liability company Saldus Medical Centre]

X

X

AR4

62.64

10 000

1.1.8.2. sabiedrība ar ierobežotu atbildību "Priekules slimnīca" [limited liability company Priekule Hospital]

X

62.64

10 000

1.1.8.3. limited liability company Sanare-KRC Jaunķemeri

X

X

AR4

10 000

1.1.8.4. akciju sabiedrība "Latvijas Jūras medicīnas centrs" [joint-stock company Latvian Maritime Medical Centre]

X

X

AR4

10 000

Notes.

¹ The profile shall be considered to be provided if the medical treatment institution has entered into a contract with another medical treatment institution for the provision thereof and has informed the Service thereof.

² IP - optional profile. The condition for mandatory provision of the profile or 24-hour duty shall not be applied; services shall be provided as necessary. If the medical treatment institution wishes to commence the provision of services in any of the optional profiles, the inclusion of the specific services in the contract is possible if the Service has additional financial resources.

³ PAC - perinatal care centre. The medical treatment institution holds a contract for the provision of perinatal care.

⁴ AR - only acute rehabilitation in mixed profile beds according to the conditions laid down in the contracts.

1.2. the number of medical practitioners available in the emergency medicine and patient reception ward and the amount of the fixed supplement:

Medical treatment institution	Specialists required for ensuring 24-hour duty in the emergency medicine and patient reception ward																Fixed supplement (EUR)
	Inter- nist1	emer- gency medi- cine physi- cian2	Sur- geon3	gynae- colo- gist, birth atten- dant	trau- mato- logist, ortho- paedist4	neuro- logist	Paedi- atrician5	neo- nato- logist6	anaest- hetist, reani- matolo- gist	radio- logist	psychi- atrist	narco- logist	other speci- alities	nurse, mid- wife, doc- tor's assis- tant	radio- logy assis- tant, radio- grapher	other per- sons invol- ved in medi- cal treat- ment or in the health care process7	for the opera- tion of emer- gency medi- cal ser- vices and patient recep- tion ward	for patient obser- vation for up to 24 hours
1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19
1.2.1. Level V medical treatment institutions
1.2.1.1. State limited liability company Pauls Stradiņš Clinical University Hospital		7	1	1		1		1	2	2			6	32	2	30	11 447 172	2 380 736
1.2.1.2. limited liability company Riga East University Hospital	2	5	4	2	1	2			2	2			8	40	2	40	14 884 930	1 902 944
1.2.1.3. State limited liability company Children's Clinical University Hospital			2				68		2	1	1		3	15	2	10	6 486 814	2 690 868
1.2.2. Level IV medical treatment institutions
1.2.2.1. limited liability company Liepāja Regional Hospital	2		1	1	1	1	1	1	1	19			110	9+110	1	7+110	4 222 821	563 002
1.2.2.2. limited liability company Daugavpils Regional Hospital	2		2	1	1	1	1		1	19			1	10	1	7	4 502 111	864 902
1.2.2.3. limited liability company Ziemeļkurzeme Regional Hospital11	2		2	1	1	1	1		1+112	19			113	9	2	6	4 635 541	474 716
1.2.2.4. limited liability company Jelgava City Hospital	2		1	1	1	1	1		1	19				8	1	8	3 843 760	475 480
1.2.2.5. limited liability company Vidzeme Hospital	1		1	1	1	1	1	1	1	19				8	1	8	3 843 760	389 476
1.2.2.6. limited liability company Jēkabpils Regional Hospital	1		1	1	1	1	1	1	1	19				8	1	8	3 843 760	693 093
1.2.2.7. limited liability company Rēzekne Hospital	1+114		1	1	1	1	1		1	1				7	1	7	3 574 912	173 601
1.2.3. Level III medical treatment institutions
1.2.3.1. Madona municipality limited liability company Madona Hospital	1		1	1	1		1		112	19				6	1	6	2 914 140	259 447
limited liability company Cēsis Clinic	1		1				1		112	19				4	1	4	2 029 091	389 099
1.2.3.3. limited liability company Dobele and Surrounding Area Hospital	1		1	1			1		112	19				5	1	5	2 471 616	130 022
1.2.3.4. limited liability company Jūrmala Hospital	1		1	1					112	19				5	1	4	2 142 481	85 695
1.2.3.5. limited liability company Ogre District Hospital	1		1	1			1		112	19				5	1	5	2 471 616	605 302
1.2.3.6. limited liability company Balvi and Gulbene Hospital Association	1		1	1			1		112	19				5	1	5	2 471 616	130 001
1.2.3.7. limited liability company Kuldīga Hospital	1		1	1			1		112	19				5	1	5	2 471 616	215 603
1.2.4. Level II medical treatment institutions
1.2.4.1. limited liability company Alūksne Hospital	1		1				1		112	19				4	1	4	2 029 091	174 216
1.2.4.2. limited liability company Preiļi Hospital	1		1	1					112	19				4	1	4	2 029 091	44 191
1.2.4.3. limited liability company Tukums Hospital	1		1				1		112	19				3	1	3	1 840 135	85 861
1.2.4.4. limited liability company Krāslava Hospital	1		1						112	19				3	1	3	1 586 567	42 977
1.2.5. Level I medical treatment institutions
1.2.5.1. Līvāni municipality limited liability company Līvāni Hospital	1		115							19				1+115	1	1+115	937 845
1.2.5.2. limited liability company Aizkraukle Hospital	1		115							19				1+115	1	1	905 264
1.2.5.3. limited liability company Bauska Hospital	1		115							19				1+115	1	1+115	937 845
1.2.5.4. limited liability company Limbaži Hospital	1		115							19				1+115	1	1+115	937 845
1.2.5.5. limited liability company Ludza Medical Centre	1		115							19				1+115	1	1	905 264
1.2.6. Level V specialised medical treatment institutions
1.2.6.1. State limited liability company Traumatology and Orthopaedics Hospital		1			3				2	1				6	2	4	2 984 362
1.2.6.2. limited liability company Riga Maternity Hospital				4				2	1	19			116	11	1	3	3 742 708	86 012
1.2.6.3. State limited liability company National Rehabilitation Centre Vaivari	1													1		1	442 524
1.2.6.4. State limited liability company National Psychiatric Health Centre											2	1	117	3		3	1 372 723	47 945
1.2.7. Specialised medical treatment institutions
1.2.7.1. limited liability company Rīga 2nd Hospital		1			1				112	1				3	1	3	1 649 959
1.2.7.2. State limited liability company Seaside Hospital											1			1		1	442 524	10 242
1.2.7.3. State limited liability company Daugavpils Psychoneurological Hospital											1			1		1	442 524	37 042
1.2.7.4. State limited liability company Hospital Ģintermuiža											1			1		1	442 524	23 022
1.2.7.5. State limited liability company Strenči Psychoneurological Hospital											1			1		1	442 524	25 950
1.2.7.6. limited liability company Sigulda Hospital			1	1					112	19				3	1	3	1 586 567	43 704

Notes.

¹ If a level I, II, or III medical treatment institution cannot ensure an internist being on duty, an internist may be substituted by a general practitioner, emergency medicine physician, anaesthetist, reanimatologist, or another physician of internal profile. If medical treatment institutions of other levels or specialised medical treatment institutions cannot ensure an internist being on duty, an internist may be substituted by a general practitioner, emergency medicine physician or anaesthetist, reanimatologist.

² If a medical treatment institution cannot ensure an emergency medicine physician being on duty, an emergency medicine physician may be substituted by an internist or anaesthetist, reanimatologist.

³ If a medical treatment institution cannot ensure a surgeon on duty, a surgeon may be substituted by a paediatric surgeon or traumatologist, orthopaedist. In level I medical treatment institutions, a surgeon may also be substituted by an emergency medicine physician.

⁴ If a medical treatment institution cannot ensure a traumatologist, orthopaedist on duty, a traumatologist, orthopaedist may be substituted by a paediatric surgeon.

⁵ If a medical treatment institution cannot ensure a paediatrician on duty, a paediatrician may be substituted by a general practitioner.

⁶ The condition for mandatory 24-hour duty in the emergency medicine and patient reception ward shall not be applied; however, the medical treatment institution shall ensure a 24-hour duty of a neonatologist in the perinatal care centre.

⁷ Nurse's assistants, client and patient receptionists of the medical treatment institution, laboratory specialists, medical assistants.

⁸ State limited liability company Children's Clinical University Hospital shall, at its discretion, ensure 24-hour duties of a paediatrician or an emergency medicine physician.

⁹ The condition for mandatory 24-hour duty shall not be applied, the radiologist shall provide services as necessary.

¹⁰ Limited liability company Liepāja Regional Hospital shall provide the services of a cardiologist (and a nurse and a nurse's assistant) on working days from 8:00 to 16:00.

¹¹ Limited liability company Ziemeļkurzeme Regional Hospital shall ensure 24-hour duties of an internist, a surgeon, an anaesthetist, a reanimatologist, a radiology assistant, or a radiographer and two nurses at the branch in Talsi.

¹² The emergency medicine and patient reception ward shall ensure the availability of an anaesthetist and a reanimatologist 24 hours a day, but the payment for the operation of the emergency medicine and patient reception ward includes the working hours of an anaesthetist and a reanimatologist on working days from 16:00 to 8:00 and 24 hours a day on weekends and public holidays.

¹³ Limited liability company Ziemeļkurzeme Regional Hospital shall ensure 24-hour duties of an ophthalmologist.

¹⁴ Limited liability company Rēzekne Hospital shall provide the services of one internist on weekdays, weekends, and public holidays from 8:00 to 20:00.

¹⁵ The payment for the operation of the emergency medicine and patient reception ward shall include the working hours of a surgeon (and a nurse and a nurse's assistant) on weekdays, weekends, and public holidays from 8:00 to 20:00.

¹⁶ Limited liability company Riga Maternity Hospital shall provide the services of a surgeon (proctologist) as required, without applying the condition of mandatory 24-hour duty.

¹⁷ State limited liability company National Psychiatric Health Centre shall provide a psychiatrist for the provision of remote consultations on weekdays from 8:00 to 16:00.

2. Medical treatment institutions shall provide the following health care services in accordance with their level and the payment conditions laid down in the contract:

Medical treatment institution		Name of programme	Treatment tariffs per patient for marked programmes (EUR)
1		2	3
2.1.	Vascular surgery profile (V, IV)
2.1.1.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Thoracic aortic endografting	21 061.25
2.1.2.	Level V and IV medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Inpatient care in vascular surgery	DRG
2.1.3.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Abdominal aortic endografting	14 078.32
2.2.	Gastro-enterology profile (V, IV)
2.2.1.	Level V medical treatment institutions (excluding specialised medical treatment institutions), limited liability company Daugavpils Regional Hospital, limited liability company Liepāja Regional Hospital, limited liability company Jelgava City Hospital	Planned temporary surgery. Gastrointestinal endoscopy	DRG planned temporary surgery
2.3.	Gynaecology profile (V, IV, III, II)
2.3.1.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Gynaecology in particularly severe cases	DRG
2.3.2.	Level V (excluding specialised medical treatment institutions, limited liability company Riga Maternity Hospital, State limited liability company National Rehabilitation Centre Vaivari), level IV, III, II medical treatment institutions and joint-stock company Latvian Maritime Medicine Centre	Planned temporary surgery. Gynaecology	DRG planned temporary surgery
2.4.	Pregnancy and childbirth profile (V, IV, III, II)
2.4.1.	State limited liability company Pauls Stradiņš Clinical University Hospital, limited liability company Riga Maternity Hospital, limited liability company Sigulda Hospital, level IV, III, and II medical treatment institutions (excluding limited liability company Cēsis Clinic, limited liability company Alūksne Hospital, limited liability company Tukums Hospital, limited liability company Krāslava Hospital)	Childbirth in cases of obstetric pathology	DRG
2.4.2.	State limited liability company Pauls Stradiņš Clinical University Hospital, limited liability company Riga Maternity Hospital, limited liability company Sigulda Hospital, level IV, III, and II medical treatment institutions (excluding limited liability company Cēsis Clinic, limited liability company Alūksne Hospital, limited liability company Tukums Hospital, limited liability company Krāslava Hospital)	Physiological childbirth	DRG
2.4.3.	State limited liability company Pauls Stradiņš Clinical University Hospital, limited liability company Riga Maternity Hospital, limited liability company Sigulda Hospital, level IV, III, and II medical treatment institutions (excluding limited liability company Cēsis Clinic, limited liability company Alūksne Hospital, limited liability company Tukums Hospital, limited liability company Krāslava Hospital)	Caesarean section	DRG
2.5.	Care profile (V, IV, III, II, I)
2.5.1.	Limited liability company Riga East University Hospital, limited liability company Daugavpils Regional Hospital, limited liability company Liepāja Regional Hospital, limited liability company Vidzeme Hospital, limited liability company Rēzekne Hospital, limited liability company Ziemeļkurzeme Regional Hospital, limited liability company Ogre District Hospital, limited liability company Kuldīga Hospital, limited liability company Balvi and Gulbene Hospital Association, limited liability company Rīga 2nd Hospital, level II and I medical treatment institutions (excluding limited liability company Alūksne Hospital, limited liability company Tukums Hospital), limited liability company Priekule Hospital, limited liability company Saldus Medical Centre	Services provided in care hospitals or care beds	584.29
2.5.2.	Level V medical treatment institutions (excluding limited liability company Riga Maternity Hospital), level IV, III, II, and I medical treatment institutions, State limited liability company Seaside Hospital, limited liability company Rīga 2nd Hospital, limited liability company Saldus Medical Centre, limited liability company Sanare-KRC Jaunķemeri, joint-stock company Latvian Maritime Medical Centre	Chronic patient care with a treatment duration of up to 14 bed days	749.25
2.5.3.	Level V medical treatment institutions (excluding limited liability company Riga Maternity Hospital), level IV, III, II, and I medical treatment institutions, State limited liability company Seaside Hospital, limited liability company Rīga 2nd Hospital, limited liability company Saldus Medical Centre, limited liability company Sanare-KRC Jaunķemeri, joint-stock company Latvian Maritime Medical Centre	Chronic patient care starting from the 15th day of treatment or continued care following an acute treatment period within the same institution	Tariff for bed days 91.74
2.6.	Infection profile (V, IV)
2.6.1.	Limited liability company Daugavpils Regional Hospital, limited liability company Liepāja Regional Hospital, limited liability company Jēkabpils Regional Hospital, limited liability company Rēzekne Hospital	Treatment of post-tuberculosis sequelae	2986.54
2.6.2.	State limited liability company Strenči Psychoneurological Hospital	Tuberculosis (psychiatric patients)	12 057.79
2.6.3.	State limited liability company Childrenʼs Clinical University Hospital	Treatment of post-tuberculosis sequelae in children	2275.08
2.6.4.	Limited liability company Riga East University Hospital	Treatment of post-tuberculosis sequelae in children	953.96
2.6.5.	State limited liability company Childrenʼs Clinical University Hospital	Diagnosis and treatment of tuberculosis in children	16 221.31
2.6.6.	Limited liability company Riga East University Hospital	Diagnosis and treatment of tuberculosis in children	13 554.30
2.6.7.	Limited liability company Riga East University Hospital	Treatment of patients with multi-drug resistant tuberculosis	19 553.52
2.6.8.	Limited liability company Riga East University Hospital	Treatment of tuberculosis for patients subject to mandatory isolation	18 707.03
2.6.9.	Limited liability company Daugavpils Regional Hospital, limited liability company Liepāja Regional Hospital, limited liability company Jēkabpils Regional Hospital, limited liability company Rēzekne Hospital	Diagnosis and treatment of tuberculosis	8232.91
2.6.10.	Limited liability company Riga East University Hospital	Diagnosis and treatment of tuberculosis	7679.44
2.6.11.	Limited liability company Riga East University Hospital	Treatment of post-tuberculosis sequelae	1880.32
2.7.	Stroke unit profile (V, IV)
2.7.1.	Level V and IV medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Neurology (stroke unit)	1989.59
2.8.	Invasive cardiology profile (V, IV)
2.8.1.	Level V medical treatment institutions (excluding limited liability company Riga East University Hospital and specialised medical treatment institutions)	Correction of congenital and acquired heart defects using invasive cardiology technique	DRG
2.8.2.	State limited liability company Pauls Stradiņš Clinical University Hospital	Transcatheter aortic valve implantation (TAVI)	27 096.63
2.8.3.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions), limited liability company Daugavpils Regional Hospital, limited liability company Liepāja Regional Hospital	Elective and emergency invasive cardiology	DRG
2.8.4.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions), limited liability company Daugavpils Regional Hospital, limited liability company Liepāja Regional Hospital	Planned temporary surgery. Invasive cardiology	DRG planned temporary surgery
2.9.	Cardiology profile (V, IV)
2.9.1.	Level V medical treatment institutions (excluding specialised medical treatment institutions)	Cardiac pacing, pacemaker implantation, ICD (intracardiac defibrillator) implantation, CRT and CRTD implantation for resynchronisation, radiofrequency catheter ablation	DRG
2.10.	Surgery profile (V, IV, III, II)
2.10.1.	Level V medical treatment institutions (excluding limited liability company Riga East University Hospital and specialised medical treatment institutions)	Cardiac surgery	DRG
2.10.2.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Hepatobiliary surgery	DRG
2.10.3.	Limited liability company Riga East University Hospital	Microsurgical treatment of pressure ulcers (stage III, IV)	22 079.76
2.10.4.	Level V, IV, III, II medical treatment institutions and joint-stock company Latvian Maritime Medical Centre	Planned temporary surgery. General surgery	DRG planned temporary surgery
2.10.5.	Limited liability company Riga East University Hospital, State limited liability company Traumatology and Orthopaedics Hospital, level IV medical treatment institutions (excluding limited liability company Jēkabpils Regional Hospital), Madona municipality limited liability company Madona Hospital, limited liability company Rīga 2nd Hospital	Hip joint endoprosthetic replacement with cemented endoprosthesis	2913.81
2.10.6.	State limited liability company Childrenʼs Clinical University Hospital	Scoliosis surgery	DRG
2.10.7.	State limited liability company Pauls Stradiņš Clinical University Hospital	Specialised treatment of oral, maxillo-facial disorders in cases of congenital pathologies and tumours	DRG
2.10.8.	Limited liability company Riga East University Hospital, State limited liability company Traumatology and Orthopaedics Hospital	Microsurgery for adults	3333.90
2.10.9.	Limited liability company Riga East University Hospital, State limited liability company Traumatology and Orthopaedics Hospital, State limited liability company Childrenʼs Clinical University Hospital, limited liability company Liepāja Regional Hospital	Basic microsurgery programme	DRG
2.10.10.	State limited liability company Pauls Stradiņš Clinical University Hospital	Inpatient treatment of congenital cleft palate, lip and facial clefts, congenital and severe occlusion anomalies	DRG
2.10.11.	Limited liability company Liepāja Regional Hospital, limited liability company Vidzeme Hospital, limited liability company Rīga 2nd Hospital, limited liability company Riga East University Hospital	Revision arthroplasty (including the value of the endoprosthesis)	4730.46
2.10.12.	State limited liability company Traumatology and Orthopaedics Hospital	Knee joint endoprosthetic replacement in complex cases	5405.06
2.10.13.	State limited liability company Traumatology and Orthopaedics Hospital, limited liability company Riga East University Hospital	Partial (radial head) elbow joint endoprosthetic replacement	2985.06
2.10.14.	State limited liability company Traumatology and Orthopaedics Hospital, limited liability company Riga East University Hospital	Total elbow joint endoprosthetic replacement	6080.87
2.10.15.	State limited liability company Traumatology and Orthopaedics Hospital	Hip joint endoprosthetic replacement with cementless fixation or hybrid type endoprosthesis in complex cases	3992.80
2.10.16.	State limited liability company Traumatology and Orthopaedics Hospital	Hip joint endoprosthetic replacement with cemented endoprosthesis in complex cases	3026.62
2.10.17.	State limited liability company Traumatology and Orthopaedics Hospital, limited liability company Riga East University Hospital	Shoulder joint endoprosthetic replacement	4792.74
2.10.18.	State limited liability company Traumatology and Orthopaedics Hospital, limited liability company Riga East University Hospital	Implantation of revision endoprostheses, endoprosthetic replacement for patients with osteomyelitis and oncological conditions (excluding the value of the implant)	4102.26
2.10.19.	State limited liability company Traumatology and Orthopaedics Hospital, limited liability company Rīga 2nd Hospital	Hip joint endoprosthetic replacement with cementless metal-on-metal prosthesis	5167.66
2.10.20.	Limited liability company Riga East University Hospital, State limited liability company Traumatology and Orthopaedics Hospital, level IV medical treatment institutions (excluding limited liability company Jelgava City Hospital, limited liability company Jēkabpils Regional Hospital, limited liability company Rēzekne Hospital), Madona municipality limited liability company Madona Hospital, limited liability company Rīga 2nd Hospital	Hip joint endoprosthetic replacement with cementless fixation or hybrid type endoprosthesis	3640.10
2.10.21.	Limited liability company Riga East University Hospital, State limited liability company Traumatology and Orthopaedics Hospital, level IV medical treatment institutions (excluding limited liability company Jēkabpils Regional Hospital, limited liability company Rēzekne Hospital), Madona municipality limited liability company Madona Hospital, limited liability company Rīga 2nd Hospital	Knee joint endoprosthetic replacement	3719.70
2.10.22.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions), State limited liability company Traumatology and Orthopaedics Hospital, limited liability company Daugavpils Regional Hospital, limited liability company Liepāja Regional Hospital, limited liability company Rēzekne Hospital, limited liability company Vidzeme Hospital, limited liability company Ziemeļkurzeme Regional Hospital	Surgical treatment of spinal diseases and injuries	DRG
2.10.23.	Limited liability company Riga East University Hospital, State limited liability company Traumatology and Orthopaedics Hospital, limited liability company Rīga 2nd Hospital	Osteomyelitis	DRG
2.10.24.	Level V, IV, III, and II medical treatment institutions	Other surgical services	DRG
2.10.25.	State limited liability company Traumatology and Orthopaedics Hospital	Combined orthopaedic treatment of complicated osteomyelitis, musculoskeletal injuries, orthopaedic and oncological diseases and their sequelae (defects, functional disorders)	7801.74
2.10.26.	State limited liability company Traumatology and Orthopaedics Hospital, limited liability company Ziemeļkurzeme Regional Hospital	Surgical treatment of degenerative and complex spine diseases, traumas using implants and navigation technologies	8309.98
2.11.	Nephrology profile (V, IV)
2.11.1.	State limited liability company Pauls Stradiņš Clinical University Hospital	Preparation of patients for kidney transplantation, patients with transplant dysfunction, patients with complications of immunosuppressive therapy requiring monitoring and adjustment, and also patients with non-functioning transplants	2031.62
2.12.	Neurosurgery profile (V, IV)
2.12.1.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Neuroangiology. Functional neurosurgery	DRG
2.13.	Neurology profile (V, IV, III)
2.13.1.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Programme "Multiple Sclerosis", inpatient care	DRG
2.14.	Ophthalmology profile (V)
2.14.1.	Level V and IV medical treatment institutions (excluding limited liability company Jelgava City Hospital, limited liability company Jēkabpils Regional Hospital, limited liability company Rēzekne Hospital)	Planned temporary surgery. Ophthalmology	DRG planned temporary surgery
2.15.	Oncology profile (V, IV)
2.15.1.	State limited liability company Traumatology and Orthopaedics Hospital	Oncology programme	DRG
2.15.2.	Level V and IV medical treatment institutions (excluding State limited liability company Children's Clinical University Hospital, State limited liability company National Rehabilitation Centre Vaivari, limited liability company Riga Maternity Hospital)	Diagnostic and emergency surgical care in oncology	DRG
2.15.3.	State limited liability company Pauls Stradiņš Clinical University Hospital, limited liability company Riga East University Hospital, State limited liability company Traumatology and Orthopaedics Hospital, limited liability company Liepāja Regional Hospital, limited liability company Daugavpils Regional Hospital	Diagnostic and planned surgical care in oncology	DRG
2.15.4.	State limited liability company Childrenʼs Clinical University Hospital	Diagnostic and surgical care for children in oncology and haematology	DRG
2.15.5.	State limited liability company Childrenʼs Clinical University Hospital	Chemotherapy for children	5420.32
2.15.6.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital), limited liability company Liepāja Regional Hospital, limited liability company Daugavpils Regional Hospital	Chemotherapy for adults	990.88
2.15.7.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Neuro-oncology	DRG
2.15.8.	Limited liability company Liepāja Regional Hospital, limited liability company Daugavpils Regional Hospital	Radiotherapy	4796.41
2.15.9.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Radiotherapy and chemotherapy for adults	5745.09
2.15.10.	Limited liability company Riga East University Hospital, State limited liability company Pauls Stradiņš Clinical University Hospital	Radiosurgery, stereotactic radiotherapy, and radiotherapy with advanced technological irradiation techniques	5760.86
2.15.11.	Limited liability company Riga East University Hospital, State limited liability company Pauls Stradiņš Clinical University Hospital, limited liability company Liepāja Regional Hospital, limited liability company Daugavpils Regional Hospital	Mastectomy with breast reconstruction or breast reconstruction due to malignant breast neoplasm	DRG
2.16.	Otolaryngology profile (V, IV)
2.16.1.	Level V and IV medical treatment institutions	Planned temporary surgery. Otolaryngology	DRG planned temporary surgery
2.17.	Palliative care profile (V, IV)
2.17.1.	State limited liability company Strenči Psychoneurological Hospital	Palliative care for patients with drug-resistant tuberculosis	Tariff for bed days 62.64
2.17.2.	Limited liability company Riga East University Hospital, State limited liability company Pauls Stradiņš Clinical University Hospital, level IV medical treatment institutions (excluding limited liability company Jelgava City Hospital)	Palliative care	1492.83
2.18.	Paediatrics profile (IV, III, II)
2.18.1.	State limited liability company Childrenʼs Clinical University Hospital	Conditions originating in the perinatal period	DRG
2.18.2.	State limited liability company Pauls Stradiņš Clinical University Hospital, limited liability company Riga Maternity Hospital, limited liability company Vidzeme Hospital, limited liability company Jēkabpils Regional Hospital, limited liability company Liepāja Regional Hospital	Intensive therapy and reanimation for newborns (up to 7 days of life)	DRG
2.18.3.	State limited liability company Childrenʼs Clinical University Hospital	Tertiary level service for newborns	DRG
2.18.4.	State limited liability company Childrenʼs Clinical University Hospital	Cystic fibrosis	DRG
2.18.5.	Otolaryngology sub-profile
2.18.5.1.	State limited liability company Childrenʼs Clinical University Hospital	Implantation of bone-anchored hearing aid (BAHA) for children (excluding implant value)	2578.41
2.18.5.2.	Limited liability company Riga East University Hospital	Paediatric audiology (temporary or permanent hearing and speech disorders). Inpatient care. Rehabilitation	1753.29
2.18.5.3.	State limited liability company Childrenʼs Clinical University Hospital	Cochlear implant placement for children	27 434.00
2.18.5.4.	State limited liability company Childrenʼs Clinical University Hospital	Implantation of bone-anchored hearing aid (BAHA) for children (including implant value)	9812.97
2.18.6.	Cardiology sub-profile
2.18.6.1.	State limited liability company Childrenʼs Clinical University Hospital	Congenital cardiovascular system anomalies, circulatory system pathology occurring in the perinatal period - examination, treatment	DRG
2.18.7.	Microsurgery sub-profile
2.18.7.1.	State limited liability company Childrenʼs Clinical University Hospital	Microsurgery for children	3089.41
2.18.8.	Ophthalmology sub-profile
2.18.8.1.	State limited liability company Childrenʼs Clinical University Hospital	Surgical treatment of diseases causing low vision in children	DRG
2.19.	Psychiatry profile (V, IV)
2.19.1.	State limited liability company Children's Psychoneurological Hospital Ainaži	Long-term inpatient psychiatric treatment for children, including treatment according to court decisions	Estimate financing
2.19.2.	State limited liability company Daugavpils Psychoneurological Hospital	Long-term inpatient psychiatric treatment, including treatment according to court decisions	Estimate financing
2.19.3.	State limited liability company Daugavpils Psychoneurological Hospital, State limited liability company National Psychiatric Health Centre, State limited liability company Seaside Hospital, State limited liability company Hospital Ģintermuiža	Psychiatric care for children	2442.59
2.19.4.	State limited liability company Daugavpils Psychoneurological Hospital, State limited liability company Seaside Hospital, State limited liability company National Psychiatric Health Centre, State limited liability company Hospital Ģintermuiža, State limited liability company Strenči Psychoneurological Hospital	Psychiatric care, including care according to court decisions	3165.75
2.19.5.	State limited liability company National Psychiatric Health Centre	Involuntary inpatient psychiatric treatment with security	Estimate financing
2.19.6.	State limited liability company Childrenʼs Clinical University Hospital, State limited liability company National Psychiatric Health Centre	Inpatient psychiatric care for children	3707.72
2.20.	Rehabilitation profile (V, IV)
2.20.1.	In level IV and V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital), in level V specialised medical treatment institutions (excluding limited liability company Riga Maternity Hospital) and limited liability company Rīga 2nd Hospital	Second stage medical rehabilitation services for adults provided in day and night hospitals (high-intensity care)	Tariff for bed days 118.07*
2.20.2.	In level IV and V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital), in level V specialised medical treatment institutions (excluding limited liability company Riga Maternity Hospital) and limited liability company Rīga 2nd Hospital	Second stage medical rehabilitation services for adults provided in day and night hospitals (low-intensity care)	Tariff for bed days 62.64*
2.20.3.	State limited liability company National Rehabilitation Centre Vaivari	Medical rehabilitation for patients requiring long-term mechanical ventilation	Tariff for bed days 118.07*
2.20.4.	State limited liability company National Rehabilitation Centre Vaivari	Rehabilitation for patients with spinal cord injury (spinal patients)	Tariff for bed days 118.07*
2.20.5.	State limited liability company Children's Clinical University Hospital, State limited liability company National Rehabilitation Centre Vaivari, level IV medical treatment institutions	Second stage medical rehabilitation services for children provided in day and night hospitals (high-intensity care)	Tariff for bed days 118.07*
2.20.6.	State limited liability company Children's Clinical University Hospital, State limited liability company National Rehabilitation Centre Vaivari, level IV medical treatment institutions	Second stage medical rehabilitation services for children provided in day and night hospitals (low-intensity care)	Tariff for bed days 62.64*
2.20.7.	State limited liability company Children's Clinical University Hospital, limited liability company Liepāja Regional Hospital, limited liability company Vidzeme Hospital, limited liability company Jēkabpils Regional Hospital	Rehabilitation services for conditions arising in the perinatal period provided in day and night hospitals to children in their first year of life	Tariff for bed days 118.07*
2.21.	Therapy profile (V, IV, III, II, I)
2.21.1.	Level V, IV, III, II, and I medical treatment institutions, limited liability company Sanare-KRC Jaunķemeri, joint-stock company Latvian Maritime Medical Centre	Other therapeutic services	DRG
2.22.	Thoracic surgery profile (V)
2.22.1.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Thoracic surgery	DRG
2.22.2.	Limited liability company Riga East University Hospital	Thoracic surgery for tuberculosis patients	13 683.5
2.23.	Traumatology profile (V, IV, III, II)
2.23.1.	Level V and IV medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Severe traumatic brain injury	DRG
2.23.2.	Level V, IV, III, and II medical treatment institutions (excluding limited liability company Riga Maternity Hospital, State limited liability company National Rehabilitation Centre Vaivari), State limited liability company Seaside Hospital, limited liability company Rīga 2nd Hospital	Planned temporary surgery. Traumatology, orthopaedics, reconstructive microsurgery of the hand, plastic surgery	DRG planned temporary surgery
2.23.3.	Limited liability company Riga East University Hospital	Inpatient treatment of burns for adults	6836.55
2.23.4.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Inpatient treatment of frostbite for adults	4850.42
2.24.	Urology profile (V, IV)
2.24.1.	Level V medical treatment institutions (excluding specialised medical treatment institutions, limited liability company Riga Maternity Hospital and State limited liability company National Rehabilitation Centre Vaivari), level IV, III, and II medical treatment institutions	Planned temporary surgery. Urology	DRG planned temporary surgery
2.25.	Other services
2.25.1.	Limited liability company Riga East University Hospital	Stem cell transplantation	6551.36
2.25.2.	State limited liability company Pauls Stradiņš Clinical University Hospital	Inpatient treatment of Chernobyl Atomic Power Plant accident liquidators and occupational disease patients	999.06
2.25.3.	Level V and IV medical treatment institutions	Inpatient treatment in haematology	DRG
2.25.4.	Level V medical treatment institutions (excluding State limited liability company Childrenʼs Clinical University Hospital and specialised medical treatment institutions)	Rehabilitation of persons who suffered under the National Socialist regime	2373.95
2.25.5.	State limited liability company Pauls Stradiņš Clinical University Hospital	Orthotopic heart transplantation	36 697.95
2.25.6.	Level IV, III, and II medical treatment institutions, State limited liability company National Rehabilitation Centre Vaivari	Care for patients requiring long-term mechanical lung ventilation	Tariff for bed days 70.29
2.25.7.	Limited liability company Riga East University Hospital	Provision of inpatient treatment for patients with infectious, sexually transmitted, and skin diseases, HIV/AIDS patients	DRG
2.25.8.	State limited liability company Childrenʼs Clinical University Hospital	Inpatient care for children and infants in particularly severe cases	DRG
2.25.9.	State limited liability company Childrenʼs Clinical University Hospital	Syphilis, gonorrhoea in children	1886.29
2.25.10.	Level V medical treatment institutions, limited liability company Daugavpils Regional Hospital, limited liability company Liepāja Regional Hospital	Planned temporary surgery. Interventional radiology	DRG planned temporary surgery
2.25.11.	State limited liability company Pauls Stradiņš Clinical University Hospital
2.25.11.1.	State limited liability company Pauls Stradiņš Clinical University Hospital	Examination of patients prior to orthotopic liver transplantation	1999.11
2.25.11.2.	State limited liability company Pauls Stradiņš Clinical University Hospital	Orthotopic liver transplantation	45 504.18
2.25.12.	State limited liability company Pauls Stradiņš Clinical University Hospital	Kidney transplantation and postoperative period	15 852.54
2.25.13.	Narcology sub-profile
2.25.13.1.	State limited liability company Hospital Ģintermuiža	Mandatory addiction treatment for children	2966.10
2.25.13.2.	State limited liability company Hospital Ģintermuiža	Inpatient rehabilitation for children with drug addiction	2966.10
2.25.13.3.	State limited liability company Hospital Ģintermuiža	Inpatient rehabilitation for adults with drug addiction	10 418.81
2.25.13.4.	State limited liability company Hospital Ģintermuiža, State limited liability company National Psychiatric Health Centre	Inpatient Minnesota Model	2530.83
2.25.13.5.	State limited liability company Hospital Ģintermuiža, State limited liability company National Psychiatric Health Centre, State limited liability company Strenči Psychoneurological Hospital, limited liability company Daugavpils Regional Hospital, limited liability company Rēzekne Hospital, State limited liability company Seaside Hospital	Narcology	659.23

Note. * The Service shall additionally pay for the manipulations specified in the payment conditions of the contract with the medical treatment institution as manipulations binding for the programme.

 

Annex 7
Cabinet Regulation No. 555
28 August 2018

[19 November 2024]

Health Care Services Payable According to Invoices Submitted by Medical Treatment Institutions

1. State limited liability company Traumatology and Orthopaedics Hospital shall receive payments from the Service for the following:

1.1. large joint endoprostheses, endoprosthesis components and implants for patients who have been treated under the services programme "Implantation of revision endoprostheses, endoprosthetic replacement for osteomyelitis and oncology patients";

1.2. spinal cord stimulation kits and parts thereof.

2. State limited liability company Pauls Stradiņš Clinical University Hospital shall receive payments from the Service for the following:

2.1. deep brain stimulation kits and parts thereof intended for the replacement of already implanted electronic neurostimulators;

2.2. the use of double-balloon catheters for organ perfusion used in transplantation;

2.3. single-use kits for connecting organs to pulsatile perfusion and preservation machines;

2.4. individually designed stent prostheses for cases of endovascular thoracoabdominal aneurysm.

3. Limited liability company Riga East University Hospital shall receive payments from the Service for the following:

3.1. medicinal products for the treatment of opportunistic infections of human immunodeficiency virus and for ensuring the following preventive care:

3.1.1. for ensuring vertical prophylaxis of human immunodeficiency virus infection for women who are HIV positive;

3.1.2. for ensuring post-exposure prophylaxis (PEP) to medical practitioners;

3.1.3. reagents necessary for the diagnosis of human immunodeficiency virus infection;

3.2. the following medicinal products used in the treatment of patients with tuberculosis and those undergoing allogeneic and autologous stem cell transplantation:

No.	Name of medicinal product	Pharmaceutical form
3.2.1.*	Ethambutoli hydrochloridum	tab.
3.2.2.*	Moxifloxacin	tab.
3.2.3.*	Moxifloxacin	sol.
3.2.4.*	Capreomycin	sol.
3.2.5.*	Ethambutoli hydrochloridum	sol.
3.2.6.*	Isoniasidum	tab.
3.2.7.*	Isoniasidum	sol.
3.2.8.*	Kanamycinum	sol.
3.2.9.*	Natrii paraaminosalicylas	pac.
3.2.10.*	Protionamidum	tab.
3.2.11.*	Pyrazinamidum	tab.
3.2.12.*	Rifampicinum	tab.
3.2.13.*	Rifampicinum	caps.
3.2.14.*	Rifampicinum	sol.
3.2.15.*	Streptomycinum	sol.
3.2.16.*	Terizidonum	caps.
3.2.17.*	Ofloxacinum	tab.
3.2.18.**	Linezolidum	tab. sol.
3.2.19.*	Levofloxacinum	tab.
3.2.20.*	Rifabutin	tab.
3.2.21.*	Kalii clavulanas, Amoxicillinum trihydricum	tab.
3.2.22.*	Clarithromycinum	tab.
3.2.23.*	Cilastinum, Imipinemum	sol.
3.2.24.*	Amikacinum	sol.
3.2.25.	Delamanidi	tab.
3.2.26.	Bedaquiline	tab.
3.2.27.	Clofaziminum	caps.
3.2.28.	Antimicrobials:
3.2.28.1.	Imipenenum/cilastatinum	sol.
3.2.28.2.	Meropenenum	sol.
3.2.28.3.	Piperacillinum, Tazobactamum	sol.
3.2.29.	Antifungals:
3.2.29.1.	Amphotericinum B (liposomal)	sol.
3.2.29.2.	Amphotericinum B	sol.
3.2.29.3.	Amphoteracinum B	susp. oral
3.2.29.4.	Caspofunginum	sol.
3.2.29.5.	Voriconazolum	sol.
3.2.29.6.	Voriconazolum	tab.
3.2.30.	Antivirals:
3.2.30.1.	Valganciclovirum	caps.
3.2.30.2.	Ganciclovirum	sol.
3.2.31.	Cytostatic medicinal products:
3.2.31.1.	Alemtuzumabum	sol.
3.2.31.2.	Carmustinum	powder for injection
3.2.32.	Colony stimulating medicinal products:
3.2.32.1.	Human erythropoietin	sol.
3.2.32.2.	Kepivance	powder for injection
3.2.33.	Immunosuppressive medicinal products:
3.2.33.1.	Immunoglobulinum antilymphocytarium	sol.
3.2.34.	Immunoglobulins:
3.2.34.1.	Pentaglobin	sol.
3.2.35.	Other medicinal products:
3.2.35.1.	Pamidronic acid	sol.
3.2.35.2.	Tacrolimus	ointment
3.2.35.3.	Treosulfan	sol.
Notes. * Not paid for patients receiving inpatient health care services at limited liability company Riga East University Hospital. ** Not paid for patients receiving inpatient health care services at limited liability company Riga East University Hospital for tuberculosis treatment.

3.3. large joint endoprostheses, endoprosthesis components and implants for patients who have been treated under the services programme "Implantation of revision endoprostheses, endoprosthetic replacement for osteomyelitis and oncology patients";

3.4. individually designed stent prostheses for cases of endovascular thoracoabdominal aneurysm.

4. State limited liability company Children's Clinical University Hospital shall receive payments from the Service for the following:

4.1. the administration of the monoclonal antibody Palivizumabum 50 mg or 100 mg for children (under two years of age) who are hospitalised and receiving prophylaxis for high-risk children against seasonal respiratory syncytial virus infection in accordance with the recommendations agreed upon by the State limited liability company Children's Clinical University Hospital and the Latvian Neonatal Society;

4.2. the use of nitric oxide (iNO) in the treatment of pulmonary hypertension in children, provided that the service is paid for on an hourly basis, but for no more than 96 hours in a single course of treatment;

4.3. the purchase of new respiratory devices for children receiving health care at home, the replacement of existing equipment and the maintenance of such equipment;

4.4. the following medicinal products used for the treatment of children with oncological and oncohaematological diseases in cases of invasive mycoses following chemotherapy and for outpatient treatment of children with cystic fibrosis:

No.	Name of medicinal product	Pharmaceutical form	Unit of activity
4.4.1.	Caspofunginum	sol.	70 mg
4.4.2.	Caspofunginum	sol.	50 mg
4.4.3.	Voriconazolum	sol.	200 mg
4.4.4.	Voriconazolum	tab.	200 mg
4.4.5.	Dornasum alfac (Deoxyribonuclease)	inhalation solution	1 mg/ml
4.4.6.	Tobramycinum	inhalation solution	300 mg/ml
4.4.7.	Tobramycinum	powder for inhalation	28 mg

4.5. the purchase of medicinal products and care products for children with epidermolysis bullosa who are registered with the consulting room of rare diseases of the State limited liability company Children's Clinical University Hospital;

4.6. disposable insulin pump accessories for existing patients, insulin pumps for new patients, disposable insulin pump accessories for new patients and the purchase of new insulin pumps to replace damaged insulin pumps for persons up to 24 years of age.

5. The Service shall pay for the use of recombinant activated factor VII (Nova Seven) medicinal products for all level V and IV inpatient medical treatment institutions (including the limited liability company Riga Maternity Hospital).

6. The Service shall make payments for medicinal products to all medical treatment institutions which provide treatment to oncology patients through parenteral administration of medicinal products, provided that these products have not been centrally procured and their use has been coordinated with the Service in conformity with the conditions laid down in the contract with the Service.

7. In order to provide endovascular thrombectomy from precerebral and cerebral arteries, the Service shall make payments for the cost of the following medical devices to State limited liability company Pauls Stradiņš Clinical University Hospital, limited liability company Riga East University Hospital, and limited liability company Daugavpils Regional Hospital:

7.1. guide catheters;

7.2. reperfusion aspiration catheters for cerebral indications;

7.3. microcatheters for cerebral indications;

7.4. micro-guidewires for cerebral indications;

7.5. aspiration pump canisters;

7.6. aspiration pump connecting tubes;

7.7. balloon occlusion catheters;

7.8. intracranial thrombectomy stents;

7.9. intracranial detachable stents for stenosis treatment.

 

Annex 8
Cabinet Regulation No. 555
28 August 2018

[8 July 2025]

Conditions for Centralised Procurements

1. The Service shall perform centralised procurements for the supply of the following medicinal products and foods for specific groups:

1.1. in the capacity of the procurement competition organiser - the representative of the contracting authority - for the supply of parenterally administered medicinal products intended for the treatment of oncological diseases specified in the laws and regulations regarding the procedures for the reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for outpatient treatment and which are to be administered in an inpatient or day hospital under the supervision of the relevant specialist (hereinafter - parenterally administered medicinal products) in accordance with Paragraph 2 of this Annex;

1.2. in the capacity of the procurement contracting authority and payer for the supply of the following medicinal products, standard tuberculin, medical devices, and foods for specific groups:

1.2.1. vaccines in accordance with the laws and regulations regarding vaccination regulations;

1.2.2. syringes for the administration of the tuberculosis vaccine (BCG);

1.2.3. standard tuberculin;

1.2.4. corrective products for phenylketonuria and other congenital metabolic diseases;

1.2.5. means of medical treatment for the provision of peritoneal dialysis (solutions and accessories);

1.2.6. eyesight corrective aids for children in accordance with the conditions referred to in Sub-paragraph 4.11.1.1 of this Regulation;

1.2.7. immune sera and specific immunoglobulins;

1.2.8. artificial formulas for infants and artificial supplementary feeding formulas for children up to one year of age who were born to HIV-infected mothers;

1.2.9. colorectal cancer screening test kits;

1.2.10. medical nutritional supplements, enteral and parenteral nutrition mixtures and the medical devices necessary for their administration for patients in accordance with the conditions referred to in Sub-paragraph 4.11.1.2 of this Regulation, ensuring payment for the service for outpatient medical treatment of patients, but a medical treatment institution shall, within the scope of general agreement, enter into a supply contract with the supplier and make payment for patients under inpatient care.

2. The Service shall procure parenterally administered medicinal products in conformity with the following conditions:

2.1. the Service shall establish and maintain a list of centrally procured parenterally administered medicinal products and publish it on its website once a year by 1 July of the current year, taking into account the following conditions:

2.1.1. in order to include a new common name of medicinal products in the list of parenterally administered medicinal products, the holder (owner) of the marketing authorisation for medicinal products or his or her authorised representative or the wholesaler of medicinal products or his or her authorised representative shall submit an application to the Service and the documents attached thereto in accordance with the laws and regulations regarding the procedures for the reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for outpatient treatment;

2.1.2. the decision on the inclusion of the common name of medicinal products in the list of parenterally administered medicinal products shall be taken and the medicinal products shall be evaluated in accordance with the laws and regulations regarding the procedures for the reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for outpatient treatment in accordance with the requirements for the evaluation of the application for the inclusion of a new common name of medicinal products in the list of reimbursable medicinal products;

2.1.3. the Service shall procure the medicinal products included in the list of parenterally administered medicinal products for the needs of the medical treatment institutions with which it has entered into contracts for the provision of and payment for the planned oncological health care services or an inter-institutional agreement on cooperation;

2.2. the Service shall perform the activities related to the procurement procedure and enter into a framework agreement, whereas the medical treatment institution shall enter into a supply contract with the supplier under the framework agreement and make the payment for the purchase. The Service shall settle accounts with medical treatment institutions for the use of parenterally administered medicinal products for the treatment of oncological diseases after the medical treatment institution has submitted to the Service a report on the consumption of the relevant medicinal products, indicating information on the amount of medicinal products used in the treatment of the specific patient.

3. After new common names of medicinal products are included in the list of parenteral medicinal products, medical treatment institutions shall commence the use thereof not earlier than from 1 January of the following year after completion of the centralised procurement.

4. Medical treatment institutions and the State administration institution responsible for planning population vaccination shall submit requests for necessary medicinal products to the Service, whereas the Service shall ensure the fulfilment of the duties related to the work of the procurement commission. The Service shall invite authorised representatives from medical treatment institutions to participate in the procurement commission established for the relevant procurement. Authorised representatives from other State administration institutions may also be included in the procurement commission.

5. The Service shall procure only such medicinal products which are permitted for distribution in accordance with the laws and regulations governing health care regarding the procedures for the reimbursement of expenditures for the acquisition of medicinal products and medical devices intended for outpatient treatment. In order to ensure efficient use of State budget funds in the procurement process and to evaluate the usefulness of the procurement, the Service may require medical treatment institutions to indicate in their procurement request the number of persons for whom the requested medicinal products are intended and also the current stock levels and minimum reserve quantities of medicinal products in medical treatment institutions.

6. When establishing requirements for applicants, the Service shall require the applicant to submit certification confirming their ability to supply the medicinal products in the quantities specified in the procurement for which they have submitted a tender.

 

Annex 9
Cabinet Regulation No. 555
28 August 2018

Specific Medicinal Treatment Diagnoses in the Field of Rare Diseases

[29 December 2021]

 

Annex 10
Cabinet Regulation No. 555
28 August 2018

[8 July 2025]

Emergency Rooms and Calculation of Monthly Fixed Payments (Supplements) for Consulting Rooms of Medical Specialists and Units

1. The Service shall enter into contracts for the provision of the services of emergency rooms with:

1.1. medical treatment institutions that provide only outpatient health care services:

1.1.1. sabiedrība ar ierobežotu atbildību "Sarkanā Krusta Smiltenes slimnīca" [limited liability company Red Cross Smiltene Hospital];

1.1.2. pašvaldības sabiedrība ar ierobežotu atbildību "Saulkrastu slimnīca" [municipal limited liability company Saulkrasti Hospital];

1.2. inpatient medical treatment institutions which have established an emergency room in populated areas separate from their main service provision location:

1.2.1. limited liability company Balvi and Gulbene Hospital Association (service provision location - the town of Gulbene);

1.2.2. limited liability company Vidzeme Hospital (service provision location - the town of Valka);

1.3. other inpatient medical treatment institutions - limited liability company Saldus Medical Centre and limited liability company Priekule Hospital.

2. Annual resources required for fixed payments to support specialists and medical treatment institution units in outpatient health care

No.	Speciality or unit1	For one full-time workload (EUR)	For 0.25 of a full-time workload (EUR)	For half of a full-time workload (EUR)	For 2 full-time workloads (EUR)	For 2.25 full-time workloads (EUR)	For 3 full-time workloads (EUR)	For 4.5 full-time workloads (ensuring 24-hour availability) (EUR)	Ensuring 24-hour availability in reception wards (EUR)
2.1.	Psychiatrist2, 3, 4	4692	1173	2346	-	-	-	-	11 247
2.2.	Narcologist	-	-	-	-	-	-	-	11 297
2.3.	Pneumonologist5, 6, 7	4692	1173	2346	-	-	-	-	11 677
2.4.	Consulting room of diabetic foot care8	4160	1040	2080	-	-	-	-	-
2.5.	Palliative care consulting room	4223	1056	2112	-	-	-	-	-
2.6.	Consulting room of chronic obstructive pulmonary diseases8	4288	1072	2144	-	-	-	-	-
2.7.	Emergency room	6582	1646	3291	-	12 327	-	19 233	18 771
2.8.	Stoma consulting room	5773	1443	2887	-	-	-	-	-
2.9.	Consulting room of a doctor on duty8	4545	1136	2273	-	-	-	-	-
2.10.	Consulting room of a paediatrician	4371	1093	2186	-	-	-	-	12 182
2.11.	Palliative care consulting room at State limited liability company Children's Clinical University Hospital9, 15	11 010	-	-	-	-	-	32 171	-
2.12.	Consulting room of rare diseases at State limited liability company Children's Clinical University Hospital:
2.12.1.	consulting room of cystic fibrosis	29 413	-	14 707	-	-	-	-	-
2.12.2.	consulting room of other rare diseases	3736	934	1868	-	-	-	-	-
2.13.	Consulting room of a psychologist/psychotherapist2	3736	934	1868	-	-	-	-	-
2.14.	Consulting room of methadone maintenance treatment9	3736	934	1868	6794	-	9512	-	-
2.15.	Training room of diabetes mellitus patients	3736	934	1868	-	-	-	-	-
2.16.	HIV compliance room10	3736	934	1868	-	-	-	-	-
2.17.	Consulting room of functional specialists2	3736	934	1868	-	-	-	-	-
2.18.	Consulting room of a nurse in psychiatry and narcology2	3849	962	1925	-	-	-	-	-
2.19.	Consulting room of an arrhythmologist	3736	-	-	-	-	-	-	-
2.20.	Consulting room of a midwife	2831	-	-	-	-	-	-	-
2.21.	Enteral and parenteral nutrition patient care consulting room11	3736	-	1868	-	-	-	-	-
2.22.	Consulting room of psychoemotional support for oncology patients10, 12	2420	-	-	-	-	-	-	-
2.23.	Mood disorder consulting room for children2, 10, 13,14	3993	-	-	-	-	-	-	-
2.24.	Consulting room of the oncology patient coordinator	3736	-	-	-	-	-	-	-
2.25.	Tracheostomy patient care consulting room	3736	934	1868	-	-	-	-	-
2.26.	Health care consulting room at a long-term social care and social rehabilitation institution	4746	1186	2373	-	-	-	-	-

Notes.

¹ The total monthly fixed payment shall consist of the following amounts:

1) the monthly fixed payment intended for operational support, which is 1/12 of the annual volume specified in this Annex for the activities of specialists and units of medical treatment institutions, and which is applied only to premises actually provided for the work of medical practitioners;

2) the remuneration for doctors and nurses, calculated in accordance with the average remuneration for doctors and medical practitioners specified in this Regulation (Paragraph 153 of this Regulation), taking into account the workload of doctors and nurses specified in the contract with the Service, and including in the calculation payment for work on weekends, public holidays, at night, and for overtime work.

² When calculating the monthly fixed payment for the consulting room of a psychiatrist, the consulting room of a psychologist/psychotherapist, the consulting room of a nurse and the consulting room of functional specialists, and also the mood disorder consulting room for children, the remuneration calculation shall additionally include the following:

1) the fee for complexity (work with patients with mental and psychiatric disorders) in the amount of EUR 405.00 for the consulting room of a psychiatrist, the consulting room of a psychologist/psychotherapist, and the functional specialist consulting room and in the amount of EUR 243.00 for the consulting room of a nurse in psychiatry and narcology;

2) the fee for ensuring availability and work in high-intensity conditions in the amount of EUR 540.00 for the consulting room of a psychiatrist and the consulting room of a psychologist/psychotherapist;

3) the fee for work in high-intensity conditions in the amount of EUR 540.00 for a psychologist, a psychotherapist, and a psychiatrist employed in the mood disorder consulting room for children.

³ Within the scope of funding intended for the consulting room of a psychiatrist, State limited liability company National Psychiatric Health Centre shall provide persons with the necessary assistance to prevent criminal offences against morality and sexual inviolability of a child.

⁴ If a medical treatment institution cannot ensure at least half a full-time workload of a psychiatrist or a paediatric psychiatrist in the consulting room of a psychiatrist, then the Service shall pay for the services provided by the psychiatrist or paediatric psychiatrist in accordance with the procedures laid down in Annex 4 to this Regulation.

⁵ The workload of pneumonologists shall be planned, taking into account that 10 visits per day correspond to one full time equivalent.

⁶ By 1 August each year (for the period from 1 January to 30 June), the Service shall evaluate the volume of health care services provided by the medical treatment institutions which receive the fixed payment specified in this Annex for ensuring the work of a pneumonologist for at least six consecutive months. If the volume of work performed during the evaluation period is less than that planned in the contract, the Service shall amend the contract from 1 September according to the volume of work performed. If the volume of work performed during the evaluation period is less than half a full-time workload, the Service shall amend the contract, stipulating that from 1 September the Service shall pay for the health care services provided in accordance with the care episode tariffs and the list of manipulations specified in Annex 4 to this Regulation.

⁷ Prior to entering into a contract for the provision of health care services of pneumonologists for patients with tuberculosis (diagnosis codes in accordance with ICD-10: A15-A19, B90, J65, P37.0, R76.1, Y58.0, Y60.3, Z03.0, Z20.1), the Service shall assess the information entered in the management information system on the amount of the relevant health care services provided in the medical treatment institution in the previous period and if:

1) the volume of work performed in 12 months (during the period from 1 September to 31 August) is less than half a full-time workload, it shall enter into the contract for the payment for the health care services provided in accordance with the care episode tariffs specified in Annex 4 to this Regulation and the manipulation tariffs and payment conditions for manipulations specified in the list of manipulations;

2) such health care services have not been provided at the medical treatment institution during the previous period, the amount of the fixed payment shall be determined, taking into account that not more than half a full-time workload is allocated to one specialist.

⁸ The Service has the right to terminate the contract entered into with the medical treatment institution for the provision of the relevant health care services if the Service establishes that:

1) the consulting room of a doctor on duty of the medical treatment institution which receives a fixed payment for the consulting room of a doctor on duty has not been visited by at least three patients per day;

2) the consulting room of diabetic foot care or consulting room of chronic obstructive pulmonary diseases of the medical treatment institution which receives the payment specified in this Annex for the consulting room of diabetic foot care or for the consulting room of chronic obstructive pulmonary diseases has not been visited by at least six patients per day.

⁹ In order to ensure the operation of the consulting room of methadone maintenance treatment and the palliative care consulting room, the remuneration calculation shall also include the remuneration of a psychologist (in accordance with the average remuneration of doctors and functional specialists specified in this Regulation).

¹⁰ The average remuneration specified in Sub-paragraph 153.2 of this Regulation shall be taken into account when calculating the remuneration for health care service coordinators in the consulting room of rare diseases, the HIV compliance consulting room, the consulting room of psychoemotional support for oncology patients, and the mood disorder consulting room for children.

¹¹ Limited liability company Riga East Clinical University Hospital shall receive the payment for the operation of the enteral and parenteral nutrition patient care consulting room. The services in the consulting room shall be provided by a nurse, a nutritionist, and a dietician.

¹² Limited liability company Riga East Clinical University Hospital shall receive the payment for the operation of the consulting room of psychoemotional support for oncology patients. The services in the consulting room shall be provided by a patient flow coordinator, a nurse, functional specialists, a psychologist, and a psychotherapist.

¹³ Limited liability company Child and Adolescent Resource Centre shall receive the payment for the operation of the mood disorder consulting room for children. Services in the consulting room shall be provided by a patient flow coordinator, a functional specialist, a psychologist, a psychotherapist, a narcologist, and a psychiatrist.

¹⁴ If the number of full-time workloads of functional specialists, psychologists, psychotherapists, narcologists, or psychiatrists employed in the consulting room exceeds one full-time workload, then the payment referred to in Sub-paragraph 2.23 of this Annex shall be applied when calculating the fixed payment for the consulting room. If the number of full-time workloads of functional specialists, psychologists, psychotherapists, narcologists, or psychiatrists employed in the consulting room is less than one full-time workload, then the payment referred to in Sub-paragraph 2.23 of this Annex shall be reduced proportionally.

¹⁵ Children and also persons up to 24 years of age who have been included in the register of the consulting room before 18 years of age, may be registered with the palliative care consulting room of State limited liability company Children's Clinical University Hospital, and these persons are entitled to receive the same health care services as children registered with the consulting room.

 

In the wording provided by the Ministry of Health

Annex 11
Cabinet Regulation No. 555
28 August 2018

[8 July 2025]

Planning of Primary Health Care Funding

1. The Service shall plan the resources for the payment for primary health care services according to the following territories:

1.1. Rīga (Rīga, Jūrmala, Ādaži municipality, Ķekava municipality, Mārupe municipality, Olaine municipality, Ropaži municipality, Salaspils municipality, Saulkrasti municipality, Sigulda municipality);

1.2. Kurzeme (Liepāja, Ventspils, Dienvidkurzeme municipality, Kuldīga municipality, Saldus municipality, Talsi municipality, Tukums municipality, Ventspils municipality);

1.3. Latgale (Daugavpils, Rēzekne, Augšdaugava municipality, Krāslava municipality, Līvāni municipality, Ludza municipality, Preiļi municipality, Rēzekne municipality);

1.4. Vidzeme (Alūksne municipality, Balvi municipality, Cēsis municipality, Gulbene municipality, Limbaži municipality, Madona municipality, Smiltene municipality, Valka municipality, Valmiera municipality, Varakļāni municipality);

1.5. Zemgale (Jelgava, Aizkraukle municipality, Bauska municipality, Dobele municipality, Jelgava municipality, Jēkabpils municipality, Ogre municipality).

2. The amount of capitation, including the payment for performing receptionist functions and providing telephone consultations during the working hours of the practice, shall be EUR 2.915427 per person per month.

3. The primary health care consumption coefficient, which is necessary for determining the amount of capitation for general practitioners, shall be calculated by the Service according to the data from the management information system on the number of persons in age groups, the number of visits to the general practitioner in each age group, and the number of remote consultations provided by the general practitioner in each age group during a 12-month period (from 1 September to 31 August), taking into account the following conditions:

3.1. persons shall be divided into the following age groups:

3.1.1. up to 1 year of age;

3.1.2. 1 to 7 years of age;

3.1.3. 7 to 18 years of age;

3.1.4. 18 to 45 years of age;

3.1.5. 45 to 65 years of age;

3.1.6. persons aged 65 and older;

3.2. based on the data of the management information system of the Service on outpatient visits, the number of outpatient visits to general practitioners shall be determined for each age group and in the country as a whole;

3.3. the number of registered persons in each age group (n1 to n6) and in the country as a whole (N) shall be determined according to the data from the register of health care service recipients;

3.4. the absolute consumption coefficient of each age group shall be obtained by dividing the number of visits in an age group by the number of persons in that age group; the national average absolute consumption coefficient shall be obtained by dividing the total number of visits by the total number of persons;

3.5. the consumption coefficient of primary health care service use for each age group (ki₁ to ki₆) shall be obtained by dividing the absolute consumption coefficient of each age group by the national average absolute consumption coefficient.

4. The Service shall calculate the amount of capitation for a general practitioner according to the following criteria:

4.1. for calculating the total coefficient of patients registered with each practice of a general practitioner (K_p), the multiplication of the consumption coefficient of primary health care service use for each age group (ki₁ to ki₆) and the number of registered patients in each age group (n1 to n6) shall be summed together, and the resulting value shall be then divided by the total number of patients registered with the general practitioner (N):

Kp =	(ki1 x n1) + (ki2 x n2) + (ki3 x n3) + (ki4 x n4) + (ki5 x n5) + (ki6 x n6)
	N

4.2. the coefficient of patients for the entire country (K_V) shall be calculated according to the formula indicated in Sub-paragraph 4.1 of this Annex, taking into account the total number of patients registered with general practitioners across the country;

4.3. the differentiated coefficient of patients of the general practitioner (K_d) shall be obtained by dividing the coefficient of patients registered with each general practitioner (K_p) by the national coefficient (K_V):

K_d = K_p : K_V

4.4. the monthly amount of capitation intended for the activities of the general practitioner shall be obtained by multiplying the differentiated coefficient of patients of the general practitioner (K_d) and the total number of patients registered with the general practitioner (N) and the capitation per patient per month (L_R). In order to obtain the annual capitation for the general practitioner (L_N), the monthly capitation shall be multiplied by 12:

L_N = K_d x L_R x N x 12

4.5. for general practitioners who have commenced the registration of patients during the current year, the number of registered patients shall be determined according to the data from the management information system available on 1 December of the current year.

5. The Service shall make an annual payment to the practice of a general practitioner by 1 May of the current year for ensuring the substitution of medical practitioners employed at the practice during justified absence. The aforementioned payment shall be 1/12 of the capitation planned for the practice for the relevant year, except for the following cases:

5.1. if the practice provides primary health care services for a full calendar year, but receives a fixed payment as a newly opened practice of a general practitioner for at least one month in the relevant year - the payment for ensuring substitution shall be 1/12 of the nationally planned average capitation per practice for the relevant year;

5.2. if the practice provides primary health care services for less than six months during the calendar year - the payment for ensuring substitution shall be reduced and calculated in proportion to the number of months in which the practice provides primary health care services.

6. The funds to be allocated to the territorial departments of the Service for the payment of medical manipulations performed at the practices of general practitioners (L_M) shall be calculated by the Service separately for each manipulation by multiplying the number of manipulations performed in the practices of general practitioners of the territorial department in the previous year (S) by its projected tariff (TC) and then summing these figures:

L_M(1…5) = S_1(1…5) x TC1 + S_2(1...5) x TC2 + S_n(1...5) x TCn

7. If the list of manipulations is extended, the anticipated volume increase shall be added to this amount, calculated by multiplying the anticipated number of each new manipulation by its anticipated tariff and then summing these figures.

8. The monthly fixed payment to the practice of a general practitioner, including the risk payment, shall be EUR 1000.00 per month. The aforementioned payment shall be made to all practices of general practitioners which receive capitation in accordance with their contract with the Service.

9. The monthly fixed payment for the second and each subsequent place of reception of the general practitioner shall be EUR 400.00 in conformity with the following conditions:

9.1. the place of reception of the general practitioner shall comply with the laws and regulations regarding mandatory requirements for medical treatment institutions and their units;

9.2. the address of the additional place of reception is:

9.2.1. in another territorial unit (municipality, parish, or town);

9.2.2. in the same territorial unit if the necessity thereof has been determined by the Service after agreement thereupon with the local government (the practice has been approved in a primary health care plan coordinated with the local government) and it meets the requirements laid down in Sub-paragraphs 9.3, 9.4, and 9.5 of this Annex;

9.3. the territorial unit in which the additional place of reception is located is the declared place of residence for at least 400 inhabitants or the population density in the relevant territory is less than 500 inhabitants per square kilometre;

9.4. the additional place of reception is registered in the register of medical treatment institutions;

9.5. the general practitioner sees patients at this additional place of reception at least one day per week;

9.6. the additional place of reception of the general practitioner is located within the basic area of operation of the general practitioner.

10. The payment for the provision of primary health care services, including the risk payment, in the case referred to in Paragraph 19 of this Regulation shall be EUR 400.00 per month.

11. The practice of a general practitioner shall receive the monthly fixed supplement for operational support of the practice and the personnel in the rural area on the basis of the population density of the basic area of operation and the number of registered patients:

11.1. the area with a density above 500 inhabitants per square kilometre - no supplement;

11.2. the area with a density from 100 to 499 inhabitants per square kilometre - EUR 182.00 per month if up to 1800 adult patients or 800 children are registered at the practice, and the supplement shall be increased by EUR 0.07 per month for each additional registered patient;

11.3. the area with a density from 20 to 99 inhabitants per square kilometre - EUR 268 per month if up to 1800 adult patients or 800 children are registered in the practice, and the supplement shall be increased by EUR 0.10 per month for each additional registered patient;

11.4. the area with a density below 20 inhabitants per square kilometre - EUR 361 per month if up to 1800 adult patients or 800 children are registered in the practice, and the supplement shall be increased by EUR 0.14 per month for each additional registered patient;

11.5. the Service shall additionally calculate the supplement for registered patients specified in Sub-paragraphs 11.2, 11.3, and 11.4 of this Annex for each registered patient if the practice of the general practitioner receives double the payment for operational support of a nurse and a doctor's assistant (feldsher) in accordance with Paragraph 25 of this Annex.

12. The average population density per square kilometre of territorial units shall be determined if there are several territorial units (towns, parishes) in the basic area of operation of the general practitioner. The area, for example, a town, where several general practitioners provide care to the inhabitants, shall be considered as a single territory with unified population density.

13. The Service shall determine the monthly fixed supplement for the practice of a general practitioner for ensuring the operation of the practice in the rural area on the basis of the population density of the basic area and the number of registered patients once per calendar year, and the calculation shall be made using the data on the number of registered patients on 1 December of the previous calendar year, except for the following cases where the number of registered patients on the twentieth day of the previous calendar month shall be used:

13.1. if a new contract is entered into;

13.2. if the basic area of operation of the practice of the general practitioner is changed;

13.3. if the number of patients registered at the practice of the general practitioner has increased by more than 200 persons.

14. The general practitioner shall receive the monthly fixed supplement of EUR 28.46 for compliance of the age structure of registered patients with the type of practice of the general practitioner, provided that the number of children at the practice is up to 70 % of the total number of patients registered with the physician.

15. The practice of the general practitioner shall receive monthly fixed supplements for the chronic patient care in the following amounts:

No.	Supplement per patient, EUR per month	Diagnosis codes
15.1.	0.06	C00, C17, C26, C43, C44, C63, C68, I09, I11, I50, K50
15.2.	0.13	C04, C09, C15, C18, C53, C54, C76, E25, E27, I20, K74, M06, N18
15.3.	0.24	C20, C22, C23, C32, C50, C67, C70, C90, C91, C92, E84, G10, I05, I10, I25, N04, Z95
15.4.	0.43	C16, C25, C31, C48, C55, C56, C64, C74, C81, C88, E10, E22, E23, F20, G70, J45, K51
15.5.	0.60	C12, C13, C34, C39, C61, C71, C72, C73, C82, E11, E83, G20, G40, M05, M34
15.6.	0.75	C07, G35, M33, T66
15.7.	0.97	C37, C51, C57, C96, M32
15.8.	1.39	C45, C47, C66

16. The practice of the general practitioner shall receive the supplements referred to in Paragraph 15 of this Annex only for those patients who have visited the practice of their general practitioner three or more times within the previous six months.

17. The general practitioner shall receive the payment of EUR 250.00 for a person registered on the list of patients of the general practitioner with cancer detected at stage 1 or 2, provided that the respective stage of cancer is confirmed on the date of making the diagnosis. The Service shall disburse the aforementioned payment to the practice of the general practitioner once a year by 1 September after evaluating the information included in the register of patients suffering from specific diseases.

18. If the practice of the general practitioner has at least 20 women in the cervical cancer screening target group or breast cancer screening target group, it shall receive the payment for:

18.1. the achieved cervical cancer screening response rates:

18.1.1. EUR 10 for each screening examination performed if a response rate of at least 50 to 70 % has been achieved;

18.1.2. EUR 20 for each screening examination performed if a response rate of at least 71 % has been achieved;

18.2. the achieved breast cancer screening response rates:

18.2.1. EUR 10 for each screening examination performed if a response rate of at least 60 to 70 % has been achieved;

18.2.2. EUR 20 for each screening examination performed if a response rate of at least 71 % has been achieved.

19. The Service shall disburse the payments specified in Paragraph 18 of this Annex to the practice of the general practitioner twice a year for the response rates achieved in the previous six months (by 31 August for the period from 1 January to 30 June; by 31 March for the period from 1 July to 31 December), provided that not less than 30 % of the payment is allocated to the nurse or doctor's assistant (feldsher).

20. If the practice of the general practitioner has at least 20 persons in the intestinal cancer screening target group or prostate cancer screening target group, it shall receive the payment for:

20.1. the achieved intestinal cancer screening response rates:

20.1.1. EUR 10 for each screening examination performed if a response rate of at least 20 to 40 % has been achieved;

20.1.2. EUR 20 for each screening examination performed if a response rate of at least 41 % has been achieved;

20.2. the achieved prostate cancer screening response rates:

20.2.1. EUR 10 for each screening examination performed if a response rate of at least 60 to 70 % has been achieved;

20.2.2. EUR 20 for each screening examination performed if a response rate of at least 71 % has been achieved.

21. The Service shall disburse the payments specified in Paragraph 20 of this Annex to the practice of the general practitioner once a year by 30 September, provided that not less than 30 % of the payment is allocated to the nurse or doctor's assistant (feldsher).

22. The payment for operational support of a nurse and a doctor's assistant (feldsher) to a nurse or a doctor's assistant (feldsher) working at the workplace of the general practitioner and within the basic area of operation of the general practitioner shall be calculated according to the specified average monthly remuneration (Paragraph 153 of this Regulation):

22.1. for the health care of 1800 adult patients at the medical practice and in the basic area of operation of the general practitioner;

22.2. for the health care of 800 children at the medical practice and in the basic area of operation of the general practitioner;

22.3. if, when calculating the payment for ensuring the operations of a nurse and a doctor's assistant in accordance with the procedures laid down in Sub-paragraphs 22.1 and 22.2 of this Annex, it is less than the remuneration specified in this Regulation, it shall be increased to the amount specified in this Regulation.

23. The amount of payment for ensuring the operations of a nurse and a doctor's assistant (feldsher) at the practice of the general practitioner (A_m) shall be determined as follows:

23.1. the number of patients registered at the practice of the general practitioner (N) shall be divided by the number of adult patients specified in Sub-paragraph 22.1 of this Annex and multiplied by the average remuneration of medical practitioners, patient care persons, and assistants of functional specialists (D) specified in this Regulation, which shall be then added to the mandatory State social insurance contribution rate (S). This calculation yields the portion of payment for operational support of a nurse or a doctor's assistant (feldsher) for the care of adult patients (A_p):

A_p = N: 1800 x (D + S)

23.2. the number of children registered at the practice of the general practitioner (N_b) shall be divided by the number of children specified in Sub-paragraph 22.2 of this Annex and multiplied by the average remuneration of medical practitioners, patient care persons, and assistants of functional specialists (D) specified in this Regulation, which shall be then added to the mandatory State social insurance contribution rate (S). This calculation yields the portion of payment for operational support of a nurse or a doctor's assistant (feldsher) for the care of patients (A_b) up to 18 years of age:

A_b = N_b: 800 x (D + S)

23.3. the calculated portions of the payment for operational support of a nurse or a doctor's assistant (feldsher) at the practice of the general practitioner for the care of adults (A_p) and children (A_b) shall be added together to obtain the total amount of payment for operational support of a nurse or a doctor's assistant (feldsher) at the practice of the general practitioner (A_m):

A_m = A_p + A_b

24. If a doctor's assistant (feldsher) is employed at a feldsher station owned by the local government with which the Service has entered into a contract, they shall receive the average remuneration of medical practitioners, patient care persons, and assistants of functional specialists specified in this Regulation, plus the mandatory State social insurance contribution rate and taking into account the workload specified in the contract with the Service, which shall be determined according to the following conditions:

24.1. the number of visits to the feldsher station recorded in the management information system of the Service for the previous contract period;

24.2. the data submitted to the Centre for Disease Prevention and Control by feldsher stations that have not previously been engaged in contractual relations with the Service on the number of visits to the feldsher station in the previous year;

24.3. the remuneration specified in this Regulation shall be multiplied by the full-time workload corresponding to the number of visits:

24.3.1. if the average number of monthly visits to the feldsher station is up to 210 - 0.5 full-time workload;

24.3.2. if the average number of monthly visits to the feldsher station is 211-325 - 0.75 full-time workload;

24.3.3. if the average number of monthly visits to the feldsher station is 326-420 - 1 full-time workload;

24.3.4. if the average number of monthly visits to the feldsher station is 421-525 - 1.25 full-time workloads;

24.3.5. if the average number of monthly visits to the feldsher station is greater than 525 - 1.5 full-time workloads;

24.4. for newly opened feldsher stations, the amount of remuneration shall be determined at the level of half a full-time workload for six months, except for the cases where the feldsher station is established in an area where the general practitioner has terminated contractual relations with the Service and there is no other general practitioner taking over this area. In such case, the Service shall determine the remuneration for one full-time workload. Thereafter, the remuneration shall be calculated according to the number of visits to the feldsher station, based on the data from the management information system of the Service.

25. The Service shall double the payment for operational support of a nurse and a doctor's assistant (feldsher) intended for the practice of a general practitioner if the practice of a general practitioner has submitted to the Service the application for an increase in the payment and ensures the fulfilment of the following conditions:

25.1. if at least 1200 patients or 600 patients under 18 years of age are registered at the practice of the general practitioner at the time of submitting the application;

25.2. if there are at least two medical practitioners and patient care persons (a nurse or a doctor's assistant (feldsher)) at the practice of the general practitioner and each is provided with an equipped workplace;

25.3. if the independent patient reception time of the nurse or doctor's assistant (feldsher) is not less than 10 hours per week.

26. The doctor's assistant (feldsher) and nurse shall complete outpatient patient tickets for separately performed work.

27. If both a nurse and a doctor's assistant (feldsher), several nurses or several doctor's assistants (feldshers) work at the practice of the general practitioner, the general practitioner has the right, upon written agreement with these employees, to distribute the payment for operational support of a nurse and a doctor's assistant (feldsher) by determining different remuneration for each employee according to their qualification, length of service, and scope of duties.

28. The working hours of a nurse or a doctor's assistant (feldsher) may not fully or partially overlap with the working hours of the same nurse or doctor's assistant (feldsher) with another general practitioner. The general practitioner shall ensure that the working time of a nurse or a doctor's assistant (feldsher) for whom the general practitioner receives the payment for operational support is 40 hours per week.

29. The Service shall make the payment for the employment of an additional employee at the practice of the general practitioner which consists of the average monthly remuneration referred to in Sub-paragraph 153.3 of this Regulation and the mandatory State social insurance contributions if the practice of the general practitioner has submitted to the Service the application for the allocation of the payment and meets one of the following conditions:

29.1. such number of patients has been registered at the practice of the general practitioner at the moment of submission which, in accordance with Paragraph 25 of this Regulation, meets the conditions of a full practice;

29.2. the practice of the general practitioner receives the monthly fixed supplement in accordance with Paragraph 11 of this Annex at the time of submitting the application and at least 1500 patients are registered at the practice;

29.3. the number of patients registered at the practice of the general practitioner at the time of submitting the application is between 1500 and 1800 and one nurse or doctor's assistant (feldsher) is employed at the practice.

30. The practice of the general practitioner shall ensure that the additional employee referred to in Paragraph 29 of this Annex is registered in the register of medical practitioners and medical support persons as the receptionist of clients and patients of the medical treatment institution not later than within two months from the date of entering into the contract with the Service. This condition shall not apply to cases where a medical practitioner is employed as an additional employee.

31. In the event of the death of a general practitioner or if a court judgment or decision has entered into force prohibiting the general practitioner from providing primary health care services, the Service shall pay for the processing and transfer of medical documentation to the patient or doctor in accordance with the procedures laid down in the contract entered into by and between the Service and the medical treatment institution in the following amount:

31.1. the payment for operational support of the relevant nurse or doctor's assistant (feldsher) calculated in accordance with the procedures laid down in this Annex;

31.2. the payment for the maintenance of the premises of the practice of the general practitioner in accordance with Paragraph 8 of this Annex.

32. If the practice of a general practitioner terminates its contractual relations with the Service due to the retirement of the general practitioner, the Service shall pay compensation to the practice in the cases specified in this Regulation at double the amount of the payment for operational support of a nurse and a doctor's assistant (feldsher) calculated in accordance with the procedures laid down in this Annex, or at quadruple the amount if more than one nurse or doctor's assistant (feldsher) is employed at the practice.

33. If the practice of a general practitioner terminates its contractual relations with the only doctor's assistant or nurse employed at the practice, the Service shall pay compensation for operational support of the doctor's assistant or nurse at 50 % of the payment for operational support of a nurse and a doctor's assistant (feldsher) calculated in accordance with the procedures laid down in this Annex until the practice commences employment of a new doctor's assistant or nurse, but for not longer than three months per calendar year.

34. The total funding for a medical treatment institution for dental services (Li_zob) shall be planned as follows:

34.1. the amount of funding for 12 months intended for a medical treatment institution for dental services for children up to 18 years of age and in cases of congenital orofacial clefts for persons from 18 to 22 years of age (Li_b+š) shall be calculated for each procedure separately, multiplying the number of dental procedures performed in the previous period (S₁, S₂ etc.) by the planned tariff thereof (TC₁, TC₂ etc.) and summing the multiplication result:

Li_b+š = S₁ x TC₁ + S₂ x TC₂ + … + S_n x TC_n

34.2. the amount of funding for the payment for dental services to the participants in the liquidation of the consequences of the accident at the Chernobyl Atomic Power Plant and the persons who suffered due to the accident at the Chernobyl Atomic Power Plant (hereinafter - the participants) (Lč_zob) shall be planned as follows:

34.2.1. the amount of funding shall be calculated for the payment for dental services provided to the participants related to dental assistance (Lčz_zob) for each procedure separately by multiplying the number of dental procedures performed for the participants in the previous period (Sz₁, Sz₂ etc.) by the planned tariff thereof (TCz₁, TCz₂ etc.) and summing the multiplication result. 50 % of the obtained total planned financial resources for 12 months shall be calculated as follows:

Lčz_zob = (Sz₁ x TCz₁ + Sz₂ x TCz₂ + … + Sz_n x TCz_n) x 50 %

34.2.2. the amount of funding for the payment for dental services provided to the participants related to dental prosthetics with removable plastic prostheses (Lčp_zob) shall be calculated separately for each procedure by multiplying the number of dental procedures performed for the participants in the previous period (Sp₁, Sp₂ etc.) by the planned tariff thereof (TCp₁, TCp₂ etc.) and summing the multiplication result. The planned amount of financial resources for 12 months shall be obtained as follows:

Lčp_zob = Sp₁ x TCp₁ + Sp₂ x TCp₂ + … + Sp_n x TCp_n

34.2.3. the total amount of funding for a medical treatment institution for the payment for dental services (Li_zob) shall be obtained by summing the calculated amount of funds for dental care for children and dental services in cases of clefts (Li_b+š) with the amount of funds for dental services for the participants (Lčz_zob and Lčp_zob):

Li_zob = Li_b+š + Lčz_zob + Lčp_zob

35. The total amount of funding for dental services (Lk_zob) shall be obtained as follows:

35.1. the total amount of funding for dental care in each territorial department (Lt_zob) shall be obtained, i.e. the funds calculated for each medical treatment institution in this territorial department (Li_zob1, Li_zob2 etc.) shall be summed up:

Lt_zob = Li_zob1 + Li_zob2 + … + Li_zobn

35.2. the funds calculated for dental care for all territorial departments (Lt_zob1 to Lt_zob5) shall be summed up:

Lk_zob = Lt_zob1 + … + Lt_zob5

36. The total amount of funding for the payment for dental services may be reviewed, taking into account the financial resources available for the payments for health care services in the State budget of the current year.

37. The necessary amount of funding for service providers with whom the contract for the payment for health care services was not entered into during the previous period shall be planned taking into account the information submitted by the service provider and the contractual amount at institutions with a similar profile.

38. The number of doctors on duty and the necessary funding shall be planned according to the number of inhabitants of the town, ensuring not more than one full-time workload of the doctor on duty per 40 000 inhabitants.

39. In order to ensure the following for health care at home:

39.1. mechanical ventilation of lungs and parenteral feeding of children, and also payment for home visits by doctors of rehabilitation and physical medicine, the Service shall plan financial resources for medical treatment institutions according to the volume of services actually provided in the previous calendar year, using data from the first nine months of the current year;

39.2. other health care services, the Service shall plan financial resources for medical treatment institutions according to the number of inhabitants in the relevant municipality in conformity with the following conditions:

39.2.1. financial resources for the administration of medicinal products, care of skin injuries, urinary catheter replacement and care, artificial opening (stoma) care, including education and training of relatives, and also enteral feeding through a tube shall be planned at EUR 4.44 per person;

39.2.2. financial resources for rehabilitation services shall be planned at EUR 0.68 per person;

39.2.3. if health care at home in the relevant territory is provided by one medical treatment institution, funds shall be allocated to that specific medical treatment institution in full amount;

39.2.4. if health care at home in the relevant territory is provided by several medical treatment institutions, funds shall be proportionally divided between these institutions according to the proportion of health care services provided to inhabitants of the relevant territory, using data from the first nine months of the current year.

40. In the contract with a medical treatment institution which provides health care at home, the Service shall indicate the amount of the planned financial resources for the medical treatment institution in the relevant territory calculated according to the procedures laid down in Sub-paragraph 39.2 of this Annex and also the total amount of the planned financial resources for the medical treatment institution.

41. If providers of the services of dental care and health care at home fail to fulfil the contracted volume of health care services, the Service shall carry out the financial revision of the contractual amount in conformity with the following conditions:

41.1. the planned amount of funding for the second half of the year shall be determined according to the actual financial performance in the first half of the year if in the first half of the current year the financial performance of the contract for outpatient health care services is less than 80 % of the planned amount of funding for the first half of the year;

41.2. the total contractual amount shall be reduced according to the volume of health care services actually provided over nine months if the contractual performance for outpatient health care services during nine months of the current year is less than 90 % of the planned amount of funding for the nine-month period.

42. The financial resources obtained by reviewing the planned contractual amount for medical treatment institutions providing health care at home in accordance with the procedures laid down in Paragraph 41 of this Annex shall be primarily allocated to the medical treatment institutions that in at least 75 % of cases have provided health care at home to persons whose place of residence is declared in the territories specified in the contract of the medical treatment institution, except for the cases where the population in the relevant territory is less than 700. If the medical treatment institutions of the relevant administrative territory in at least 75 % of cases do not provide health care at home to persons whose place of residence is declared in the specific administrative territory, the Service shall contract a new service provider from the waiting list, provided that financial resources are available.

 

Annex 12
Cabinet Regulation No. 555
28 August 2018

[4 April 2023]

Planning Territories for Secondary Outpatient Health Care Services and Minimum Level of Provision by Service Type

1. Planning territories for secondary outpatient services:

No.	Planning territory for health care services	Planning unit for health care services	Administrative territories included in the planning unit for health care services
1.1.	Riga	Riga Health Care Service Planning Unit	Mārupe municipality
			Riga
		Ādaži Health Care Service Planning Unit	Ādaži municipality
			Ropaži municipality
			Saulkrasti municipality
		Jūrmala Health Care Service Planning Unit	Jūrmala
		Ķekava Health Care Service Planning Unit	Ķekava municipality
		Olaine Health Care Service Planning Unit	Olaine municipality
		Salaspils Health Care Service Planning Unit	Salaspils municipality
		Sigulda Health Care Service Planning Unit	Sigulda municipality
1.2.	Kurzeme	Kuldīga Health Care Service Planning Unit	Kuldīga municipality
		Liepāja Health Care Service Planning Unit	Liepāja
			Dienvidkurzeme municipality
		Saldus Health Care Service Planning Unit	Saldus municipality
		Talsi Health Care Service Planning Unit	Talsi municipality
		Tukums Health Care Service Planning Unit	Tukums municipality
		Ventspils Health Care Service Planning Unit	Ventspils
			Ventspils municipality
1.3.	Latgale	Daugavpils Health Care Service Planning Unit	Daugavpils
			Augšdaugava municipality
		Krāslava Health Care Service Planning Unit	Krāslava municipality
		Ludza Health Care Service Planning Unit	Ludza municipality
		Preiļi Health Care Service Planning Unit	Līvāni municipality
			Preiļi municipality
		Rēzekne Health Care Service Planning Unit	Rēzekne
			Rēzekne municipality
1.4.	Vidzeme	Alūksne Health Care Service Planning Unit	Alūksne municipality
		Balvi Health Care Service Planning Unit	Balvi municipality
		Cēsis Health Care Service Planning Unit	Cēsis municipality
		Gulbene Health Care Service Planning Unit	Gulbene municipality
		Limbaži Health Care Service Planning Unit	Limbaži municipality
		Madona Health Care Service Planning Unit	Madona municipality
			Varakļāni municipality
		Valka Health Care Service Planning Unit	Smiltene municipality
			Valka municipality
		Valmiera Health Care Service Planning Unit	Valmiera municipality
1.5.	Zemgale	Aizkraukle Health Care Service Planning Unit	Aizkraukle municipality
		Bauska Health Care Service Planning Unit	Bauska municipality
		Dobele Health Care Service Planning Unit	Dobele municipality
		Jelgava Health Care Service Planning Unit	Jelgava
			Jelgava municipality
		Jēkabpils Health Care Service Planning Unit	Jēkabpils municipality
		Ogre Health Care Service Planning Unit	Ogre municipality

2. Types of secondary outpatient services¹:

No.	Type of the health care service	Speciality codes and diagnosis codes according to ICD-10
2.1.	Service type group - specialists:
2.1.1.	allergology	A1510; PP01
2.1.2.	algology	PP16
2.1.3.	anaesthesiology	P18
2.1.4.	occupational disease specialists	P53
2.1.5.	dermato-venereology	P27; M62
2.1.6.	endocrinology	A156; P58
2.1.7.	gastro-enterology	A158; PP02; P60
2.1.8.	gynaecology	P14
2.1.9.	haematology	P17; A159
2.1.10.	infectology	P24; A152
2.1.11.	internal medicine	P01; P02
2.1.12.	cardiology	A153; P52; M37; M351; M352
2.1.13.	surgery	P03; P04; P05; P06; P07; P09; P12; P26; PP31
2.1.14.	narcology	P28
2.1.15.	nephrology	A157; P59
2.1.16.	neurology	P20; PP21; P62
2.1.17.	ophthalmology	P22
2.1.18.	oncology (chemotherapy)	P16; A142
2.1.19.	otolaryngology	P23; A231; A232
2.1.20.	paediatrics	P15; A151
2.1.21.	psychiatry	P19; P64; A191
2.1.22.	pulmonology	A155; P57
2.1.23.	rheumatology	A154; P56
2.1.24.	traumatology, orthopaedics	P13; A131
2.1.25.	urology	P08
2.1.26.	other specialities	PP03; PP06; PP18; PP19; PP24; PP26; P39
2.1.27.	oxygen therapy	P52; P57
2.2.	Service type group - examinations:
2.2.1.	computer tomography
2.2.2.	Doppler ultrasound
2.2.3.	endoscopy
2.2.4.	nuclear magnetic resonance imaging examinations
2.2.5.	mammography
2.2.6.	neuroelectrophysiological functional examinations
2.2.7.	osteodensitometry
2.2.8.	positron emission tomography with computer tomography (PET/CT)
2.2.9.	radionuclide diagnostics
2.2.10.	radiology
2.2.11.	cardiovascular system functional examinations:
2.2.11.1.	electrocardiography
2.2.11.2.	other cardiovascular system functional examinations
2.2.12.	ultrasonography
2.2.13.	elastography
2.3.	Service type group - rehabilitation:
2.3.1.	adult rehabilitation
2.3.2.	paediatric rehabilitation
2.3.3.	rehabilitation of conditions originating in the perinatal period
2.4.	Service type group - specialised services:
2.4.1.	outpatient audiology services
2.4.2.	consultation of patients with genetic disorders
2.4.3.	HIV compliance room
2.4.4.	consultations related to kidney transplantation	N18.4; N18.5; Z94.0; Z94.00; Z52.4
2.4.5.	medically assisted insemination
2.4.6.	methadone maintenance treatment
2.4.7.	consultation and examination of multiple sclerosis patients	A81; A69.2; B22.0; B94.1; F07.9; G05.0; G05.8; G09; G11.0-G11.3; G32.0; G32.8; G35; G36.0; G36.1; G36.8; G36.9; G37; G81; G82.1; G82.2; G82.4; G82.5; G83.0-G83.3; G83.8; G83.9; G92; G95; G96.8; G96.9; G99.2; G99.8; I67.3; I69.8; M47.0; M47.1; M50.0; M51.0; T91.3; Z03.3
2.4.8.	radiotherapy
2.4.9.	forensic psychiatric and psychological assessment
2.5.	Service group - day hospital services	In accordance with the types of day hospitals and the manipulations associated with them as specified in this Regulation

Note. ¹ The manipulation codes associated with the type of service are included in the contract with the medical treatment institution.

3. Health care services to be provided in the planning unit:

No.	Health care service planning unit - territory	Specialists, types of health care services	Types of examinations	Rehabilitation	Types of day hospitals	Additional conditions
3.1.	With a population of up to 30 000	Gynaecology, surgery, neurology, ophthalmology, otolaryngology, psychiatry	Electrocardiography, radiology, ultrasonography		Gynaecology; general surgical services	Day hospital services shall not be evaluated if the planning unit borders the city of Riga
3.2.	With a population ranging from 30 001 to 50 000	Anaesthesiology, dermato-venereology, endocrinology, gynaecology, cardiology, surgery, neurology, ophthalmology, otolaryngology, psychiatry, pulmonology, traumatology, and orthopaedics	Computer tomography, Doppler ultrasound, electrocardiography and other functional examinations of the cardiovascular system, radiology, ultrasonography	Rehabilitation services	Gynaecology; treatment of neurological and internal diseases; traumatology and orthopaedics; general surgical services	Computer tomography services shall not be evaluated if the planning unit borders the city of Riga
3.3.	With a population ranging from 50 001 to 75 000	Anaesthesiology, dermato-venereology, consulting room of diabetic foot care, endocrinology, gynaecology, chronic obstructive pulmonary disease consulting room, cardiology, surgery, narcology, neurology, ophthalmology, otolaryngology, psychiatry, pulmonology, traumatology and orthopaedics, urology	Computer tomography, Doppler ultrasound, electrocardiography and other functional examinations of the cardiovascular system, endoscopy, radiology, ultrasonography	Rehabilitation services	Gastrointestinal endoscopies; gynaecology; treatment of neurological and internal diseases; otolaryngology for children and adults; rehabilitation; traumatology, orthopaedics, hand and reconstructive microsurgery, plastic surgery; urology; general surgical services
3.4.	With a population of 75 001 and above	Anaesthesiology, occupational disease specialists, paediatric specialists, dermato-venereology, consulting room of diabetic foot care, endocrinology, gynaecology, haematology, consulting room of chronic obstructive pulmonary diseases, internists, cardiology, surgery, narcology, neurology, ophthalmology, oncology, otolaryngology, palliative care consulting room, psychiatry, pulmonology, rheumatology, stoma consulting room, traumatology and orthopaedics, urology	Computer tomography, Doppler ultrasound, elastography, electrocardiography and other functional examinations of the cardiovascular system, endoscopy, neuroelectrophysiological functional examinations, radiology, ultrasonography	Rehabilitation services	Gastrointestinal endoscopies; gynaecology; treatment of addiction patients in a narcology profile day hospital; treatment of neurological and internal diseases; ophthalmology; otolaryngology for children and adults; treatment of psychiatric patients in a psychiatric profile day hospital; rehabilitation; traumatology, orthopaedics, hand and reconstructive microsurgery, plastic surgery; urology; general surgical services
3.5.	Rīga, Kurzeme, Latgale, Vidzeme, and Zemgale (in accordance with Paragraph 1 of this Annex)	Allergology, algology, anaesthesiology, occupational disease specialists, paediatric specialists, dermato-venereology, consulting room of diabetic foot care, endocrinology, gynaecology, haematology, chronic obstructive pulmonary disease consulting room, infectology, internists, cardiology, surgery, narcology, nephrology, neurology, ophthalmology, oncology, otolaryngology, palliative care consulting room, paediatrics, psychiatry, pulmonology, rheumatology, stoma consulting room, forensic psychiatric and psychological examinations, traumatology and orthopaedics, urology	Computer tomography, Doppler ultrasound, elastography, electrocardiography and other functional examinations of the cardiovascular system, endoscopy, nuclear magnetic resonance imaging, neuroelectrophysiological functional examinations, mammography, osteodensitometry, radiology, ultrasonography	Rehabilitation services	Gastrointestinal endoscopies; gynaecology; treatment of addiction patients in a narcology profile day hospital; treatment of neurological and internal diseases; renal replacement therapy; ophthalmology; otolaryngology for children and adults; treatment of psychiatric patients in a psychiatric profile day hospital; rehabilitation; traumatology, orthopaedics, hand and reconstructive microsurgery, plastic surgery; general surgical services; urology
3.6.	Entire country	Allergology, algology, outpatient audiology services, outpatient consultation related to kidney transplantation, anaesthetics, occupational disease specialists, paediatric specialists, dermato-venereology, training room of diabetes mellitus patients, consulting room of diabetic foot care, endocrinology, gastro-enterology, gynaecology, consultation of patients with genetic disorders, haematology, HIV compliance room, chronic obstructive pulmonary disease consulting room, infectology, internists, cardiology, surgery, medically assisted insemination, consultation and examination of multiple sclerosis patients, narcology, nephrology, neurology, ophthalmology, oncology, otorhinolaryngology, palliative care consulting room, paediatrics, psychiatry, pulmonology, rheumatology, consulting room of rare diseases, stoma care consulting room, forensic psychiatric and psychological examinations, traumatology and orthopaedics, urology, oxygen therapy and the other specialities	Computer tomography, Doppler ultrasound, elastography, endoscopy, laboratory and histological examinations, nuclear magnetic resonance imaging, mammography, neuroelectrophysiological functional examinations, osteodensitometry, positron emission tomography with computer tomography, radionuclide diagnostics, radiology, functional examinations of the cardiovascular system, radiotherapy, ultrasonography	Rehabilitation services	Paediatric surgery; gastrointestinal endoscopies; gynaecology; treatment of patients with chronic pain; invasive cardiology; chemotherapy; interventional radiology; treatment of addiction patients in a narcology profile day hospital; treatment of neurological and internal diseases; renal replacement therapy; ophthalmology; otolaryngology for children and adults; treatment of psychiatric patients in a psychiatric profile day hospital; rehabilitation; robotised stereotactic radiosurgery, radiotherapy; traumatology, orthopaedics, hand and reconstructive microsurgery, plastic surgery; urology; general surgical services

 

Annex 13
Cabinet Regulation No. 555
28 August 2018

[10 December 2019; 9 June 2020; 14 July 2020; 17 December 2020 / Amendment to Paragraph 1 and Note 2 shall come into force on 1 January 2021. See Paragraph 3 of Amendments]

Amount of Patient Co-payment

Health care service			Patient co-payment (price), EUR1
1. For an outpatient visit to a practice of a general practitioner2	1.1. for a person under 65 years of age		2.00
	1.2. for a person aged 65 years and over		1.00
2. For an outpatient visit to a secondary outpatient health care physician2			4.00
3. For a home visit by a general practitioner			2.85
4. For treatment in a day hospital4.5	4.1. per day for receiving renal replacement therapy, chemotherapy, haematology, radiotherapy, rehabilitation services, and treatment of neurological, internal diseases, addiction or psychiatric disorders and chronic pain in a day hospital		7.00
	4.2. a one-time co-payment for receiving invasive cardiology, interventional radiology, and surgical services in a day hospital		7.00
5. For inpatient treatment in a day and night hospital, starting from the second day	5.1. for treatment in inpatient medical treatment institutions		10.00
	5.2. for treatment in care departments or beds, including those for chronic patient care		7.00
	5.3. for the treatment of oncological or oncohaematological diseases (diagnosis codes according to the ICD-10: C00-C97, D00-D09, D37-D48, and D61) and for the treatment of alcohol, narcotic, psychotropic, and toxic substance addiction (diagnosis codes according to the ICD-10: F10-F19)		7.00
	5.4. for treatment in rehabilitation profile beds as specified in Sub-paragraph 2.20 of Annex 6 to this Regulation		5.00
6. For diagnostic examinations performed on an inpatient basis	6.1. computer tomography examinations:	6.1.1. examination without tracer substance	14.00
		6.1.2. examination with tracer substance3, including:	21.00
		6.1.2.1. for the examination	14.00
		6.1.2.2. for the intravenous tracer substance	7.00
	6.2. nuclear magnetic resonance imaging examinations:	6.1.2. examination without tracer substance	28.00
		6.2.2. examination with tracer substance3, including:	35.00
		6.2.2.1. for the examination	28.00
		6.2.2.2. for the intravenous tracer substance	7.00
7. For diagnostic examinations performed on an outpatient basis	7.1. electrocardiographic examinations		2.00
	7.2. non-invasive functional cardiac examinations		4.00
	7.3. functional examinations of the main blood vessels of the head and extremities		4.00
	7.4. neuroelectrophysiological examinations		4.00
	7.5. functional examinations of the gastrointestinal tract		4.00
	7.6. radionuclide diagnostics		4.00
	7.7. ultrasound examinations		4.00
	7.8. endoscopic examinations		7.00
	7.9. radiological examinations:	7.9.1. examination without tracer substance (including radiological examinations with gastrointestinal tract tracer substance)	3.00
		7.9.2. examination with tracer substance3, including:	10.00
		7.9.2.1. for the examination	3.00
		7.9.2.2. for the intravenous tracer substance	7.00
	7.10. computer tomography examinations:	7.10.1. examination without tracer substance	14.00
		7.10.2. examination with tracer substance3, including:	21.00
		7.10.2.1. for the examination	14.00
		7.10.2.2. for the intravenous tracer substance	7.00
	7.11. nuclear magnetic resonance imaging examinations:	7.11.1. examination without tracer substance	28.00
		7.11.2. examination with tracer substance,3 including:	35.00
		7.11.2.1. for the examination	28.00
		7.11.2.2. for the intravenous tracer substance	7.00
8. For each surgery performed on an outpatient basis or in a day hospital			4.00
9. For medically assisted insemination procedures	9.1. ovarian puncture for oocyte aspiration		21.00
	9.2. embryo transfer		21.00
	9.3. testicular biopsy		21.00

Notes. 1 Value added tax shall not be applied in accordance with Section 52, Paragraph one, Clauses 3 and 4 of the Value Added Tax Law. 2 A consultation provided remotely (for example, by telephone, in video format), a laboratory examination, a functional examination, and a therapeutic procedure shall not be considered as an outpatient visit. The co-payment for visiting the practice of a general practitioner shall be collected once per day. 3 When performing an examination without a tracer substance followed by an examination with a tracer substance, the patient co-payment shall be collected only for the examination with the tracer substance. 4 When receiving dental services under general anaesthesia in a day hospital, the patient co-payment shall be covered from State budget funds and shall be included in the service tariff. 5 When receiving medically assisted insemination services in a day hospital, the patient co-payment shall be applied in accordance with the provisions of Paragraph 9 of this Annex.

 

Annex 14
Cabinet Regulation No. 555
28 August 2018

[14 July 2022]

Planning of the Payment Amount

1. The Service shall determine the payment amount for secondary outpatient health care service providers by applying the following planning indicators:

1.1. the number of actually performed examinations, care episodes, or day hospital bed days by types of health care services over a 12-month period (from 1 September to 31 August) in conformity with the following conditions:

1.1.1. the number of performed care episodes, examinations, or day hospital bed days which does not exceed the number of care episodes, examinations, or day hospital bed days planned in the contract of the previous year as of 1 July, except for the following cases where the following is taken into account:

1.1.1.1. the number of care episodes and examinations for children and pregnant women;

1.1.1.2. the number of care episodes, examinations, or day hospital bed days for patients who have received renal replacement therapy, chemotherapy, radiotherapy services or methadone maintenance treatment, consultations related to kidney or liver transplantation, oncology, haematology, and mammography services;

1.1.1.3. the number of care episodes provided by an audio speech therapist (speech therapist) for patients with cleft lip and cleft palate at sabiedrība ar ierobežotu atbildību "Rīgas Stradiņa universitātes Stomatoloģijas institūts" [limited liability company Riga Stradiņš University Institute of Stomatology];

1.1.2. for a health care service provider that has not provided the relevant health care services in the previous period, if according to the contract with the Service they were required to be provided, the amount of funding for the next period shall be determined in the contract without including the relevant health care services;

1.1.3. for a health care service provider that has not provided certain health care services in the previous period but has acquired the right to provide them in the future, the planned number of care episodes, examinations, or days spent by patients in a day hospital shall be determined in the contract according to the proportion of the population in the planning unit and the number of examinations performed in the previous calendar year relative to the average number of examinations performed nationwide;

1.1.4. for a health care service provider that has provided a health care service for an incomplete period in one of the types of services during the previous period, the planned number of care episodes or examinations shall be determined in the contract in proportion to the volume of services provided during the period if it is not less than three calendar months. If the service provision period is shorter, the volume of services shall be determined according to the procedures by which it is planned for the service providers specified in Sub-paragraph 1.1.3 of Annex 14 to this Regulation who have not provided such health care services in the previous period;

1.2. human resources available for the provision of health care services in the medical treatment institution;

1.3. the results of the performed procedures for selecting secondary outpatient health care service providers and the secondary outpatient health care services for the provision of which the Service has agreed in accordance with the procedures laid down in this Regulation with a secondary outpatient health care service provider outside of the procedure for selecting service providers;

1.4. territorial accessibility of health care services;

1.5. the planned tariff for the secondary outpatient health care service;

1.6. the average costs planned from the State budget by types of health care services for a specific medical treatment institution;

1.7. the amount of funding specified in the law on the State budget for the current year for the payment for health care services, including taking into account the amount of funding for final settlements for health care services provided in December of the previous calendar year and the planned amount of funding for the advance payment for health care services to be provided in the current year;

1.8. the objectives for granting additional funding, if there is an increase in funding.

2. The Service shall calculate the payment amount for secondary outpatient health care service providers, taking into account the indicators used in planning, in accordance with the following procedures:

2.1. the average treatment cost planned from the State budget for one examination or care episode by types of health care services in a specific medical treatment institution shall be calculated according to the data from the management information system of the Service for a 12-month period (from 1 September to 31 August);

2.2. the estimated average costs for the compensation of patient co-payments for persons who are exempt from patient co-payments for one examination or care episode across health care service types for each medical treatment institution shall be calculated according to the data from the management information system of the Service for a 12-month period (from 1 September to 31 August);

2.3. the average treatment costs of one examination or care episode planned from the State budget shall be multiplied by the planned number of examinations or episodes;

2.4. when determining the contractual amount, funding for level IV or V inpatient medical treatment institutions shall be given priority;

2.5. if the total health care funding is reduced, the planned volume across all health care service types shall be reduced, except for funding intended for the treatment of children and pregnant women, and also persons who have received oncology, haematology, and kidney replacement therapy services, consultations related to kidney or liver transplantation, chemotherapy, radiotherapy services, or methadone maintenance treatment;

2.6. when determining the contractual amount for medical treatment institutions that provide mental health care services, funding for mental health care services to the medical treatment institutions which provide multiprofessional mental health care services both on an outpatient basis and in day hospitals shall be given priority.

3. The Service shall determine the payment amount for inpatient health care service providers by applying the following planning indicators:

3.1. the number of persons actually treated within the scope of health care service programmes during a 12-month period (from 1 September to 31 August), taking into account the following conditions:

3.1.1. for DRG service programmes, the Service shall determine the planned number of patients for the medical treatment institution by assessing the fulfilment of quality indicators specified in the contract with the medical treatment institution and their impact conditions in relation to the number of patients planned in the previous year, but not exceeding 10 % of the number of patients planned in the previous year;

3.1.2. for marked service programmes, the Service shall determine the planned number of patients for the medical treatment institution by comparing the number of patients actually treated with the number of patients planned in the contract for the medical treatment institution in the previous year in conformity with the following conditions:

3.1.2.1. the total number of patients actually treated shall be considered when planning childbirth, tuberculosis treatment, stroke unit, frostbite and burn treatment, chemotherapy, stem cell transplantation, palliative care services, and also major joint endoprosthesis services (if the medical treatment institution has the necessary resources to fulfil the planned volume), but it shall not be determined lower than the number of patients planned in the contract for the medical treatment institution in the previous year;

3.1.2.2. when planning kidney transplantation services, the number of patients shall be determined according to the publicly available current data from the Register of Natural Persons to ensure transplantation surgeries for not less than 28 patients per 1 000 000 inhabitants;

3.1.2.3. if the number of patients actually treated exceeds the number planned in the contract in the previous year, then it shall be determined at the level of the previous year for marked service programmes not referred to in Sub-paragraph 3.1.2.1 or 3.1.2.2 of this Annex;

3.1.2.4. if the number of patients actually treated is less than planned in the contract in the previous year, then it shall be determined according to the number of patients actually treated for marked service programmes not referred to in Sub-paragraph 3.1.2.1 or 3.1.2.2 of this Annex;

3.1.3. if the medical treatment institution has not provided health care services within the scope of any of the service programmes for the full previous period, the number of patients shall be determined in proportion to the number of patients treated during the period in which services were provided, including if the service was planned in the contract but not provided due to justified reasons and the medical treatment institution has notified the Service thereof in writing;

3.2. the treatment tariffs per patient for marked service programmes as specified in this Regulation;

3.3. indicators which are used for calculating DRG service payments in accordance with the procedures laid down in this Regulation:

3.3.1. the average base tariff for the costs of one patient hospitalisation case for the medical treatment institutions which provide DRG services (calculated annually according to the date from the management information system - the sum obtained by multiplying the number of bed days by the tariff for bed days specified for level III medical treatment institutions in Paragraph 1 of Annex 6 to this Regulation, plus the sum of tariffs for manipulations performed as marked with an asterisk (*) in the list of manipulations and dividing the total sum by the total number of hospitalisation cases. For level V medical treatment institutions, except for specialised medical treatment institutions, a base coefficient shall be additionally applied according to available funding, approximating the value of the tariff for bed days used in the base tariff calculation to the tariff for bed days specified for level V medical treatment institutions in Paragraph 1 of Annex 6 to this Regulation);

3.3.2. the DRG service group coefficient (calculated by dividing the average hospitalisation case costs of one patient for each DRG service group by the base tariff calculated in accordance with the procedures referred to in Sub-paragraph 3.3.1 of this Annex);

3.3.3. the index of the work done by the medical treatment institution (the sum obtained by multiplying the actual number of patients in each DRG service group by the DRG service group coefficient and adding up the results, divided by the total actual number of patients);

3.4. the amount of funding for the payment for health care services in accordance with the law on the State budget for the current year, including taking into account the amount of funds for final settlements for health care services provided in December of the previous calendar year and the planned amount of funds for the advance payment for health care services to be provided in the current year;

3.5. the objectives for granting additional funding, if there is an increase in funding.

4. The Service shall calculate the payment amount for inpatient health care service providers, taking into account the indicators used in planning, in accordance with the following procedures:

4.1. the fixed payment for DRG services per year shall be obtained by multiplying the base tariff calculated in accordance with this Regulation by the index of the work done by each medical treatment institution and the number of patients;

4.2. the monthly fixed payment amount for DRG services shall be determined as 1/12 of the fixed payment calculated for the year;

4.3. the amount of funding for marked services per year shall be obtained by multiplying the number of patients for each marked service programme by the treatment tariff for one patient as stipulated in Annex 6 to this Regulation and adding up the obtained results for each medical treatment institution;

4.4. the amount of the monthly fixed payment referred to in Sub-paragraph 201.5 of this Regulation for State limited liability company Children's Clinical University Hospital shall be determined as 1/12 of the sum obtained by adding up the following:

4.4.1. the fixed payment for DRG services per year which is obtained by multiplying the base tariff calculated in accordance with this Regulation by the index of the work done by the medical treatment institution and the number of patients;

4.4.2. the funding calculated by summing the results obtained by multiplying the relevant treatment tariff for one patient by the anticipated number of patients in each of the health care service programmes specified in the contract with the Service;

4.5. the amount of the monthly fixed supplement for the operations of the reception ward of an inpatient medical treatment institution is specified in Paragraph 1 of Annex 6 to this Regulation;

4.6. the funding necessary for the payment for inpatient health care services reimbursed by the Service in accordance with this Regulation according to the invoices submitted by the medical treatment institution and also the funding for the payment of manipulations reimbursed by the Service according to the actual number of manipulations performed shall be planned by the Service according to the amount paid in the previous year;

4.7. the funding necessary for the payment of services provided to persons who have been ill for a protracted period of time, persons with a predictable disability, and persons receiving continuous mechanical ventilation of lungs shall be planned by the Service according to the amount paid in the previous year and the planned State budget funding for the current year;

4.8. the compensation of patient co-payments for persons who are exempt from patient co-payments shall be planned according to the amount of funds compensated in the previous year, allocated proportionally to the total number of patients;

4.9. if the total amount of funding for health care has been reduced, the planned volume shall be reduced across all types of health care services, except for funding intended for the treatment of children and pregnant women, and also oncology, tuberculosis, and psychiatric patients.

5. If a secondary outpatient health care service provider fails to fulfil the contracted volume of health care services, the Service shall carry out the financial revision of the contractual amount in conformity with the following conditions:

5.1. the planned amount of funding for the second half of the year shall be determined according to the actual financial performance in the first half of the year if in the first half of the current year the contractual performance for outpatient health care services is less than 80 % of the planned amount of funding for the first half of the year;

5.2. the total contractual amount shall be reduced according to the actual volume of health care services provided over nine months if the contractual performance for outpatient health care services during nine months of the current year is less than 90 % of the planned amount of funding for the nine-month period;

5.3. the financial resources obtained as a result of financial revision for outpatient health care shall be allocated by the Service to the payment for health care services in the following priority order:

5.3.1. for the payment of patient co-payments reimbursed by the State if the amount of actually reimbursed patient co-payments exceeds the planned amount in the reporting period;

5.3.2. for the payment of preventive examination programmes if the volume of services actually provided exceeds the planned amount in the reporting period;

5.3.3. for ensuring the territorial accessibility of health care services;

5.3.4. for those types of outpatient health care services where the planned funding excess includes the volume of reimbursed health care services intended for a larger number of patients or where there are longer waiting lists for service recipients;

5.3.5. if it is established in the calculations that the amount of funding for the medical treatment institution needs to be increased or reduced by an amount not exceeding EUR 300 in the relevant type of services, the Service shall not change the amount of funding previously determined for the medical treatment institution.

6. If an outpatient health care service provider fails to ensure the provision of services in the amount of at least 50 % of the contracted volume for the relevant period during the first year after entering into the contract (or after supplementation of the contract establishing the obligation to provide a new type of health care service or to provide it in a larger volume), the amount of funding of the contract in the relevant type of health care services shall be reduced by the unfulfilled volume. In such case, the financial resources obtained shall be allocated for the provision of these health care services to another service provider in this planning unit or, if there is none, to another service provider in the geographically closest planning unit.

7. If the inpatient health care service provider fails to fulfil the contracted volume of health care services, the Service shall carry out the financial revision of the contractual amount in conformity with the following conditions:

7.1. the fixed payment for DRG services or funding for the marked services for the second half of the year shall be reduced by determining it according to the actual volume of health care services provided during six months, if in the first half of the year the number of patients actually treated in the relevant type of services (DRG services or marked services) is less than 80 % of the number planned in the contract for the relevant period;

7.2. the fixed payment for DRG services or funding for the marked services for the last three months of the year shall be reduced by determining it according to the actual volume of health care services provided during nine months, if in the nine months the number of patients actually treated in the relevant type of services (DRG services or marked services) is less than 90 % of the number planned in the contract for the relevant period;

7.3. the monthly fixed payment referred to in Sub-paragraph 201.5 of this Regulation shall not be reduced for the State limited liability company Children's Clinical University Hospital if the medical treatment institution achieves the indicators specified in the contract;

7.4. the financial resources obtained as a result of financial revision shall be allocated to the geographically closest inpatient medical treatment institution, taking into account the following conditions:

7.4.1. the funding intended for the payment of DRG services shall be allocated to the medical treatment institution for which the number of patients actually treated in the DRG service programmes in six or nine months exceeds the number of patients planned in the contract for the relevant period;

7.4.2. the funding intended for the payment of marked services shall be allocated to those programmes of inpatient health care services of the medical treatment institution in which the funding is being reduced, taking into account whether the medical treatment institution has the necessary resources for the fulfilment of the planned increase in the contractual amount;

7.4.3. if the medical treatment institutions do not have resources in the relevant types of services for the fulfilment of the planned increase in the contractual amount, then the Service is entitled to allocate the financial resources obtained as a result of financial revision for the payment of such inpatient health care services (including DRG services) which are provided as a matter of urgency in excess of the contractual amount.

8. If the health care service provider exceeds the planned annual amount of funding, the Service shall not pay for the health care services provided in excess of the planned annual amount of funding, except for secondary outpatient health care services, which shall be paid for within the total amount of funding provided for in the contract, but with the condition that the Service does not divert the financial resources intended for the payment of the services provided by specialists planned in the contract in order to pay for the examinations provided in excess of the annual amount planned in the contract for the relevant type of services.

9. The Service, on the basis of a written application by the medical treatment institution, which has been submitted by 1 November of the relevant year, but for the reallocation of resources intended for the payment of inpatient health care services to the payment of outpatient care services - by 1 August, may make the following changes, except for the case where financial resources have been allocated for a specific purpose:

9.1. allocate the financial resources intended for the payment for the marked services in one of the service programmes in an amount not exceeding 5 % to another programme of inpatient health care services, taking into account the division of services - health care services to be provided as emergency assistance or as a planned service;

9.2. allocate not more than 15 % of the financial resources planned for the payment for outpatient health care services in one type of service to another type of outpatient health care service, except for the case where they are allocated in an amount not exceeding 25 % from consultations by one specialist to consultations by another specialist and from services of one day hospital to services of another day hospital;

9.3. allocate the financial resources intended for the payment of inpatient health care services to the payment of outpatient health care services if the medical treatment institution provides both outpatient and inpatient health care services and has not achieved the amount of funding specified in the contract. In such case, the data from the management information system of the Service on the volume of services actually provided by the medical treatment institution shall be taken into account.

 

Annex 15
Cabinet Regulation No. 555
28 August 2018

[4 April 2023]

Methodology for the Annual Performance Evaluation and Payment Distribution of a General Practitioner

1. The annual performance indicators for a general practitioner shall be determined in the following areas:

1.1. health examinations and preventive care:

1.1.1. assessment of the health condition of a newly registered patient;

1.1.2. child vaccination coverage;

1.2. care for patients with chronic conditions:

1.2.1. care of diabetes mellitus patients:

1.2.1.1. glycohemoglobin measurements for type 2 diabetes mellitus patients;

1.2.1.2. quantitative determination of microalbuminuria for type 2 diabetes mellitus patients;

1.2.2. care for patients with arterial hypertension and coronary heart diseases - determination of LDL cholesterol;

1.2.3. care for bronchial asthma patients - measurement of peak expiratory flow for bronchial asthma patients;

1.3. diversity of manipulations and additional services performed by general practitioners.

2. The evaluation criteria for annual performance indicators are as follows:

No.	Quality criterion	Definition of criterion	Fulfilment conditions	Threshold value	Significance assessment, %
2.1.	Health examinations and preventive care	Assessment of the health condition of newly registered patients	The general practitioner has assessed the newly registered patient within three months from the date of registration, or the examination and assessment of the health condition have been performed within 10 days prior to the registration of the patient	75-90 %	10
		Child vaccination coverage	1. Two-year-old children have been vaccinated in accordance with the vaccination calendar against diphtheria, tetanus, poliomyelitis, pertussis, Haemophilus influenzae type b infection, and hepatitis B. 2. The cases where vaccination has not been performed due to contraindications or refusal by the patient or parents shall be excluded when calculating vaccination coverage. In such cases, the diagnosis code Z28.0-Z28.8 shall be indicated in the outpatient patient ticket	92-98 %	15
2.2.	Care for patients with chronic conditions	Monitoring of diabetes mellitus patients by performing glycohemoglobin (glycated Hb) measurements for type 2 diabetes mellitus patients	1. The diagnosis has been established in previous years. 2. The patient has been registered with the same general practitioner throughout the entire evaluation period. 3. Glycohemoglobin (glycated Hb) has been measured for at least 55 % of type 2 diabetes mellitus patients registered with the general practitioner. 4. The coverage indicator shall be calculated by relating the number of patients with at least one measurement below 7.5 % to the number of patients meeting the third condition of this Paragraph. 5. The calculated coverage rate is at least 60 %	55-90 % 60-80 %	30
		Monitoring of diabetes mellitus patients by quantitative microalbuminuria testing for type 2 diabetes mellitus patients	1. The diagnosis has been established in previous years. 2. The patient has been registered with the same general practitioner throughout the previous year. 3. At least 50 % of patients have undergone one microalbuminuria test during the year, excluding tests performed during inpatient treatment	50-75 %	10
		Care for arterial hypertension and coronary heart disease patients - determination of low-density cholesterol levels	1. The diagnosis has been established in previous years. 2. The patient has been registered with the same general practitioner throughout the previous year. 3. LDL cholesterol has been determined at least once for at least 70 % of arterial hypertension and coronary heart disease patients registered with the general practitioner. 4. One of the following manipulations is indicated: "41058 - LDL cholesterol level in blood - concentration less than 2.0 mmol/L" or "41059 - LDL cholesterol level in blood - concentration from 2.0 mmol/L to 2.5 mmol/L", or "41060 - LDL cholesterol level in blood - concentration greater than 2.5 mmol/L". 5. Diagnoses are indicated in accordance with the ICD-10 codes for arterial hypertension - I10, I15, I15.0-I15.9, for coronary heart disease - I20, I20.0-I20.9, I21, I21.0-I21.9, I22, I22.0-I22.9, I24, I24.0-I24.9, I25, I25.0-I25.9	70-90 %	10
		Healthcare for bronchial asthma patients - peak expiratory flow measurement for bronchial asthma patients	1. The diagnosis has been established in previous years. 2. The patient has been registered with the same general practitioner throughout the previous year. 3. Bronchial asthma patients from six years of age. 4. At least 70 % of patients have had peak expiratory flow measured at least once a year. 5. Diagnosis is indicated with the ICD-10 code J45, J45.0-J45.9	70-90 %	10
2.3.	Diversity of additional manipulations and additional services performed by the general practitioner	The general practitioner uses as many manipulations as possible in their practice which fall within their professional competence and are listed as manipulations eligible for additional payment to the general practitioner	During the year, at least 25 % of manipulations are used from those which are identified in the list of manipulations eligible for additional payment to the general practitioner, excluding preventive examinations and vaccination manipulations	25-50 %	15

3. The Service shall compile the information entered in the management information system on the health care services provided to each patient during the evaluation year and shall determine the quality indicators referred to in Paragraph 1 of this Annex for each general practitioner.

4. The indicators obtained shall be compared with the evaluation criteria specified in Paragraph 2 of this Annex and the amount of money to be paid to the general practitioner for quality indicators shall be calculated in conformity with the following conditions:

4.1. if the calculated indicators are equal to or exceed the highest threshold value of the specified evaluation criterion, the doctor shall receive the annual performance evaluation payment calculated for the corresponding quality indicator in the amount of 100 %;

4.2. if the calculated indicators fall within the threshold value interval of the specified evaluation criteria, the amount of the annual performance evaluation payment calculated for the corresponding quality indicator shall be proportionally reduced;

4.3. if the calculated indicators are lower than the lowest threshold value of the specified evaluation criteria, the payment amount calculated for the corresponding quality indicator shall not be paid to the general practitioner;

4.4. if there are no persons registered at the practice of the general practitioner who correspond to the type of patients specified in the evaluation criterion, the payment for the relevant quality criterion shall not be made to the general practitioner;

4.5. if there is a person in the list of patients of the general practitioner whose registration is blocked, then such person shall not be included in the calculations of quality indicators.

5. If during the evaluation year the general practitioner has changed the place of reception without maintaining patient registration, or terminated the contractual relations with the Service without working a full year, or the contract for the provision and payment of primary health care services was entered into during the evaluation year (the contract is not in effect from the beginning of the year), or the general practitioner was substituted by another doctor during the evaluation year, the Service shall not evaluate the annual performance of the general practitioner in accordance with Paragraph 4 of this Annex.

6. If during the evaluation year the general practitioner has changed the place of reception without maintaining patient registration, or terminated the contractual relations with the Service without working a full year, or the contract for the provision and payment of primary health care services was entered into during the evaluation year (the contract is not in effect from the beginning of the year), the annual performance evaluation payment of the general practitioner shall be calculated by using the following formula:

A = B x % where

A - the annual performance evaluation payment to be paid to the respective general practitioner;

B - the amount of the annual performance evaluation payment of the general practitioner for the full months worked in the relevant territorial department, noting that during the period when the general practitioner receives the fixed payment stipulated in laws and regulations for a newly opened practice of a general practitioner and does not receive capitation, B = 0;

% - the average percentage of the annual performance evaluation payment of the general practitioner at the practice of the general practitioner in the relevant territorial department which the Service shall calculate by dividing the annual performance evaluation payments to be disbursed to the practices of general practitioners in the territorial department by the annual performance evaluation payment funds calculated for the relevant practices of general practitioners and multiplying by 100.

7. If another doctor has substituted for the general practitioner during the evaluation year, the annual performance evaluation payment to the general practitioner and their substitute shall be calculated by using the following formulae:

7.1. for the general practitioner who substitutes:

BA = BAP x % where

BA - the annual performance evaluation payment to be disbursed to the substitute general practitioner for the months of substitution;

BAP - the annual performance evaluation payment of the substituted general practitioner for the months of substitution;

% - the percentage of the annual performance evaluation payment in the practice of the substituted general practitioner which shall be calculated by dividing the annual performance evaluation payment to be disbursed for the health care of all patients of the substituted general practitioner during the evaluation year (A) by the calculated annual performance evaluation payment to the substituted general practitioner (B);

7.2. for the general practitioner who is substituted:

BB = A - BA where

BB - the annual performance evaluation payment to be disbursed to the substituted general practitioner for the months worked;

A - the annual performance evaluation payment to be disbursed for the health care of all patients of the substituted general practitioner during the evaluation year;

BA - the annual performance evaluation payment to be disbursed to the substitute general practitioner for the months of substitution.

8. If there has been a change in the legal status and workplace of the general practitioner, transitioning from employee status in a hospital (polyclinic, general practice) (hereinafter - the medical treatment institution) to the form of medical practice or vice versa, the annual performance evaluation payment shall be disbursed, unless specified otherwise in the contract entered into by and between the general practitioner and their employer:

8.1. to the relevant general practitioner if the transition from employee status in a medical treatment institution to the form of medical practice has occurred during the evaluation year;

8.2. to the relevant general practitioner by transferring the annual performance evaluation payment to the account of the medical treatment institution if the general practitioner has terminated their practice during the evaluation year and has become an employee in a medical treatment institution;

8.3. to the relevant general practitioner, by transferring the annual performance evaluation payment to the account of the medical treatment institution in which the general practitioner was an employee if the transition from employee status in a medical treatment institution to the form of medical practice has occurred after 31 December of the evaluation year.

9. The annual performance evaluation funds to be disbursed shall be calculated based on the situation on 31 December of the evaluation year. The funds to be disbursed shall be paid to the general practitioner by 1 September of the following year regardless of any change in the legal status and workplace of the general practitioner (transition from employee status in a medical treatment institution to the form of medical practice or vice versa) that has occurred during the evaluation year, unless specified otherwise in the contract entered into by and between the general practitioner and their employer.

10. The amount of financial resources intended for the annual performance evaluation payments for general practitioners and the procedures for the calculation and disbursement thereof to each practice of a general practitioner shall be specified in the contract with the Service.

 

Annex 16
Cabinet Regulation No. 555
28 August 2018

[8 July 2025]

Determination of the Payment Amount for Outpatient Laboratory Services

1. The Service shall plan the amount of resources intended for the payment for outpatient laboratory services for:

1.1.outpatient histological examinations;

1.2. laboratory services performed within the scope of care for pregnant women and women who have recently given birth;

1.3. laboratory services performed within the scope of the State organised screening;

1.4. laboratory services performed within the scope of primary and secondary diagnostics of malignant neoplasms;

1.5. examinations for the identification of mutations in neoplasm cells;

1.6. examinations related to transplantation services;

1.7. laboratory diagnostic examinations for rare diseases;

1.8. laboratory testing for patients with malignant neoplasms;

1.9. laboratory services in the reception ward;

1.10. COVID-19 laboratory services;

1.11. other outpatient laboratory services.

2. The Service shall determine the amount of funding for laboratory service providers in proportion to the share of laboratory services provided over nine months in the country, taking into account the total amount of laboratory funding. If the costs of the provided volume of laboratory services are less than EUR 1200 per year, the Service shall not enter into a contract with such laboratory service provider.

3. The proportion of the remaining laboratory resources between general practitioners and secondary outpatient health care specialists shall be determined according to the share of laboratory services provided during nine months of the current year.

4. From the amount of remaining laboratory resources, the Service shall create a financial reserve of 5 % which shall be used for the following purposes:

4.1. outpatient laboratory services according to the volume of services actually performed if they are provided in accordance with:

4.1.1. a referral from a general practitioner who receives a fixed payment as a newly opened practice of a general practitioner;

4.1.2. a referral from a doctor on duty;

4.1.3. a referral from a doctor working in a place of imprisonment, a doctor working in a long-term social care and social rehabilitation institution, and also a doctor employed at a medical treatment institution of the National Armed Forces, a doctor employed at an accommodation centre for asylum seekers, or a doctor employed at an accommodation centre for detained foreigners;

4.2. outpatient laboratory services if the Service has increased the amount of resources intended for payment for outpatient laboratory services to the general practitioner or medical treatment institution in accordance with the procedures laid down in this Regulation;

4.3. outpatient laboratory services with a referral from a secondary outpatient health care specialist and general practitioner who have entered into contractual relations with the Service after completion of the planning process for resources intended for the payment for laboratory services;

4.4. outpatient laboratory services with a referral from a secondary outpatient health care specialist and general practitioner if it is not required for the purposes referred to in Sub-paragraphs 4.1, 4.2, and 4.3 of this Annex and the general practitioner or medical treatment institution providing secondary outpatient health care services has exhausted the resources allocated for the payment for laboratory services.

5. When planning the costs of laboratory services provided upon referral from a general practitioner, the Service shall take into account that the costs of laboratory services for a patient with one of the principal diagnoses C00-D48 or E10-E14 (in accordance with the ICD-10) and a referral from a general practitioner, compared to a patient without such a diagnosis, constitute a difference of EUR 32.70. The Service shall determine the total amount of the cost difference by multiplying EUR 32.70 by the number of patients obtained according to the data entered in the management information system on laboratory services provided in the first half of the year to patients with principal diagnoses C00-D48 or E10-E14 (in accordance with the ICD-10) and a referral from a general practitioner.

6. The costs of laboratory services provided upon referral from a general practitioner per person for the following year shall be determined as follows:

6.1. initially, the total costs of laboratory services provided upon referral from a general practitioner shall be calculated, i.e. the 5 % reserve of laboratory resources intended for referrals by general practitioners and the previously calculated total amount of cost difference shall be deducted from the amount of other laboratory resources;

6.2. subsequently, the costs of laboratory services per person shall be obtained by dividing the total costs of laboratory services provided upon referral from a general practitioner by the number of persons registered with general practitioners on 30 September of the current year (except for the persons blocked in accordance with this Regulation).

7. The annual allocation of funds for each general practitioner for referring patients for outpatient laboratory services shall be calculated as follows:

7.1. the costs of laboratory services provided upon referral from a general practitioner per person shall be multiplied by an age-appropriate coefficient and by the number of patients registered with the specific general practitioner in the corresponding age group on 30 September of the current year (except for the persons blocked in accordance with this Regulation) or, if the general practitioner has begun contractual relations with the Service during the current year, by the number of registered patients in the corresponding age group on 1 December of the current year:

7.1.1. up to 1 year of age - 0.49;

7.1.2. from 1 year to 6 years of age - 0.64;

7.1.3. from 7 to 17 years of age - 0.58;

7.1.4. from 18 to 44 years of age - 0.64;

7.1.5. from 45 to 64 years of age - 1.25;

7.1.6. for persons older than 65 years - 1.72;

7.2. the obtained costs of the patient groups shall be summed up and the previously calculated total amount of cost difference shall be added thereto, thus obtaining the total amount of funds intended for outpatient laboratory service referrals for the specific general practitioner for the year that shall be indicated in the contract entered into by and between the Service and the medical treatment institution for the provision of and payment for primary health care services.

8. The amount of funds designated for outpatient laboratory service referrals for a doctor working in a place of imprisonment, a doctor working in a long-term social care and social rehabilitation institution, and also a doctor employed at a medical treatment institution of the National Armed Forces shall be calculated based on the number of persons on 30 September of the current year whom the doctor is authorised to refer for State paid health care services in accordance with the terms of the interdepartmental agreement.

9. For a general practitioner who, in accordance with the procedures stipulated in this Regulation, has entered into a contract for the substitution of a general practitioner on prolonged absence, the amount of funds designated for outpatient laboratory service referrals shall be determined proportionally to the substitution period, with a corresponding reduction in the amount of funds designated for outpatient laboratory service referrals for the general practitioner on prolonged absence.

10. The costs of a single episode of outpatient laboratory services for secondary outpatient healthcare specialists shall be obtained as follows:

10.1. the amount of funds designated for outpatient laboratory service referrals shall be determined for the following year for service providers that provide renal replacement therapy in day hospitals, i.e. the number of patients who received renal replacement therapy in day hospitals during the first half of the current year shall be multiplied by the average cost of laboratory tests performed for these patients during the first half of the current year, and the resulting figure shall be multiplied by two;

10.2. a 5 % reserve of laboratory funds designated for referrals by secondary outpatient healthcare specialists and the calculated total costs of laboratory services for renal replacement therapy patients shall be deducted from the remaining laboratory funds, dividing the resulting figure by the total number of episodes in the first half of the current year, and the resulting figure shall be multiplied by two.

11. When calculating the amount of funds necessary for a specialist to refer a patient for outpatient laboratory services within the scope of secondary outpatient health care, the following coefficients shall be applied:

11.1. for a doctor of physical and rehabilitation medicine, ophthalmologist, psychiatrist, paediatric psychiatrist, paediatric neurologist - 0.03;

11.2. for a paediatric surgeon, anaesthetist, reanimatologist - 0.10;

11.3. for an otolaryngologist, traumatologist, orthopedist - 0.23;

11.4. for a narcologist - 0.34;

11.5. for a surgeon, neurologist - 0.60;

11.6. for a cardiologist, urologist - 0.86;

11.7. for a dermatologist, venereologist, pneumonologist, paediatric pneumonologist, gynaecologist, birth attendant, paediatrician - 1.18;

11.8. for an infectologist, oncologist chemotherapist, internist - 2.90;

11.9. for an endocrinologist, paediatric endocrinologist - 3.97;

11.10. for an immunologist - 12.57;

11.11. for a geneticist - 42.10;

11.12. for other secondary outpatient health care specialists referred to in Paragraph 5 of Annex 4 to this Regulation - 1.89.

12. The total annual amount of funds for each secondary outpatient health care specialist for referring patients for outpatient laboratory services shall be calculated by multiplying the cost of a single episode of outpatient laboratory services by the coefficient of the respective specialist and the number of episodes in the first half of the current year, and then multiplying the resulting figure by two.

13. The annual amount of funds for a medical treatment institution whose specialist refers a patient for outpatient laboratory services shall be specified for each secondary outpatient health care specialist in the contract entered into by and between the Service and the medical treatment institution for the provision of and payment for secondary outpatient health care services, by summing the funds designated for the payment for outpatient laboratory services of all secondary outpatient health care specialists of the relevant medical treatment institution, and adding the total costs of laboratory services for renal replacement therapy patients if the medical treatment institution provides renal replacement therapy services.

14. Twice yearly - by 1 August (for the period from 1 January to 30 June) and by 1 February (for the period from 1 January to 31 December of the previous year) - the Service shall compare the calculated amount of funds designated for outpatient laboratory service referrals indicated in the contract with the medical treatment institution with the amount of funds used for outpatient laboratory service referrals.

15. If a general practitioner or a medical treatment institution providing outpatient health care services has not used more than 20 % of the amount of funds designated for outpatient laboratory service referrals specified in the contract during the first half of the year, the amount of funds designated for outpatient laboratory service referrals calculated for the second half of the relevant year for that general practitioner or medical treatment institution shall be reduced by 50 % of the unused amount of funds designated for the payment for outpatient laboratory services.

16. If the Service, when carrying out the evaluation for the previous year, determines that a general practitioner has not fully used the funds intended for outpatient laboratory service referrals as specified in the contract, but has used at least 80 % of the funds, the general practitioner, for whom the amount of funds planned for laboratory referrals in the contract with the Service was determined for a full calendar year, shall receive payment of 20 % of the difference between the contractual amount and the resources actually used by 1 March of the current year.

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Translation © 2025 Valsts valodas centrs (State Language Centre)