Arbitration

Article 184

In order to resolve any disputes arisen between the branches i.e. the Republic Institute and health care providers, in regard to entering into, modifying and implementation of the contract on providing health care, an arbitration may be constituted.

A health care facility i.e. private practice with whom the contract is not entered into on providing health care to the insured whose costs are to be at the expense of the compulsory health insurance funds, and which has rendered an emergency medical aid to the insured, may require an agreement to be made on setting the arbitration, in accordance with this Act

Each party involved in a dispute referred to in paragraphs. 1 and 2 of this Article, may require an agreement to be made on arbitration within 8 days as of the date of arising a dispute, i.e. as of the date of delivering the contract referred to in Article 175 of this Act, to a health care services provider.

Arbitration shall consist of 5 members: a representative of the branch, i.e. the Republic Institute and a health care provider, as parties involved in a dispute, a representative of the associations of health care facilities, a representative of the health professionals’ chambers, founded in accordance with law and a representative from the Ministry.

In dispute resolutions between the branch and the health care providers from the territory of the autonomous province, one member of the arbitration is to be a representative of the Provincial Institute.

The President of the arbitration is chosen among the arbitration members by mutual agreement of the disputing parties, and if they cannot reach such an agreement, the President shall be appointed by the Minister.

Article 185

Proceeding before the arbitration is summary, and the award on the issue in dispute is to be made within 30 days as of the date of making an agreement on settling the arbitration, by the majority of votes among the members of the arbitration.

For the duration of arbitration, terms for bringing the case before the court are of no effect.

If the parties involved reach a settlement upon the issue in dispute, the arbitration shall on their request make an award on the basis of such settlement, unless the settlement reached by the parties is contrary to the public policy.

An award made on the basis of the settlement is effective as any other arbitration award, except that it needs not have a rationale.

The arbitration is governed by the provisions of the Act governing the chosen court, i.e. arbitration, unless otherwise provided by this Act.

3. Contract Enforcement Control

Article 186

The Republic Institute is obliged to arrange for and carry out control over enforcement of the contracts entered into with the health care services providers.

The Republic Institute controls how the contracts between branches and providers of health care services are being enforced.

The control of such contracts is made by the branches and the Provincial Institute as well, in accordance with this Act..

Article 187

An officer of the Republic Institute, the branch, i.e. the Provincial Institute (hereinafter referred to as the “Insurance Supervisor”) controls the regularity of enforcement of the contracts entered into with providers of health care services, as well as the legal and purposeful use of the compulsory health insurance funds, which have been designated to providers of health care services for purposes of exercising the rights of the insured prescribed by law.

Control of personal data related to health status of the insured, which are kept in the medical record of the insured, in accordance with law, is made by an insurance supervisor i.e. an authorise MD, dentist or pharmacist.

The Republic Institute delievers a general by-law specifying in detail the manner and procedure of performing activities referred to in paragraphs 1 and 2 of this Article.

The general by-law, referred to in paragraph 3 of this Article is published in the Official Gazette of the Republic of Serbia.

Article 188

While carrying out the control referred to in Article 161 of this Act, an Insurance Supervisor is to have and produce an official ID document.

The official ID document is issued by the Director of the Republic Institute. The form, appearance and contents of the ID document is prescribed by the Director of the Institute.

Article 189

While performing his/her job, an Insurance Supervisor is authorised to have a direct insight in the required information, official and financial documentation of the provider of health care services, as well as an insight in certain medical documentation relevant for exercising rights of the insured covered out of the compulsory health insurance funds.

Upon the established state of facts in the control procedure, the Insurance Supervisor makes an official record and delivers it to the provider of health care services.

The Insurance Supervisor shall grant the provider of health care services 15 days as of the date of presenting the official record for rectifying any established irregularities in providing health services or in carrying out the contract entered into with the Republic Institute i.e. the respective branch.

If the health care services provider fails to rectify within due term referred in paragraph 3 of this Article any established irregularities in providing health services or in carrying out the contract entered into, the Insurance Supervisor may suggest for the measures referred to in Article 190 of this Act to be applied.

Article 190

The Insurance Supervisor may do the following:

1. order for the established irregularities and faults, or activities which are contrary to law and the contract entered into with the provider of health care services, to be rectified in a certain time period;

2. suggest a temporary suspension of funds transfer until the provider of health care services rectifies the established irregularities in carrying out the contract;

4. suggest for the funds allocated for a provider of health care services to be decreased for the part of the obligations undertaken under the contract which the provider has not carried out;

5. suggest a termination of a part of the contract or the whole contract entered into with the provider of health care services; and

6. undertake other measures in accordance with law and the contract enterd into.

A decision on the suggested measures referred to in paragraph 1 of this Article is made by the Director of the Republic Institute, i.e. Director of the respective branch who shall notify the Director of the Republic Institute thereof.

6. COMPENSATION FOR DAMAGES IN HEALTH INSURANCE