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Interpretation
J.Y. Interpretation |
NO. 723
[ The Period for Declaring National Health Insurance Medical Service Points ] |
Date |
2014/7/25 |
Issue |
Is it unconstitutional to promulgate regulations to prescribe the two-year period for declaring National Health Insurance Medical Service Points? |
Holding |
1 Article 6, Paragraph 1 of the Regulations Governing the Review on Medical Services of National Health Insurance Medical Care Institutions (the “Regulations”) as amended and published on December 29, 2000 provided: “The Insurer shall not make payment to the contracted medical care institution if such an institution declares its medical service points after the two-year declaration period provided in the preceding article” (the “Provision”). (The Regulations were amended and promulgated on March 22, 2002, leaving the Provision unchanged. The Provision was deleted as of the amendment on January 24, 2012.) The aforesaid Provision contradicts the principle of legal reservation and breaches the right to property of the people. It is inconsistent with the constitutional intention of Articles 15 and 23 of the Constitution of the Republic of China (Taiwan). As such, the Provision shall not be applicable.
2 As to the interim disposition filed by the petitioner, since the case has been addressed by this interpretation, the interim disposition has become unnecessary. Therefore, it shall be dismissed.
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Reasoning |
1 The purpose of a statute of limitation is to respect pre-existing factual status and maintain the stability of the legal order, which pertains to public interest and significantly affects the rights and obligations of the people. Whether the statute of limitation is for rights of claim under public law or private law, it shall be expressly stipulated by law. Its stipulation shall not be delegated to the executive branch, nor shall it be stipulated in regulations promulgated by the executive branch by its own authority. Only then will the statute of limitation be considered to be consistent with the constitutional intention of the principle of legal reservation under Article 23 of the Constitution (with reference to J.Y. Interpretation No. 474).
2 Article 50, Paragraph 1 of the National Health Insurance Act as enacted and published on August 9, 1994 stipulated: “The contracted medical care institution shall declare to the Insurer its medical service points representing the medical services it rendered and its pharmaceutical expenses based on the standard for payment of medical expenses and the criterion of pharmaceutical price.” Paragraph 2 of the same article provided: “The Insurer shall calculate the value of each point based on the budget allocated in the preceding article and the total points of medical service as reviewed by the Insurer. The Insurer shall pay each contracted medical care institution according to the reviewed points.” No declaration period was stipulated for contracted medical care institutions to declare their medical service points. Article 52 of the same Act further indicated: “In reviewing the quantity and quality of medical service items rendered by contracted medical care institutions, the insurer shall retain those medical and pharmaceutical specialists with clinical or practical experience to form a medical service review commission. The regulations governing such reviews shall be established by the competent authorities.” Mandated by this provision, the competent authorities established and promulgated the Regulations Governing the Review on Medical Services of National Health Insurance Medical Care Institutions (the “Regulations”). The competent authorities further amended Article 6, Paragraph 1 of the Regulations on December 29, 2000, which stated: “The Insurer shall not pay the contracted medical care institution if the institution declares its medical service points after the two-year declaration period provided in the preceding article has expired” (the “Provision”). (The Regulations were amended and promulgated on March 22, 2002, where the Provision remained unchanged [hereinafter referred to as the “Provision in Dispute”]. The Regulations were further amended and promulgated on January 24, 2012 and were renamed “The Regulations Governing the Review on National Health Insurance Medical Expense Declaration and Payment as well as Medical Services,” where the Provision in Dispute was deleted. Meanwhile, the National Health Insurance Act was amended and published on January 26, 2011, where Article 50 was moved to Article 62 with Paragraph 2 added, which reads: “Contracted medical care institutions should declare the medical expenses in the preceding paragraph from the first day of the month following the treatment up to six months after. However, should there be unavoidable circumstances, another six months after the facts will be provided.”) Accordingly, the Provision in Dispute sets the declaration period for two years for contracted medical care institutions to declare their medical service points.
3 In declaring the medical service points to the Insurer, the contracted medical care institution is exercising its rights of claim under public law based on relevant provisions of the National Health Insurance Act. After the Insurer has reviewed the total medical service points and calculated the expense amount for each point in order to pay the expense, those points then have property values. Thus, the declaration period provided by the Provision in Dispute is a statute of limitation on the rights of claim under public law. With regard to the declaration of medical service points, the Provision in Dispute hence uses an executive regulation to impose a statute of limitation on the rights of claim under public law. In so doing, it creates an extra restriction that is not mandated by law and that breaches the principle of legal reservation as well as infringing the right to property of the people. As such, it is inconsistent with the constitutional intention of Articles 15 and 23 of the Constitution, and therefore shall not be applicable.
4 As to the interim disposition filed by the petitioner, since the case has been addressed by this interpretation, the interim disposition has become unnecessary. Accordingly, it shall be dismissed. ______________________
* Translated by Spenser Y. HO, Esq.
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Editor's Note |
Summary of facts: The petitioner, Chang-Rong Qiu, as in the Clinic of Dentist Qiu, declared his clinic’s medical expenses incurred during the months from June to August, November, and December of 2005, as well as January of 2006 to the Bureau of National Health Insurance under the Department of Health, the Executive Yuan (now, after restructuring, called the National Health Insurance Administration of the Ministry of Health and Welfare, the Executive Yuan). Such expenses were denied declaration due to incomplete information. Upon review by the Northern Branch of the Bureau of National Health Insurance, the denial of declaration was confirmed due to incomplete information. After losing the administrative litigation that he initiated, the petitioner attempted to declare the medical expenses for the aforementioned time period by submitting supplementary information. Nevertheless, the Bureau of National Health Insurance held that the declaration procedures had been concluded and that the case had been dismissed by litigation, and thus there was no cause to accept the declaration. The petitioner brought yet another administrative litigation, which was dismissed per Taipei High Administrative Court Judgment (2009) Su-Zi No. 285 on the grounds of initiating repetitive lawsuits on the same matter, which is against the law. In addition, no payment was to be made after the expiration of the two-year declaration period as stipulated by Article 6, Paragraph 1 of the Regulations Governing the Review on Medical Services of National Health Insurance Medical Care Institutions, and the case was thus dismissed. On appeal, the Supreme Administrative Court rendered a final judgment dismissing the case as an unlawful appeal pursuant to Supreme Administrative Court Ruling (2009) Cai-Zi No. 2219. In response, the petitioner asserted that the Provision in Dispute raises doubts of conflicting with Articles 15 and 23 of the Constitution as well as J.Y. Interpretation No. 474, and filed this petition for a constitution interpretation and an interim disposition.
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