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(영문) 서울행정법원 2019.06.20 2016구합8517

요양급여감액조정처분 취소

Text

1. The Defendant’s disposition of reducing the amount of each medical care benefit cost as stated in the attached Tables 2 and 7, which the Plaintiff provided.

Reasons

(c) Examination of whether the details of medical care benefit costs are appropriate as publicly notified by the Minister of Health and Welfare;

(4) Matters necessary for the examination and payment of medical care benefit costs shall be determined and publicly notified by the Minister of Health and Welfare.

Article 4 (Examination of Medical Care Benefit Costs) (1) The Review and Assessment Service* upon receipt of a request for review of medical care Benefit costs, shall review whether the details of such request for review meet the following requirements:

In such cases, the criteria for examination falling under subparagraph 4 shall be disclosed.

3. Guidelines for calculation of medical care benefit costs determined by the Minister of Health and Welfare;

4. Other review criteria, etc. for medical care benefit costs determined by the president of the Review and Assessment Service following deliberation by the Review and Assessment Committee established under Article 59*: Health Insurance Review and Assessment Service* the National Health Insurance Review and Assessment Service* the National Health Insurance Act was wholly amended by Act No. 11141 on December 31, 2011. Article 59 was related to the "Medical Examination and Assessment Committee" before the amendment, and Article 59 was related to the "Protection of Entitlement" after the amendment.

Article 59 of the Act seems not to be reflected in this part.

Article 59 of the Act was amended on August 11, 2015 as "Article 66 of the Act."

Article 59 of the former National Health Insurance Act (wholly amended by Act No. 11141, Nov. 31, 201) (1) (1) In order to efficiently perform the duties of the Review and Evaluation Institute, the Medical Treatment and Evaluation Committee (hereinafter referred to as the “Examination Committee”) shall be established under the Review and Evaluation Committee.

The review should be made.

[The specific scope of the "affirmative Preservation Treatment Act" among the benefit standards related to spine surgery] positive preservation of a certain period of time in accordance with the benefit standards related to spine surgery.