From 2019, the normalized insurance stock of Compulsory Health Insurance Terfunds will include funds to combat staffing shortages in primary care. Now it's being funded medical care services provided outside the home region, additional education for doctors, as well as the purchase and repair of medical equipment.

The Ministry of Health proposes to form a normalized safety stock (NSS) of territorial compulsory funds in a different way. health insurance(OMS). Now it is intended “for the implementation of territorial compulsory medical insurance programs, payments for medical care provided to insured persons outside the territory of the subject of the Russian Federation in which the compulsory medical insurance policy, organization of additional professional education for medical workers under advanced training programs, acquisition and repair of medical equipment.” In 2019–2024, it will also include funds to eliminate staffing shortages in clinics providing primary medical care. The corresponding draft law amending Article 51 of the Federal Law “On Compulsory Health Insurance in the Russian Federation” was published on the website of the Government of the Russian Federation.

Where the funds will come from and how they will be used by medical organizations must be approved by the Ministry of Health in an additional order. , now the normalized TFOMS insurance stock is formed from the budget revenues of the territorial fund (FFOMS subvention), money intended to pay for medical care for residents of other regions, as well as part of the funds from penalties imposed on clinics based on the results of inspections.

The government also ordered to submit to the State Duma a draft budget for the Federal compulsory medical insurance fund for next year and for the planning period 2020 and 2021. According to it, the formation of a normalized safety stock FFOMS is planned annually in the amount of 3.1 billion rubles.

For the next year, MHIF revenues are provided in the amount of 2,098.2 billion rubles, for 2020 - 2,349.9 billion rubles, for 2021 - 2,495.8 billion rubles (2018 budget - 1,887.9 billion rubles). It is expected that expenses for 2019 will amount to 2,190.4 billion rubles, in 2020 – 2,350.5 billion rubles and in 2021 – 2,501.5 billion rubles (2018 budget – 1,994.1 billion rubles) .

“The Fund’s budget deficit in 2019 will amount to 92.3 billion rubles, in 2020 – 0.5 billion rubles, in 2021 – 5.7 billion rubles. The balance of the Fund’s budget will be achieved through the carryover balances of funds at the end of the corresponding financial year,” the Cabinet of Ministers said in its order.

"In them (budgets social funds- Approx. ed.) we have allocated funds that will ensure the required level social protection people,” said Prime Minister Dmitry Medvedev at a government meeting on September 20 during a discussion of bills. - The money will be used to further improve the quality of medicine. We will also include in the basic program Compulsory medical insurance new types of high-tech care, we will continue to eliminate the shortage of individual specialists in hospitals.”

Federal Fund compulsory medical insurance (hereinafter referred to as the Federal Fund) in connection with incoming questions regarding the implementation of the Rules for the use by medical organizations of the funds of the normalized insurance stock of the territorial compulsory medical insurance fund for financial support of activities for the organization of additional professional education of medical workers under advanced training programs, as well as for the acquisition and carrying out repairs of medical equipment (hereinafter referred to as measures) approved by Government Decree Russian Federation dated 04/21/2016 N 332, (hereinafter referred to as the Rules), reports.

1. Regarding the formation of an action plan. Clause 8 of the Rules establishes the obligation of the executive body of the constituent entity of the Russian Federation, authorized by the highest executive body of state power of the constituent entity of the Russian Federation (hereinafter referred to as the authorized body), to approve and agree upon in the prescribed manner action plan within a period not exceeding 30 calendar days from the date of entry into force of the Rules (until 06/03/2016), and subsequently - quarterly, until the 1st day of the first month of the next quarter (for the third quarter of 2016 - until 07/01/2016) .

In accordance with paragraph 3 of the Rules, funds for financial support of events are provided by the territorial compulsory health insurance fund (hereinafter referred to as the territorial fund) medical organizations within the limits of the normalized safety stock (hereinafter referred to as the NSZ) provided for in the budget of the territorial fund for the financial support of events.

Clause 5 of the Procedure for using the funds of the normalized insurance reserve of the territorial compulsory health insurance fund, approved by order of the Federal Fund dated December 1, 2010 N 227, financial support for activities is carried out within the limits of the funds of the National Health Insurance Fund of the territorial fund, formed in accordance with part 6.3 of Article 26 of the Federal Law of November 29, 2010 N 326-FZ "On compulsory medical insurance in the Russian Federation" (hereinafter - the federal law N 326-FZ).

Thus, the amount of necessary funding for activities established by plan activities, is determined based on the actual amount of funds in the territorial fund's NSA, formed on the date of coordination and approval of the action plan, and the use of funds for these purposes is carried out by the territorial fund only after amendments are made to the law on the budget of the territorial fund, establishing in accordance with part 6.4 of the article 26 of Federal Law N 326-FZ, the size of the NHS and the purposes of its use, including financial support for events.

In accordance with subparagraph "b" of paragraph 4 of the Rules, the authorized body approves the selection criteria for medical organizations for inclusion in the action plan (hereinafter referred to as the selection criteria).

The selection criteria established by the authorized body must ensure the possibility of distributing medical organizations on the basis of their compliance with the specified selection criteria for the subsequent formation of a list of activities based on the actual funds of the National Health Service formed in the budget of the territorial fund. These measures will create equal conditions inclusion of medical organizations in the action plan, regardless of their departmental affiliation and organizational and legal form.

Please note that the action plan is approved quarterly on an accrual basis. Thus, the amount of necessary financial support for the action plan at the end of the current financial year should be established within the limits of the actually generated funds of the National Social Security Fund of the territorial fund.

2. On issues of financial support for contracts concluded for the implementation of activities.

The basis for concluding contracts is the existence of an action plan approved using the selection criteria.

Thus, financial support for activities at the expense of the National Health Fund of the territorial fund under contracts concluded before the date of entry into force of the Rules and approval of the action plan is unlawful.

Based on the norms established by Articles 34 and 42 of the Federal Law of 04/05/2013 N 44-FZ "On the contract system in the field of procurement of goods, works, services to meet state and municipal needs" (hereinafter referred to as Law N 44-FZ), the contract is concluded on the conditions stipulated by the notice of procurement, which must contain information, including the source of its financial support.

Medical organizations keep separate records of transactions with compulsory health insurance funds (Part 6 of Article 15 of Federal Law N 326-FZ), including funds for financial support of activities (clause 11 of the Rules).

Thus, we consider it possible to provide financial support for agreements (contracts) concluded for the purpose of implementing activities from several sources if the the said agreements(contracts) of the amount of financial support for each source, followed by separate analytical accounting of funds received from the National Health Insurance Fund of the territorial fund, compulsory health insurance funds received to pay for medical care (subject to the norms of Part 7 of Article 35 of Federal Law N 326-FZ) and others sources of financial support for agreements (contracts).

Taking into account the above, the following measures must be taken in the constituent entities of the Russian Federation:

1. Bring the budgets of territorial funds into compliance with Federal Law N 326-FZ in terms of financial support for activities.

2. Establish selection criteria that ensure equal conditions for all medical organizations.

3. When approving the action plan, ensure:

Correspondence of the amount of its financing to the amount of funds actually generated within the National Health Fund of the territorial fund for the financial support of activities;

Compliance with the deadlines established by paragraph 8 of the Rules;

Formation of an action plan on an accrual basis.

4. Ensure compliance with the requirements of Federal Law N 44-FZ and the Rules when concluding contracts in order to implement activities.

Document overview

Explanations are provided by the Federal Compulsory Compulsory Medical Insurance Fund of Russia on the implementation of the Rules for the use by medical organizations of funds from the normalized safety stock (NSS) of the Federal Compulsory Compulsory Medical Insurance Fund to finance activities for additional professional education of medical workers and the acquisition (repair) of medical equipment.

The amount of funding is determined based on the actual amount of funds in the NHA of the territorial fund, formed as of the date of coordination and approval of the action plan. Funds are used by the territorial fund only after amendments are made to the law on the budget of the territorial fund. Therefore, regions must bring fund budgets into compliance with the law.

The authorized body approves the criteria for selecting medical organizations for inclusion in the action plan. This will create equal conditions for them.

The plan is approved quarterly on an accrual basis. Therefore, the amount of funds at the end of the current financial year is set within the limits of the actually generated funds of the National Health Fund.

Activities cannot be financed from NHS funds under government contracts concluded before the date of entry into force of the rules and approval of the action plan.

Financing of government contracts from several sources is possible if the amounts of financial support for each source are established in them, followed by separate analytical accounting funds received from the NHS fund, compulsory medical insurance funds received to pay for medical care and other sources.