The procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory medical insurance has been adjusted. The procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory medical insurance Obzha has been adjusted
FEDERAL FUND
ORDER
Lost force on June 29, 2019 based on
Order of the Compulsory Medical Insurance Fund of February 28, 2019 N 36
____________________________________________________________________
In accordance with Chapter 9 of the Federal Law of November 29, 2010 N 326-FZ “On Compulsory Medical Insurance in the Russian Federation” (Collection of Legislation Russian Federation, 2010, N 49, art. 6422; 2011, N 49, art. 7047; 2012, N 49, art. 6758; 2013, N 27, art. 3477; N 48, art. 6165; 2016, N 1, Art. 52) and in order to improve the organization and control of volumes, timing, quality and conditions of provision medical care for compulsory health insurance
I order:
Amend the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230 (registered by the Ministry of Justice of the Russian Federation on January 28, 2011, registration N 19614) as amended by order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 N 144 (registered by the Ministry of Justice of the Russian Federation on December 9, 2011, registration N 22523), by order of the Federal Compulsory Medical Insurance Fund dated July 21, 2015 N 130 (registered with the Ministry of Justice of the Russian Federation on July 27, 2015, registration N 38182), by order of the Federal Compulsory Medical Insurance Fund dated December 29, 2015 N 277 (registered with the Ministry of Justice of the Russian Federation on January 27, 2016, registration number N 40813), according to the appendix to this order.
Chairman
N.N.Stadchenko
Registered
at the Ministry of Justice
Russian Federation
May 4, 2017,
registration N 46609
Application. Changes made to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Fund for Compulsory...
Application
to the order
Federal Fund mandatory
health insurance
dated February 22, 2017 N 45
1. In paragraph 10, the words “(except for control when making payments for medical care provided to insured persons outside the constituent entity of the Russian Federation on the territory of which the compulsory medical insurance policy was issued)” should be deleted.
2. In paragraph 14:
a) subparagraph "a"
"a) repeated calls for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the date of the previous call - when calling emergency medical services again; ";
b) subparagraph “b” shall be considered invalid.
3. In paragraph 17, the words “determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” are deleted.
4. Paragraph one of paragraph 19 should be stated as follows:
“19. Based on the results of a planned or targeted medical and economic examination, a specialist expert draws up a medical and economic examination report in two copies: one is transferred to the medical organization, one copy remains in the medical insurance organization / territorial compulsory health insurance fund.
In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 10 to this Procedure.
If defects in medical care/violations in the provision of medical care are identified (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 3 to this Procedure.".
5. In paragraph 21, after the words “carried out by verification,” add the words “(including using an automated system).”
6. In paragraph 25:
a) subparagraph “e” should be stated as follows:
"f) repeated justified call for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the date of the previous call - when calling emergency medical services again ;";
b) subparagraph “g” shall be considered invalid.
7. In paragraph 30:
a) the words “is determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” shall be deleted.
b) replace the number “0.8” with the number “0.5”.
8. In subparagraph “a” of paragraph 33, after the words “average duration of treatment,” add the words “shortened or extended treatment periods.”
9. In subparagraph “b” of paragraph 34, the words “divided by age, gender and other characteristics” should be deleted.
10. Paragraph 37 should be stated as follows:
"37. The quality of medical care expert who carried out the examination of the quality of medical care draws up an expert opinion (Appendix 11 to this Procedure) containing a description of the conduct and results of the examination of the quality of medical care, on the basis of which an act of examination of the quality of medical care is drawn up.
In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 6 to this Procedure.
In case of detection of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with.
In accordance with parts 9 and 10 of Article 40 of the Federal Law, the results of the examination of the quality of medical care, drawn up in accordance with Appendix 5 to this Procedure, are the basis for applying to a medical organization the measures provided for in Article 41 of the Federal Law, the terms of the contract for the provision and payment of medical care on compulsory health insurance and a list of grounds for refusal to pay for medical care (reduction of payment for medical care) (Appendix 8 to this Procedure).
Insurance medical organizations, on the basis of examination reports on the quality of medical care, prepare proposals for improving the quality of medical care and send them to the territorial fund of compulsory health insurance with the attachment of action plans to eliminate violations in the provision of medical care identified based on the results of the examination of the quality of medical care submitted by medical organizations." .
11. Paragraph 43 should be stated as follows:
"43. The number of cases subject to re-examination is determined by the number of reasons for their conduct in accordance with paragraphs 40, 41 of this Procedure, and is:
a) from the number of primary medical and economic examinations not less than:
8% - in a 24-hour hospital;
8% - in day hospital;
0.8% - with outpatient care;
3% - emergency medical care outside a medical organization;
b) from the number of primary examinations of the quality of medical care no less than:
5% - in a 24-hour hospital;
3% - in day hospital;
0.5% - with outpatient care;
1.5% - emergency medical care outside a medical organization.
During the calendar year, all medical insurance organizations operating in the field of compulsory medical insurance must be subjected to re-examination in cases of medical care provided in all medical organizations."
12. In paragraph 52, after the words “corresponding medical request,” add the words “including in electronic form when using an electronic medical record.”
13. Paragraph 57
“The medical organization notifies the territorial compulsory health insurance fund if the medical insurance organization fails to submit a report within the prescribed period.”
14. In paragraph 58:
a) in paragraph two, after the words “and one copy,” add the words “with an action plan to eliminate violations in the provision of medical care identified as a result of the examination of the quality of medical care,”;
"Insurance medical organization reviews the protocol of disagreements within 10 working days from the date of its receipt and sends the results of reviewing the protocol to the medical organization."
15. In subparagraph "b" of paragraph 66 the words "(according to insured event, in which defects in medical care and/or violations in the provision of medical care were identified)" shall be excluded.
16. In paragraph 67:
a) paragraph one should be supplemented with the words “taking into account the results of consideration of the protocol of disagreement (if any) under paragraph 58 and paragraph 74 (if any) of this Procedure.”;
b) paragraph three should be supplemented with the words “exceeding the established time of arrival of emergency medical teams when providing emergency medical care;”.
17. In paragraph 73:
a) subparagraph “c” should be stated as follows:
“c) internal control materials on the disputed case.”;
b) add the following paragraph:
“The results of departmental quality control of medical care (if any) are attached to the claim.”
18. Paragraph 77 should be supplemented with the following paragraph:
“If the territorial compulsory health insurance fund at the place of insurance does not agree with the results of the medical and economic examination and/or examination of the quality of medical care, territorial funds compulsory health insurance, the candidacy of a specialist expert and/or an expert on the quality of medical care is agreed upon, and the territorial fund at the place of provision of medical care conducts the corresponding examination again."
19. In Appendices 3, 5 to this Procedure, the word “(target)” should be deleted.
20. In Appendix 6 to this Procedure:
a) replace the word “(planned)” with the word “(consolidated)”;
b) the words “Identified defects in medical care/violations in the provision of medical care (in accordance with the List of grounds for refusal (reduction) of payment for medical care - Appendix 8 to this Procedure):" be replaced with the words “Checked cases of provision of medical care:”;
c) the table should be stated as follows:
Dates of requests | Paid for | Service |
|||||
compulsory health insurance | medical documentation | medical services | |||||
d) the words “Of these, the following were recognized as containing defects in medical care/violations in the provision of medical care: _____________
Subject to non-payment/payment reduction in ____ cases in the amount of ___ rubles.
The fine in _______ cases in the amount of ____________ rubles shall be excluded.
21. In Appendix 8 to this Procedure:
a) clause 3.11 is declared invalid;
b) subclause 1.1.3 of clause 1.1, clause 3.5, clause 4.2, subclause 4.6.1 of clause 4.6 shall be stated in the following wording:
"1.1.3. violation of the conditions for the provision of medical care, including the waiting period for medical care provided as planned, the time of arrival of emergency medical teams when providing emergency medical care in an emergency.";
"3.5. Violations in the provision of medical care (in particular, defects in treatment, premature discharge), as a result of which, in the absence of positive dynamics in the state of health, the insured person required a second justified request for medical help for the same disease within 15 days from the date of completion of outpatient treatment; re-hospitalization within 30 days from the date of completion of treatment in a hospital; repeated call to emergency medical services within 24 hours from the date of the previous call.";
"4.2. Absence in the primary medical documentation of the results of examinations, examinations, consultations with specialists, diary entries that allow assessing the dynamics of the health status of the insured person, the volume, nature, conditions of medical care and assessing the quality of the medical care provided.";
"4.6.1. Incorrect application of the tariff, requiring its replacement based on the results of the examination.";
c) clause 4.6 is supplemented with a new subclause 4.6.2:
"4.6.2. Inclusion in the invoice for payment of medical care/medical services in the absence of medical document information confirming the provision of medical care to the patient."
22. In Appendix 10 to this Procedure:
a) delete the word “(planned)”;
b) the table should be stated as follows:
Dates of requests | Paid for | Service |
|||||
compulsory health insurance | medical documentation | medical services | |||||
c) the words “Recognized as containing defects/violations in ___ cases in the amount of ___ rubles.
Not presented for medical and economic examination __________.
Subject to non-payment/payment reduction in ___ cases in the amount of ___ rubles.
A fine in _______ cases in the amount of ___________ rubles." shall be deleted.
Electronic document text
prepared by Kodeks JSC and verified against:
Official Internet portal
legal information
www.pravo.gov.ru, 05.05.2017,
N 0001201705050023
FEDERAL COMPULSORY HEALTH INSURANCE FUND
ABOUT MAKING CHANGES
IN ORGANIZATION AND CONTROL OF VOLUMES,
TERMS, QUALITY AND CONDITIONS OF PROVIDING MEDICAL CARE
ASSISTANCE FOR COMPULSORY HEALTH INSURANCE,
APPROVED BY ORDER OF THE FEDERAL FUND
COMPULSORY HEALTH INSURANCE
DATED DECEMBER 1, 2010 N 230
In accordance with “On compulsory health insurance in the Russian Federation” (Collection of Legislation of the Russian Federation, 2010, No. 49, Art. 6422; 2011, No. 49, Art. 7047; 2012, No. 49, Art. 6758; 2013, No. 27, Art. 3477; N 48, Art. 6165; 2016, N 1, Art. 52) and in order to improve the organization and control of the volumes, timing, quality and conditions of providing medical care under compulsory health insurance, I order:
Introduce changes to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved (registered by the Ministry of Justice of the Russian Federation on January 28, 2011, registration N 19614), as amended (registered by the Ministry of Justice of the Russian Federation Federation on December 9, 2011, registration N 22523), (registered with the Ministry of Justice of the Russian Federation on July 27, 2015, registration N 38182), (registered with the Ministry of Justice of the Russian Federation on January 27, 2016, registration number N 40813), according to Appendix to this order.
Chairman
N.N.STADCHENKO
Application
to the order of the Federal Fund
compulsory health insurance
dated February 22, 2017 N 45
CHANGES,
AMENDED TO THE ORGANIZATION AND CONTROL PROCEDURE
VOLUME, DATE, QUALITY AND CONDITIONS OF PROVISION
MEDICAL CARE FOR COMPULSORY MEDICAL CARE
INSURANCE, APPROVED BY ORDER OF THE FEDERAL
COMPULSORY HEALTH INSURANCE FUND
DATED DECEMBER 1, 2010 N 230
1. In paragraph 10, the words “(except for control when making payments for medical care provided to insured persons outside the constituent entity of the Russian Federation on the territory of which the compulsory medical insurance policy was issued)” should be deleted.
2. In paragraph 14:
a) subparagraph “a” should be stated as follows:
"a) repeated calls for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the date of the previous call - when calling emergency medical services again; ";
3. In paragraph 17, the words “determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” are deleted.
4. Paragraph one of paragraph 19 should be stated as follows:
“19. Based on the results of a planned or targeted medical and economic examination, a specialist expert draws up a medical and economic examination report in two copies: one is transferred to the medical organization, one copy remains in the medical insurance organization / territorial compulsory health insurance fund.
In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 10 to this Procedure.
If defects in medical care/violations in the provision of medical care are identified (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 3 to this Procedure."
5. In paragraph 21, after the words “carried out by verification,” add the words “(including using an automated system).”
6. In paragraph 25:
a) subparagraph “e” should be stated as follows:
"f) repeated justified call for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the date of the previous call - when calling emergency medical services again ;";
7. In paragraph 30:
a) the words “is determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” shall be deleted.
b) replace the number “0.8” with the number “0.5”.
8. In subparagraph “a” of paragraph 33, after the words “average duration of treatment,” add the words “shortened or extended treatment periods.”
9. In subparagraph “b” of paragraph 34, the words “divided by age, gender and other characteristics” should be deleted.
10. Paragraph 37 should be stated as follows:
"37. The quality of medical care expert who carried out the examination of the quality of medical care draws up an expert opinion (Appendix 11 to this Procedure) containing a description of the conduct and results of the examination of the quality of medical care, on the basis of which an act of examination of the quality of medical care is drawn up.
In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 6 to this Procedure.
If defects in medical care/violations in the provision of medical care are identified (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 5 to this Procedure.
In accordance with parts 9 and 10 of article 40 Federal Law the results of the examination of the quality of medical care, drawn up in accordance with Appendix 5 to this Procedure, are the basis for applying to a medical organization the measures provided for in Article 41 of the Federal Law, the terms of the contract for the provision and payment of medical care under compulsory health insurance and a list of grounds for refusing payment medical care (reduction of payment for medical care) (Appendix 8 to this Procedure).
Insurance medical organizations, on the basis of examination reports on the quality of medical care, prepare proposals for improving the quality of medical care and send them to the territorial fund of compulsory health insurance with the attachment of action plans to eliminate violations in the provision of medical care identified based on the results of the examination of the quality of medical care submitted by medical organizations." .
11. Paragraph 43 should be stated as follows:
"43. The number of cases subjected to re-examination is determined by the number of reasons for their conduct in accordance with paragraphs 40, 41 of this Procedure, and is:
a) from the number of primary medical and economic examinations not less than:
8% - in a 24-hour hospital;
8% - in day hospital;
0.8% - with outpatient care;
3% - emergency medical care outside a medical organization;
b) from the number of primary examinations of the quality of medical care no less than:
5% - in a 24-hour hospital;
3% - in day hospital;
0.5% - with outpatient care;
1.5% - emergency medical care outside a medical organization.
During the calendar year, all medical insurance organizations operating in the field of compulsory medical insurance must be subjected to re-examination in cases of medical care provided in all medical organizations."
12. In paragraph 52, after the words “corresponding medical request,” add the words “including in electronic form when using an electronic medical record.”
13. Paragraph 57 should be supplemented with the following paragraph:
“The medical organization notifies the territorial compulsory health insurance fund if the medical insurance organization fails to submit a report within the prescribed period.”
14. In paragraph 58:
a) in paragraph two, after the words “and one copy,” add the words “with an action plan to eliminate violations in the provision of medical care identified as a result of the examination of the quality of medical care,”;
“The medical insurance organization reviews the protocol of disagreements within 10 working days from the date of its receipt and sends the results of the review of the protocol to the medical organization.”
15. In subparagraph “b” of paragraph 66, the words “(for an insured event in which defects in medical care and/or violations in the provision of medical care were identified)” should be deleted.
16. In paragraph 67:
a) paragraph one should be supplemented with the words “taking into account the results of consideration of the protocol of disagreement (if any) under paragraph 58 and paragraph 74 (if any) of this Procedure.”;
b) paragraph three should be supplemented with the words “exceeding the established time of arrival of emergency medical teams when providing emergency medical care;”.
17. In paragraph 73:
a) subparagraph “c” should be stated as follows:
“c) internal control materials on the disputed case.”;
b) add the following paragraph:
“The results of departmental quality control of medical care (if any) are attached to the claim.”
18. Paragraph 77 should be supplemented with the following paragraph:
"If the territorial compulsory health insurance fund at the place of insurance does not agree with the results of the medical-economic examination and/or examination of the quality of medical care, the territorial compulsory health insurance funds agree on the candidacy of an expert specialist and/or an expert on the quality of medical care and the territorial fund at the place of provision of medical care conducts the appropriate examination again."
19. In Appendices 3, 5 to this Procedure, the word “(target)” should be deleted.
20. In Appendix 6 to this Procedure:
a) replace the word “(planned)” with the word “(consolidated)”;
b) the words “Identified defects in medical care/violations in the provision of medical care (in accordance with the List of grounds for refusal (reduction) of payment for medical care - Appendix 8 to this Procedure):" be replaced with the words “Checked cases of provision of medical care:”;
c) the table should be stated as follows:
|
Type, N of medical documentation |
Dates of requests |
Paid for medical services |
Service mark |
d) the words “Of these, the following were recognized as containing defects in medical care/violations in the provision of medical care: _________
Subject to non-payment/reduction of payment in _____ cases in the amount of _____ rubles.
A fine in _____ cases in the amount of _______ rubles shall be deleted.
21. In Appendix 8 to this Procedure: _
a) clause 3.11 is declared invalid;
b) subclause 1.1.3 of clause 1.1, clause 3.5, clause 4.2, subclause 4.6.1 of clause 4.6 shall be stated in the following wording:
"1.1.3. violation of the conditions for the provision of medical care, including the waiting period for medical care provided as planned, the time of arrival of emergency medical teams when providing emergency medical care in an emergency.";
"3.5. Violations in the provision of medical care (in particular, defects in treatment, premature discharge), as a result of which, in the absence of positive dynamics in the state of health, the insured person required a second justified request for medical help for the same disease within 15 days from the date of completion of outpatient treatment; re-hospitalization within 30 days from the date of completion of treatment in a hospital; repeated call to emergency medical services within 24 hours from the date of the previous call.";
"4.2. Absence in the primary medical documentation of the results of examinations, examinations, consultations with specialists, diary entries that allow assessing the dynamics of the health status of the insured person, the volume, nature, conditions of medical care and assessing the quality of the medical care provided.";
"4.6.1. Incorrect application of the tariff, requiring its replacement based on the results of the examination.";
c) clause 4.6 is supplemented with a new subclause 4.6.2:
"4.6.2. Inclusion in the invoice for payment of medical care/medical services in the absence of information in the medical document confirming the fact of provision of medical care to the patient."
22. In Appendix 10 to this Procedure:
a) delete the word “(planned)”;
b) the table should be stated as follows:
|
N of the compulsory health insurance policy A fine in ____ cases in the amount of _____ rubles." shall be deleted. |
FEDERAL COMPULSORY HEALTH INSURANCE FUND
ABOUT MAKING CHANGES
IN ORGANIZATION AND CONTROL OF VOLUMES,
TERMS, QUALITY AND CONDITIONS OF PROVIDING MEDICAL CARE
ASSISTANCE FOR COMPULSORY HEALTH INSURANCE,
APPROVED BY ORDER OF THE FEDERAL FUND
COMPULSORY HEALTH INSURANCE
DATED DECEMBER 1, 2010 N 230
In accordance with Chapter 9 of the Federal Law of November 29, 2010 N 326-FZ “On Compulsory Medical Insurance in the Russian Federation” (Collected Legislation of the Russian Federation, 2010, N 49, Art. 6422; 2011, N 49, Art. 7047; 2012, N 49, Art. 6758; 2013, N 27, Art. 3477; N 48, Art. 6165; 2016, N 1, Art. 52) and in order to improve the organization and control of volumes, timing, quality and conditions of provision medical assistance under compulsory health insurance I order:
To introduce changes to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230 (registered by the Ministry of Justice of the Russian Federation on January 28, 2011, registration N 19614), as amended by order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 N 144 (registered by the Ministry of Justice of the Russian Federation on December 9, 2011, registration N 22523), by order of the Federal Compulsory Medical Insurance Fund dated July 21, 2015 N 130 (registered with the Ministry of Justice of the Russian Federation on July 27, 2015, registration N 38182), by order of the Federal Compulsory Medical Insurance Fund dated December 29, 2015 N 277 (registered with the Ministry of Justice of the Russian Federation on January 27, 2016, registration number N 40813), according to the appendix to this order.
Chairman
N.N.STADCHENKO
Application
to the order of the Federal Fund
compulsory health insurance
dated February 22, 2017 N 45
CHANGES,
AMENDED TO THE ORGANIZATION AND CONTROL PROCEDURE
VOLUME, DATE, QUALITY AND CONDITIONS OF PROVISION
MEDICAL CARE FOR COMPULSORY MEDICAL CARE
INSURANCE, APPROVED BY ORDER OF THE FEDERAL
COMPULSORY HEALTH INSURANCE FUND
DATED DECEMBER 1, 2010 N 230
1. In paragraph 10, the words “(except for control when making payments for medical care provided to insured persons outside the constituent entity of the Russian Federation on the territory of which the compulsory medical insurance policy was issued)” should be deleted.
2. In paragraph 14:
a) subparagraph “a” should be stated as follows:
"a) repeated calls for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the date of the previous call - when calling emergency medical services again; ";
3. In paragraph 17, the words “determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” are deleted.
4. Paragraph one of paragraph 19 should be stated as follows:
“19. Based on the results of a planned or targeted medical and economic examination, a specialist expert draws up a medical and economic examination report in two copies: one is transferred to the medical organization, one copy remains in the medical insurance organization / territorial compulsory health insurance fund.
In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 10 to this Procedure.
If defects in medical care/violations in the provision of medical care are identified (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 3 to this Procedure."
5. In paragraph 21, after the words “carried out by verification,” add the words “(including using an automated system).”
6. In paragraph 25:
a) subparagraph “e” should be stated as follows:
"f) repeated justified call for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the date of the previous call - when calling emergency medical services again ;";
7. In paragraph 30:
a) the words “is determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” shall be deleted.
b) replace the number “0.8” with the number “0.5”.
8. In subparagraph “a” of paragraph 33, after the words “average duration of treatment,” add the words “shortened or extended treatment periods.”
9. In subparagraph “b” of paragraph 34, the words “divided by age, gender and other characteristics” should be deleted.
10. Paragraph 37 should be stated as follows:
"37. The quality of medical care expert who carried out the examination of the quality of medical care draws up an expert opinion (Appendix 11 to this Procedure) containing a description of the conduct and results of the examination of the quality of medical care, on the basis of which an act of examination of the quality of medical care is drawn up.
In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 6 to this Procedure.
If defects in medical care/violations in the provision of medical care are identified (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 5 to this Procedure.
In accordance with parts 9 and 10 of Article 40 of the Federal Law, the results of the examination of the quality of medical care, drawn up in accordance with Appendix 5 to this Procedure, are the basis for applying to a medical organization the measures provided for in Article 41 of the Federal Law, the terms of the contract for the provision and payment of medical care on compulsory health insurance and a list of grounds for refusal to pay for medical care (reduction of payment for medical care) (Appendix 8 to this Procedure).
Insurance medical organizations, on the basis of examination reports on the quality of medical care, prepare proposals for improving the quality of medical care and send them to the territorial fund of compulsory health insurance with the attachment of action plans to eliminate violations in the provision of medical care identified based on the results of the examination of the quality of medical care submitted by medical organizations." .
11. Paragraph 43 should be stated as follows:
"43. The number of cases subjected to re-examination is determined by the number of reasons for their conduct in accordance with paragraphs 40, 41 of this Procedure, and is:
a) from the number of primary medical and economic examinations not less than:
8% - in a 24-hour hospital;
8% - in day hospital;
0.8% - with outpatient care;
3% - emergency medical care outside a medical organization;
b) from the number of primary examinations of the quality of medical care no less than:
5% - in a 24-hour hospital;
3% - in day hospital;
0.5% - with outpatient care;
1.5% - emergency medical care outside a medical organization.
During the calendar year, all medical insurance organizations operating in the field of compulsory medical insurance must be subjected to re-examination in cases of medical care provided in all medical organizations."
12. In paragraph 52, after the words “corresponding medical request,” add the words “including in electronic form when using an electronic medical record.”
13. Paragraph 57 should be supplemented with the following paragraph:
“The medical organization notifies the territorial compulsory health insurance fund if the medical insurance organization fails to submit a report within the prescribed period.”
14. In paragraph 58:
a) in paragraph two, after the words “and one copy,” add the words “with an action plan to eliminate violations in the provision of medical care identified as a result of the examination of the quality of medical care,”;
“The medical insurance organization reviews the protocol of disagreements within 10 working days from the date of its receipt and sends the results of the review of the protocol to the medical organization.”
15. In subparagraph “b” of paragraph 66, the words “(for an insured event in which defects in medical care and/or violations in the provision of medical care were identified)” should be deleted.
16. In paragraph 67:
a) paragraph one should be supplemented with the words “taking into account the results of consideration of the protocol of disagreement (if any) under paragraph 58 and paragraph 74 (if any) of this Procedure.”;
b) paragraph three should be supplemented with the words “exceeding the established time of arrival of emergency medical teams when providing emergency medical care;”.
17. In paragraph 73:
a) subparagraph “c” should be stated as follows:
“c) internal control materials on the disputed case.”;
b) add the following paragraph:
“The results of departmental quality control of medical care (if any) are attached to the claim.”
18. Paragraph 77 should be supplemented with the following paragraph:
"If the territorial compulsory health insurance fund at the place of insurance does not agree with the results of the medical-economic examination and/or examination of the quality of medical care, the territorial compulsory health insurance funds agree on the candidacy of an expert specialist and/or an expert on the quality of medical care and the territorial fund at the place of provision of medical care conducts the appropriate examination again."
19. In Appendices 3, 5 to this Procedure, the word “(target)” should be deleted.
20. In Appendix 6 to this Procedure:
a) replace the word “(planned)” with the word “(consolidated)”;
b) the words “Identified defects in medical care/violations in the provision of medical care (in accordance with the List of grounds for refusal (reduction) of payment for medical care - Appendix 8 to this Procedure):" be replaced with the words “Checked cases of provision of medical care:”;
c) the table should be stated as follows:
| N p/p | Dates of requests | ICD code | Service mark | Start | end | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
d) the words “Of these, the following were recognized as containing defects in medical care/violations in the provision of medical care: _________
Subject to non-payment/reduction of payment in _____ cases in the amount of _____ rubles.
A fine in _____ cases in the amount of _______ rubles shall be deleted.
21. In Appendix 8 to this Procedure: _
a) clause 3.11 is declared invalid;
b) subclause 1.1.3 of clause 1.1, clause 3.5, clause 4.2, subclause 4.6.1 of clause 4.6 shall be stated in the following wording:
"1.1.3. violation of the conditions for the provision of medical care, including the waiting period for medical care provided as planned, the time of arrival of emergency medical teams when providing emergency medical care in an emergency.";
"3.5. Violations in the provision of medical care (in particular, defects in treatment, premature discharge), as a result of which, in the absence of positive dynamics in the state of health, the insured person required a second justified request for medical help for the same disease within 15 days from the date of completion of outpatient treatment; re-hospitalization within 30 days from the date of completion of treatment in a hospital; repeated call to emergency medical services within 24 hours from the date of the previous call.";
"4.2. Absence in the primary medical documentation of the results of examinations, examinations, consultations with specialists, diary entries that allow assessing the dynamics of the health status of the insured person, the volume, nature, conditions of medical care and assessing the quality of the medical care provided.";
"4.6.1. Incorrect application of the tariff, requiring its replacement based on the results of the examination.";
c) clause 4.6 is supplemented with a new subclause 4.6.2:
"4.6.2. Inclusion in the invoice for payment of medical care/medical services in the absence of information in the medical document confirming the fact of provision of medical care to the patient."
22. In Appendix 10 to this Procedure:
a) delete the word “(planned)”;
b) the table should be stated as follows:
| N p/p | N of the compulsory health insurance policy | Type, N of medical documentation | Dates of requests | ICD code | Paid for medical services | Service mark | Start | end | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
c) the words “Recognized as containing defects/violations in ____ cases in the amount of ____ rubles.
Not presented for medical and economic examination ______.
Subject to non-payment/payment reduction in ____ cases in the amount of _____ rubles.
A fine in ____ cases in the amount of _____ rubles." shall be deleted.
Order of the Federal Compulsory Health Insurance Fund dated February 22, 2017 No. 45 “On amendments to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230” (not entered into force)
In accordance with Chapter 9 of the Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation” (Collected Legislation of the Russian Federation, 2010, No. 49, Art. 6422; 2011, No. 49, Art. 7047; 2012, No. 49, Art. 6758; 2013, No. 27, Art. 3477; No. 48, Art. 6165; 2016, No. 1, Art. 52) and in order to improve the organization and control of volumes, timing, quality and conditions of provision medical assistance under compulsory health insurance I order:
Amend the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230 (registered by the Ministry of Justice of the Russian Federation on January 28, 2011, registration No. 19614) as amended by order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144 (registered by the Ministry of Justice of the Russian Federation on December 9, 2011, registration No. 22523), by order of the Federal Compulsory Medical Insurance Fund dated July 21, 2015 No. 130 (registered with the Ministry of Justice of the Russian Federation on July 27, 2015, registration No. 38182), by order of the Federal Compulsory Medical Insurance Fund dated December 29, 2015 No. 277 (registered with the Ministry of Justice of the Russian Federation on January 27, 2016, registration number No. 40813), according to the appendix to this order.
Application
to the order of the Federal Fund
compulsory health insurance
dated February 22, 2017 No. 45
Changes made to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230
1. In paragraph 10, the words “(except for control when making payments for medical care provided to insured persons outside the constituent entity of the Russian Federation on the territory of which the compulsory medical insurance policy was issued)” should be deleted.
3. In paragraph 17, the words “determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” are deleted.
4. Paragraph one of paragraph 19 should be stated as follows:
"19. Based on the results of a planned or targeted medical and economic examination, a specialist expert draws up a medical and economic examination report in two copies: one is transferred to the medical organization, one copy remains in the medical insurance organization / territorial compulsory health insurance fund.
5. In paragraph 21, after the words “carried out by verification,” add the words “(including using an automated system).”
a) the words “determined by the plan of inspections by medical insurance organizations of medical organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” shall be deleted.
b) replace the number “0.8” with the number “0.5”.
8. In subparagraph “a” of paragraph 33, after the words “average duration of treatment,” add the words “shortened or extended duration of treatment.”
9. In subparagraph “b” of paragraph 34, the words “divided by age, gender and other characteristics” should be deleted.
10. Paragraph 37 should be stated as follows:
"37. The quality of medical care expert who carried out the examination of the quality of medical care draws up an expert opinion (Appendix 11 to this Procedure) containing a description of the conduct and results of the examination of the quality of medical care, on the basis of which an act of examination of the quality of medical care is drawn up.
In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 6 to this Procedure.
If defects in medical care/violations in the provision of medical care are identified (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 5 to this Procedure.
In accordance with parts 9 and 10 of Article 40 of the Federal Law, the results of the examination of the quality of medical care, drawn up in accordance with Appendix 5 to this Procedure, are the basis for applying to a medical organization the measures provided for in Article 41 of the Federal Law, the terms of the contract for the provision and payment of medical care on compulsory health insurance and a list of grounds for refusal to pay for medical care (reduction of payment for medical care) (Appendix 8 to this Procedure).
Medical insurance organizations, on the basis of examination reports on the quality of medical care, prepare proposals for improving the quality of medical care and send them to the territorial compulsory health insurance fund, attaching action plans to eliminate violations in the provision of medical care identified based on the results of the examination of the quality of medical care, submitted by medical organizations.” .
11. Paragraph 43 should be stated as follows:
8% - in a 24-hour hospital;
0.8% - with outpatient care;
b) from the number of primary examinations of the quality of medical care no less than:
0.5% - with outpatient care;
1.5% - emergency medical care outside a medical organization.
During the calendar year, all medical insurance organizations operating in the field of compulsory medical insurance must be subjected to re-examination in cases of medical care provided in all medical organizations.”
12. In paragraph 52, after the words “corresponding medical request,” add the words “including in electronic form when using an electronic medical record.”
13. Paragraph 57 should be supplemented with the following paragraph:
a) in paragraph two, after the words “and one copy,” add the words “with an action plan to eliminate violations in the provision of medical care identified as a result of the examination of the quality of medical care,”;
15. In subparagraph “b” of paragraph 66, the words “(for an insured event in which defects in medical care and/or violations in the provision of medical care were identified)” should be deleted.
a) paragraph one should be supplemented with the words “taking into account the results of consideration of the protocol of disagreement (if any) under paragraph 58 and paragraph 74 (if any) of this Procedure.”;
b) paragraph three should be supplemented with the words “exceeding the established time of arrival of emergency medical teams when providing emergency medical care;”.
18. Paragraph 77 should be supplemented with the following paragraph:
“If the territorial compulsory health insurance fund at the place of insurance does not agree with the results of the medical and economic examination and/or examination of the quality of medical care, the territorial compulsory health insurance funds agree on the candidacy of a specialist expert and/or expert on the quality of medical care and the territorial fund at the place of provision of medical care carries out the corresponding examination again."
19. In Appendices 3, 5 to this Procedure, the word “(target)” should be deleted.
20. In Appendix 6 to this Procedure:
Draft Order of the Federal Compulsory Health Insurance Fund “On amendments to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by Order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230” (prepared Federal Compulsory Medical Insurance Fund 12/27/2016)
Project dossier
In accordance with Chapter 9 of the Federal Law of November 29, 2010 N 326-FZ “On Compulsory Medical Insurance in the Russian Federation” (Collected Legislation of the Russian Federation, 2010, N 49, Art. 6422; 2011, N 49, Art. 7047; 2012, N 49, Art. 6758; 2013, N 27, Art. 3477; N 48, Art. 6165; 2016, N 1, Art. 52) and in order to improve the organization and control of volumes, timing, quality and conditions of provision medical assistance under compulsory health insurance
Amend the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230 (registered by the Ministry of Justice of the Russian Federation on January 28, 2011, registration N 19614) as amended by order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 N 144 (registered by the Ministry of Justice of the Russian Federation on December 9, 2011, registration N 22523), by order of the Federal Compulsory Medical Insurance Fund dated July 21, 2015 N 130 (registered with the Ministry of Justice of the Russian Federation on July 27, 2015, registration N 38182), by order of the Federal Compulsory Medical Insurance Fund dated December 29, 2015 N 277 (registered with the Ministry of Justice of the Russian Federation on January 27, 2016, registration number N 40813) in accordance with the appendix to this order.
Application
to the order of the Federal Compulsory Medical Insurance Fund
dated "___"____________ 2016 N______
Changes,
introduced into the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230
a) subparagraph “a” should be stated as follows:
“a) repeated visits for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the moment of the previous call - when calling emergency medical services again;";
2. Paragraph one of paragraph 19 should be stated as follows:
"19. Based on the results of a planned or targeted medical and economic examination, a specialist expert draws up a medical and economic examination report (Appendices 3 and 10 to this Procedure) in two copies: one is transferred to the medical organization, one copy remains in the medical insurance organization / territorial compulsory medical fund insurance.
In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 10 to this Procedure.
In case of detection of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 3 to this Procedure."
3. In paragraph 21, after the words “carried out by verification,” add the words “(including using an automated system).”
a) subparagraph “e” should be stated as follows:
“f) repeated justified appeal for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the moment of the previous call - when calling emergency medical services again;";
5. In paragraph 30, replace the number “0.8” with the number “0.5”.
6. In subparagraph “a” of paragraph 33, after the words “average duration of treatment,” add the words “shortened or extended duration of treatment.”
7. In subparagraph “b” of paragraph 34, the words “divided by age, gender and other characteristics” should be deleted.
8. Paragraph two of paragraph 37 should be stated as follows:
“In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 6 to this Procedure.
In accordance with parts 9 and 10 of Article 40 of the Federal Law, the results of the examination of the quality of medical care, drawn up by the relevant act in the form established by the Federal Compulsory Health Insurance Fund (Appendix 5 to this Procedure), are the basis for applying to a medical organization the measures provided for in Article 41 of the Federal Law law, the terms of the contract for the provision and payment of medical care under compulsory health insurance and a list of grounds for refusal to pay for medical care (reduction of payment for medical care) (Appendix 8 to this Procedure).
9. Paragraph one of paragraph 43 should be stated as follows:
"43. The number of cases subjected to re-examination is determined by the number of reasons for their conduct in accordance with paragraphs 40, 41 of this Procedure, and is:
a) from the number of primary medical and economic examinations not less than:
8% - in day hospital;
3% - emergency medical care outside a medical organization;
5% - in a 24-hour hospital;
3% - in day hospital;
1.5% - emergency medical care outside a medical organization."
10. In paragraph 52, after the words “corresponding medical request,” add the words “including in electronic form when using an electronic medical record.”
11. Paragraph 57 should be supplemented with the following paragraph:
“The medical organization notifies the territorial compulsory health insurance fund if the medical insurance organization fails to submit a report within the prescribed period.”
12. Paragraph 58 should be supplemented with the following paragraph:
“The medical insurance organization reviews the protocol of disagreements within 10 working days from the date of its receipt and sends the results of the review of the protocol to the medical organization.”
13. In subparagraph “b” of paragraph 66, the words “(for an insured event in which defects in medical care and/or violations in the provision of medical care were identified)” should be deleted.
14. Paragraph three of paragraph 67 should be supplemented with the words “exceeding the established time of arrival of emergency medical teams when providing emergency medical care;”.
a) subparagraph “c” should be stated as follows:
“c) internal control materials on the disputed case.”;
b) add the following paragraph:
“The results of departmental quality control of medical care (if any) are attached to the claim.”
16. In Appendices 3, 5 to the Procedure, the word “(target)” should be deleted.
17. In Appendix 6 to the Procedure:
a) replace the word “(planned)” with the word “(consolidated)”;
b) the words “Identified defects in medical care / violations in the provision of medical care (in accordance with the List of grounds for refusal (reduction) of payment for medical care - Appendix 8 to this Procedure):" replace with the words “Checked cases of provision of medical care:”;
c) in the table, the columns “Code of medical care defect/violation”, “Subject to non-payment/reduction of payment” and “Amount of fine, rub.” exclude;
d) the words “Of these, the following were recognized as containing defects in medical care/violations in the provision of medical care: ___________________
Subject to non-payment/reduction of payment in _____ cases in the amount of ___ rubles.
Fine in ________ cases in the amount of _______________ rubles.” exclude.
18. In Appendix 8 to the Procedure:
a) clause 3.11. exclude;
b) clauses 1.1.3., 3.5., 4.2., 4.6., 4.6.1. stated in the following editions:
"1.1.3. violation of the conditions for the provision of medical care, including the waiting time for medical care provided as planned, the time of arrival of emergency medical teams.”;
"3.5. Violations in the provision of medical care (treatment defects, premature discharge, etc.), as a result of which, in the absence of positive dynamics in the state of health, the insured person required a second justified request for medical help for the same disease within 15 days from the date of completion of outpatient treatment ; re-hospitalization within 30 days from the date of completion of hospital treatment; repeat call of emergency medical services within 24 hours from the moment of the previous call.”;
"4.2. Absence in the primary medical documentation of the results of examinations, examinations, consultations with specialists, diary entries that allow assessing the dynamics of the health status of the insured person, the volume, nature, conditions of medical care and assessing the quality of the medical care provided.”;
"4.6. Inclusion in the invoice for payment of medical care/medical services in the absence of information in the medical document confirming the fact of provision of medical care to the patient.”;
"4.6.1. Incorrect application of the tariff, requiring its replacement based on the results of the examination.”
19. In Appendix 10 to the Procedure:
a) delete the words “(planned)”;
b) in the table, exclude the columns “Code of medical care defect/violation” and “Amount of mutual settlement”;
c) the words “Recognized as containing defects/violations in ___ cases in the amount of ___ rubles.
Not presented for medical and economic examination _____________.
Subject to non-payment/payment reduction in ___ cases in the amount of __ rubles.
A fine in ________ cases in the amount of ____________ rubles.” exclude.
Document overview
A draft amendment to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory medical insurance has been presented.
The cases in which a targeted medical and economic examination is carried out are specified. Thus, for repeated requests for the same disease, it will be carried out within 15 days when providing outpatient care; within 30 days - upon re-hospitalization (currently - 30 and 90 days, respectively); within 24 hours from the moment of the previous call - when calling an ambulance again.
It is proposed to reduce the volume of monthly examinations when providing medical care on an outpatient basis from 0.8% to 0.5%.
The number of cases subject to re-examination is specified.
A 10-day period is established for consideration of the protocol of disagreements by the medical insurance organization from the moment of its receipt.
It is established which forms are used to draw up reports in the event of detection of defects in medical care/violations and which forms are used in their absence.
The forms of certificates of examination of the quality of medical care are being updated. The list of grounds for refusal to pay for medical care is being revised.
2016
2015
year 2014
- Order of the Compulsory Medical Insurance Fund dated November 18, 2014 No. 200 “On establishing Requirements for the structure and content of the tariff agreement”
- order of the Federal Compulsory Medical Insurance Fund dated March 18, 2013 No. 57 “On declaring the order of the Federal Compulsory Health Insurance Fund invalid”
- order of the Compulsory Medical Insurance Fund dated March 26, 2013 No. 65 “On establishing the form and procedure for reporting on wages employees of medical organizations in the field of compulsory health insurance"
- Order of the Compulsory Medical Insurance Fund dated June 14, 2013 No. 131 “On invalidating certain regulatory legal acts of the Federal Compulsory Health Insurance Fund”
- Order of the Compulsory Medical Insurance Fund dated April 16, 2012 No. 73 “On approval of regulations on control over the activities of insurance medical organizations and medical organizations in the field of compulsory health insurance by territorial compulsory health insurance funds”
- order of the Federal Compulsory Medical Insurance Fund dated January 14, 2011 No. 9 “On the implementation of the Decree of the Government of the Russian Federation of December 31, 2010 N 1228” (together with the “Procedure for the submission by the territorial compulsory health insurance fund of an application for financial support for expenses associated with additional medical examination of working citizens”, “ The procedure for the submission by the territorial compulsory medical insurance fund of information to complete calculations for the additional medical examination of working citizens”, “The procedure for maintaining registers of invoices for the payment of expenses associated with the additional medical examination of working citizens (Form RD-1)”)
- order of the Federal Compulsory Medical Insurance Fund dated January 18, 2011 No. 10 (as amended on April 7, 2011) “On the implementation of Decree of the Government of the Russian Federation dated December 31, 2010 No. 1234” (together with the “Procedure for submission by territorial compulsory health insurance funds of applications for subsidies for medical examinations orphans and children in difficult life situations staying in inpatient institutions, and information for completing calculations for the financial support of the medical examination of orphans and children in difficult life situations staying in inpatient institutions”, “Procedure for maintaining and submitting registers of accounts to pay for the costs of medical examination of orphans and children in difficult life situations staying in inpatient institutions")
- order of the Federal Compulsory Medical Insurance Fund dated January 19, 2011 No. 12 “On approval of the Procedure for conducting medical and economic examination by territorial compulsory health insurance funds of invoices submitted by medical organizations for the payment of expenses associated with the medical examination of orphans and children in difficult life situations staying in inpatient institutions”
- order of the Federal Compulsory Medical Insurance Fund dated January 19, 2011 No. 13 “On approval of the Procedure for carrying out medical and economic examination by territorial compulsory health insurance funds of invoices submitted by medical organizations for the payment of expenses associated with additional medical examination of working citizens”
- Order of the Compulsory Medical Insurance Fund dated August 16, 2011 No. 146 “On approval of reporting forms”
- order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144 “On amendments to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230”
- Order of the Compulsory Medical Insurance Fund dated December 12, 2011 No. 229 “On approval of the form and procedure for submitting a report on the use of subventions provided from the budget of the Federal Compulsory Health Insurance Fund to the budgets of territorial compulsory health insurance funds”
- order of the Federal Compulsory Medical Insurance Fund dated December 13, 2011 No. 230 “On approval of the Procedure for maintaining a territorial register of experts on the quality of medical care by the territorial compulsory health insurance fund and posting it on the official website of the territorial compulsory health insurance fund on the Internet”
- order of the Federal Compulsory Medical Insurance Fund dated December 19, 2011 No. 235 “On approval of the procedure and form for submitting a report on the use of budget funds of the Federal Compulsory Health Insurance Fund for the purposes provided for in Part 12 of Article 51 of the Federal Law “On Compulsory Health Insurance in the Russian Federation”
- order of the Compulsory Medical Insurance Fund dated December 26, 2011 No. 245 “On amendments to the Procedure for the use of rationed funds safety stock territorial compulsory health insurance fund, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 227"
- Order of the Compulsory Medical Insurance Fund dated January 1, 2010 No. 230 “On approval of the procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance”
- order of the Federal Compulsory Medical Insurance Fund dated December 16, 2010 No. 240 (as amended on March 15, 2011) “On approval of the Procedure and form for reporting on the use of funds for the purposes of implementing regional programs for the modernization of healthcare in the constituent entities of the Russian Federation in the period 2011-2012”
- order of the Federal Compulsory Medical Insurance Fund dated March 14, 2008 No. 57 (as amended on January 19, 2011) “On approval of the forms and procedure for submitting reports on the use of subsidies for additional medical examinations of working citizens” (together with the “Procedure for the submission by the territorial compulsory health insurance fund of a report on the use of subsidies for conducting additional medical examinations of working citizens”, “The procedure for the submission by a medical organization of a report on the use of funds for additional medical examinations of working citizens”)
- Order of the Compulsory Medical Insurance Fund dated June 3, 2008 No. 120 “On approval of the form and procedure for submitting reports on the use of subsidies for medical examination of orphans and children left without parental care in inpatient institutions”
year 2013
year 2012
2011
2010
2008
Compulsory medical insurance news
06/08/2018: On the implementation of activities in the field of compulsory health insurance in the Vladimir region in 2019
Explanations on the procedure for submitting the Notification of activities in the field of compulsory medical insurance in the Vladimir region in 2019
04/19/2018: GBUZVO "Kameshkovo Central District Hospital" expressed gratitude to the territorial compulsory medical insurance fund of the Vladimir region
Gratitude to the TFOMS of the Vladimir region
01/24/2017: About an updated sample application for choosing (replacing) a medical insurance organization
The Federal Compulsory Health Insurance Fund sent an updated sample application for selection (replacement) of a medical insurance organization to the territorial compulsory health insurance funds
08/01/2016: On the termination of the activities of CJSC Capital Medical Insurance
On August 1, 2016, the medical insurance organization CJSC Capital Medical Insurance ceased its activities in the field of compulsory medical insurance.
05/26/2016: About the start of work of the contact center in the field of compulsory health insurance in the Vladimir region
From June 1, 2016, a contact center in the field of compulsory health insurance begins its work in the Vladimir region
Territorial Compulsory Medical Insurance Fund of the Vladimir Region