The tariff agreement on CHI for the next year was approved at the end of the year. Responsible for the development of tariffs for medical institutions is the commission for the development of the territorial program of the TFOMS.

The situation is considered when the commission decided to reduce the tariff without warning, as a result of which the medical institution suffered serious losses.

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Tariff agreement for CHI

Consider the practical situation and analyze it in detail from a legal point of view. The medical institution operates in CHI system, has a permissive license to carry out medical activities included in the registers of medical institutions.

The commission for the development of the territorial part of the compulsory medical insurance program annually develops and approves a regional tariff agreement that is valid within the corresponding subject of the Russian Federation.

At the end of 2016, the tariff agreement for 2017 was approved. For one of medical services provided in a medical institution, a tariff for payment was set at 7,000 rubles. This tariff was applied in settlements between TFOMS and insurance companies from the beginning of the year to May 15, 2017.

In early May, the Commission sent a tariff agreement to the medical institution, from which it follows that the previously established tariff for this medical service is reduced to 5,000 rubles. At the same time, the beginning of this agreement is determined from 01/01/2016, that is, for the past months.

Annex N 1.1. List of medical organizations providing primary health care, using the method of payment for medical care according to the per capita standard of financing for persons attached to the medical organization Appendix N 1.1-a. The list of medical organizations providing medical care in a day hospital, using the method of payment for medical care according to the capitation standard of financing for persons attached to a medical organization Appendix N 1.2. List of medical organizations providing primary health care in the direction of other medical organizations with attached persons and participating in horizontal calculations Appendix N 1.2-a. List of medical organizations providing medical care in a day hospital in the direction of other medical organizations with attached persons and participating in horizontal calculations Appendix N 1.3. List of medical organizations providing primary health care and specialized medical care that do not participate in horizontal calculations Appendix N 1.3-a. List of medical organizations providing medical care in a day hospital that do not participate in horizontal calculations

Annex N 1.4. The procedure for attaching and registering citizens insured under compulsory medical insurance in the city of Moscow to medical organizations participating in the implementation of the Territorial Compulsory Medical Insurance Program, providing primary health care, as well as primary health care in the profile "dentistry", using the method payment for medical care according to the per capita funding standard for

Appendix 1. Application for choosing a medical organization for receiving primary health care Appendix 2. Application for choosing a medical organization for receiving primary health care Annex 4. Application for the choice of a medical organization for receiving primary health care in the profile "dentistry" Annex 5. Informed consent to the conditions for the provision of primary health care when choosing a medical organization on the profile "dentistry" when choosing a medical organization

Annex N 1.5. The list of medical services provided regardless of the availability of a referral from medical organizations at the place of attachment of the insured persons as part of urgent measures, the costs of which are reimbursed in horizontal settlements with the MO Appendix N 1.6.1. List of medical organizations providing primary health care in the field of "dentistry", using the method of payment for medical care according to the capitation standard of financing for those who have attached themselves to a medical organization Appendix N 1.6.2. List of medical organizations providing primary health care in the field of "stomatology" in the direction of other medical organizations that have attached persons and participate in horizontal calculations Appendix N 1.6.3. List of medical organizations providing primary health care in the field of "dentistry" that do not participate in horizontal calculations

Appendix N 3. Instructions for recording medical care

Appendix N 4. List of medical organizations providing emergency medical care outside medical organizations Appendix N 5. Regulations on the procedure for paying for medical care provided under the territorial program of compulsory medical insurance in Moscow within the framework of the Territorial Compulsory Medical Insurance Program, used, among other things, for horizontal calculations Appendix N 7. Gender and age differentiation coefficients of the per capita standard for medical organizations with per capita financing that provide primary health care Appendix N 7.1. Gender and age differentiation coefficients of the per capita standard for medical organizations with per capita funding providing primary health care in the profile "dentistry" Appendix N 8.1. Tariffs for payment for medical care provided in inpatient conditions for completed cases of treatment of the disease within the framework of the Territorial Compulsory Medical Insurance Program Annex N 8.2. Tariffs for payment for medical care provided in inpatient conditions for certain medical services under the Territorial Compulsory Medical Insurance Program Appendix N 10. Tariffs for payment for medical care provided in a day hospital within the framework of the Territorial Compulsory Medical Insurance Program, used, among other things, for horizontal payments Appendix N 10.1. List of medical services provided in a day hospital to adults and children, not included in the per capita funding standard for persons attached to a medical organization

Appendix N 12. The procedure for calculating and transferring funds for per capita financing to medical organizations providing primary health care, and to medical organizations providing primary health care in the field of "dentistry", on an outpatient basis to attached persons for 2017

Annex N 13.1. The list of grounds for refusing to pay for medical care (reducing the payment for medical care) and the consequences of failure to fulfill contractual obligations to provide medical care to citizens insured under compulsory medical insurance in Moscow Appendix N 13.2. The list of grounds for refusing to pay for medical care (reducing the payment for medical care) and the consequences of failure to fulfill contractual obligations to provide medical care to citizens insured under compulsory medical insurance in other regions of the Russian Federation Appendix N 13.3. The list of grounds for refusing to pay for medical care (reducing the payment for medical care) and the consequences of failure to fulfill contractual obligations to provide medical care to citizens who are not identified and not insured under compulsory medical insurance Appendix N 13.5. List of grounds for refusing to pay for medical care (reducing payment for medical care) and the consequences of failure to fulfill contractual obligations to provide emergency, including emergency specialized, medical care to citizens insured under compulsory medical insurance in other regions of the Russian Federation Appendix N 13.6. The list of grounds for refusing to pay for medical care (reducing the payment for medical care) and the consequences of failure to fulfill contractual obligations to provide emergency, including emergency specialized, medical care to citizens who are not identified and are not insured under compulsory health insurance Annex N 14. The procedure for sending proposals for accounting for medical care to the Working Group on the calculation and adjustment of tariffs in the compulsory medical insurance system Annex N 14.1. Technological map of medical services Appendix N 14.2. Technological map of a comprehensive medical service Appendix No. 15. Standard form of application of a medical organization participating in the system of compulsory medical insurance in Moscow, regarding the correction of the volume of medical care and financial support

Tariff agreement
to pay for medical care provided under the territorial program of compulsory medical insurance of the city of Moscow for 2017
(Moscow, December 29, 2016)

With changes and additions from:

hereinafter referred to as the Parties, in accordance with Part 2 of Article 30 of the Federal Law of November 29, 2010 N 326-FZ "On Compulsory Medical Insurance in Russian Federation"have concluded this Tariff Agreement for the payment of medical care provided under the Territorial Program of Compulsory Medical Insurance of the City of Moscow for 2017 (hereinafter referred to as the Tariff Agreement), as follows:

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The introduction of compulsory medical insurance (CMI) has made it possible for the population to receive medical care in the country, regardless of the place of permanent residence or registration. The volume, as well as the procedure for free medical care, is determined by the relevant administrative documents of the Government and the Ministry of Health of Russia. The source of financing is insurance fees from production and business entities. The spending of funds is planned, it provides for the annual determination of the cost of services, tariffs, with their fixing in the agreement. The tariff agreement for CHI for 2020 is presented below.

What is a tariff agreement

Tariff agreement (TS) - a document regulating all issues related to the provision of insurance coverage, receipt of fees, tariffication of services, distribution of the fund's funds. The parties to the agreement are represented by the compulsory medical insurance fund, the health department, representatives of medical institutions, insurance companies and medical trade unions of the subject of the federation. Calculations of the full tariff are carried out based on an analysis of the state of affairs of the past year and prospects for the next period. Since the base represents the result of financial calculations, it should be recalled what the full tariff is in the CHI system.

Full insurance rate - all expenditure items for supporting CHI (wages, utilities, medicines, purchase of related, medical aid, etc.), with the exception of capital investments (purchase of expensive medical equipment, capital construction, repair).

The main sections of the TC include the following provisions:

• an updated list of services provided by insurance coverage;
• volume, methodology and procedure for calculating insurance rates;
• ways to pay into the fund compulsory insurance;
• a list of insurance companies licensed and admitted to insurance under compulsory health insurance;
• a list of medical institutions with concluded agreements on the provision of assistance to compulsory medical insurance;
• instructions, recommendations on keeping records of the provided medical care and spending the Fund's funds for this work;
• direct reports on the write-off of funds allocated for the provision of free medical care to the population, and so on.

During the calendar year, the tariff agreement can be supplemented with annexes with a change in the tariffing of services, the rationale for decisions made on this matter, additional instructional, informational materials, as well as other documents necessary for organizing the provision of quality medical care in a separate subject of the federation.

Where to see the list of tariffs

In pursuance of Order No. 108-FFOMS, organizational and practical measures were taken, which made it possible, from the beginning of 2015, for residents of the country to view the compulsory medical insurance tariff for any type of service provided free of charge, and for insured persons to familiarize themselves with the amount of funds spent on restoring their health. To obtain information, it is enough to apply via the Internet to the medical tariff guide posted on the official website of the local MHIF.

The information system was created to achieve the following goals:

1. Implementation of control functions by the population. If a discrepancy between the quality or volume of practically provided medical care and the declared tariff agreement is revealed, the insured person has the opportunity to demand the elimination of the deficiency by informing the insurers or the Compulsory Health Insurance Fund.
2. The provided information on tariff rules enables the insured person to compare prices within the CHI and private clinics, which allows us to assume an increase in requests for treatment to state medical institutions.
3. Prevention of corruption manifestations in health care. The certificates contain information about the part of the cost of the service provided for the remuneration of the doctor. Awareness of the approximate amount will warn the "gratitude" to the doctor from the patient.
4. Openness of information about tariffs and fees will force the heads of medical institutions to a balanced redistribution of the funds received.
5. It will make it possible for the population to take responsibility for their own health. Knowing the cost of a particular service, many will take preventive measures to preserve their health so as not to “donate” significant amounts own funds medical institutions.

If it is not possible to obtain information of interest about compulsory insurance or tariffs via the Internet, then you can check it with your doctor, the administration of a medical institution or an insurer.

Tariff agreement for CHI for 2020 in Moscow and Moscow Region

The Government of Moscow, by Decree No. 1011-PP, together with other participants in the CU, for the period of 2020, by a tariff agreement, among other things, fixed the following provisions:

• the number admitted to the provision of free medical care under the territorial program amounted to 250 medical institutions;
• the list of high-tech medical care, expanded at the expense of the funds of the territorial MHIF (in the direction: gynecology, hematology, pediatric surgery and others);
• in addition to the main program, at the expense of the local fund, free medical care is provided for abdominal surgery, combustiology, neurosurgery;
• tariffs for the provision of services that take into account all types of costs per unit of care - so only for interventions in abdominal surgery, more than 250.0 thousand rubles are provided.

The total amount of funds allocated for the provision of free medical care in Moscow has increased. Consequently, the opportunity to receive high-quality medical services, both in the capital and for people living in the country, has increased, and the waiting time for the provision of quotas has significantly decreased.

In the Moscow region, the tariff agreement was concluded in December last year. Based on the analysis of the results of providing medical care to the population, the planned level of occupancy of the territorial fund, it determined:

1. The basic "per capita" rate of payment for services per patient, which amounted to 200.0 rubles.
2. Correction factors are approved depending on the type of assistance, gender, age of the patient. They did not undergo any special changes compared to last year.
3. Expansion of the list of medical institutions participating in the system of compulsory insurance of the population of the region.
4. Algorithms for evaluating the effectiveness of the activities of medical institutions of the region, serving the population with volumes of free insurance medicine.

The tariff agreement on CHI, adopted by the subjects of the country, taking into account the peculiarities of the regions, sufficiently ensures the fulfillment of the tasks of providing free medical care to the population. The trend of increasing funding for certain types of services provides an opportunity to receive better service in medical institutions, increase the number of specialized manipulations (surgical operations, IVF, etc.), treat more people over the next calendar year.

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Tariff agreement in the system of compulsory medical insurance of the Kemerovo region for 2018

1. GENERAL PROVISIONS

1.1. Department of Public Health of the Kemerovo Region (hereinafter - DOZN), Territorial Fund compulsory medical insurance of the Kemerovo region (hereinafter referred to as TFOMS), Insurance medical organizations (hereinafter referred to as CMOs), the Kemerovo Regional Association of Doctors and the Regional Organization of the Trade Union of Healthcare Workers, hereinafter jointly referred to as the Parties, have concluded a Tariff Agreement for the implementation of the Territorial Compulsory Medical Insurance Program (hereinafter referred to as TPOMS). ).

1.2. Tariff regulation of payment for medical care in the CHI system is carried out in accordance with the legislation of the Russian Federation, normative documents Federal Fund compulsory medical insurance, the Ministry of Health of the Russian Federation, legal acts of the Kemerovo Region and this Tariff Agreement.

2. METHODS OF PAYMENT FOR MEDICAL CARE USED IN THE KEMEROVSK REGION

The list of medical organizations operating in the field of CHI, according to the conditions for providing medical care and methods of payment, is set out in Appendix 1 to this Tariff Agreement.

Payment for medical care provided to insured persons on the territory of the Kemerovo Region is made at the rates established by this Tariff Agreement, within the limits of the volume and cost of medical care established by the decision of the Commission for the Development of the TPOMS (hereinafter referred to as the Commission). The volume limit does not apply to medical care, which is paid according to the per capita standard, in the case of mutual settlements between medical organizations - per volume unit. Tariffs established by this Tariff Agreement are applied for inter-territorial settlements.

The distribution of planned indicators of the volume and cost of medical care between medical organizations and between insurance medical organizations is carried out within the framework of the volume and cost of medical care approved by the TPOMS, by decision of the Commission. Control over the compliance of the actual volumes of medical care with the planned volumes for the whole medical organization (taking into account the data for all HMOs) is carried out as part of a centralized calculation of the cost of medical care in accordance with the established methods of payment for medical care.

Interaction between the participants of compulsory health insurance is carried out in accordance with contracts in the field of compulsory health insurance, Regulations information exchange when maintaining personalized records of medical care provided to insured persons in the field of CHI and this Tariff Agreement.

Payment for outpatient care

2.1. Payment for medical care provided on an outpatient basis is carried out:

• according to the per capita funding standard for attached insured persons, taking into account the performance indicators of the medical organization, including the inclusion of expenses for medical care provided in other medical organizations (per volume unit);
• per unit of medical care - for a medical service, for a visit, for an appeal (completed case), for a conditional unit of labor input (UETu) (used when paying for medical care provided to insured persons outside the subject of the Russian Federation, on the territory of which the compulsory medical insurance policy, in individual medical organizations that do not have attached persons, and when providing external services to unattached insured persons).

2.2. The per capita standard provides for payment for the polyclinic's own activities, external consultations and examinations provided at the outpatient stage to insured attached citizens, including the services of the admission and diagnostic department of hospitals without subsequent hospitalization. Payment for visits, services provided to insured citizens outside the attachment polyclinic is carried out at approved rates. Visits and services rendered to citizens who are not attached to any medical organization, including those who are insured outside the Kemerovo region, are paid according to tariffs. The visit tariff includes the costs of visiting a specialist and the costs of auxiliary medical and diagnostic units for conducting the necessary diagnostic studies and treatment procedures (with the exception of CT, MRI and MSCT).

Payment and mutual settlements for performed MRI, MSCT are carried out subject to the availability of an electronic referral generated in the "Hospitalization Management" subsystem (the paragraph comes into effect after the implementation of changes in the format of information interaction adopted by the Order of the MHIF of March 23, 2018 No. 54). In the absence of an electronic referral, mutual settlements for the rendered MRI, MSCT in the system of centralized calculation of the cost of medical care are not carried out, payment for services is made within the framework of contractual relations between medical organizations.

Per capita financing is applied in terms of payment for primary health care, including primary pre-medical, primary medical and primary specialized, in emergency and planned forms, provided on an outpatient basis, by medical organizations with an attached population (visits, appeals, services), for with the exception of the one specified in clause 2.3.

2.3. When calculating the per capita standard, funds for payment are not taken into account:

• dental care;
• medical services in health centers;
• visits, medical services of the dermatovenerological dispensary;
• emergency visits;
• individual medical services (in accordance with Appendix 10 to the Tariff Agreement);
• completed cases of medical examinations and preventive medical examinations certain categories citizens;
• medical care provided to insured citizens of the Kemerovo region outside the region;
• early detection of cancer.

2.4. Medical organizations are financed according to differentiated per capita standards established for groups formed on the basis of an integrated differentiation coefficient.

2.5. Payment for medical care for types not included in the per capita standard (paragraph 2.3 of the Tariff Agreement) is made per unit of medical care at the rates established by this Tariff Agreement within the planned cost.

2.6. To account for outpatient dental care, a classifier of basic medical services for the provision of primary health care specialized dental care, expressed in UET (Appendix 2 to the Tariff Agreement), is used. Payment for dental care is made for a conditional unit of labor input (UET) within the agreed cost.

Payment for inpatient care

2.7. Payment for medical care in inpatient conditions is carried out:

• according to the approved tariffs for a completed case of treatment of a disease included in the corresponding group of diseases (including clinical and statistical groups in accordance with the Instructions for grouping cases or groups of VMPs);

2.8. The cost of a completed case of treatment based on clinical and statistical groups is determined taking into account the following parameters:

• the base rate for financing inpatient care;
• correction factors:

a) management coefficient;

b) the coefficient of the level of provision of inpatient medical care;

c) the coefficient of complexity of the treatment of the patient.

2.9. Taking into account the uneven consumption of medical care during the year, a risk corridor for hospitalization cases is established - 103% - an acceptable deviation from the plan for the current month.

2.10. Payment for cases of medical care in the admission, admission and diagnostic department without subsequent hospitalization in the specialized department is carried out according to mutual settlements for the service. CT, MRI, MSCT are paid additionally. Services rendered to citizens who are not attached to any medical organization, including those who are insured outside the Kemerovo region, are paid according to tariffs.

2.11. Payment for dialysis procedures is carried out for the service and is paid in addition to the DRG payment within one treatment case. If the treatment is lifelong, a treatment case is submitted for payment once a month, taking into account the number of dialysis services. If the patient is hospitalized for the underlying disease and dialysis is carried out in 2 different medical organizations, payment is made according to the DRG of the underlying disease for the medical organization in which the patient is hospitalized, and additionally for the services rendered for the medical organization in which dialysis is performed.

2.12. Payment for high-tech assistance is carried out within the established annual volumes and costs. When filling out registers medical organization the sign of VMP is indicated. The assignment of a case to VMP is carried out if the ICD-10 codes, patient model, type of treatment and method of treatment correspond to the similar parameters established by TPOMS.

Payment for medical care in a day hospital

2.13. Payment for medical care in a day hospital is carried out:

• at approved rates for a completed case of treatment of a disease included in the corresponding group of diseases (including clinical and statistical groups in accordance with the Instructions for grouping cases);
• for interrupted medical care.

2.14. The cost of a completed case of treatment in a day hospital is determined on the basis of clinical and statistical groups, taking into account the following parameters:

• the basic rate of financing medical care in a day hospital;
• coefficient of relative cost intensity of CSG;
• managerial ratio.

2.15. Taking into account the uneven consumption of medical care during the year, a risk corridor for hospitalization cases is established - 103% - an acceptable deviation from the plan for the current month.

2.16. Payment for dialysis procedures is carried out for the service and is paid in addition to the DRG payment within one treatment case. A treatment case is submitted for payment once a month, indicating the number of dialysis treatments. If the patient is hospitalized for the underlying disease and dialysis is carried out in 2 different medical organizations, payment is made according to the DRG of the underlying disease for the medical organization in which the patient is hospitalized, and additionally for the services rendered for the medical organization in which dialysis is performed.

2.17. In the case of carrying out several surgical interventions in one day in the CAC, CAG, hospital in one day, the surgical intervention related to the CSG, which has the maximum cost-intensity ratio, is presented for payment.

In the case of surgical intervention, medical rehabilitation services, the treatment case is assigned to the CSG only according to the Nomenclature code. The assignment of a case of treatment according to the ICD-10 code is excluded.

Paying for emergency medical care

2.18. Payment for emergency medical care is carried out according to the per capita standard for the number of insured persons of the population served, in combination with payment for calling an ambulance.

2.19. The population served is considered to be insured citizens who are attached to the primary link in the service area of ​​the SSMP. When providing medical assistance to an insured person who is not related to the serviced territory, payment for medical assistance is made per call. The cost of calls made to the population of the territory, which does not belong to the service area of ​​the SSMP, is deducted from the accrued per capita ambulance standard, which territorially serves these insured persons.

2.20. When calculating the per capita standard, funds for thrombolysis in patients with acute and recurrent myocardial infarction, remote ECG and medical care provided to insured citizens of the Kemerovo Region outside the region are not taken into account.

2.21. Payment for thrombolysis in patients with acute and recurrent myocardial infarction by mobile ambulance teams is carried out additionally per case (separate medical services) within the agreed volumes.

3. AMOUNT AND STRUCTURE OF FEES FOR MEDICAL CARE

3.1. Tariffs for payment for medical care are formed in accordance with the methods of payment for medical care accepted in the TPOMS, taking into account the requirements established by the methodology for calculating tariffs for paying for medical care, approved in the CHI rules, within the limits of the funds approved in the TFOMS budget for the implementation of the TPOMS, and determine the level of reimbursement of the costs of medical organizations for the medical care provided under the TPOMS.

3.2. The approved rates include the costs of:

in a hospital - to the extent that ensures the treatment and diagnostic process in the treatment of the underlying disease, as well as a concomitant, background disease in the acute stage or requiring constant maintenance therapy, including:

• admissions costs,
• profile department,
• certain medical services, with the exception of dialysis,
• consultations of specialists, including from other medical organizations,
• consumables used in surgical interventions, including imported suture material,
• mesh implants for hernioplasty (all manufacturers, including titanium ones),
• metal structures (including imported ones: screws, including dynamic, cannulated, screws, plates, rods, submersible fixators, screw metal implants, porous, including from Ti-Ni alloy, tightening brackets with a "memory" effect forms, etc.)
• cages of all manufacturers used for stabilizing surgical interventions on the spine, incl. in the treatment of diseases of the spine (spondylodesis),
• plasmapheresis, hemosorption,
• operational aids, including those performed by minimally invasive methods, using laser technologies and endoscopic methods, incl. arthroscopic,
• all types of anesthesia, including anesthesia (drugs included in the list of vital and essential medicines),
• medicines and medical devices in accordance with the current regulatory documents and the list of vital and essential medicines;
• laboratory (including PCR diagnostics), X-ray studies, other medical and diagnostic studies, physiotherapy and therapeutic massage, physiotherapy exercises, apparatus treatment, blockades with medicines included in the list of vital and essential medicines, densitometry, etc. ;

in a day hospital - in the amount that ensures the treatment and diagnostic process in the treatment of the underlying disease and concomitant, background in the stage of exacerbation or requiring constant maintenance therapy, including: expenses of a specialized day hospital, specialist consultations, laboratory, x-ray studies, other treatment and diagnostic research, physiotherapy and therapeutic massage, physiotherapy, apparatus treatment, as well as the cost of medical manipulations and procedures according to indications, drug therapy, including using parenteral routes of administration, and the provision of medical products, medicines and medical products in accordance with the current regulatory documents and the list of vital and essential medicines, medical devices and consumables used in the provision of medical care;

on an outpatient basis - a visit rate in the amount that ensures the treatment and diagnostic process in the treatment of the underlying and / or concomitant disease, including: the cost of operations (manipulations), physiotherapy, therapeutic massage, physiotherapy, treatment room services, X-ray , ultrasound, endoscopic and other diagnostic studies.

Tariff for the completed case of medical examination, preventive medical examinations - carrying out the entire volume of examinations, studies and other measures provided for by the relevant regulatory documents (with the exception of the costs of conducting an examination by a psychiatrist);

In dentistry (the cost of UETA) - in the amount that ensures the treatment and diagnostic process in the treatment of the underlying disease, including: the costs of the corresponding office, operational benefits, all types of anesthesia, including anesthesia, medical diagnostic studies, visiography, drug provision in the provision of emergency help; medicines and medical products, filling and other consumables, incl. imported, necessary for the provision of dental care, etc.;

in the provision of emergency medical care - in the amount that ensures the provision of emergency and emergency medical care, drug provision for the provision of emergency and emergency care.

3.3. To calculate the cost of agreed volumes of medical care for medical organizations, averaged tariffs and standards are used (Appendix 3).

3.4. The cost of the agreed volumes for medical organizations and insurance medical organizations is balanced with the cost of TPOMS for the current financial year, minus the costs of medical care provided to the insured of the Kemerovo Region outside the region, and the costs of administrative and managerial personnel in the CHI system.

Tariffs for outpatient medical care

3.5. The average standard of financial provision of primary health care in an outpatient setting per one insured person, determined on the basis of standards for the volume of medical care and financial costs per unit of volume established by TPOMS - 4,568.9 rubles.

3.6. The per capita standard for financing primary health care on an outpatient basis per one attached insured person is 276.74 rubles. per month, including the base part of 262.90 rubles.

3.6.1. From April 1, 2018, the per capita standard for financing primary health care on an outpatient basis per one attached insured person is 269.89 rubles. per month, including the base part of 256.40 rubles.

3.6.2. From 05/01/2018, the per capita standard for financing primary health care on an outpatient basis per one attached insured person is 274.34 rubles. per month, including the base part of 260.62 rubles.

3.7. The basic (average) per capita standard is differentiated by groups of medical organizations with an attached population, based on factors that objectively characterize the differences in the needs of the attached population for medical care and the specifics of the organization of medical care. For this, the integrated coefficient of differentiation of the per capita standard is used (Appendix 4).

3.8. The integrated differentiation coefficient is defined as the product of:

• Gender and age coefficient calculated taking into account the coefficients of medical care consumption according to gender and age groups(Appendix 5);
• The coefficient of differentiation by the level of expenses for the maintenance of individual structural units (medical and obstetric stations).

3.9. In order to improve the efficiency of medical organizations in providing outpatient medical care to the attached population, and to compensate for the risks arising from per capita payment, part of the funds - 10% of the per capita standard (the incentive part of the per capita standard) - is transferred based on a monthly assessment of performance indicators (Appendices 6, 7 ).

3.10. Tariffs for payment for medical care provided on an outpatient basis are established:

• for visiting, contacting a doctor by specialty, by type of admission (Appendix 8);
• for medical services, including services of reception, reception and diagnostic departments of hospitals (Appendix 9);
• for individual medical services (Appendix 10);
• for a completed case of medical examination of orphans and children in difficult life situations staying in stationary institutions, orphans and children left without parental care, including those adopted (adopted), taken under guardianship (guardianship), to the reception or patronage family, separate groups of the adult population; preventive medical examination (Appendix 11).

3.11. For settlements between institutions within the framework of the centralized calculation of the cost of medical care, the tariffs established by the Tariff Agreement are applied. When generating invoice registers, all services provided to non-attached patients at approved rates are taken into account. Mutual settlements for medical care provided between medical organizations are accounted for in the framework of the centralized settlement performed by the TFOMS. The register of accounts for a medical organization includes all the volumes of medical care performed. The consolidated account is reduced by the amount of funds to be transferred to other medical organizations for medical services.

Tariffs for medical care provided in a hospital

3.12. The average standard for the financial provision of medical care per one insured person, determined on the basis of the standards for the volume of medical care and financial costs per unit of volume established by the TP MHI - 5,887.4 rubles.

3.13. The base rate for an inpatient treatment case is 17,339 rubles, taking into account the differentiation coefficient of 20,460 rubles. The base rate may be reviewed on a quarterly basis, taking into account the actual implementation of the approved volumes and the cost of inpatient care.

3.14. The list of clinical and statistical groups of diseases, coefficients of relative cost intensity and management coefficients by groups, the cost of a case by levels, the amount of payment for interrupted cases are given in Appendix 12.

3.15. The coefficients of the level of provision of inpatient medical care are set in the amount

1st level
Level 2 (weighted average)
3rd level (weighted average)

The coefficient of the level of provision of inpatient medical care reflects the difference in the costs of providing medical care, taking into account the severity of the patient's condition, the presence of complications, conducting in-depth studies at various levels of medical care.

The list of DRGs to which the level factor does not apply is given in Appendix 12.

3.16. Patient treatment complexity factors:

* valid from 01.09.2018.

The coefficient of complexity of patient treatment during the same type of operations on paired organs and combined surgical interventions is not applied for KSG 233 "Severe multiple and combined trauma (polytrauma)".

The value of the coefficient of complexity of treating a patient in the presence of several criteria cannot exceed 1.8, with the exception of cases of extra-long hospitalization. In the case of a combination of the fact of extra-long hospitalization with other criteria, the calculated value of the coefficient of complexity of patient treatment based on the duration of hospitalization is taken into account without limiting the final value.

Treatment complexity coefficients are not applied when paying for high-tech medical care.

3.17. The assignment of a case of treatment to a specific CSG is carried out by the TFOMS in accordance with the methodological recommendations of the FFOMS, with the exception of 2.003 "Complications associated with pregnancy, treatment of multiple organ failure syndrome in pregnant women and puerperas" and 233 "Severe multiple and combined trauma (polytrauma)". For these groups, the assignment of a case to a specific group is carried out by a medical organization independently when forming registers.

In accordance with the Instructions for grouping cases, the assignment of a case to the CSG is carried out taking into account the diagnosis code according to ICD-10 and the service code according to the Nomenclature. The list of DRGs that do not provide for the possibility of choosing between the criterion of diagnosis and service is given in Appendix 17.

3.18. Tariffs for payment for cases of treatment using high-tech medical care methods are given in Appendix 18.

3.19. Payment procedure for interrupted cases of treatment.

For payment purposes, interrupted cases include cases when a patient is transferred from one structural unit to another within one medical organization, when a patient is transferred to another medical organization, the patient refuses further treatment, unauthorized care, death, as well as cases in which the duration of hospitalization is less than 3 days inclusive. The amount of payment for interrupted cases is set for each group (Appendix 12).

3.19.1. In case of in-hospital transfer, if this is due to the occurrence of a new disease or condition included in another ICD-10 class, all cases are subject to payment under the relevant DRG.

3.19.2. In case of in-hospital transfer, if the disease belongs to one ICD-10 class, payment is made within the single case with the highest payment amount. At the same time, the duration of a case of treatment is estimated in total by staying in several departments.

3.19.3. The exception is class XV - pregnancy, childbirth and the postpartum period (ICD codes X O00 - O99). Payment for two DRGs: 2 "Complications associated with pregnancy" and 4 "Delivery" or 5 "Caesarean section" is possible:

in case of staying in the pregnancy pathology department for 6 days or more.

in case of staying in the pregnancy pathology department for at least 2 days when providing medical care according to ICD-10 O14.1, O34.2, O36.3, O36.4, O42.2.

3.19.4. Lethal cases lasting more than 3 days are paid at the rate per case of treatment.

3.20. Payment for two DRGs within one treated case is carried out in the following cases of treatment for diseases belonging to the same class of ICD during medical rehabilitation after completion of treatment for the disease for which treatment was carried out;

3.21. Payment for cases of justified extra-long hospitalization is carried out using the coefficient of complexity of the patient's treatment. At the same time, the criterion for classifying a case as an extra-long one is hospitalization for a period of more than 30 days, except for DRGs, which are considered extra-long for a stay of more than 45 days, the list is given in Appendix 16. The value of the patient’s treatment complexity coefficient is determined depending on the actual number of bed-days spent. The procedure for calculating the coefficient is given in the Algorithm for calculating the cost of medical care (Appendix 26).

3.22. In the case of several surgical interventions performed in the hospital, all surgical interventions are charged for payment. Payment is made for one surgical intervention related to the CSG, which has the maximum cost-intensive ratio. At the same time, for cases of treatment in which it is envisaged to perform the same type of operations on paired organs and combined surgical interventions, the coefficient of complexity of the patient's treatment is applied. The list of combined surgical interventions and the List of similar operations on paired organs and symmetrical areas of the body are given in Appendices 13, 14.

Tariffs for medical care provided in a day hospital

3.23. The average standard of financial provision of medical care per one insured person, determined on the basis of the standards for the volume of medical care and financial costs per unit of volume established by the TPOMS - 1,027.7 rubles.

3.24. The base rate of a case of treatment in a day hospital is 10,746 rubles, taking into account the differentiation coefficient of 12,680 rubles. The base rate may be reviewed on a quarterly basis, taking into account the actual implementation of the approved volumes and the cost of medical care provided in a day hospital.

3.24.1. The base rate of a case of treatment in a day hospital from 08/01/2018 is 10,678 rubles, taking into account the differentiation coefficient of 12,600 rubles.

3.25. The list of clinical and statistical groups of diseases, coefficients of relative cost intensity and management coefficients by groups, the cost of a case, the amount of payment for interrupted cases are given in Appendix 19.

3.26. Payment procedure for interrupted cases of treatment. For payment purposes, interrupted cases include cases when a patient is transferred from one structural unit to another within the same medical organization, when a patient is transferred to another medical organization, the patient is prematurely discharged from a medical organization, the patient refuses further treatment, death, as well as cases in which the duration of hospitalization is less than 3 days inclusive. The amount of payment for interrupted cases is set for each group (Appendix 19), with the exception of KSG 5001 “In Vitro Fertilization”, KSG 5002 “In Vitro Fertilization (confirmed pregnancy).

3.26.1. Payment for two DRGs for diseases belonging to the same ICD class is carried out during the medical rehabilitation of the patient after completion of treatment in the same medical organization for the disease for which treatment was carried out.

Tariffs for ambulance

3.27. The average standard for the financial provision of medical care per one insured person, determined on the basis of the standards for the volume of medical care and financial costs per unit of volume established by the TPOMS, is 777.2 rubles.

3.28. The size of the average regional per capita standard for calculating differentiated per capita standards for financing emergency medical care is 64.20 rubles. per 1 insured person per month.

3.29. When calculating the per capita standard (Appendix 20), an integrated differentiation coefficient is used. The integrated differentiation coefficient takes into account the sex and age coefficient calculated taking into account the coefficients of medical care consumption by sex and age groups (Appendix 21), and the differentiation coefficient taking into account the average radius of the service area.

3.30. The cost of calling an ambulance for mutual settlements by types of teams and the cost of individual medical services are given in Appendix 22.

3.31. When generating account registers, all calls made to unattached patients at approved rates are taken into account. Mutual settlements for medical care provided between medical organizations are accounted for in the framework of the centralized settlement performed by the TFOMS. The register of accounts for a medical organization includes all the volumes of medical care performed. The consolidated account is reduced by the amount of funds to be transferred to other medical organizations for medical services.

Tariff structure

3.32. The structure of tariffs for paying for medical care is established in accordance with the territorial program of compulsory medical insurance of the Kemerovo region and includes the cost of wages, accruals for wages, other payments, the purchase of medicines, consumables, food, soft equipment, medical instruments, reagents and chemicals, other inventories, expenses for paying the cost of laboratory and instrumental studies conducted in other institutions (in the absence of a laboratory and diagnostic equipment in a medical organization), catering (in the absence of organized catering in a medical organization), expenses for paying for communication services, transport services, utilities, works and services for the maintenance of property, expenses for rent for the use of property, payment for software and other services, social security for employees of medical organizations established by the legislation of the Russian Federation, other expenses, expenses for the acquisition of fixed assets (equipment, production and household inventory) worth up to one hundred thousand rubles per unit.

Detailed information with a list of expenses included in the tariffs is given in Appendix 23.

3.33. The following expenses of medical organizations are not included in the tariff structure and are not subject to payment at the expense of compulsory medical insurance:

• not related to the activities under the TPOMS, including expenses for the maintenance of property leased and (or) used in commercial activities;
• for the overhaul of non-financial assets (including buildings and structures, the purchase of materials for the overhaul and the remuneration of employees involved in the overhaul, the preparation and examination of design estimates, overhaul equipment, vehicles, etc.);
• for the purchase of immunobiological preparations for vaccination of the population in accordance with the National calendar of preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications;
• for the acquisition of fixed assets worth more than 100,000 rubles per unit;
• expenses for paying for higher and/or secondary specialized education, residency training, internship;
• other expenses financed according to the TPSG from the budgets of all levels.

3.34. If there are several sources of funding, it is not allowed to reimburse general hospital expenses solely at the expense of compulsory medical insurance. When allocating costs by sources of funding, it is necessary to determine appropriate criteria for the distribution of costs by source for items of expenditure and approve them in accounting policy organizations.

3.35. The distribution of general hospital expenses, expenses of auxiliary units by sources of financing, as well as by the conditions for the provision of medical care (in an outpatient setting, day hospital, round-the-clock hospital and SMP) is carried out in one of the following ways:

• in proportion to the wage fund of the main personnel directly involved in the provision of medical care (medical services);
• in proportion to the volume of medical services provided;
• in proportion to the share of income in the total income of a medical organization;
• in proportion to another selected reference criterion.

3.36. The share of expenses for the current maintenance of medical organizations is taken into account when calculating tariffs based on the average share of expenses of this group in the total amount of expenses established in the CHI system for the previous financial period by types of medical care.

4. AMOUNT OF NON-PAYMENT OR INCOMPLETE PAYMENT OF MEDICAL CARE COSTS

4.1. Payment for medical care is made taking into account the results of monitoring the volumes, terms, quality and conditions for the provision of medical care under compulsory medical insurance, carried out in accordance with the Procedure for organizing and conducting control over the volumes, terms, quality and conditions for the provision of medical care under compulsory medical insurance, approved FFOMS order dated 01.12.2010 No. 230.

4.2. For violations identified in the course of monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance, medical organizations are liable in accordance with Article 40 of Federal Law No. 326-ФЗ “On Compulsory Medical Insurance in the Russian Federation”, applying measures provided for by Article 41 of the Federal Law, the terms of contracts for the provision and payment of medical care under compulsory medical insurance.

4.3. The basis for partial or complete non-payment of medical care is the results of monitoring the volumes, terms, quality and conditions for the provision of medical care under compulsory medical insurance, carried out in the manner approved by the regulatory and administrative documents of the Ministry of Health of Russia, the Federal CHI Fund, DODN KO and TFOMS KO.

4.4. The tariffs for medical care approved by this Tariff Agreement are used to calculate the amount not payable (reduced payment) based on the results of monitoring the volume, timing and quality of medical care (with the exception of medical and economic control, the calculation of the amount not payable based on the results of which carried out at the estimated cost of the case in the registry). The list of grounds for refusing to pay for medical care (reducing the payment for medical care) and the amount of sanctions applied are given in Appendix 24.

5. FINAL PROVISIONS

5.1. Separate features of the calculation and payment of the cost of medical care are established by the Algorithm for calculating the cost of medical care (Appendix 26).

5.2. If a citizen's affiliation to the HIO has changed during the treatment period, visits are distributed between the HMOs, taking into account the actual insurance during the period of medical care, the payment for the treatment case is made by the HMO in which the patient was insured at the beginning of treatment. If the patient was not insured at the beginning of treatment, the payment is made by the HMO that insured the citizen at the end of treatment.

5.3. The cost of treatment of the insured is determined according to the tariffs in force on the first day of the billing month. Changes made to the Tariff Agreement shall enter into force from the billing period following the month in which the decision is made, unless a different procedure for entry into force is established.

5.4. Indexation of tariffs for medical services is carried out on the basis of the actual receipt of funds for compulsory medical insurance.

5.5. This Tariff Agreement applies to the relationship of the parties in terms of payments for medical care from 01.2018 to 31.12.2018. This agreement may be amended or supplemented by agreement of all parties. Changes and additions are an integral part of this agreement from the moment they are signed by the parties.

5.6. The following Annexes are an integral part of this Tariff Agreement:

1. List of medical organizations providing medical care in the CHI system, and payment methods;
2. Classifier of basic medical services for the provision of primary health care specialized dental care provided on an outpatient basis, expressed in conventional units of labor intensity (UUT);
3. Average tariffs and standards for calculating the cost of agreed volumes of medical care;
4. Per capita norms for financing outpatient medical care;
5. Gender and age cost ratio for paying for medical care provided on an outpatient basis;
6. List of performance indicators of medical organizations;
7. Target performance indicators of medical organizations;
8. Tariffs for visits, appeals of medical specialists;
9. Tariffs for medical services for inter-institutional and inter-territorial settlements;
10. Tariffs for individual medical services (without mutual settlements);
11. Tariffs for a completed case of clinical examination and preventive medical examinations;
12. List of clinical and statistical groups of diseases, coefficients of relative cost intensity and coefficients of managerial impact for payment for medical care provided in inpatient conditions, cost of a treatment case, amount of payment for interrupted cases;
13. List of combined surgical interventions;
14. List of similar operations on paired organs and symmetrical areas of the body;
15. List of combinations of different types of anticancer treatment within 1 hospitalization;
16. List of DRGs that are considered super-long for stays over 45 days;
17. A list of DRGs that do not provide for the possibility of choosing between the criterion of diagnosis and service;
18. Tariffs for high-tech medical care;
19. List of clinical and statistical groups of diseases, coefficients of relative cost intensity and coefficients of managerial impact to pay for medical care provided in a day hospital, the cost of a treatment case; the amount of payment for interrupted cases;
20. Per capita standards for financing emergency medical care;
21. Gender and age cost ratio for emergency medical care;
22. The cost of calling an ambulance for mutual settlements by type of teams;
23. List of expenses included in the structure of the tariff for payment of medical care;
24. A list of grounds for refusing to pay for medical care (reducing payment for medical care) and paying fines by a medical organization based on the results of monitoring the volume, timing, quality and conditions of medical care, as well as ensuring the rights of insured citizens, and the amount of sanctions;
25. duration of treatment;
26. Algorithm for calculating the cost of medical care.

1.1. The subject of the agreement is the positions agreed by the parties on payment for medical care provided to citizens in the Moscow Region under the current Moscow Regional Compulsory Medical Insurance Program (hereinafter referred to as the Compulsory Medical Insurance Program).
1.2. Tariff regulation of payment for medical care in the system OMS Moscow region is carried out in accordance with the current legislation, this agreement, the Regulations on the tariff regulation of payment for medical care in the system of compulsory medical insurance of citizens in the Moscow region, regulations public authorities of the Moscow Region, regulatory documents of the Fund, decisions of the Moscow Regional Conciliation Commission for determining tariffs for payment for medical care and municipal interdepartmental commissions for tariff regulation of payment for medical care in the compulsory medical insurance system.
1.3. Payment for medical care provided to citizens in the Moscow Region under the Compulsory Medical Insurance Program by medical and preventive institutions (TPI) is made by an insurance medical organization (HIO) on the basis of an agreement for the provision of medical preventive care(medical services) for compulsory health insurance at uniform rates within the limits of the funds transferred to insurance medical organizations by the Fund to finance the Compulsory Medical Insurance Program within the framework of the municipal order.
The municipal order is coordinated by the Ministry of Health of the Moscow Region, MOFOMS, executive authorities of municipalities annually.
Tariffs for payment for medical care provided in medical facilities of federal and departmental subordination, financed through an authorized medical insurance organization, are established in accordance with an agreement concluded between the Ministry of Health of the Moscow Region, the Fund and the relevant department.
1.4. The tariff for medical care is a part of the unit cost of medical care reimbursed by health care facilities from the funds of compulsory medical insurance. According to the tariffs, the costs of health facilities (departments) operating in the compulsory medical insurance system are compensated for the provision of medical care to citizens in the Moscow region according to the following types expenses (codes budget classification <*>):
1.4.1. "Remuneration of civil servants" - code 110100 (in accordance with the Decree of the Government of the Russian Federation "On differentiation in the levels of remuneration of public sector employees on the basis of the Unified tariff scale" dated 10.14.92 N 785, by order of the Ministry of Health of the Russian Federation dated 10.15.99 N 377 " On Approval of the Regulations on the Remuneration of Health Workers" with subsequent amendments and additions, resolutions, orders of the Government of the Russian Federation regulating the remuneration of employees of health care institutions, including departmental subordination, laws and regulations of the Moscow Region). Exceeding the wages of employees of health care institutions that go beyond the specified federal regulations and adopted by resolutions, orders of the Government of the Moscow Region, is subject to compensation at the expense of compulsory medical insurance, provided that the necessary changes are made to the law of the Moscow Region on the regional budget in terms of increasing the item of expenses for the payment of contributions on compulsory medical insurance for the non-working population, as well as to the law of the Moscow Region on the budget of the Moscow Regional Compulsory Medical Insurance Fund in terms of increasing the income item ( insurance premiums on CHI of the non-working population). Any other payments wages, established by the administrations of municipalities, are not subject to payment at the expense of compulsory medical insurance.
The costs of establishing increased tariff rates, allowances, additional payments, increases and other payments established for employees of healthcare facilities of departmental subordination in accordance with regulatory legal acts and administrative documents of ministries and departments that go beyond the resolutions, orders of the Government of the Russian Federation in the field of remuneration, compensation at the expense of CHI funds are not subject to.
1.4.2. "Accruals for wages (insurance contributions for state social insurance of citizens)" - code 110200.
1.4.3. "Medicines, dressings and other medical expenses" - code 110310 regarding:
- the costs of healthcare institutions (departments) operating in the MHI system of the Moscow Region for the independent purchase of medicines (in accordance with the current List of vital and essential medicines and the formula for the treatment of major nosologies in hospitals, approved in in due course), dressings and other medical expenses, with the exception of:
expenses for the purchase of implantable artificial organs, prostheses;
preserved blood and blood substitutes, medicines for scientific works;
the cost of paying for donating blood to donors, including meals;
expenses for the purchase of consumables for dental prosthetics in accordance with the legislation of the Russian Federation;
expenses for paying the cost of medicines dispensed free of charge for outpatient treatment in accordance with the established procedure.
1.4.4. "Soft equipment and uniforms" - code 110320 (excluding expenses for the purchase of special (protective) clothing and footwear, in the manner prescribed by the legislation of the Russian Federation).
1.4.5. "Food" - code 110330.
1.4.6. In the absence of debts under articles 110100, 110200 ("Payment of civil servants", "Accruals for wages") and achievement of the level of costs<**>: for hospitals of groups 1, 2, 4 for medicines - at least 18%, food - at least 10%, soft inventory - at least 1.4% of the amount of actual expenses of health facilities for hospitals of groups 1, 2, 4, for hospitals 3 groups - for medicines - at least 9%, food - at least 10%, soft inventory - at least 1% of the amount of actual expenses of health facilities for a hospital Group 3 - it is allowed to spend MHI funds on the following items:
- "Payment of utility services" - code 110700 (with the exception of "Payment of rent and land" - code 110750, "Payment of benefits for communal services" - code 110760, "Other utilities" - code 110770);
- "Payment for current repairs of equipment and inventory" - code 111020;
- "Payment for current repairs of buildings and structures" - code 111030;
- "Payment for fuel and lubricants" - code 110340;
- "Other consumables and supplies" - code 110350 (in terms of expenses for paying for consumables and supplies, expenses for paying for materials, items for current business purposes, expenses for purchasing spare parts for vehicles, computer and organizational technology, medical equipment, instruments, devices, devices, means of communication, the purchase of furniture, inventory, etc., equipment and devices, including the costs of their installation and adjustment, the costs of delivery and storage of low-value items, materials and spare parts, the cost of binding and binding documents);
- "Transport services" - code 110500;
- "Payment for communication services" - code 110600;
- "Acquisition and modernization of non-production equipment and durable items for state and municipal institutions" - code 240120 - in terms of expenses for the purchase of medical equipment, computer and special equipment and in agreement with the municipal interdepartmental Commission on tariff regulation of payment for medical care in the compulsory medical insurance system Moscow region.

<*> Economic classification expenses of the budgets of the Russian Federation is given in accordance with Appendix 7 to federal law"On the budget classification of the Russian Federation" dated 15.08.1996 N 115-FZ and by order of the Ministry of Finance of the Russian Federation dated 05.25.99 N 38N "On approval of instructions on the procedure for applying the budget classification of the Russian Federation", taking into account subsequent changes and additions. In the event that changes and additions are made (during the current year), Order No. 38N of the Ministry of Finance of the Russian Federation is subject to the version adopted at the beginning of the year.
<**>In the I quarter 2003 - according to the results of the annual report of 2002, in the II quarter. 2003 - according to the results of the report for the I quarter. 2003, in the III quarter. 2003 - according to the results of the report for the first half of 2003, etc.

1.5. Financial resources, directed in accordance with the Decree of the Government of the Moscow Region dated 05.03.2001 N 50/7 for the centralized purchase and supply of medicines and medical devices, are not included in the tariffs for payment for medical care of healthcare institutions and are not included in the funds of compulsory medical insurance transferred to insurance companies. medical organizations according to per capita funding standards.
1.6. The Fund informs the heads of administrations of municipalities no later than 5 days before the beginning of the next month:
- the size of the approved municipal differentiated per capita funding standard;
- the cost of the agreed volumes of medical care under the compulsory medical insurance program provided in municipalities (in points and rubles);
- the value of the main component of the full monetary equivalent of one point, according to which the Fund provides financing.
1.7. Means of a unified social tax, a single tax levied in connection with the application of a simplified taxation system, a single tax on imputed income for certain types of activities, a single agricultural tax received by the Fund from the Department Federal Treasury in the Moscow Region, fines, penalties, subventions of the Federal Compulsory Medical Insurance Fund to equalize the conditions for the provision of medical care within the territorial CHI programs, funds received from the regional budget as insurance premiums for compulsory medical insurance of the non-working population, other receipts are transferred by the Fund to insurance medical organizations within the time limits specified in the agreement on financing compulsory medical insurance.
Other revenues transferred to the Fund and included as an additional component of the full monetary equivalent of one point are not subject to consolidation and redistribution, they are used to cover the costs of the healthcare facility of this municipality.
1.8. Settlements between health facilities and HMOs are made within the framework of existing contracts for the provision of medical and preventive care (medical services) under compulsory medical insurance in accordance with the approved methods of payment based on a scale of uniform tariffs for inpatient, hospital-replacing and outpatient-polyclinic medical care (in points, Appendix No. 1 -6 to this agreement) and the full monetary equivalent of one point, approved monthly by municipal interdepartmental commissions for tariff regulation of payment for medical care in the compulsory medical insurance system.
1.9. Payment for medical care provided by medical and preventive institutions is carried out by HMOs in accordance with the current contracts for the provision of medical and preventive care (medical services) under compulsory medical insurance within the terms and on the conditions stipulated the said agreements.
1.10. The CMO exercises control over the volume and quality of medical care provided to the insured in accordance with the current legislative and regulatory acts of the Russian Federation and the Moscow Region, as well as the regulatory and administrative acts of the Fund.
1.11. If the MOFOMS reveals the facts of misuse of MHI funds by health facilities, the amounts of funds spent for other purposes are withheld at the next financing by the health insurance organization of the health facility.