1. In accordance with the program of state guarantees of free provision of medical care to citizens, the authorities state power subjects Russian Federation approve territorial programs of state guarantees of free medical care to citizens, including territorial programs of compulsory health insurance established in accordance with legislation

2. Within the framework of the territorial program of state guarantees of free provision of medical care to citizens, state authorities of the constituent entities of the Russian Federation establish:

1) target values ​​of criteria for the availability of medical care in accordance with the criteria established by the program of state guarantees of free provision of medical care to citizens;

2) a list of diseases (conditions) and a list of types of medical care provided to citizens without charging them at the expense of budget allocations budget of a constituent entity of the Russian Federation and budget funds territorial fund compulsory health insurance;

3) the procedure and conditions for the provision of medical care, including waiting periods for medical care provided as planned;

4) implementation procedure established by law Russian Federation right of extraordinary provision of medical care individual categories citizens in medical organizations located on the territory of a constituent entity of the Russian Federation;

5) a list of medications dispensed to the population in accordance with the List of population groups and categories of diseases for outpatient treatment of which medicines and medical products are dispensed according to doctors' prescriptions free of charge, as well as in accordance with the List of population groups, for outpatient treatment of which medicines are dispensed according to doctors' prescriptions with a fifty percent discount;

6) list medical organizations participating in the implementation of the territorial program of state guarantees of free medical care to citizens;

7) the volume of medical care provided within the framework of the territorial program of state guarantees of free medical care to citizens in accordance with the legislation of the Russian Federation on compulsory health insurance;

8) the volume of medical care per capita, the cost of the volume of medical care taking into account the conditions of its provision, per capita financing standard;

9) a list of measures for the prevention of diseases and the formation healthy image life implemented within the framework of the territorial program of state guarantees of free medical care to citizens;

10) the procedure and amount of reimbursement of expenses associated with the provision of emergency medical care to citizens.

3. Territorial programs of state guarantees of free provision of medical care to citizens, subject to compliance with financial standards, installed by the program state guarantees of free medical care to citizens may contain additional types and conditions for the provision of medical care, as well as additional volumes of medical care, including those providing for the possibility of exceeding the average indicators established by the standards of medical care.

4. When forming a territorial program of state guarantees of free medical care to citizens, the following are taken into account:

2) features of the age and sex composition of the population;

3) the level and structure of morbidity among the population of a constituent entity of the Russian Federation, based on medical statistics;

4) climatic and geographical features of the region and transport accessibility medical organizations;

5) balance of the volume of medical care and its financial support, including payment of insurance premiums for compulsory medical insurance of the non-working population in the manner established by the legislation of the Russian Federation on compulsory medical insurance.

5. The authorized federal executive body annually monitors the formation, economic justification territorial programs of state guarantees of free medical care to citizens and evaluates the implementation of such programs, and together with the Federal Compulsory Health Insurance Fund - territorial programs of compulsory health insurance.

6. The authorized federal executive body, the Federal Compulsory Medical Insurance Fund and the highest executive bodies of state power of the constituent entities of the Russian Federation enter into agreements on the implementation of territorial programs of state guarantees of free medical care to citizens, including territorial programs of compulsory medical insurance, in the manner established by the Government Russian Federation. The agreements specified in this part are concluded in a form approved by the authorized federal body executive power.

The state guarantees the residents of our country free receipt medical assistance if necessary. To ensure these guarantees, two types of compulsory health insurance programs have been developed - basic and territorial compulsory medical insurance programs. Today we will talk in more detail about the differences between these programs and their common features.

Legislation regulating the work of federal compulsory medical insurance programs

Both the territorial and basic compulsory medical insurance programs are subject to:

• provisions of the Constitution of the Russian Federation;
• Law No. 326-FZ “On Compulsory Health Insurance in the Russian Federation”;
• Law No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”;
• Decree of the Government of the Russian Federation No. 1403 “On the program of state guarantees of free medical care to citizens for 2017 and for the planning period of 2018 and 2019” (hereinafter referred to as “Resolution No. 1403”);
• other things regulations, valid for the period of their development.

You will be able to manage your business and maintain documentation in accordance with all legal requirements after automating the clinic. Try the Online Clinic and appreciate its convenience.

Try Clinic Online

Basic compulsory medical insurance program for 2019

The main task of the federal compulsory medical insurance program for 2019 is to determine the rights of medical insurance policy holders to free medical diagnostics, medical consultations and treatment. The funds necessary for this are provided by the compulsory health insurance fund. The formation of cash receipts into insurance funds occurs thanks to contributions to the Compulsory Medical Insurance Fund from employers, payments from individual entrepreneurs and self-employed persons, and transfers from the budgets of constituent entities of Russia for non-working citizens.

Another goal of the basic compulsory health insurance program is to establish standards for requirements for the operation of territorial compulsory health insurance programs.

The federal compulsory medical insurance program states:

• Types of medical care to which a resident of the country is entitled (this list includes a list of types high-tech medical care, and methods of treatment used);
• A list of possible insured events, in the event of which the policy owner can receive medical assistance;
• The structure of tariffs applied when paying for medical care;
• Options payment medical care, which Russian citizens receive from compulsory medical insurance funds;
• Criteria according to which the availability and quality of Russian medical care is determined.

In addition, in the federal compulsory medical insurance program you can find:

• Standards of conditions necessary for the provision of medical care;
• Standards for the volume of medical care that everyone can count on. Volumes are calculated on average for each citizen;
• Limits financial costs per unit volume of medical care provided to policy holders;
• Standards cash security work of the basic compulsory medical insurance program per one policy owner, taking into account the coefficient of possible increase in the cost of services under the basic medical care program.

You can download the text of the basic compulsory medical insurance program below. Downloading is available for registered users.

The right to free consultation, diagnosis and treatment for compulsory medical insurance policy everyone who has received a policy under the federal compulsory medical insurance program has (Part 5 of Article 35 N 326-FZ).

Types of medical care that can be received within the framework of the basic compulsory medical insurance program:

• The services received by citizens under the basic health insurance program (Part 6 of Article 35 N 326-FZ) include:
• Primary and preventive medical care and sanitary care,
• Emergency medical care services (except for those cases when aviation is required to provide it);
• Provision of specialized medical care, including high-tech, included in the list of types allowed in the basic compulsory medical insurance program.

According to Law N 326-FZ, in order to provide health care, it is necessary that the policy owner have a certain disease or have a condition that is also determined by the basic compulsory medical insurance program.

When insured Russians are provided with assistance under the federal compulsory medical insurance program

So, part 6 of Art. 35 of Law N 326-FZ approves the list of diseases and possible conditions, the presence of which allows the provision of medical care within the framework of the guaranteed basic compulsory medical insurance program. But part 8 of Art. 35 of Law N 326-FZ gives the Government of the Russian Federation the opportunity to supplement federal program Compulsory medical insurance with an expanded additional list of diseases and conditions. Resolution No. 1403 implemented this right.

This also includes audiological screening services and IVF services. The federal compulsory medical insurance program also included the provision of medications in accordance with current legislation.

Services within the framework of the basic health insurance program also include measures for medical examinations and preventive medical examinations of certain categories of Russians.

Territorial compulsory medical insurance program

This type of program is written according to the requirements determined by the basic health insurance program. It is being developed by a special commission, the composition and work procedure of which is determined by Appendix 1 to Order of the Ministry of Health of the Russian Federation dated February 28, 2011 N 158n.

When developing this type of program, in addition to the standards for the provision of medical care, the gender and age composition of the subject of the Russian Federation and its morbidity level are taken into account. The climate and geography of the region are taken into account, as well as the accessibility of medical organizations and the degree of balance of medical care. The financial component of the territorial compulsory medical insurance program depends on the payment of insurance premiums for compulsory health insurance in the region.

Then, after completion of the development, the territorial executive body of the constituent entity of the Russian Federation publishes it on its official website no later than 14 calendar days from the date of its adoption.

Below you can download the text of the territorial program for Moscow and St. Petersburg. Downloading is available for registered users.

Basic and territorial compulsory medical insurance programs - differences

Within the framework of guaranteed territorial compulsory medical insurance programs (Part 2 of Article 36 N326-FZ), operating in each region of Russia, medical services, which can be provided to policy owners through financing from local budgets and health insurance funds. As in the text of the basic compulsory medical insurance program, they contain the types and conditions for policy holders to receive medical consultations, diagnostics and treatment in medical clinics and medical institutions. They also include a list of certain types and methods of high-tech medical care acceptable for use.

It also includes a list of eligible cases, which is described in the basic health insurance program. And it sets out in detail the standards for guaranteed volumes of medical care, based on the standards for the financial costs of providing this assistance.

Another difference between the basic and the territorial compulsory medical insurance program is the presence of conditions for choosing the attending physician, the process of providing medicines and medical products, and the procedure for providing transport to health workers when accompanying the patient to the place of treatment. It also approves the list of medications provided to insured citizens free of charge or at a discount, and other nuances of providing medical care.

The program is also required to include a register of clinics in a given region operating within its framework, the structure of payment tariffs for medical care and other financial indicators.

1. Territorial program compulsory medical insurance is an integral part of the territorial program of state guarantees of free medical care to citizens, approved in the manner established by the legislation of the constituent entity of the Russian Federation. The territorial compulsory health insurance program is formed in accordance with the requirements established by the basic compulsory health insurance program.

2. The territorial compulsory health insurance program includes the types and conditions of medical care (including a list of types of high-tech medical care, which includes treatment methods), a list of insured events established by the basic compulsory health insurance program, and determines taking into account the morbidity structure in the constituent entity of the Russian Federation, the values ​​of standards for the volume of medical care provided per one insured person, standards for financial costs per unit of volume of medical care per one insured person and standards for financial support of the territorial compulsory health insurance program per one insured person. The values ​​of the standards of financial costs per unit of volume of medical care per insured person specified in this part are also established according to the list of types of high-tech medical care, which also contains treatment methods.

3. The standard for financial support of the territorial compulsory health insurance program may exceed the standard for financial support of the basic compulsory health insurance program established by the basic compulsory health insurance program if an additional volume is established insurance coverage for insured events established by the basic compulsory medical insurance program, as well as in the case of establishing a list of insured events, types and conditions for the provision of medical care in addition to those established by the basic compulsory medical insurance program.

4. Financial support for the territorial compulsory health insurance program in the cases specified in part 3 of this article is carried out through payments from constituent entities of the Russian Federation paid to the budget of the territorial fund, in the amount of the difference between the standard of financial support for the territorial compulsory health insurance program and the standard of financial support for the basic compulsory health insurance programs taking into account the number of insured persons on the territory of a constituent entity of the Russian Federation.

5. If an additional volume of insurance coverage is established for insured events established by the basic compulsory health insurance program, the territorial compulsory health insurance program must provide a list of areas for using compulsory health insurance funds.

6. The territorial compulsory medical insurance program, as part of the implementation of the basic compulsory medical insurance program, determines on the territory of a constituent entity of the Russian Federation methods of payment for medical care provided to insured persons under compulsory medical insurance, the structure of the tariff for payment of medical care, contains a register of medical organizations participating in the implementation of the territorial compulsory health insurance programs, determines the conditions for the provision of medical care in them, as well as target values ​​for the criteria for the availability and quality of medical care.

7. The territorial compulsory health insurance program may include a list of insurance cases, types and conditions for the provision of medical care in addition to those established by the basic compulsory health insurance program, subject to the requirements established by the basic compulsory health insurance program.

8. When the territorial compulsory health insurance program establishes a list of insured events, types and conditions for the provision of medical care, in addition to those established by the basic compulsory health insurance program, the territorial compulsory health insurance program must also include the values ​​of the standards for the volume of medical care provided per one insured person , standards of financial costs per unit of volume of provision of medical care per one insured person, the value of the standard of financial support per one insured person, methods of payment for medical care provided under compulsory health insurance to insured persons, tariff structure for payment of medical care, register of medical organizations participating in the implementation of the territorial compulsory health insurance program, conditions for the provision of medical care in such medical organizations.

9. To develop a draft territorial compulsory health insurance program in a constituent entity of the Russian Federation, a commission is created to develop a territorial compulsory medical insurance program, which includes representatives of the executive body of the constituent entity of the Russian Federation, authorized by the highest executive body of state power of the constituent entity of the Russian Federation, the territorial fund, insurance medical organizations and medical organizations, representatives of medical professional non-profit organizations or their associations (unions) and trade unions medical workers or their associations (associations) operating on the territory of a constituent entity of the Russian Federation on a parity basis. The commission for the development of a territorial compulsory health insurance program is formed and carries out its activities in accordance with the regulations, which are an annex to the rules of compulsory health insurance.

(see text in the previous edition)

10. The volumes of medical care established by the territorial compulsory health insurance program are distributed by decision of the commission specified in part 9 of this article between medical insurance organizations and between medical organizations based on the number, gender and age of insured persons, the number of insured persons attached to medical organizations providing outpatient care, as well as the medical care needs of insured persons. The volumes of medical care provided by the territorial compulsory medical insurance program of the constituent entity of the Russian Federation, in which the insured persons were issued a compulsory medical insurance policy, include the volumes of medical care provided to these insured persons outside the territory of this constituent entity of the Russian Federation.

The territorial program includes:
The approved cost of the Territorial program of state guarantees of free medical care to citizens in the city of Moscow for 2019 and for the planning period of 2020 and 2021 by sources of financial support (Appendix 1 to this Territorial program).
The approved cost of the Territorial program of state guarantees of free medical care to citizens in the city of Moscow for 2019 and for the planning period of 2020 and 2021 according to the conditions of its provision (Appendix 2 to this Territorial program).
The procedure for providing citizens with medicines, medical devices, medical nutrition, including specialized products therapeutic nutrition, as prescribed by a doctor, as well as donated blood and (or) its components for medical reasons in accordance with the standards of medical care, taking into account the types, forms and conditions of medical care (Appendix 3 to this Territorial Program).
List of vital and essential medications for the provision of primary health care in a day hospital and in an emergency, specialized, including high-tech, medical care, emergency, including emergency specialized medical care, palliative care in inpatient conditions(Appendix 4 to this Territorial Program).
The list of medicines dispensed to the population in accordance with the list of population groups and categories of diseases, for the outpatient treatment of which medicines and medical products are dispensed free of charge as prescribed by doctors, as well as in accordance with the list of population groups, for the outpatient treatment of which medicines are dispensed free of charge or with a fifty percent discount on doctors’ prescriptions (Appendix 5 to this Territorial Program).
List of activities for the prevention of diseases and the promotion of a healthy lifestyle carried out within the framework of the Territorial Program of State Guarantees of Free Medical Care to Citizens in the City of Moscow for 2019 and for the planning period of 2020 and 2021 (Appendix 6 to this Territorial Program).
Conditions and terms of medical examination of the population for certain categories of citizens (Appendix 7 to this Territorial Program).
The procedure for implementing the right established by the legislation of the Russian Federation to provide extraordinary medical care to certain categories of citizens in medical organizations participating in the implementation of the Territorial program of state guarantees of free medical care to citizens in the city of Moscow for 2019 and for the planning period of 2020 and 2021 (Appendix 8 to this Territorial program).
The procedure for reimbursement of expenses associated with the provision of emergency medical care to citizens by medical organizations not participating in the implementation of the Territorial Program of State Guarantees of Free Medical Care to Citizens in the City of Moscow for 2019 and for the planning period of 2020 and 2021 (Appendix 9 to this Territorial program).
List of medical organizations of the state healthcare system of the city of Moscow participating in the implementation of the Territorial program of state guarantees of free medical care to citizens in the city of Moscow for 2019 and for the planning period of 2020 and 2021 (Appendix 10 to this Territorial program).
List of medical organizations not included in state system Healthcare of the city of Moscow and participating in the implementation of the Territorial program of state guarantees of free medical care to citizens in the city of Moscow for 2019 and for the planning period of 2020 and 2021 (Appendix 11 to this Territorial program).
A list of types of high-tech medical care, including treatment methods and sources of financial support for high-tech medical care, for 2019 and for the planning period of 2020 and 2021 (Appendix 12 to this Territorial Program).

The territorial program was formed taking into account the procedures for providing medical care and on the basis of standards of medical care, as well as the characteristics of the gender and age composition, the level and structure of morbidity among residents of the city of Moscow, based on medical statistics. When forming the Territorial Program, the balance of the volume of medical care and its financial support was taken into account

Application. Action plan to eliminate comments based on the results of monitoring the formation and economic justification of the territorial program of state guarantees of free provision of medical care to citizens

Agreement dated July 10, 2017
Ministry of Health of the Russian Federation, Federal Fund compulsory health insurance and the Government of the Moscow Region on the implementation of the territorial program of state guarantees of free medical care to citizens, including the territorial program of compulsory health insurance, the Moscow Region for 2017 and the planning period of 2018 and 2019

The Ministry of Health of the Russian Federation (hereinafter - the Ministry) represented by the Minister of Health of the Russian Federation Veronika Igorevna Skvortsova, acting on the basis of the Regulations on the Ministry of Health of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 19, 2012 N 608, the Federal Compulsory Medical Insurance Fund (hereinafter - Fund) represented by the Chairman of the Federal Compulsory Medical Insurance Fund, Natalya Nikolaevna Stadchenko, acting on the basis of the charter of the Federal Compulsory Medical Insurance Fund, approved by Decree of the Government of the Russian Federation of July 29, 1998 N 857, and the Government of the Moscow Region (hereinafter referred to as the highest executive body ), represented by the First Deputy Chairman of the Government of the Moscow Region, Olga Sergeevna Zabralova, acting on the basis of the order of the Government of the Moscow Region dated June 30, 2017 N 357-RP, hereinafter referred to as the “Parties”, in accordance with Article 81 of the Federal Law of November 21, 2011. N 323-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation", have concluded this Agreement as follows:

I. Subject of the Agreement

The subject of this Agreement is the conditions for the implementation of the territorial program of state guarantees of free medical care to citizens (hereinafter referred to as the territorial program), including the territorial program of compulsory health insurance, in the Moscow region for 2017 and the planning period of 2018 and 2019.

II. Rights and obligations of the Parties to implement the territorial program, including the territorial compulsory health insurance program

1. Ministry:

1.1. Provides organizational and methodological guidance, providing the necessary explanations on the implementation of the territorial program.

1.2. Carries out an assessment of the implementation of the territorial program for the next financial year and for the planning period, including in terms of the implementation of the action plan to eliminate the comments contained in the Ministry’s conclusion on the results of monitoring the formation and economic justification of the territorial program (hereinafter referred to as the conclusion), in accordance with the annex to this Agreement .

1.3. Informs the highest executive body about cases of non-compliance with the terms of this Agreement, as well as, if there is an action plan to eliminate the comments contained in the conclusion, about non-compliance with these measures.

2.1. Provides the necessary clarifications on the implementation of the territorial compulsory health insurance program.

2.2. Carries out an assessment of the implementation of the territorial program for the next financial year and for the planning period, including in terms of the implementation of the action plan to eliminate the comments contained in the conclusion.

2.3. Informs the Ministry about cases of non-compliance with the terms of this Agreement, as well as, if there is an action plan to eliminate the comments contained in the conclusion, about non-compliance with these measures.

2.4. Provides subventions to the budget of the territorial fund of compulsory medical insurance of the Moscow region in the manner and on the conditions established by Article 27 of the Federal Law of November 29, 2010 N 326-FZ "On compulsory medical insurance in the Russian Federation" (hereinafter - the federal law N 326-FZ).

3. The highest executive body:

3.1. Implements a territorial program in accordance with legislation in the field of health care and the Program of state guarantees of free medical care to citizens for the next financial year and for the planning period (hereinafter referred to as the Program), approved by the Government of the Russian Federation.

3.2. Implements an action plan to eliminate the comments contained in the conclusion.

3.3. Makes changes to the territorial program in accordance with the conclusion and submits it to the Ministry and the Fund.

3.4. Establishes in the territorial program the values ​​of standards for the volume of medical care, including those adjusted taking into account the conclusion:

number of hospitalization cases: due to budgetary allocations from the budget of the Moscow Region - 0.005 hospitalization cases per 1 resident; within the framework of the basic compulsory health insurance program - 0.17233 per 1 insured person; at the expense of funds from the budget of the Moscow region transferred interbudgetary transfer to the territorial compulsory medical insurance fund of the Moscow region - 0.009 cases of hospitalization per 1 insured person;

number of cases of treatment in day hospitals: within the framework of the basic compulsory health insurance program - 0.06 cases of treatment per 1 insured person; at the expense of funds from the budget of the Moscow region, transferred by interbudgetary transfer to the territorial fund of compulsory health insurance of the Moscow region - 0.001 per 1 insured person;

number of visits for emergency medical care - 0.56 visits per 1 insured person within the framework of the territorial compulsory health insurance program;

the number of bed days for medical rehabilitation in inpatient settings is 0.039 bed days per 1 insured person within the framework of the territorial compulsory health insurance program.

3.5. Provides financial support for the provision of medical care within the framework of the territorial program, including the territorial compulsory health insurance program, in accordance with the legislation of the Russian Federation.

3.6. Provides financial support for the additional volume of insurance coverage for insured events established by the basic program of compulsory medical insurance in the amount of 6,852,177.0 thousand rubles by transferring payments from the budget of the Moscow region to the budget of the territorial fund of compulsory medical insurance of the Moscow region monthly in January - April in in the amount of 2,284,059.0 thousand rubles, and in May - December 4,568,118.0 thousand rubles, indicating in the territorial program a list of areas for using compulsory health insurance funds.

3.7. Provides financial support for the list of insured events, types and conditions for the provision of medical care in addition to those established by the basic compulsory medical insurance program in the amount of 9,425,448.0 thousand rubles by transferring payments from the budget of the Moscow region to the budget of the territorial fund of compulsory medical insurance of the Moscow region on a monthly basis in January - April in the amount of 3,147,083.2 thousand rubles, and in May - December 6,278,364.8 thousand rubles, subject to the following conditions:

fulfillment of the requirements established by the basic compulsory health insurance program;

indication in the territorial program of a list of insurance cases, types and conditions of medical care in addition to those established by the basic compulsory health insurance program; values ​​of standards for the volume of medical care provided per 1 insured person; the values ​​of financial cost standards per unit of volume of medical care per 1 insured person are not lower than those approved by the Program; values ​​of the financial security standard per 1 insured person; methods of payment for medical care provided under compulsory health insurance to insured persons; tariff structures for payment of medical care; register of medical organizations participating in the implementation of the territorial compulsory health insurance program; conditions for the provision of medical care in such medical organizations.

3.8. Establishes, within the framework of the activities of the commission for the development of a territorial compulsory health insurance program, differentiated volumes of medical care and their cost for medical organizations subordinate to the Federal Medical and Biological Agency that provide medical care residents of closed administrative-territorial entities, in accordance with the average standards approved by the Program, in proportion to the size of the attached population, taking into account the capacity bed capacity by profiles, medical specialties, profiles of medical care provided.

III. Duration of the Agreement

This Agreement comes into force on the date of its signing and is valid until December 31, 2017.

IV. Final provisions

4.1. The parties have the right to make changes to this Agreement or terminate its validity in the manner prescribed by the legislation of the Russian Federation.

4.2. All disputes arising from this Agreement or arising in connection with this Agreement shall be resolved by the Parties through negotiations.

4.3. Relations between the Parties not regulated by this Agreement are governed by the legislation of the Russian Federation.

V. Details of the Parties

Ministry of Health of the Russian Federation	Government of the Moscow Region	Federal Compulsory Health Insurance Fund
Address: Rakhmanovsky lane, 3, Moscow, 127994	Address: Stroiteley Boulevard 1, Krasnogorsk, Moscow region, 143407	Address: st. Novoslobodskaya, 37, Moscow, 101481
Business and finance 2024 emny.ru