Participants of personalized accounting in the OMS system are. In the field of compulsory health insurance. III. Maintaining the regional segment of the unified register of insured persons
APPROVED
by order of the Ministry of Health and Social Development Russian Federation dated January 25, 2011
Order
maintaining personalized accounting
in the area of \u200b\u200bcompulsory health insurance
I. General Provisions
1. This Procedure determines the rules for maintaining personalized records of information about each insured person in the field of compulsory health insurance, including:
1) the organization of personalized accounting in the field of compulsory health insurance;
2) maintaining a unified register of insured persons;
3) maintaining personalized records of information on medical care provided to insured persons;
4) the technology of information exchange when maintaining personalized records in the field of compulsory health insurance.
2. The goals of personified accounting in the field of compulsory health insurance are:
1) creation of conditions for ensuring guarantees of the rights of insured persons to free provision of medical care of appropriate quality and volume within the framework of basic and territorial compulsory medical insurance programs;
2) creating conditions for exercising control over the use of compulsory health insurance funds;
3) determination of the need for the volume of medical care in order to form the basic and territorial programs of compulsory medical insurance.
II. Organization of personalized accounting
3. Personalized accounting of information about insured persons is maintained in the form of a unified register of insured persons, which is a combination of its central and regional segments, and includes the collection, processing, transfer and storage of the following information about the insured persons:
1) surname, name, patronymic;
3) date of birth;
4) place of birth;
5) citizenship;
6) data of the identity document;
7) place of residence;
8) place of registration;
9) date of registration;
10) insurance number of an individual personal account (SNILS), adopted in accordance with the legislation of the Russian Federation on individual (personified) accounting in the compulsory pension insurance system;
11) number of the policy of compulsory medical insurance of the insured person;
12) data on the medical insurance organization chosen by the insured person;
13) the date of registration as an insured person;
14) the status of the insured person (employed, unemployed).
4. Personalized accounting of information on medical care provided to insured persons includes collection, processing, transfer and storage of the following information:
1) the number of the policy of compulsory medical insurance of the insured person;
2) medical organizationwho provided the relevant services;
3) types of medical care provided;
4) conditions for the provision of medical care;
5) terms of rendering medical assistance;
6) the volume of medical care provided;
7) the cost of the provided medical care;
8) diagnosis;
9) the profile of medical care;
10) medical services provided to the insured person and medicinal products used;
11) applied medical and economic standards;
12) the specialty of the medical worker who provided medical assistance;
13) the result of seeking medical help;
14) the results of the carried out control of volumes, terms, quality and conditions for the provision of medical care.
5. Information about the insured person and about the medical care provided to him can be provided both in the form of documents in writing and in electronic form if there are guarantees of their reliability (authenticity), protection from unauthorized access and distortion in accordance with the requirements established by the legislation of the Russian Federation on the protection of personal data. In this case, the legal force of the submitted documents is confirmed by an electronic digital signature in accordance with the legislation of the Russian Federation. The decision on the possibility of submitting information in electronic form is made jointly by the participants in the information exchange.
6. Insurance medical organizations and medical organizations store copies of paper documents and electronic archives containing personalized information about the insured persons and the medical care provided to them, submitted in territorial fund compulsory medical insurance (hereinafter referred to as the territorial fund) for personalized accounting, according to the rules for organizing state archival affairs.
7. After the expiration of the period established for storing copies of documents on paper and electronic media in an insurance medical organization, they are subject to destruction in accordance with the legislation of the Russian Federation on the basis of an act on their destruction, approved by the head of the insurance medical organization.
8. Information about the insured person and about the medical care provided to him refers to information with limited access and is subject to protection in accordance with the legislation of the Russian Federation.
III. Maintaining the regional segment of the unified register of insured persons
9. Information about each insured person specified in paragraph 3 of this Procedure shall be entered in the unified register of insured persons.
10. Maintaining the regional segment of the unified register of insured persons is carried out by the territorial fund on the basis of information about the insured persons provided by the medical insurance organization.
11. The insurance medical organization and the territorial fund, by orders, determine the employees admitted to work with the regional segment of the unified register of insured persons, and comply with the requirements of the legislation of the Russian Federation on the protection of personal data.
12. When entering information about the insured person into the regional segment of the unified register of insured persons, the medical insurance organization ensures the accuracy and correctness of the information entered and carries out checks to prevent duplicate entries from appearing in the regional segment of the unified register of insured persons:
1) for the presence of repetitions by last name, first name, patronymic, date and place of birth;
2) for the presence of repetitions according to the data of the identity document;
3) the correctness of the indication of the sex of the insured person;
4) for the presence of repetitions by date of birth and registration address at the place of residence;
5) for the presence of repetitions of the last name, first name and patronymic and registration address at the place of residence;
6) for the presence of repetitions according to the insurance number of the individual personal account (SNILS).
13. In order to update the regional segment of the unified register of insured persons and enter information about insured persons into it, an insurance medical organization forms and transfers information files with changes in information about insured persons, under paragraph 3 of this Procedure (hereinafter referred to as files with changes), to the territorial fund as necessary, but at least once a day if there are changes in the information about the insured persons, in accordance with the agreement on financial support compulsory health insurance.
14. The territorial fund provides round-the-clock reception and processing of files with changes received from medical insurance organizations.
15. When processing files with changes in the territorial fund, format-logical data control, identification of records for the regional segment of the unified register of insured persons, and entering information about insured persons are carried out.
16. After processing files with changes in the territorial fund, files of confirmation and / or rejection of changes are generated, which are sent to the relevant medical insurance organizations to correct information about the insured persons.
17. Territorial authority The Pension Fund of the Russian Federation, on a quarterly basis no later than the 15th day of the second month following the reporting period, provides, in accordance with the Agreement on information exchange between the Pension Fund of the Russian Federation and the Federal Compulsory Medical Insurance Fund, information on working insured persons to the relevant territorial fund for entering them to the regional segment of the unified register of insured persons.
18. Territorial fund on a monthly basis on the basis of information on the state registration of death provided by the civil registration authorities in accordance with article 12 of the Federal Law of 01.01.01. "On acts of civil status" (Collected Legislation of the Russian Federation, 1997, No. 47, Art. 5340; 2001, No. 44, Art. 4149; 2003, No. 17, Art. 1553; No. 50, Art. 4855; 2009, No. 51 , Art. 6154; 2010, No. 15, Art. 1748), updates the regional segment of the unified register of insured persons, notifies medical insurance organizations on the territory of the constituent entity of the Russian Federation and sends information files with information about the state registration of death in the constituent entity of the Russian Federation for persons, information about which is not available in the regional segment of the unified register of insured persons, in Federal fund compulsory health insurance (hereinafter referred to as the Federal Fund) to update the central segment of the unified register of insured persons.
19. The territorial fund quarterly updates the regional segment of the unified register of insured persons on the basis of information about working insured persons and sends information files with information about working insured persons, information about which is not available in the regional segment of the unified register of insured persons, to the Federal Fund for updating the central segment of the unified register of insured persons.
20. The insured for non-working citizens on a monthly basis, no later than the 5th day of each month, provides to the relevant territorial fund information about non-working insured persons, provided for in subparagraphs 1-10, 14 of paragraph 3 of this Procedure, in accordance with agreements on information exchange between territorial funds and policyholders for non-working citizens in the constituent entities of the Russian Federation, and in the form approved by the Federal Fund and the Pension Fund of the Russian Federation.
21. The territorial fund updates the regional segment of the unified register of insured persons on the basis of information received from the Federal Fund from the central segment of the unified register of insured persons.
22. In case of violation of the terms for providing data on insured persons, as well as information on changes in these data, established by the contract on financial security of compulsory medical insurance, the medical insurance organization is obliged to pay the territorial fund at its own expense a fine in the amount established by part 10 of Article 38 of the Federal Law of 29 November 2010 "On compulsory health insurance in the Russian Federation" (hereinafter - the federal law "On compulsory health insurance in the Russian Federation").
23. The Territorial Fund exercises general control over the regional segment of the unified register of insured persons. In case of detection of errors and inconsistencies, the territorial fund sends the relevant information to the medical insurance organization with an indication of the list of inconsistencies and the timing of their correction.
IV. Maintaining the central segment of the unified register of insured persons
24. The territorial fund, when making changes to the regional segment of the unified register of insured persons, generates files with changes, which are sent to the Federal Fund for updating the central segment of the unified register of insured persons as necessary, but at least once a day if there are changes in the information about the insured faces.
The files with changes include all newly entered and changed information about the insured persons since the last submission.
25. The Federal Fund provides round-the-clock reception and processing of files with changes from territorial funds.
26. When processing files with changes, it is ensured that the insured person has a previously issued current policy compulsory health insurance uniform sample in the central segment of the unified register of insured persons.
27. In the central segment of the unified register of insured persons, information files are processed with information on the state registration of death and information on the status of insured persons (employed, unemployed) sent by territorial funds to persons whose information is not available in their regional segments of the unified register of insured persons, the results of which are sent to the territorial funds at the place of insurance.
28. The Federal Fund maintains central segment of the unified register of insured persons, provides general control over the updating and use of the unified register of insured persons.
29. The exchange of data between medical insurance organizations, territorial funds and the Federal Fund for the purpose of maintaining personalized accounting of information about insured persons is carried out in in electronic format through dedicated or open communication channels, including the Internet, using an electronic digital signature in accordance with the requirements for the protection of personal data established by the legislation of the Russian Federation.
V. Procedure for maintaining personalized records of information about medical care provided to insured persons
30. Personalized accounting of information about medical care provided to insured persons is kept in electronic form by medical organizations and medical insurance organizations operating in the compulsory health insurance system, and territorial funds.
31. A medical organization, an insurance medical organization and a territorial fund, by order, determine the employees admitted to work with the information of personalized accounting of medical care provided to insured persons and ensure their confidentiality in accordance with the requirements of the legislation of the Russian Federation on the protection of personal data.
32. Medical organizations submit information on medical care provided to insured persons, provided for in subparagraphs 1-13 of paragraph 4 of this Procedure, to the territorial fund.
33. The territorial fund within two working days, on the basis of the regional segment of the unified register of insured persons, carries out automated processing of information received from medical organizations about medical assistance provided to insured persons.
34. At the stage of automated processing of information from personalized records of medical care provided to insured persons in the territorial fund:
1) identification of the insured person by the regional segment of the unified register of insured persons, determination of the medical insurance organization responsible for paying the bill;
2) identification of the insured persons who have been provided with medical assistance outside the insurance territory and determination of their insurance territory;
3) sending in electronic form the results obtained in accordance with subparagraphs 1 and 2 of this paragraph to the medical organization that provided medical assistance to the insured persons.
35. A medical organization, based on the results of automated processing of information about medical care provided to insured persons, carried out in accordance with paragraph 34 of this Procedure, submits them to insurance medical organizations in the amount and terms established by the contract for the provision and payment of medical care for compulsory medical insurance.
36. After monitoring the volumes, terms, quality and conditions for the provision of medical care in accordance with Article 40 of the Federal Law "On Compulsory Health Insurance in the Russian Federation", the information specified in clause 4 of this Procedure is transferred by the medical insurance organization to medical organizations and the territorial fund within the time frames stipulated by the contract on the financial support of compulsory medical insurance.
37. In case of difficulties in determining the insurance territory of a person who received medical assistance outside the insurance territory, the territorial fund generates an electronic request to the central segment of the unified register of insured persons, where within 5 working days a check is carried out and a response is generated indicating the identified insurance territory and valid policy number of the insured person.
38. The exchange of data between medical organizations, medical insurance organizations, territorial funds and the Federal Fund in order to maintain a personalized record of information about medical care provided to insured persons is carried out in electronic form via dedicated or open communication channels, including the Internet, using electronic digital signatures in accordance with the requirements for the protection of personal data established by the legislation of the Russian Federation.
Registration N 19742
In accordance with Article 43 of the Federal Law of November 29, 2010 N 326-FZ "On Compulsory Medical Insurance in the Russian Federation" (Collected Legislation of the Russian Federation, 2010, N 49, Art. 6422) i order:
Approve the attached Procedure for maintaining personalized records in the field of compulsory health insurance.
Minister T. Golikova
The procedure for maintaining personalized records in the field of compulsory health insurance
I. General provisions
1. This Procedure determines the rules for maintaining personalized records of information about each insured person in the field of compulsory health insurance, including:
1) the organization of personalized accounting in the field of compulsory health insurance;
2) maintaining a unified register of insured persons;
3) maintaining personalized records of information on medical care provided to insured persons;
4) the technology of information exchange when maintaining personalized records in the field of compulsory health insurance.
2. The goals of personified accounting in the field of compulsory health insurance are:
1) creation of conditions for ensuring guarantees of the rights of insured persons to free provision of medical care of appropriate quality and volume within the framework of basic and territorial compulsory medical insurance programs;
2) creating conditions for exercising control over the use of compulsory health insurance funds;
3) determination of the need for the volume of medical care in order to form the basic and territorial programs of compulsory medical insurance.
II. Organization of personalized accounting
3. Personalized accounting of information about insured persons is maintained in the form of a unified register of insured persons, which is a combination of its central and regional segments, and includes the collection, processing, transfer and storage of the following information about the insured persons:
1) surname, name, patronymic;
3) date of birth;
4) place of birth;
5) citizenship;
6) data of the identity document;
7) place of residence;
8) place of registration;
9) date of registration;
10) insurance number of an individual personal account (SNILS), adopted in accordance with the legislation of the Russian Federation on individual (personified) accounting in the compulsory pension insurance system;
11) number of the policy of compulsory medical insurance of the insured person;
12) data on the medical insurance organization chosen by the insured person;
13) the date of registration as an insured person;
14) the status of the insured person (employed, unemployed).
4. Personalized accounting of information on medical care provided to insured persons includes collection, processing, transfer and storage of the following information:
1) the number of the policy of compulsory medical insurance of the insured person;
2) a medical organization that has provided the relevant services;
3) types of medical care provided;
4) conditions for the provision of medical care;
5) terms of rendering medical assistance;
6) the volume of medical care provided;
7) the cost of the provided medical care;
8) diagnosis;
9) the profile of medical care;
10) medical services provided to the insured person and medicinal products used;
11) applied medical and economic standards;
12) the specialty of the medical worker who provided medical assistance;
13) the result of seeking medical help;
14) the results of the carried out control of volumes, terms, quality and conditions for the provision of medical care.
5. Information about the insured person and about the medical care provided to him can be provided both in the form of documents in writing and in electronic form if there are guarantees of their reliability (authenticity), protection from unauthorized access and distortion in accordance with the requirements established by the legislation of the Russian Federation on the protection of personal data. In this case, the legal force of the submitted documents is confirmed by an electronic digital signature in accordance with the legislation of the Russian Federation. The decision on the possibility of submitting information in electronic form is made jointly by the participants in the information exchange.
6. Insurance medical organizations and medical organizations store copies of paper documents and electronic archives containing personalized information about the insured persons and the medical care provided to them, submitted to the territorial compulsory medical insurance fund (hereinafter - the territorial fund) for personalized accounting, according to the rules for organizing the state archive affairs.
7. After the expiration of the period established for storing copies of documents in paper and electronic media in an insurance medical organization, they are subject to destruction in accordance with the legislation of the Russian Federation on the basis of an act on their destruction, approved by the head of the insurance medical organization.
8. Information about the insured person and about the medical care provided to him refers to information with limited access and is subject to protection in accordance with the legislation of the Russian Federation.
III. Maintaining the regional segment of the unified register of insured persons
9. Information about each insured person specified in paragraph 3 of this Procedure shall be entered in the unified register of insured persons.
10. Maintaining the regional segment of the unified register of insured persons is carried out by the territorial fund on the basis of information about the insured persons provided by the medical insurance organization.
11. The insurance medical organization and the territorial fund, by orders, determine the employees admitted to work with the regional segment of the unified register of insured persons, and comply with the requirements of the legislation of the Russian Federation on the protection of personal data.
12. When entering information about the insured person into the regional segment of the unified register of insured persons, the medical insurance organization ensures the accuracy and correctness of the information entered and carries out checks to prevent duplicate entries from appearing in the regional segment of the unified register of insured persons:
1) for the presence of repetitions by last name, first name, patronymic, date and place of birth;
2) for the presence of repetitions according to the data of the identity document;
3) the correctness of the indication of the sex of the insured person;
4) for the presence of repetitions by date of birth and registration address at the place of residence;
5) for the presence of repetitions of the last name, first name and patronymic and registration address at the place of residence;
6) for the presence of repetitions according to the insurance number of the individual personal account (SNILS).
13. In order to update the regional segment of the unified register of insured persons and enter information about insured persons into it, an insurance medical organization forms and transfers information files with changes in information about insured persons provided for in paragraph 3 of this Procedure (hereinafter - files with changes) to the territorial fund as necessary, but at least once a day if there are changes in the information about the insured persons, in accordance with the contract on the financial support of compulsory health insurance.
14. The territorial fund provides round-the-clock reception and processing of files with changes received from medical insurance organizations.
15. When processing files with changes in the territorial fund, format-logical data control, identification of records for the regional segment of the unified register of insured persons, and entering information about insured persons are carried out.
16. After processing files with changes in the territorial fund, files of confirmation and / or rejection of changes are generated, which are sent to the relevant medical insurance organizations to correct information about the insured persons.
17. The territorial body of the Pension Fund of the Russian Federation on a quarterly basis no later than the 15th day of the second month following the reporting period, in accordance with the Agreement on information exchange between the Pension Fund of the Russian Federation and the Federal Fund of Compulsory Medical Insurance, to the relevant territorial fund, information on the working insured persons to enter them into the regional segment of the unified register of insured persons.
18. Territorial fund on a monthly basis on the basis of information on the state registration of death provided by the civil registration authorities in accordance with Article 12 of the Federal Law of November 15, 1997 N 143-FZ "On Acts of Civil Status" (Collected Legislation of the Russian Federation, 1997, 47, Art.5340; 2001, N 44, Art.4149; 2003, N 17, Art.1553; N 50, Art.4855; 2009, N 51, Art.6154; 2010, N 15, Art.1748) , carries out updating of the regional segment of the unified register of insured persons, notifies medical insurance organizations on the territory of the constituent entity of the Russian Federation and sends information files with information on the state registration of death in the territory of the constituent entity of the Russian Federation for persons whose information is absent in the regional segment of the unified register of insured persons , to the Federal Compulsory Health Insurance Fund (hereinafter - the Federal Fund) to update the central segment of the unified register of insured persons.
19. The territorial fund quarterly updates the regional segment of the unified register of insured persons on the basis of information about working insured persons and sends information files with information about working insured persons, information about which is not available in the regional segment of the unified register of insured persons, to the Federal Fund for updating the central segment of the unified register of insured persons.
20. The insured for non-working citizens on a monthly basis, no later than the 5th day of each month, provides to the relevant territorial fund information about non-working insured persons, provided for in subparagraphs 1-10, 14 of paragraph 3 of this Procedure, in accordance with agreements on information exchange between territorial funds and policyholders for non-working citizens in the constituent entities of the Russian Federation, and in the form approved by the Federal Fund and the Pension Fund of the Russian Federation.
21. The territorial fund updates the regional segment of the unified register of insured persons on the basis of information received from the Federal Fund from the central segment of the unified register of insured persons.
22. In case of violation of the terms for providing data on insured persons, as well as information on changes in these data, established by the contract on financial support of compulsory medical insurance, the medical insurance organization is obliged to pay the territorial fund at its own expense a fine in the amount established by part 10 of Article 38 of the Federal Law of 29 November 2010 N 326-FZ "On compulsory health insurance in the Russian Federation" (hereinafter - the Federal Law "On compulsory health insurance in the Russian Federation").
23. The Territorial Fund exercises general control over the regional segment of the unified register of insured persons. In case of detection of errors and inconsistencies, the territorial fund sends the relevant information to the medical insurance organization with an indication of the list of inconsistencies and the timing of their correction.
IV. Maintaining the central segment of the unified register of insured persons
24. The territorial fund, when making changes to the regional segment of the unified register of insured persons, generates files with changes, which are sent to the Federal Fund for updating the central segment of the unified register of insured persons as necessary, but at least once a day if there are changes in the information about the insured faces.
The files with changes include all newly entered and changed information about the insured persons since the last submission.
25. The Federal Fund provides round-the-clock reception and processing of files with changes from territorial funds.
26. When processing files with changes, it is ensured that the insured person has a previously issued compulsory medical insurance policy of a single sample in the central segment of the unified register of insured persons.
27. In the central segment of the unified register of insured persons, information files are processed with information on the state registration of death and information on the status of insured persons (employed, unemployed) sent by territorial funds to persons whose information is not available in their regional segments of the unified register of insured persons, the results of which are sent to the territorial funds at the place of insurance.
28. The Federal Fund maintains the central segment of the unified register of insured persons, provides general control over the updating and use of the unified register of insured persons.
29. Data exchange between medical insurance organizations, territorial funds and the Federal Fund for the purpose of maintaining personalized accounting of information about insured persons is carried out in electronic form via dedicated or open communication channels, including the Internet, using an electronic digital signature in accordance with the requirements established by the legislation of the Russian Federation on the protection of personal data.
V. Procedure for maintaining personalized records of information about medical care provided to insured persons
30. Personalized accounting of information about medical care provided to insured persons is kept in electronic form by medical organizations and medical insurance organizations operating in the compulsory health insurance system, and territorial funds.
31. A medical organization, an insurance medical organization and a territorial fund, by order, determine the employees admitted to work with the information of personalized accounting of medical care provided to insured persons and ensure their confidentiality in accordance with the requirements of the legislation of the Russian Federation on the protection of personal data.
32. Medical organizations submit information about medical care provided to insured persons, provided for in subparagraphs 1-13 of paragraph 4 of this Procedure, to the territorial fund.
33. The territorial fund within two working days, on the basis of the regional segment of the unified register of insured persons, carries out automated processing of information received from medical organizations about medical assistance provided to insured persons.
34. At the stage of automated processing of information from personalized records of medical care provided to insured persons in the territorial fund:
1) identification of the insured person by the regional segment of the unified register of insured persons, determination of the medical insurance organization responsible for paying the bill;
2) identification of the insured persons who have been provided with medical assistance outside the insurance territory and determination of their insurance territory;
3) sending in electronic form the results obtained in accordance with subparagraphs 1 and 2 of this paragraph to the medical organization that provided medical assistance to the insured persons.
35. A medical organization, based on the results of automated processing of information about medical care provided to insured persons, carried out in accordance with paragraph 34 of this Procedure, submits them to insurance medical organizations in the amount and terms established by the contract for the provision and payment of medical care for compulsory medical insurance.
36. After monitoring the volumes, terms, quality and conditions for the provision of medical care in accordance with Article 40 of the Federal Law "On Compulsory Health Insurance in the Russian Federation", the information specified in paragraph 4 of this Procedure is transferred by the medical insurance organization to medical organizations and the territorial fund within the time frames stipulated by the contract on the financial support of compulsory medical insurance.
37. In case of difficulties in determining the insurance territory of a person who received medical assistance outside the insurance territory, the territorial fund generates an electronic request to the central segment of the unified register of insured persons, where within 5 working days a check is carried out and a response is generated indicating the identified insurance territory and valid policy number of the insured person.
38. The exchange of data between medical organizations, medical insurance organizations, territorial funds and the Federal Fund in order to maintain a personalized record of information about medical care provided to insured persons is carried out in electronic form via dedicated or open communication channels, including the Internet, using electronic digital signatures in accordance with the requirements for the protection of personal data established by the legislation of the Russian Federation.
Order dated July 20, 2017 No. 1538-r. The bill provides for the improvement of the mechanism of control over whether a citizen has the right to compulsory medical insurance. The amendments proposed by the bill will make it possible to exclude insurance of citizens whose medical care is financed from the federal budget. Thus, the bill is aimed at eliminating double funding for medical care.
The draft federal law "On Amending Certain Legislative Acts of the Russian Federation on Issues of Personified Accounting in the Sphere of Compulsory Health Insurance" (hereinafter referred to as the draft law) was introduced by the Ministry of Health of Russia.
The bill is aimed at improving personalized accounting in the field of compulsory health insurance (hereinafter - CHI).
The bill, in particular, provides for the specification of the categories of servicemen and persons equated to them in the organization of the provision of medical care who are not subject to compulsory health insurance, determination of mechanisms for the suspension and termination of compulsory medical insurance in relation to military personnel and persons equated to them in the organization of medical care.
It is proposed to regulate information interaction between federal state bodies and the Federal Compulsory Medical Insurance Fund (MHIF) in maintaining personalized records of information about insured persons, including determining the procedures and terms for submitting (sending) information about insured persons and persons not subject to compulsory health insurance.
It is proposed that the territorial CHI funds be empowered to verify the accuracy of personalized accounting information about insured persons in terms of their compliance with the identity documents of a citizen of the Russian Federation on the territory of Russia.
It is proposed that the Government of Russia be empowered to approve the procedure and methodology for determining the number of insured persons for the purposes of forming the MHIF budget, the budgets of the subjects of the Federation and the budgets of the territorial MHI funds.
The bill provides for the improvement of the mechanism for monitoring a citizen's right to compulsory medical insurance, including the introduction of duties:
- a citizen who has passed into the category of citizens not subject to compulsory medical insurance (with the exception of citizens doing military service by conscription), - to hand over an invalid compulsory medical insurance policy or report its loss to any medical insurance organization or any territorial compulsory medical insurance fund;
- military commissariats - to transfer to the territorial funds of the OMS information about citizens called up for military service and information about the beginning of military service upon conscription;
- federal state bodies according to the list approved by the Government of Russia, whose employees belong to the category of citizens not subject to compulsory medical insurance, to ensure control over the fulfillment by employees and military personnel undergoing military service under the contract, the obligation to surrender an invalid compulsory medical insurance policy or report its loss to any medical insurance organization or any territorial CHI fund;
- MHIF and territorial MHI funds - on a monthly basis, on the basis of information on the suspension and termination of MHI in respect of certain categories of persons, ensure the reflection of information about temporarily inactive and invalid compulsory medical insurance policies in the unified register of insured persons in accordance with the Rules of Compulsory Health Insurance.
The amendments proposed by the bill will make it possible to exclude insurance of citizens whose medical care is financed from the federal budget. Thus, the bill is aimed at eliminating double funding for medical care.
Also, the purpose of the bill is to improve the personalized accounting of insured persons in the field of compulsory medical insurance, to improve the quality of planning the budget of the compulsory health insurance fund, the budgets of the subjects of the federation and the budgets of territorial compulsory medical insurance funds. Updating the personalized accounting of insured persons in the area of \u200b\u200bcompulsory medical insurance as a result of the implementation of the draft law will help reduce the burden on regional budgets for paying insurance premiums for compulsory medical insurance.
5 February 2020, Changes in criminal liability legislation The government submitted to the State Duma a bill to mitigate punishment for pregnant women and women with children under the age of three for minor crimes Order of February 4, 2020 No. 196-r
December 30, 2019, Domestic and Inbound Tourism The government has submitted to the State Duma bills on the introduction of a unified federal register of travel agents Orders of December 27, 2019 No. 3232-r, No. 3233-r. From January 2021, it is proposed to introduce a unified federal register of travel agents in the form of a subsystem of the information system "Unified Federal Register of Tour Operators". The adoption and implementation of bills are aimed at increasing the protection of the interests of consumers of tourism services, creating a transparent and controlled market for travel agency activities.
December 26, 2019 The government submitted to the State Duma a bill on improving the procedure for considering applications for state registration of the results of intellectual activity Order of December 25, 2019 No. 3175-r. The draft law provides for the possibility of Rospatent carrying out activities related to the legal protection of the results of intellectual activity, directly or through an institution subordinate to it.
December 17, 2019, Domestic and inbound tourism The government submitted to the State Duma a bill on improving the legal regulation of the activities of tour guides, guide-translators and instructors-guides Order of December 14, 2019 No. 3047-r. It is proposed to establish the main criteria for the certification of tour guides (guides), guides-translators and instructors-guides and the requirements for their education, work experience, as well as for the availability of professional knowledge and skills. The amendments proposed by the bill are aimed at increasing the protection of the interests of consumers of tourist services, streamlining the activities of tour guides (guides), guides-translators, instructors, guides, ensuring the safety of tourists when passing tourist routes of increased danger, creating a transparent and controlled market for excursion services.
December 13, 2019, Higher, postgraduate and continuing education The government submitted to the State Duma a bill on changing the procedure for training scientific and pedagogical personnel in graduate school Order of November 12, 2019 No. 2986-r. In particular, it is proposed, instead of federal state educational standards in the areas of training highly qualified personnel in graduate school, to establish federal state requirements for the training of highly qualified personnel in postgraduate programs and, as a result, to cancel the state accreditation of educational activities in postgraduate programs. The requirements for the final certification for postgraduate programs are also being clarified.
December 12, 2019, National Program "Digital Economy of the Russian Federation" The government submitted to the State Duma a bill on conducting an experiment on the introduction of electronic personnel document management Order of December 11, 2019 No. 2976-r. It is proposed to conduct an experiment from April 1 to December 31, 2020 to conduct an experiment on maintaining electronic documents related to labor relations with employees, in respect of whom it is envisaged to be issued in paper form or familiarized with an employee against signature, without duplicating them on paper.
2 December 2019 The government submitted a biological safety bill to the State Duma Order of November 30, 2019 No. 2859-r. The adoption and implementation of the bill is aimed at protecting the population and protecting the environment from the effects of dangerous biological factors, preventing biological threats, creating and developing a system for monitoring biological risks. This will ensure that an acceptable level of risk is maintained. negative impact dangerous biological factors on the population and environment, which is the main goal of the state policy in the field of biological safety.
December 2, 2019, The government submitted to the State Duma a bill on improving the mechanism of state and municipal control Order of November 30, 2019 No. 2861-r. The adoption of the bill will create a systemic procedural regulation of control and supervisory activities aimed at minimizing administrative pressure on business entities.
December 2, 2019, System of state control and supervision The government has submitted to the State Duma a bill on mandatory requirements, compliance with which is subject to verification as part of control and supervisory activities Order of November 30, 2019 No. 2860-r. The adoption of the bill will make it possible to legislatively consolidate the foundations for the establishment, assessment of the application of mandatory requirements contained in regulatory legal acts, and will help reduce administrative pressure on business entities.
November 27, 2019, Maternity capital The government submitted to the State Duma a bill to expand the possibilities for the use of funds maternity capital Order of November 26, 2019 No. 2799-r. The bill proposes to extend the possibility of directing maternity capital funds for the construction or reconstruction of an individual housing facility on a garden land plot.
19 November 2019, Cultural heritage The government submitted to the State Duma a bill on amendments to legal regulation issues of preservation of monuments of history and culture Order of November 16, 2019 No. 2712-r. The bill proposes to eliminate the redundancy of the requirements of permits when carrying out work on the preservation of a cultural heritage object included in the unified state register of cultural heritage objects of the peoples of the Russian Federation, as well as an identified cultural heritage object.
November 6, 2019, Small and medium business The government submitted to the State Duma a bill on changes in the legal regulation of the participation of "self-employed" citizens in the procurement of goods, works, services Order of October 31, 2019 No. 2594-r. The bill proposes to extend the measures of support provided by the legislation in relation to small and medium-sized businesses to “self-employed” citizens.
October 8, 2019, Family Policy. Childhood protection and education The government submitted to the State Duma a bill on changes in the legal regulation of the participation of parents in additional expenses for children Order of October 7, 2019 No. 2291-r. The adoption of the bill will ensure the protection of housing rights minor child in the event of a divorce of parents, including by involving a parent living separately from the child to participate in additional obligations related to the provision of a minor with living quarters.
October 8, 2019, Anti-corruption regulation The government submitted to the State Duma a bill on the approval of standard additional professional anti-corruption programs Order of October 7, 2019 No. 2294-r. The bill is aimed at ensuring unified approaches in the additional professional education of state and municipal employees in the field of combating corruption.
October 8, 2019, Nature Conservancy. Nature reserves, national parks The government submitted to the State Duma a bill on changes in the legal regulation of the conservation of hunting resources Order of October 7, 2019 No. 2295-r. The bill proposes to expand the range of subjects of law regulating the number of hunting resources in public hunting grounds, and to provide the right to hunt in order to regulate the number of hunting resources to hunters, information about which is contained in the state hunting register.
October 8, 2019, Housing and utilities The government submitted to the State Duma a bill on changes in the legal regulation of management issues apartment buildings Order of October 7, 2019 No. 2297-r. The bill proposes to establish that the management of apartment buildings, all premises in which are in federal, regional or municipal ownership, is carried out on the basis of an agreement concluded with a management organization selected by the results of an open tender. This will contribute to the development of a competitive environment in the multi-apartment building management market.
The government submitted to the State Duma a bill on improving the mechanisms of resettlement of citizens from hazardous housing Order of October 7, 2019 No. 2292-r. Prepared in pursuance of the instruction of the President of Russia following a meeting with members of the Government on the issue of resettlement of citizens from emergency housing stock.
September 30, 2019, Federal budget The government submitted to the State Duma a bill on federal budget for 2020 and for the planning period 2021 and 2022 Order of September 30, 2019 No. 2211-r. The main characteristics of the draft budget: revenues in 2020 - 20379.4 billion rubles, in 2021 - 21246.5 billion rubles, in 2022 - 22058.3 billion rubles. Expenditures in 2020 - 19503.3 billion rubles, in 2021 - 20634 billion rubles, in 2022 - 21763.3 billion rubles. The surplus in 2020 is 876.1 billion rubles, in 2021 - 612.5 billion rubles, in 2022 - 295 billion rubles.
September 30, 2019, Social insurance The government submitted to the State Duma a bill on insurance rates for compulsory social insurance against industrial accidents and occupational diseases for 2020 and for the planning period of 2021 and 2022 Order of September 30, 2019 No. 2215-r. There are 32 insurance rates for compulsory social insurance against industrial accidents and occupational diseases in accordance with the types economic activity by occupational risk classes. The privilege of paying insurance contributions for compulsory social insurance against industrial accidents and occupational diseases remains. The adoption of the bill will allow to form revenue side the budget of the Social Insurance Fund, which provides the full amount of payments for the mandatory social insurance from industrial accidents and occupational diseases in 2020 and the target period 2021 and 2022.
1personalized accounting of services for mandatory
health insurance
annotation
The article is devoted to the analysis of the effectiveness of the system of personified accounting of medical services provided under compulsory health insurance.
Keywords: medical services, personalized accounting, insurance coverage, subject of personalized accounting, insured event, insurer
Until now, the main tasks of accounting in the CHI system were the issues of operational data collection for accounting and statistical tasks, institutional activities and accounting, ensuring mutual settlements between oMS participants... For these purposes, two main sources of information are mainly used - the base of the insured population (accounting for consumers of services) and the base of the "treated population" (accounting for services rendered to the consumer).
In the system of compulsory health insurance, it is necessary to create not only a personalized record of provided medical services, but also information on insurance coverage received by the insured person upon the occurrence of an insured event.
Personalized accounting system of medical services
Based on the goals and objectives of personalized accounting, it is also necessary to consider the subjects of the personalized accounting system from the point of view of their influence.
Olga Krestyaninova
postgraduate student of the Faculty of Finance, St. Petersburg state University service and economy [email protected]
in system
Mandatory
Medical
Insurance
it is necessary to create \\ only personalized accounting of _provided
medical services,
But also information
About insurance
providing,
received
On the offensive
insured event
on guarantee insurance coverage for compulsory medical insurance, the costs of the insurer and directly to personified accounting. A citizen is the recipient of insurance coverage for compulsory medical insurance and, accordingly, the subject of personal data.
It should be noted that the citizen is endowed with significant rights. In particular, the right to independently claim medical services (for example, consult other specialists) or reimburse material damagecaused by the fault of the insurance organization. Let us add that the exercise of these rights can significantly affect the amount of insurance coverage for CHI and, accordingly, the financial stability of the CHI system, which may lead to a decrease in guarantees of insurance coverage for other insured persons. Insurance coverage for compulsory medical insurance belongs to the individual. Data about him is personal and, accordingly, the recording of this data is personalized.
this information is necessary for insurers to ensure the implementation and protection of the rights and legitimate interests of the insured for health protection and free medical care in the CHI system.
Thus, the system of personalized accounting of medical services is a system for recording information about insured events and amounts of insurance coverage received by each person insured in the compulsory health insurance system.
To successfully complete the tasks of the CHI, this activity must be effective. This presupposes the use of up-to-date and reliable information about the medical care received by the insured. Based on the wide variety of medical services and their consumers, it is necessary to develop a special system for the effective recording of these indicators. The consumer of these benefits is a link that allows you to systematize the accounting of medical care provided. This necessitates personalized accounting of medical services in the CHI.
Principles of the system of personalized accounting of medical services
In the current economic conditions, the system of personalized accounting of medical services should be based on the following principles:
1) the unity of compulsory medical insurance in the Russian Federation;
2) the universality of compulsory health insurance and the obligation to record information about insured persons;
3) the availability for each insured person of information about him, which is available to the CHI Funds that carry out personalized accounting;
4) the use of information generated in the system of personalized registration of medical services exclusively for the purposes of compulsory medical insurance, and, above all, for the realization of the rights of citizens to receive free medical care throughout the territory of the Russian Federation;
5) implementation of the functioning of the personalized accounting system throughout the entire period of a person's insurance. It should be noted that the procedure for the provision of specialized medical care provides for a referral from the attending physician of a polyclinic or a primary hospital. The problem is the lack of mandatory feedback. In addition, the patient receives a document on counseling and other medical servicesreceived in a specialized institution, and often does not inform the attending physician about it.
Thus, the norm of the law is not being fulfilled, according to which the recommendations of consultants are implemented only in agreement with the attending physician. The only exceptions are emergencies that threaten the patient's life. The situation is complicated by the fact that inconsistency, lack of continuity in the patient's treatment, arising in connection with the informational disunity of the two levels of medical care, entails unnecessary
The citizen is endowed
significant
In particular, the right to independently claim medical services ... or compensation for material damage caused by the fault of an insurance company
insurance
personification system
medical services is an accounting system
Information
insured events the amount of insurance
Security,
Received
By every face
insured _in the system
obligatory
Medical
Insurance
new costs of insurance coverage and large accounting errors. Within the framework of the current legislation, the solution to this problem is possible by sending personal data about the diagnosis, medical services received in a specialized institution, from this institution directly to the attending physician providing primary health care. IN in this case insurance medical organizations (hereinafter CMO) and CHI funds receive complete, ordered information about each insured event... The main work of insurers will focus on improving links with primary health care facilities, which will simplify the solution of insurance problems.
Legal and informational issues
The relationship of medical insurance organizations with medical institutions is regulated by an agreement for the provision of medical and preventive care (medical services) under compulsory medical insurance, which, inter alia, provides for the control of the information provided by the medical institution by the health insurance company and transferring them to the compulsory medical insurance funds. As part of its activities, the HIO uses the following information resources directly related to the personalized accounting system of medical services:
1) updated data on the insured population;
2) information about the funds received from the TF CHI and spent on payment for medical services;
3) reporting and analytical information on the fulfillment of obligations for insurance coverage;
4) information characterizing the activities of medical institutions for the provision of medical care.
The relationship of the territorial funds of the CHI with the CMO is regulated by the agreement on financing of CHI, other normative legal acts regulating the compulsory health insurance system. From the functions of TFOMS
a number of functions can be distinguished related to the task of personalized accounting of medical services in the subject of the federation:
Maintaining the consolidated register of the population insured under the compulsory medical insurance of the constituent entity of the Russian Federation;
Maintaining a consolidated personalized database of medical services provided;
Financing of health insurance organizations according to differentiated per capita standards, taking into account the number of insured population
Ensuring control over the activities of the CMO;
Providing mutual settlements between the TFOMI of the constituent entities of the Federation for medical care (in the amount of the basic compulsory medical insurance program) provided to Russian citizens outside the insurance territory;
Calculation of insurance coverage and financing standards territorial program Compulsory medical insurance of the population;
Solving the issues of protecting the rights of the insured. The Federal Compulsory Health Insurance Fund implements public policy in the field of compulsory health insurance of citizens.
MHI and CMO funds maintain databases of insured citizens, which are required to keep up to date. When the databases are updated, information about insured citizens is exchanged between the TFOMS and the health insurance company, as well as other information carriers.
Personalized accounting as a multi-level system for collecting and processing information
Thus, the system of personalized accounting of medical services is a multi-level system of sequential collection and processing of information.
Level 1 - the attending physician who records all the medical services provided to the patient by himself or according to his direction by the specialists of his institution or other specialized services and diagnostic centers. This is the only source in the system of primary information about the services provided to the patient. Level 2 - medical institutionproviding primary health care - form-
raising
efficiency
management
financial
streams
in the CHI requires
proper accounting
medical care,
provided by
insured
insurance
it provides complete information about primary and specialized medical care provided to the patients who applied to it, insured under the compulsory medical insurance.
Level 3 - an insurance medical organization - generates generalized information about medical services received by persons insured under the compulsory medical insurance of this health insurance.
Level 4 - the territorial CHI fund - generates generalized information about medical services received by persons insured under CHI in the constituent entity of the Russian Federation.
Level 5 - Federal CHI Fund - generates generalized information about medical services received by persons insured under CHI in the Russian Federation, determines the procedure for the formation of an accounting and reporting system, as well as the procedure and conditions for maintaining databases and other information resources in the CHI system.
At the first and second levels, the information generated includes both the personal data of patients and medical information (diagnoses and medical services). the remaining levels must be transferred for processing information containing information about the medical services provided and the identification number of the insured to whom these services were provided. To carry out the functions of protecting the rights of the insured and to conduct a medical and economic examination of the quality of medical care provided, the insurer (compulsory medical insurance and medical insurance funds) personifies the information necessary for these tasks on the basis of the insured's identification number, using for this purpose its own databases of insured citizens.
Conclusion
Improving the efficiency of managing financial flows in the CHI requires proper accounting of medical care provided to the insured. Complete and reliable information about actually provided medical services will allow for proactive forecasting of problem situations, promptly identify cost centers, perform a multidimensional analysis of the need for medical care, etc.
Literature
1. Federal Law of November 29, 2010 No. 326-FZ "On Compulsory Medical Insurance in the Russian Federation".
2. Federal Law of 27.07.2006 No. 152-FZ "On Personal Data" (revised on 25.07.2011).
3. Federal Law of 21.11.011 No. 323-FZ "On the basics of protecting the health of citizens in the Russian Federation."
4. FFOMS order dated 07.04.20011 No. 79 "On approval general principles build and operate information systems and order communication in the field of compulsory health insurance "(as amended by the FFOMS Order dated 22.08.2011 No. 154).
5. Order of the Ministry of Health and Social Development dated 25.01.2011 No. 29n "On approval of the procedure for maintaining personalized records in the field of compulsory health insurance."
6. Information letter of the Ministry of Health and Social Development of Russia dated January 30, 2012 "To the heads of the executive authorities of the constituent entities of the Russian Federation in the field of healthcare."
Olga G. Krestyaninova
Postgraduate Student, Department of Finance and Credit, St Petersburg State University of Service and Economics
Personalized Registration of Compulsory Health Insurance Services
The article studies the effectiveness of the system of personified registration of medical services provided by the compulsory health insurance. Keywords: medical services, personified registration, insurance coverage, subject of personified registration, insurance case, insurer
