Submission of bills to the State Duma. On approval of the procedure for maintaining personalized accounting in the field of compulsory health insurance Personalized accounting in the OMS system
personalized 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 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 provided 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 on 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 a citizen is endowed with significant rights. In particular, the right to independently request 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 volume 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 the 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 relevant and reliable information received by the insured medical care... 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 connecting 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 health insurance in 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 services received in a specialized institution, and often does not inform the attending physician about this.
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 an 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 medical insurance organizations (hereinafter CMO) and cHI funds get 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 insurance medical organizations with medical institutions is governed by an agreement for the provision of medical and preventive care (medical services) under compulsory health insurance, which, inter alia, provides for the control of the information provided by the medical institution by the health insurance organization and their transfer to the compulsory health 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 HCI 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 a consolidated register of the population insured under 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 based on differentiated per capita rates 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 the state policy in the field of compulsory health insurance of citizens.
The MHI and CMO funds maintain databases of insured citizens, which must be kept 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 of primary information in the system 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 - the 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 on actually rendered 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 29.11.2010 No. 326-FZ "On Compulsory Health 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. Order of FFOMS dated 07.04.20011 No. 79 "On approval of the general principles for the construction and functioning of information systems and the procedure for information interaction in the field of compulsory health insurance" (as amended by Order of FFOMS dated 22.08.2011 No. 154).
5. Order of the Ministry of Health and Social Development of January 25, 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
Chapter 6. PERSONAL ACCOUNTING IN THE FIELD OF COMPULSORY HEALTH INSURANCE
One of the innovations introduced by Ch. 10 of Law N 326-FZ, is a personified account in the field of compulsory health insurance.
A funny children's cartoon about a kid, who could count to 10. A simple, accessible story for a preschool child, comes to mind. The kid learned to count to 10 and began to demonstrate his skill to everyone he met. At first, everyone was angry with him, but in the end, in a difficult situation, the kid's ability to count was useful to save the rest. Conclusion - how good to be able to count.
So personalized accounting was introduced to ensure the insured the right to free provision of medical care of appropriate quality and volume within the framework of basic and territorial programs. It is designed to facilitate control over the use of compulsory health insurance funds, to help determine the need for the volume of medical care for the formation of future programs.
- 1. Areas of accounting
Personalized records are kept in the form single register, which is a set of its central and regional segments, and includes collection, processing, transfer and storage of a variety of information about insured persons.
In addition, a personalized registration of information about medical care provided to the insured population.
This area of \u200b\u200baccounting includes the collection, processing, transfer and storage of information such as the number of the compulsory health insurance policy, types, conditions, terms of medical care, which medical organizations provided this assistance. In this direction, the accounting will contain information on the volume of medical care provided, its cost, diagnoses delivered to the insured patient, and the profile of medical care. From the accounting data, it will be possible to clearly know which medical worker of which specialty and with the use of which medical and economic standards provided assistance. Finally, the accounting will reflect the results of the patient's appeal for medical care, as well as the results of the control of the volume, timing, quality and conditions of its provision.
The law allows keeping records in writing and in in electronic format... The latter option should guarantee the reliability (authenticity) of the data, protection from unauthorized access and possible distortion. Information about the insured person and about the medical care provided to him is confidential, refers to information with limited access and is subject to protection in accordance with the law.
- 2. Processing and storage of documents
Information about the working insured persons for entering them into the regional segment of the unified register of insured persons is monthly transferred to TFOMS by the territorial body of the PFR.
Insurance medical companies, clinics and hospitals must keep copies of paper documents and electronic archives containing personalized information. After the expiration of the established storage period in the insurance medical organization documents are subject to destruction.
Insurance companies are required to check the information entered in the register for repetitions:
- by last name, first name, patronymic, date and place of birth;
- according to the data of the identity document;
- by date of birth and registration address at the place of residence;
- by last name, first name and patronymic and registration address at the place of residence;
- according to the insurance number of the individual personal account.
At least once a month insurance Company must transfer files to TFOMS with changes in information about the insured. The policyholder for non-working citizens also monthly, no later than the 5th day of each month, submits information about the non-working insured persons to the fund. This must be done so that the information in the registry is always up to date. The TFOMI should receive and process such information around the clock.
Medical organizations provide TFOMI with information about medical care provided to insured persons. He within two working days on the basis of the regional segment of the unified register of insured persons carries out automated processing of the information received.
At the same time, the persons who received medical assistance outside the insurance territory are identified and their insurance territory is determined. In case of difficulties, TFOMS must prepare a request to the central segment of the unified register, where within five working days a check will be carried out and a response will be generated indicating the identified insurance territory and the current policy number of the insured person.
MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION
ORDER
On approval of the Procedure for maintaining personalized records in the field of compulsory health insurance
Document with changes made:
(Official Internet portal of legal information www.pravo.gov.ru, 03.02.2017, N 0001201702030009);
(Official Internet portal of legal information www.pravo.gov.ru, 31.01.2019, N 0001201901310031).
____________________________________________________________________
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.
The minister
T. Golikova
Registered
at the Ministry of Justice
Russian Federation
February 8, 2011
registration N 19742
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 mandatory pension insurance;
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);
15) information about the medical organization selected by the insured person in accordance with the legislation of the Russian Federation to receive primary health care;
by order of the Ministry of Health of Russia dated January 15, 2019 N 12n)
16) information about a medical worker chosen by the insured person in accordance with the legislation of the Russian Federation to receive primary health care.
(The subparagraph is additionally included from February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n)
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) information about the medical organization that provided medical services;
by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
3) types of medical care provided;
4) conditions for the provision of medical care;
4_1) forms of medical care;
(The subparagraph is additionally included from February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n)
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) information about the medical services provided to the insured person and the medicinal products used;
(Subclause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
11) applied standards of medical care;
(Subclause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
12) information about the medical worker or medical workers who provided medical services;
(Subclause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
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 into the unified register of insured persons.
10. Maintenance of the regional segment of the unified register of insured persons is carried out by the territorial fund on the basis of information about insured persons provided by an insurance medical organization, a medical organization, tax authorities, military commissariats, as well as on the basis of information provided within the framework of interdepartmental interaction from other state information systems in in accordance with this Procedure.
by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
11. An insurance medical organization, a medical organization and a territorial fund by orders determine 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.
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
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 the insured persons into it, the medical insurance organization generates and transmits information files with changes in information about the insured persons provided for in subparagraphs 1-13 of 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 agreement on financial support compulsory health insurance.
In order to update the information about the medical organization and the medical worker selected by the insured person in accordance with the legislation of the Russian Federation to receive primary medical and sanitary care, the medical organization generates and transmits information files with changes in the information about the insured persons provided for in subparagraphs 1, 3, 11, 15 and 16 of clause 3 of this Procedure, to insurance medical organizations and the territorial fund as necessary, but at least once a day if there are changes in the information about the insured persons.
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
14. The territorial fund provides round-the-clock reception and processing of files with changes received from insurance medical organizations and medical organizations.
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
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, entering information about insured persons is 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, medical organizations to correct information about the insured persons.
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
17. Tax authorities quarterly, no later than the 15th day of the second month following the reporting period, provide in accordance with the Agreement on information exchange between The Federal Fund compulsory medical insurance (hereinafter - the Federal Fund) and the federal executive body authorized to control and supervision in the field of taxes and fees, to the relevant territorial fund information about the working insured persons, provided for in subparagraphs 1-10 and 14 of paragraph 3 of this Procedure, for entering them to the regional segment of the unified register of insured persons.
(Clause as amended by the order of the Ministry of Health of Russia dated December 8, 2016 N 941n; as amended on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
18. Military commissariats, on a quarterly basis, no later than the 15th day of the month following the reporting period, submit to the territorial funds information about the citizens called up for military service, provided for in paragraphs 1 and 6 of part 2 of article 44 of the Federal Law of November 29, 2010 N 326- Federal Law "On Compulsory Medical Insurance in the Russian Federation" (Collected Legislation of the Russian Federation, 2010, N 49, Art. 6422; 2012, N 31, Art. 4322, N 49, Art. 6758; 2013, N 48, Art. 6165; 2014, N 11, Art. 1098; 2015, N 51, Art. 7245; 2018, N 31, Art. 4857) (hereinafter - the Federal Law "On Compulsory Health Insurance in the Russian Federation"), and information on the beginning, timing and the end of military service in accordance with Part 8 of Article 49 of the Federal Law "On Compulsory Medical Insurance in the Russian Federation".
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
19. Territorial fund:
1) as necessary, but at least 1 time a day, checks the accuracy of information about the insured person received from an insurance medical organization by sending requests to the authorities issuing and replacing identity documents of a citizen of the Russian Federation on the territory of the Russian Federation, and in case of revealing discrepancies in the information about the insured person, sends information files to the medical insurance organization with their indication;
2) weekly on the basis of information on state registration of the conclusion or dissolution of marriage, establishment of paternity, change of name contained in the Unified State Register of Civil Status Acts, provided within the framework of interagency cooperation in accordance with (Collected Legislation of the Russian Federation, 1997, N 47, Art. .5340; 2016, N 26, Art. 3888; 2018, N 31, Art. 4857, 4861, N 53, Art. 8454), identifies the insured person in the regional segment of the unified register of insured persons in order to determine the insurance medical organization, in which it is insured, and if the information about the insured person changes, sends the specified information to the medical insurance organization to ensure control over the change in information about the identity document of the insured person, re-issuance of the compulsory medical insurance policy and further sending information files to the territorial fund for updating ration of the regional segment of the unified register of insured persons within 30 days from the date of state registration of the conclusion or dissolution of marriage, establishment of paternity, change of name;
3) monthly:
a) on the basis of information on the state registration of death contained in the Unified State Register of Civil Status Acts, provided in the framework of interagency cooperation in accordance with Article 13_2 of the Federal Law of November 15, 1997 N 143-FZ "On Acts of Civil Status" (Collection legislation of the Russian Federation, 1997, No. 47, article 5340; 2016, No. 26, article 3888; 2018, No. 31, article 4857, 4861, No. 53, article 8454):
Terminates the policy of compulsory medical insurance for persons whose information is available in the regional segment of the unified register of insured persons;
Sends to the Federal Fund information files with information about the state registration of death for persons, information about which is not available in the regional segment of the unified register of insured persons;
b) makes a request to the Federal Fund to obtain information about persons, information about which is available in the regional segment of the unified register of insured persons, but who died outside the territory of the constituent entity of the Russian Federation, in which it is insured;
c) on the basis of information received from the Federal Fund, recognizes the compulsory medical insurance policy as invalid if:
Termination of citizenship of the Russian Federation in the absence of grounds for recognizing a person as an insured person in accordance with Part 1 of Article 10 of the Federal Law "On Compulsory Medical Insurance in the Russian Federation" - from the date of receipt of information in accordance with subparagraph 1 of paragraph 27_1 of this Procedure;
Cancellation of a residence permit in relation to foreign citizens, stateless persons - from the date of receipt of information in accordance with subparagraph 2 of paragraph 27_1 of this Procedure;
Cancellation of a temporary residence permit for foreign citizens, stateless persons - from the date of receipt of information in accordance with subparagraph 3 of paragraph 27_1 of this Procedure;
Loss or deprivation of refugee status - from the date of receipt of information in accordance with subparagraph 4 of paragraph 27_1 of this Procedure;
4) quarterly:
a) on the basis of information about the insured person, provided for in paragraph 17 of this Procedure, within 15 working days from the date of receipt:
Updates the regional segment of the unified register of insured persons and sends information files with information about working insured persons to the Federal Fund;
Sends to the Federal Fund 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;
b) no later than the 15th day of the third month following the reporting period, provides the policyholder for non-working citizens with information about the insured persons who are recorded as non-working insured persons, and information about which, provided for in subparagraphs 1-10, 14 of paragraph 3 of this Procedure, not provided in accordance with clause 17 of this Procedure;
c) on the basis of the information provided for in clause 18 of this Procedure, suspends the compulsory health insurance policy.
(Clause 19 as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
20. The Territorial Fund ensures that the regional segment of the unified register of insured persons is updated on the basis of information in accordance with subparagraphs 2-4 of clause 19 of this Procedure, notifies medical insurance organizations about this and sends information files to the Federal Fund to update the central segment of the unified register of insured persons.
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
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 "On compulsory health insurance in the Russian Federation ".
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
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 insurance medical organization and the medical organization, indicating the list of inconsistencies.
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
IV. Maintaining the central segment of the unified register of insured persons
24. When making changes to the regional segment of the unified register of insured persons, the territorial fund generates files with changes, which are sent to the Federal Fund to update 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 about the insured person, including on the suspension of the compulsory health insurance policy, on the recognition of the compulsory health insurance policy as invalid, on the state registration of death, on the status of insured persons (working, unemployed), about medical organizations and medical professionals selected by the insured persons.
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
27_1. The federal fund on a quarterly basis, no later than the 15th day of the month following the reporting period, ensures the processing of information received from the federal executive body in the field of internal affairs, provided for in subparagraphs 1 and 6 of paragraph 3 of this Procedure:
1) on persons whose citizenship of the Russian Federation has been terminated;
2) on foreign citizens, stateless persons, in respect of whom the residence permit has been canceled in accordance with (Collected Legislation of the Russian Federation, 2002, No. 30, article 3032; 2018, No. 1, article 77, article 82, No. 27 , Art.3951, N 30, Art.4537, Art.4551);
3) about foreign citizens, stateless persons in respect of whom a temporary residence permit has been canceled in accordance with Federal Law of July 25, 2002 N 115-FZ "On the Legal Status of Foreign Citizens in the Russian Federation" (Collected Legislation of the Russian Federation ", 2002, N 30, Art.3032; 2018, N 1, Art. 77, Art. 82, N 27, Art. 3951, N 30, Art. 4537, Art. 4551);
4) on persons recognized as refugees on the territory of the Russian Federation, if they lose their refugee status or are deprived of their refugee status in accordance with the Federal Law of February 19, 1993 N 4528-1 "On Refugees" (Collection of laws of the Russian Federation, 1997, No. 26, article 2956; 1998, No. 30, article 3613; 2000, No. 33, article 3348, No. 46, article 4537; 2003, No. 27, article 2700; 2004, No. 27, article 2711, No. 35, article 3607; 2006, No. 31, article 3420; 2007, No. 1, article 29; 2008, No. 30, article 3616; 2011, No. 1, article 29, No. 27, article 3880; 2012 , No. 10, article 1166, No. 47, article 6397, No. 53, article 7647; 2013, No. 27, article 3477; 2014, No. 52, article 7557; 2018, No. 1, article 82).
(Clause 27_1 is additionally included from February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n)
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. The exchange of data between medical insurance organizations, medical organizations, territorial funds and the Federal Fund for the purpose of maintaining personalized accounting of information about insured persons, provided for in paragraph 3 of this Procedure, is carried out in electronic form via dedicated or open communication channels, including the Internet, using electronic digital signature in accordance with the requirements for the protection of personal data established by the legislation of the Russian Federation.
(Clause as amended, entered into force on February 11, 2019 by order of the Ministry of Health of Russia dated January 15, 2019 N 12n.
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 personalized records 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 care provided to insured persons.
34. At the stage of automated processing of information on 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.
Document revision taking into account
changes and additions prepared
JSC "Codex"
Article 43. Personalized registration in the field of compulsory health insurance
1. Personalized accounting in the field of compulsory health insurance (hereinafter referred to as personalized accounting) - organizing and maintaining records of information about each insured person in order to exercise the rights of citizens to free medical care under compulsory health insurance programs.
2. The purposes of personalized accounting are:
3. Personalized accounting, collection, processing, transfer and storage of information is carried out by the Federal Fund and territorial funds, the Pension Fund of the Russian Federation and its territorial bodies, medical insurance organizations, medical organizations and insurers for unemployed citizens in accordance with the powers provided for by this Federal law.
4. For the purposes of personalized accounting, the Federal Fund and territorial funds carry out information interaction with policyholders for non-working citizens, with the Pension Fund of the Russian Federation and its territorial bodies, medical organizations, medical insurance organizations and other organizations in accordance with this Federal Law.
5. The procedure for maintaining personalized accounting is determined by the authorized federal executive body.
Personalized accounting of informationabout insured persons is kept 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 certain information about insured persons.
The list of information included in the registers is contained in Art. 44 of the Law, and is also duplicated in the order of the Ministry of Health and Social Development of the Russian Federation dated 25.01.2011 No. 29n "On approval of the Procedure for maintaining personalized records in the field of compulsory health insurance." The established procedure determines the rules for maintaining personalized records of information about each insured person in the field of compulsory health insurance. In particular, the organization of personalized accounting in the field of compulsory health insurance; maintaining a unified register of insured persons; maintaining personalized records of information about medical care provided to insured persons and the technology of information exchange when maintaining personalized records in the field of compulsory health insurance.
The organization of personalized accounting in relation to pension insurance demanded the adoption of a special voluminous Federal Law dated 01.04.1996 No. 27-FZ "On individual (personified) accounting in the compulsory pension insurance system." In the field of compulsory health insurance, such a law has not been adopted, and the relevant legal relationship is regulated by bylaws.
Federal Mandatory Health Insurance Fund approved general principles construction and functioning of information systems and the procedure for information interaction in the field of compulsory health insurance (order of the MHIF dated 07.04.2011 No. 79). In order to establish uniform requirements and rules for information interaction applied by participants and subjects of the compulsory health insurance system on the territory of the Russian Federation, the following were approved:
General requirements for the construction and functioning of information systems in the field of compulsory health insurance;
Requirements for the regional information system of compulsory health insurance;
General requirements for the information system of the territorial compulsory health insurance fund;
Requirements for the subsystem of maintaining the regional segment of the Unified Register of Insured Persons;
Requirements for the subsystem for maintaining personalized records of medical care provided to insured persons in the field of compulsory medical insurance;
Requirements for the subsystem of informing citizens (the official website of the territorial fund of compulsory medical insurance on the Internet);
General requirements for the information system of an insurance medical organization;
Requirements for the subsystem of personalized accounting of information about insured persons;
Requirements for the subsystem of personalized accounting of medical care provided to insured persons in the field of compulsory medical insurance;
Requirements for the citizen information subsystem (the official website of the medical insurance organization on the Internet);
General requirements for the information system of a medical organization; requirements for the subsystem of personalized accounting of medical care provided to insured persons in the field of compulsory medical insurance.
In order to ensure information interaction between the Federal Fund and territorial funds, insurers for non-working citizens, with the Pension Fund of the Russian Federation and its territorial bodies, medical organizations, medical insurance organizations and other organizations, the following have been concluded:
- Agreement on information exchange between the Pension Fund of the Russian Federation and the Federal Fund of Compulsory Medical Insurance dated December 31, 2010, PF RF No. AD-30-32 / 09sog, FOMS No. 6547 / 20-1264;
- Agreement on information exchange between the Pension Fund of the Russian Federation and the Federal Fund of Compulsory Medical Insurance dated January 31, 2011, PF RF No. AD-08-33 / 03sog, FOMS No. 558/91-i265.
Thus, a fully legal basis for information interaction between these bodies has not yet been created and should be formed in the future.
Purposes of personified accounting according to the law are:
1) creation of conditions for ensuring guarantees of the rights of insured persons to free provision of medical care of adequate quality and in an appropriate volume within the framework of compulsory medical insurance programs;
2) creating conditions for exercising control over the use of compulsory health insurance funds;
3) determining the need for the volume of medical care in order to develop compulsory health insurance programs.
In fact, personalized accounting data will make it possible to uniquely identify a citizen, determine the volume and quality of medical care provided to him, but only within the framework of compulsory medical insurance, that is, provided to him free of charge within the basic and territorial program; will provide more accurate forecasting
the need for medical care, determine the necessary costs.
Analysis of personalized accounting data is one of the conditions for organizing control over the quality of medical care provided and, accordingly, the use of compulsory medical insurance, which, in the event of poor-quality medical care: violation of the volume, timing, quality and conditions of medical care, are subject to withholding from the volume funds provided for payment for medical care provided by medical organizations, or are subject to return to an insurance medical organization in accordance with the contract for the provision and payment of medical care under compulsory medical insurance, a list of grounds for refusing to pay for medical care, or the payment for medical care is reduced.
Article 44. Personalized accounting of information about insured persons and information about medical care provided to insured persons
1. In the field of compulsory health insurance, personalized records of information about insured persons and personalized records of information about medical care provided to insured persons are kept.
2. When maintaining personalized records of information about insured persons, the following information about insured persons is collected, processed, transferred and stored:
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;
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).
3. Personalized accounting of information about insured persons is maintained in the form of a unified register of insured persons, which is a set of its central and regional segments containing information about insured persons.
4. When maintaining personalized records of information about medical care provided to insured persons, the following information is collected, processed, transferred and stored:
1) the number of the policy of compulsory medical insurance of the insured person;
8) diagnosis;
11) applied medical and economic standards;
5. Information about the insured person and about the medical care provided to him may be provided in the form of documents both in writing and in electronic form, provided there is a guarantee of their reliability (authenticity), protection from unauthorized access and distortion. 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 providing information in electronic form is made jointly by the participants in the information exchange.
6. 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.
The regional segment of the unified register of insured persons is maintained by the territorial fund on the basis of information about insured persons provided by an insurance medical organization.
At the stage of automated processing of information on personalized accounting 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 the above paragraphs 1 and 2 to a medical organization that provided medical assistance to the insured.
A medical organization, based on the results of automated processing of information about medical care provided to insured persons, submits them to insurance medical organizations in the amount and within the time limits established by the contract for the provision and payment of medical care under compulsory medical insurance.
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 electronically via dedicated or open communication channels, including the Internet, using an electronic digital signature in in accordance with the requirements for the protection of personal data established by the legislation of the Russian Federation.
The protection of personal data is ensured by the following mechanism provided for by the Federal Law of 27.07.2006 No. 152-FZ "On Personal Data" and the Decree of the Government of the Russian Federation of 17.11.2007 No. 781 "On approval of the Regulation on ensuring the security of personal data when processing them in personal data information systems ".
An insurance medical organization and a territorial fund, by orders, determine 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.
When processing personal data, the operator is obliged to take the necessary organizational and technical measures to protect personal data from unauthorized or accidental access to them, destruction, modification, blocking, copying, dissemination of personal data, as well as from other illegal actions.
Implementation of information security requirements in information security tools is the responsibility of their developers.
Article 45. Compulsory health insurance policy
1. The policy of compulsory medical insurance is a document certifying the right of the insured person to provide free medical care throughout the Russian Federation in the amount stipulated by the basic compulsory medical insurance program.
2. The compulsory health insurance policy is provided by the federal electronic application contained in the universal electronic card, in accordance with the Federal Law of July 27, 2010 No. 210-FZ "On the organization of the provision of state and municipal services." Uniform requirements for a policy of compulsory health insurance are established by the rules of compulsory health insurance.
In accordance with Part 2 of Art. 50 of the commented Law from May 1, 2011 for all constituent entities of the Russian Federation there are policies of the same sample. Their production is organized by the Federal Mandatory Health Insurance Fund. At the same time, the policies issued before the entry into force of the Law are valid until they are replaced with policies of a single sample.
The compulsory health insurance rules establish the following requirements for the compulsory health insurance policy. The policy can be presented in the form of a paper form or in the form plastic card with electronic media. For both forms of the policy, uniform requirements have been introduced.
Firstly, the policy is a document of strict reporting and, accordingly, accounting is carried out as for a strict reporting form. Secondly, both policies are bilateral (have front and back sides, reflecting the relevant information) and have a protective complex.
At the same time, the difference between the carriers causes additional requirements. So, a paper policy is a sheet of A5 format, on the front side of which there is information about the policy and personal data of the insured person, certified by his signature. In addition, the front side contains a barcode containing general information about the policy and the insured person. The reverse side of the policy contains information about the insurance medical organization chosen by the insured person, certified by the signature of its representative and the seal.
Plastic policy with an electronic carrier (electronic policy) has visual (graphic) information about the policy and the insured person. In addition, for insured persons over 14 years of age, it is mandatory to place a photograph on the back of the policy. For electronic policies provides for the possibility of placing (reading) insurance and medical applications. Through the first, the insured person's access to services in the field of compulsory health insurance is realized, as well as changeable and unchangeable data about the policy and the insured person is embedded. The medical application mediates the information about the insured person necessary to provide him with medical assistance.
In accordance with paragraph 1 of Art. 940 of the Civil Code of the Russian Federation, an insurance contract must be concluded in writing. However, Federal Law No. 326-FZ does not directly provide for the conclusion oMS agreement in this form. Obligatory relations between the policyholder, the insurer and the insured persons are formed directly by virtue of the law.
The Civil Code of the Russian Federation provides that an insurance contract can be concluded by issuing a policy by an insurer, while Federal Law No. 326-FZ establishes that compulsory medical insurance policy issued by an insurance medical organization.
Federal Law No. 326-FZ does not explain the legal nature of the compulsory medical insurance policy. An article containing the rules for issuing compulsory health insurance policies is in the section on personalized accounting in the field of compulsory health insurance.
In Art. 45 of the Federal Law No. 326-FZ provides that the OMI policy is provided by the federal electronic application contained in the universal electronic card in accordance with Art. 23 of the Federal Law of 27.07.2010 No. 210-FZ “On the organization of the provision of state and municipal services”.
In accordance with Art. 25 of the Federal Law "On the Organization of the Provision of State and Municipal Services" universal electronic cards are issued to citizens on the basis of applications for the issuance of cards from 01.01.2012 to 31.12.2013. However, the law of a constituent entity of the Russian Federation, as well as a decree of the Government of the Russian Federation earlier date of issue of such cards. Issuing a card is free of charge.
If citizens, within the specified period, have not applied for the issuance of a universal electronic card and have not submitted an application for refusal to receive a card, then the right to receive a card is not lost.
Article 26 of the Federal Law "On the Organization of the Provision of State and Municipal Services" establishes that citizens who have not submitted applications for the issuance of a universal electronic card before January 1, 2014 and have not applied to refuse to receive this card, a universal electronic card is issued for free of charge by an authorized organization of a constituent entity of the Russian Federation from January 1, 2014 (Fig. 1). If a citizen refuses to receive a universal electronic card, he will be able to use the compulsory health insurance policy. Citizens can also refuse the card at any time after receiving it: such a card is canceled in accordance with the established procedure.
Figure: 1. Sample of a universal electronic card.
Article 46. Procedure for issuing a compulsory health insurance policy to an insured person
1. To obtain a policy of compulsory medical insurance, the insured person personally or through his representative submits, in accordance with the procedure established by the rules of compulsory medical insurance, an application for choosing an insurance medical organization, provided for by paragraph 2 of part 2 of Article 16 of this Federal Law, to an insurance medical organization or absence in the territorial fund.
2. On the day of receipt of the application for choosing an insurance medical organization, the insurance medical organization or, in its absence, the territorial fund shall issue the insured person or his representative a policy of compulsory health insurance or a temporary certificate in cases and in the manner determined by the rules of compulsory health insurance.
An application for choosing an insurance medical organization is submitted to an insurance medical organization. In the event that such an organization is absent, then the corresponding application is submitted to the territorial compulsory medical insurance fund.
The insured person submits an application for choosing an insurance medical organization personally or through his representative. In cases established by law, the commission of such a legally significant action as filing an application for choosing an insurance medical organization can be carried out exclusively through a legal representative (for minors, persons recognized by a court as incapable).
An application for the choice (replacement) of an insurance medical organization is drawn up in writing or in a typewritten form and submitted (sent) to an insurance medical organization or transmitted using public information and communication networks, including the Internet, through the official website of the territorial fund or a single portal government services.
Article 47. Interaction of a medical organization with a territorial fund and an insurance medical organization in maintaining personalized records of information about medical care provided to insured persons
1. Medical organizations provide information on medical care provided to insured persons, provided for in paragraphs 1-13 of part 4 of Article 44 of this Federal Law, to the territorial fund and the medical insurance organization in accordance with the procedure for maintaining personalized records established by the authorized federal executive body.
2. Data of personalized accounting of information about medical care provided to insured persons are provided by medical organizations to medical insurance organizations in the amount and terms established by the contract for the provision and payment of medical care for compulsory medical insurance.
3. Insurance medical organizations and medical organizations, in accordance with the rules for organizing state archival affairs, store copies of documents in paper and electronic media containing the information specified in part 1 of this article and provided to the territorial fund for maintaining personalized records.
4. Medical organizations, medical insurance organizations and territorial funds determine the employees admitted to work with the personalized accounting data of information about medical care provided to insured persons, and ensure their confidentiality in accordance with the requirements for the protection of personal data established by the legislation of the Russian Federation.
5. After the expiration of the period established for storing copies of documents in paper and electronic media in an insurance medical organization specified in part 3 of this article, these copies 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 medical insurance organization ...
6. Data of personalized accounting of information about medical care provided to insured persons specified in part 1 of this article shall be stored in accordance with the legislation of the Russian Federation.
Every citizen in accordance with Art. 23 of the Constitution of the Russian Federation has the right to personal secrecy, which also includes information about the state of his health, past or existing diseases. Information about medical care provided to insured persons is classified as confidential information. In this regard, increased requirements are imposed on the relevant information regarding their safety and non-disclosure. Confidential information is information requiring protection, access to which is limited within established limits. Therefore, medical organizations, medical insurance organizations and territorial funds carry out the necessary protection of the relevant information.
For these purposes, they are obliged to determine the employees admitted to work with personalized accounting data on information about the medical care provided, and to impute to them in their official duties the observance of the relevant information in secret, as well as responsibility for their disclosure.
Confidentiality of personal data is a mandatory requirement for the operator or other person who has gained access to personal data to prevent their dissemination without the consent of the subject of personal data or other legal grounds.
Specifically, the relevant organizations are obliged to ensure the confidentiality of information within the framework of the requirements established by the legislation on the protection of personal data, including by blocking access to them, depersonalization, etc.
The law establishes special periods for the storage of copies of documents on the provision of medical care within the framework of compulsory medical insurance by insurance organizations. After expiration deadlines storage of copies of documents (on paper and electronic media) on the provided medical care shall be destroyed.
An appropriate act must be drawn up on the destruction of documents. The act on the allocation for destruction of cases that are not subject to storage is drawn up for the affairs of the entire organization. If the act indicates the cases of several divisions, then the name of each division is indicated before the group of headings of the cases of this division. Headings of similar cases selected for destruction are entered into the act under a general heading, indicating the number of cases assigned to this group. Cases to be destroyed are transferred for processing (disposal). The transfer of cases is drawn up with a delivery note, which indicates the date of transfer, the number of cases to be submitted and the weight of waste paper. Loading and removal for disposal are carried out under the control of an employee responsible for ensuring the safety of archive documents (clauses 2.4.5, 2.4.7 of the Basic Rules for the Archives of Organizations).
Based on the informational significance of certain types of archival documents, the Law on Archival Affairs in Art. 22 established the period of temporary storage in the archives of organizations of documents on personnel, which includes information about personal and family secrets, at 75 years. Consequently, the personalized accounting data (information about medical care provided to the insured persons) will be required to be stored for the specified period.
Article 48. Interaction between an insurance medical organization and a territorial fund in maintaining personalized records of information about medical care provided to insured persons
1. Insurance medical organizations shall provide information on medical care provided to insured persons, received from medical organizations and specified in part 4 of Article 44 of this Federal Law, to the territorial fund in accordance with the procedure for maintaining personalized records.
2. Data of personalized accounting of information about medical care provided to insured persons are provided by medical insurance organizations to the territorial fund in the amount and terms established by the contract on financial support of compulsory medical insurance, but no later than the 20th day of the month following the reporting one.
3. Based on the information specified in Part 1 of Article 47 of this Federal Law and Part 1 of this Article, the territorial funds keep personalized records of information on medical care provided to insured persons in accordance with this Federal Law and the procedure for maintaining personalized records.
4. Maintaining personalized records of information about medical care provided to insured persons in territorial funds is carried out on paper and (or) electronic media... In case of discrepancy between information on paper and information on electronic media, information on paper media has priority.
5. The information specified in part 4 of this article shall be stored in accordance with the rules for organizing state archival affairs.
Personalized accounting information about medical care provided to insured persons includes the 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.
Part 2 of Article 48 defines the procedure for providing personalized accounting data for information about medical care provided to insured persons by medical insurance organizations to the territorial fund.
Conditions on the volumes and terms of provision are sent by medical insurance organizations within the time frames provided for by the contract on financial support of compulsory health insurance. The terms for providing information to the territorial fund can be set individually for the medical insurance organization, but no later than the 20th day of the month following the reporting one.
Part 4 of Article 48 provides that information about the insured person and about the medical care provided to him can be provided to the territorial funds both in the form of documents in writing and in electronic form, provided there are guarantees of their reliability (authenticity), protection from unauthorized access and distortion in accordance with the established requirements for 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 Federal Law No. 1-FZ of 10.01.2002 "On Electronic Digital Signature".
The decision on the possibility of submitting information in electronic form is made jointly by the participants in the information exchange.
In cases of discrepancy between the information specified on paper and information on electronic media, information on paper will have priority.
Part 5 of Article 48 provides that the maintenance of personalized records of information about medical care provided to insured persons in territorial funds is subject to storage in accordance with the Federal Law of the Russian Federation dated 22.10.2004 No. 125-FZ "On archiving in the Russian Federation". According to Art. 22 of the said Law, the storage period is 75 years.
Article 49. Interaction of the territorial body of the Pension Fund of the Russian Federation, the insured for non-working citizens and the territorial fund in maintaining personalized accounting of information about insured persons
1. 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, submits to the relevant territorial fund information on working insured persons specified in clauses 1-10 and 14 of part 2 of article 44 of this Federal Law.
2. The policyholder for non-working citizens shall, on a monthly basis, no later than the 5th day of each month, provide the relevant territorial fund with information on the non-working insured persons provided for in Clauses 1-10 and 14 of Part 2 of Article 44 of this Federal Law.
3. Territorial bodies of the Pension Fund of the Russian Federation, policyholders for non-working citizens exchange information with territorial funds in electronic form in the manner determined by agreements on information exchange and in the form approved by the Federal Fund and the Pension Fund of the Russian Federation.
4. Territorial funds, within 15 working days from the date of receipt of information about the insured person, provided for in parts 1 and 2 of this article, enter them into the regional segment of the unified register of insured persons.
Article 49 is aimed at ensuring the smooth functioning of the unified register of insured persons and creating a clear system of interaction between subjects of compulsory health insurance at the regional level.
Article 49 establishes the basis for interaction between the territorial body of the Pension Fund of the Russian Federation, the insured for non-working citizens and the territorial fund when maintaining personalized records of information about insured persons. In more detail, the interaction of these entities is regulated by the order of the Ministry of Health and Social Development of the Russian Federation dated January 25, 2011 No. 29n "On approval of the Procedure for maintaining personalized records in the field of compulsory medical insurance" and "Agreement on information exchange between the Pension Fund of the Russian Federation and the Federal Fund of Compulsory Medical Insurance".
The territorial body of the Pension Fund of the Russian Federation (hereinafter referred to as the OPFR), on a quarterly basis, no later than the 15th day of the second month following the reporting period, provides the relevant territorial fund with information on working insured persons for entering them into the regional segment of the unified register of insured persons. This is ensured by the Agreement on information exchange between the Pension Fund of the Russian Federation and the Federal Fund of Compulsory Medical Insurance.
The policyholder for non-working citizens on a monthly basis, no later than the 5th day of each month, submits information about the non-working insured persons to the relevant territorial fund. This is carried out 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.
In accordance with the Agreement on information exchange between the Pension Fund of the Russian Federation and the Federal Fund of Compulsory Medical Insurance, the interaction of the OPFR and TFOMS is carried out daily, monthly, quarterly and annually.
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 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 environmentwhich is the main goal public 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.
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