Federal law on OMS. Federal Law "On Compulsory Medical Insurance in the Russian Federation"

1. For the purposes of this Federal Law, medical organizations in the field of compulsory health insurance (hereinafter referred to as medical organizations) include those having the right to carry out medical activities and included in the register of medical organizations operating in the field of compulsory medical insurance (hereinafter also referred to as the register of medical organizations) , in accordance with this Federal Law:

1) organization of any organizational and legal form provided for by the legislation of the Russian Federation;

2) individual entrepreneurs engaged in medical activities.

2. A medical organization is included in the register of medical organizations on the basis of a notification sent by it to the territorial fund before September 1 of the year preceding the year in which the medical organization intends to operate in the field of compulsory medical insurance. The territorial fund does not have the right to refuse to include a medical organization in the register of medical organizations. The commission for the development of a territorial program of compulsory medical insurance in a constituent entity of the Russian Federation may establish other deadlines for submitting notifications by newly created medical organizations. Information on the timing and procedure for submitting a notice of inclusion of a medical organization in the register of medical organizations operating in the field of compulsory medical insurance is posted by the territorial fund on its official website on the Internet.

3. The register of medical organizations contains the names, addresses of medical organizations and a list of services provided by these medical organizations within the framework of the territorial program of compulsory medical insurance. The procedure for maintaining, the form and list of information in the register of medical organizations are established by the rules of compulsory medical insurance. The register of medical organizations is maintained by the territorial fund, posted on a mandatory basis on its official website on the Internet and may be additionally published in other ways.

4. Medical organizations included in the register of medical organizations do not have the right, during the year in which they operate in the field of compulsory medical insurance, to withdraw from the number of medical organizations operating in the field of compulsory medical insurance, except in cases of liquidation of a medical organization, loss of the right to carry out medical activities, bankruptcy or other cases provided for by the legislation of the Russian Federation. A medical organization included in the register of medical organizations that sent to the territorial fund a notice of exclusion from the register of medical organizations before the conclusion of an agreement for the provision and payment of medical care under compulsory medical insurance is excluded by the territorial fund from the register of medical organizations on the next business day after the date of receipt by the territorial fund the specified notice.

5. A medical organization carries out its activities in the field of compulsory medical insurance on the basis of an agreement for the provision and payment of medical care under compulsory medical insurance and is not entitled to refuse to provide medical care to insured persons in accordance with the territorial program of compulsory medical insurance.

6. Medical organizations keep separate records of operations with compulsory medical insurance funds.

7. Medical organizations established in accordance with the legislation of the Russian Federation and located outside the territory of the Russian Federation are entitled to provide types of medical care to insured persons established by the basic program of compulsory medical insurance at the expense of compulsory medical insurance in the manner established by the rules of compulsory medical insurance.

Judicial practice under article 15 of the Federal Law of November 29, 2010 No. 326-FZ

Decision dated May 8, 2019 in case No. А27-19099/2018

Listed by a medical organization under a contract for the provision and payment of medical care under compulsory medical insurance, used for other purposes. On the basis of Part 5, Article 15 of Law No. 326-FZ, a medical organization operates in the field of compulsory medical insurance on the basis of an agreement for the provision and payment of medical care under compulsory medical insurance. IN...

Decision dated April 30, 2019 in case No. А41-106217/2018

Arbitration Court of the Moscow Region (AC of the Moscow Region)

Register of accounts. The invoice for payment of medical care must be certified by the signature of the head and chief accountant of the medical organization and the seal of the medical organization. The organization, in the period from February 15, 2018 to February 19, 2018, in accordance with the established procedure, sent to the Medical Insurance Organization using the web service of registers of invoices for payment by the organization provided...

Decision dated April 29, 2019 in case No. А27-2411/2019

Arbitration Court of the Kemerovo Region (AC of the Kemerovo Region)

12/25/2017 No. 115-03, on the basis of standard contracts for the provision and payment of medical care under compulsory medical insurance concluded with medical insurance organizations (part 5 of article 15 of the Federal Law of 11/29/2010 No. 326-FZ "On Compulsory Medical Insurance in the Russian Federation (hereinafter - Law No. 326-FZ "On CHI") (Appendix No. 1 to the claim) and received ...

Decision dated April 29, 2019 in case No. А82-24989/2018

Arbitration Court of the Yaroslavl Region (AC of the Yaroslavl Region) - Civil

The essence of the dispute: About non-fulfillment or improper fulfillment of obligations under insurance contracts

RUB 1,159,971.40 Third party: Territorial Compulsory Medical Insurance Fund of the Yaroslavl Region. with the participation of: from the plaintiff – Menshova Zh.The. by proxy No. 10 dated 15 . 05.2018 from the defendant - Osipenko Yu.V. by power of attorney No. 449/18 dated 12/14/2018 (before the break); from a third person - did not appear. established: Federal State Health Institution "...

Ruling dated April 29, 2019 in case No. А82-6710/2018

Arbitration Court of the Yaroslavl Region (AC of the Yaroslavl Region)

Provided to the insured person, at the rates for paying for medical care at the expense of compulsory medical insurance in the manner established by the Rules for Compulsory Medical Insurance (part 7 of article 15, part 6 of article 39 of Law No. 326-FZ), in particular, on the basis of registers provided by the medical organization bills and bills for payment of medical care within the scope of medical care ...

Ruling dated April 26, 2019 in case No. А76-11164/2017

Arbitration Court of the Urals District (FAS UO)

Case materials of medical directions and research protocols on behalf of the defendant, patients of the institution, in addition to the studies carried out, additional instrumental studies were carried out. In accordance with Part 5 of Article 15 of Federal Law No. 326-FZ, the plaintiff, as an organization operating in the field of compulsory medical insurance, does not have the right to refuse to provide medical care to insured persons. Wherein...

Decision dated April 26, 2019 in case No. А74-220/2019

Arbitration Court of the Republic of Khakassia (AC of the Republic of Khakassia)

Compulsory medical insurance funds by medical organizations, approved by order of the Federal Compulsory Medical Insurance Fund dated April 16, 2012 No. 73, clauses 3.2.12 and 3.3. 15 of the Regulations on the Territorial Compulsory Medical Insurance Fund of the Republic of Khakassia, approved by the Decree of the Government of the Republic of Khakassia dated July 14, 2011 No. 435, the fund exercises control over the use of compulsory medical insurance funds by medical ...

1. The basic program of compulsory medical insurance is an integral part of the program of state guarantees of free provision of medical care to citizens, approved by the Government of the Russian Federation.

2. The basic program of compulsory medical insurance determines the types of medical care (including the list of types of high-tech medical care, which includes methods of treatment), the list of insured events, the structure of the tariff for paying for medical care, methods of paying for medical care provided to insured persons under compulsory medical insurance. insurance in the Russian Federation at the expense of compulsory medical insurance, as well as criteria for the availability and quality of medical care.

3. The basic program of compulsory medical insurance establishes the requirements for the conditions for the provision of medical care, the standards for the volume of medical care per insured person, the standards for financial costs per unit volume of medical care, the standards for financial support of the basic program of compulsory medical insurance per one insured person. the insured person, as well as the calculation of the coefficient of appreciation of the basic program of compulsory health insurance. The standards of financial costs per unit volume of medical care provided in this part are also established according to the list of types of high-tech medical care, which includes, among other things, methods of treatment.

4. Insurance coverage in accordance with the basic program of compulsory medical insurance is established based on the standards of medical care and procedures for the provision of medical care established by the authorized federal executive body.

5. The rights of insured persons to free medical care, established by the basic program of compulsory medical insurance, are uniform throughout the Russian Federation.

6. Within the framework of the basic program of compulsory medical insurance, primary health care is provided, including preventive care, emergency medical care (with the exception of air ambulance evacuation carried out by aircraft), specialized medical care, including high-tech medical care, in the following cases :

2) neoplasms;

3) diseases of the endocrine system;

4) eating disorders and metabolic disorders;

5) diseases of the nervous system;

6) diseases of the blood, blood-forming organs;

7) individual disorders involving the immune mechanism;

8) diseases of the eye and adnexa;

9) diseases of the ear and mastoid process;

10) diseases of the circulatory system;

11) respiratory diseases;

12) diseases of the digestive system;

13) diseases of the genitourinary system;

14) diseases of the skin and subcutaneous tissue;

15) diseases of the musculoskeletal system and connective tissue;

16) injuries, poisoning and some other consequences of external causes;

17) congenital anomalies (malformations);

18) deformities and chromosomal disorders;

19) pregnancy, childbirth, postpartum period and abortions;

20) individual conditions that occur in children during the perinatal period.

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

8. When approving the basic program of compulsory medical insurance, the Government of the Russian Federation has the right to establish an additional list of diseases and conditions included in the basic program of compulsory medical insurance as cases of medical care, and additional elements of the structure of the tariff for paying for medical care to those established by this Federal Law.

9. The basic program of compulsory medical insurance establishes the requirements for territorial programs of compulsory medical insurance.

Article 1

Include in the Code of the Russian Federation on Administrative Offenses (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2002, N 1, Art. 1; N 30, Art. 3029; N 44, Art. 4295, 4298; 2003, N 27, Art. 2700, 2708, 2717; N 46, item 4434; N 50, item 4847, 4855; 2004, N 31, item 3229; N 34, item 3529, 3533; N 44, item 4266; 2005, N 1, item 9, 13, 40, 45; N 10, item 763; N 13, item 1075, 1077; N 19, item 1752; N 27, item 2719, 2721; N 30, item 3104, 3131; N 50, item 5247; N 52, item 5574; 2006, N 1, item 4, 10; N 2, item 172, 175; N 6, item 636; N 10, item 1067; N 12, 1234; No. 17, article 1776; No. 18, article 1907; No. 19, article 2066; No. 23, article 2380; No. 31, articles 3420, 3438, 3452; No. 45, article 4641; No. 50, article 5279, 5281; No. 52, article 5498; 2007, No. 1, article 21, 25, 29; No. 7, article 840; No. 16, article 1825; No. 17, article 1930; N 26, item 3089; N 30, item 3755; N 31, item 4007, 4008; N 41, item 4845; N 43, item 5084; N 46, item 5553; 2008, N 18, item 1941; N 20, item 2251, 2259; N 29, item 3418; N 30, item 3582, 3604; N 49, item 5745; N 52, item 6235, 6236; 2009, N 1, item . 17; No. 7, art. 771, 777; No. 23, art. 2759, 2767; No. 26, art. 3120, 3122, 3131; No. 29, art. 3597, 3642; No. 30, Art. 3739; No. 48, Art. 5711, 5724; No. 52, art. 6412; 2010, N 1, art. 1; No. 18, art. 2145; No. 19, Art. 2291; No. 21, art. 2525; No. 23, Art. 2790; No. 27, Art. 3416; No. 30, Art. 4002, 4006, 4007; N 31, art. 4158, 4164, 4191, 4193, 4195, 4206, 4207, 4208; No. 41, art. 5192; No. 49, art. 6409; 2011, N 1, art. 10, 23, 29, 54; No. 7, Art. 901; No. 15, Art. 2039; No. 17, art. 2310; No. 19, Art. 2714, 2715; No. 23, art. 3260, 3267; No. 27, Art. 3873; No. 29, art. 4290, 4291, 4298; No. 30, Art. 4573, 4585, 4590, 4598, 4600, 4601, 4605; No. 46, Art. 6406; No. 47, Art. 6602; No. 48, Art. 6728, 6730; No. 49, art. 7025, 7061; No. 50, art. 7342, 7345, 7346, 7351, 7352, 7355, 7362, 7366; 2012, N 6, art. 621; No. 10, art. 1166; No. 19, Art. 2278, 2281; No. 24, art. 3068, 3069, 3082; No. 29, art. 3996; N 31, art. 4320, 4322, 4330; No. 41, art. 5523; No. 47, Art. 6402, 6403, 6404, 6405; No. 49, art. 6752, 6757; No. 53, art. 7577, 7602, 7640, 7641; 2013, N 8, art. 717, 720; No. 14, Art. 1651, 1657, 1658, 1666; No. 19, Art. 2307, 2323, 2325; No. 26, art. 3207, 3208, 3209; No. 27, Art. 3454, 3469, 3470, 3477, 3478; No. 30, Art. 4025, 4029, 4030, 4031, 4032, 4034, 4036, 4040, 4044, 4078, 4082; N 31, art. 4191; No. 43, Art. 5443, 5444, 5445, 5452; No. 44, Art. 5624, 5643; No. 48, Art. 6159, 6161, 6163, 6165; No. 49, art. 6327, 6341, 6343; No. 51, art. 6683, 6685, 6695, 6696; No. 52, art. 6961, 6980, 6986, 6994, 6995, 7002; 2014, N 6, Art. 557, 559, 566; No. 11, art. 1092, 1096; No. 14, Art. 1561, 1562; No. 19, Art. 2302, 2306, 2310, 2317, 2324, 2325, 2326, 2327, 2330, 2335; No. 26, art. 3366, 3379, 3395; No. 30, Art. 4211, 4214, 4218, 4228, 4233, 4244, 4248, 4256, 4259, 4264, 4278; No. 42, Art. 5615; No. 43, Art. 5799; No. 48, Art. 6636, 6638, 6642, 6643, 6651; No. 52, art. 7541, 7545, 7547, 7548, 7550, 7557; 2015, N 1, art. 29, 35, 67, 74, 83, 85; No. 6, Art. 885; No. 10, art. 1405, 1416; No. 13, Art. 1811; No. 18, art. 2614, 2620; No. 21, Art. 2981; No. 24, art. 3370; No. 27, Art. 3945, 3950; No. 29, art. 4354, 4356, 4359, 4374, 4376, 4391; No. 41, art. 5629, 5637; No. 44, Art. 6046; No. 45, art. 6205, 6208; No. 48, Art. 6706, 6710, 6711, 6716; No. 51, Art. 7249, 7250; 2016, N 1, art. 11, 28, 59, 63, 84; No. 10, art. 1323; No. 11, art. 1481, 1490, 1491, 1493; No. 14, Art. 1907; No. 15, Art. 2051; No. 18, art. 2514; No. 23, Art. 3284, 3285) the following changes:

1) Paragraph one of Part 1 of Article 3.5 after the words "fifteen thousand rubles, in the cases provided for" shall be supplemented with the words "Article 5.35 1", after the words "twenty thousand rubles," shall be supplemented with the words "in the cases provided for by Article 6.1 1 of this Code, - thirty thousand rubles, ";

2) Part 1 of Article 4.5 after the words "for violation of the budgetary legislation of the Russian Federation and other normative legal acts regulating budgetary legal relations" shall be supplemented with the words "as well as for administrative offenses provided for in Articles 5.35 1 , 6.1 1 of this Code, for violation";

3) supplement Article 5.35 1 with the following content:

"Article 5.35 1. Non-payment of funds for the maintenance of children or disabled parents

1. Non-payment by a parent, without good reason, in violation of a court decision or a notarized agreement, of funds for the maintenance of minor children or disabled children who have reached the age of eighteen, within two or more months from the date of initiation of enforcement proceedings, if such actions do not contain a criminally punishable act, -

shall entail compulsory works for a term of up to one hundred and fifty hours or an administrative arrest for a term of ten to fifteen days, or the imposition of an administrative fine on persons in respect of whom, in accordance with this Code, compulsory works or administrative arrest cannot be applied, in the amount of twenty thousand roubles.

2. Non-payment by adult able-bodied children, without good reason, in violation of a court decision or a notarized agreement, of funds for the maintenance of disabled parents within two or more months from the date of initiation of enforcement proceedings, if such actions do not contain a criminally punishable act, -

shall entail compulsory works for a term of up to one hundred and fifty hours, or administrative arrest for a term of ten to fifteen days, or the imposition of an administrative fine on persons in respect of whom, in accordance with this Code, compulsory works or administrative arrest cannot be applied, in the amount of twenty thousand roubles. ;

4) add Article 6.1 1 with the following content:

"Article 6.1 1. Beatings

Beating or committing other violent acts that caused physical pain, but did not entail the consequences specified in Article 115 of the Criminal Code of the Russian Federation, if these acts do not contain a criminally punishable act -

shall entail the imposition of an administrative fine in the amount of five thousand to thirty thousand roubles, or administrative arrest for a term of ten to fifteen days, or compulsory labor for a term of sixty to one hundred and twenty hours.";

5) Article 7.27 shall be stated in the following wording:

"Article 7.27. Petty theft

1. Petty theft of someone else's property, the value of which does not exceed one thousand rubles, by theft, fraud, misappropriation or embezzlement in the absence of signs of crimes provided for in parts two, three and four of Article 158, Article 158 1 , parts two, three and four of Article 159 , parts two, three and four of Article 159 1 , parts two, three and four of Article 159 2 , parts two, three and four of Article 159 3 , parts two, three and four of Article 159 5 , parts two, three and four of Article 159 6 and parts two and three of Article 160 of the Criminal Code of the Russian Federation, -

shall entail the imposition of an administrative fine in the amount of up to five times the value of the stolen property, but not less than one thousand roubles, or administrative arrest for a term of up to fifteen days, or compulsory labor for a term of up to fifty hours.

2. Petty theft of someone else's property worth more than one thousand rubles, but not more than two thousand five hundred rubles by theft, fraud, embezzlement or embezzlement in the absence of signs of crimes provided for by parts two, three and four of Article 158, Article 158 1 , parts two, three and the fourth article 159, parts two, three and four of article 159 1 , parts two, three and four of article 159 2 , parts two, three and four of article 159 3 , parts two, three and four of article 159 5 , parts two, three and the fourth article 159 6 and parts two and three of article 160 of the Criminal Code of the Russian Federation, -

shall entail the imposition of an administrative fine in the amount of up to five times the value of the stolen property, but not less than three thousand roubles, or administrative arrest for a term of ten to fifteen days, or compulsory labor for a term of up to one hundred and twenty hours.

6) in Part 1 of Article 23.1, the figures "5.37 - 5.43" shall be replaced by the figures "5.35 1 , 5.37 - 5.43", the figures "6.1, 6.2" shall be replaced by the figures "6.1 - 6.2";

7) in paragraph 2 of Article 28.3:

a) point 1 after the figures "5.69," shall be supplemented with the figures "6.1 1 ,";

b) in paragraph 77, the figures "17.3 - 17.6" shall be replaced by the figures "5.35 1 , 17.3 - 17.6";

8) Part 1 of Article 28.7 after the words "actions that require significant time costs" shall be supplemented with the words "as well as in cases of committing administrative offenses provided for in Articles 6.1 1 , 7.27 of this Code,".

Article 2

Include in the Federal Law of October 2, 2007 N 229-FZ "On Enforcement Proceedings" (Collected Legislation of the Russian Federation, 2007, N 41, Art. 4849; 2008, N 20, Art. 2251; 2009, N 1, Art. 14 ; N 23, item 2761; N 29, item 3642; N 39, item 4539, 4540; N 51, item 6162; 2010, N 31, item 4182; 2011, N 7, item 905; N 17, item 2312; N 27, item 3873; N 29, item 4287; N 30, item 4573, 4574; N 48, item 6728; N 49, item 7014, 7041, 7061, 7067; N 50, items 7343, 7347, 7352, 7357; 2012, N 31, items 4322, 4333; 2013, N 14, items 1641, 1657; N 30, item 4039; N 51, items 6678, 6699; No. 52, article 6948, 7006; 2014, No. 11, article 1099; No. 19, article 2331; No. 30, article 4217; No. 42, article 5615;

No. 43, Art. 5799; No. 52, art. 7543; 2015, N 1, art. 29; No. 10, art. 1393, 1410, 1411, 1427; No. 14, Art. 2022; No. 27, Art. 3945, 3977, 4001; No. 48, Art. 6706; 2016, N 1, art. 11, 13, 45, 64; No. 11, art. 1493; No. 14, Art. 1910; No. 18, art. 2511) the following changes:

1) the title of Chapter 12 shall be stated as follows:

"Chapter 12. Collection of a fine imposed as a punishment for committing a crime. The procedure for the execution of an executive document on the confiscation of property and an executive document on the payment of a court fine imposed as a measure of a criminal law nature";

2) supplement Article 103 1 with the following content:

"Article 103 1. Execution of a judicial fine imposed as a measure of a criminal law nature

1. A judicial fine imposed as a measure of a criminal law nature in accordance with Article 104 4 of the Criminal Code of the Russian Federation (hereinafter referred to as a judicial fine) is executed in accordance with the rules established by this Federal Law, with the features established by this Article.

2. A court fine shall be executed by the person to whom this measure has been imposed, within the period specified by the court in the decision, ruling on the imposition of a measure of a criminal law nature.

3. Control over the execution of a court fine by a person to whom this measure is assigned is assigned to the bailiff.

4. The decision to initiate enforcement proceedings or to refuse to initiate it shall be issued by a bailiff no later than three days from the date of receipt of the writ of execution by the bailiff unit. The decision to refuse to initiate enforcement proceedings is approved by the senior bailiff or his deputy and sent to the court on the day of its issuance.

5. When initiating enforcement proceedings, the term for the voluntary execution of a court fine by the bailiff is not established, the performance fee is not collected.

6. If after ten calendar days from the date of expiration of the term for payment of the court fine, the bailiff does not have information about the payment by the debtor of the relevant amounts of money, he sends to the court a submission to cancel the specified measure of a criminal legal nature and to resolve the issue of bringing a person to justice. criminal liability.

7. Enforcement proceedings on a writ of execution on payment of a court fine shall end in the event of:

1) payment of a court fine in full;

2) return of the enforcement document at the request of the court that issued the enforcement document;

3) sending to the court that issued the writ of execution, a submission on the abolition of the court fine.".

President of Russian Federation

Announcement. Compulsory health insurance in the Russian Federation in 2019. Design features and necessary knowledge.

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Many citizens have already appreciated the value of compulsory health insurance. That is why he does not save on his health and actively pays for the pole.

So what is compulsory health insurance in Russia? And what are the main nuances of this procedure?

What you need to know

In accordance with the law, all citizens included in the system are entitled to receive free medical care throughout the Russian Federation.

How is the organization and financing of the fund

The Compulsory Medical Insurance Fund is an independent state credit company that implements state policy in the medical industry.

Such organizations are designed to accumulate insurance premiums, as well as ensure financial stability.

This is already regulated by an additional agreement on the part of the medical institution and the applicant.

In the clauses of the contract, you need to display:

• date of conclusion;
• the name of the insurer;
• basis for activity;
• subject of the contract;
• volume of medical care;
• date and signature.

Required documents

For registration you will need:

• passport of a citizen of Russia;
• birth certificate, if it is a minor citizen;
• statement of the established form.

For refugees, you must provide an additional certificate of recognition as such. A foreigner must provide a residence permit or a passport.

Stateless persons must provide registration and passport details.

Calculation procedure

How to calculate compulsory health insurance, according to the Federal Law, payment for medical care is carried out after the medical organization provides a register of accounts and an invoice for payment within the established limit.

Insurance Company:

• submits to the territorial body an application for receiving a target remuneration with an advance payment;
• apply for a refund for services rendered.

Then the territorial body considers the application and satisfies it, transferring the required amount.

Detailed information about insurance premiums for compulsory health insurance (CHI)

The duration of the billing period is determined for each year of hours worked. This is how accounting works.

The duration of the provision of the service is the entire life of the insured person. Paying insurance premiums - an individual or an employer.

If a person is not employed, then he can independently contribute money to the FSS. Insurance premiums are credited to the federal fund.

"On Compulsory Medical Insurance in the Russian Federation" Federal Law No. 313-FZ of November 29, 2010 "On Amendments to Certain Legislative Acts of the Russian Federation in Connection with the Adoption of the Federal Law "On Compulsory Medical Insurance in the Russian Federation"*1

_____
*1. The texts of the documents are not given. See the texts of all regulatory documents on the website www.site.

A comment

L.P. Fomichev
auditor, tax consultant

New Law on Compulsory Health Insurance

Medical insurance in the Russian Federation is provided in two types: compulsory and voluntary.

Compulsory health insurance (CHI) is an integral part of state social insurance and provides all Russian citizens with equal opportunities to receive medical and drug assistance provided at the expense of MHI funds in the amount and on the terms of the relevant programs.

The current Law of the Russian Federation of June 28, 1991 N 1499-1 "On medical insurance of citizens in the Russian Federation" was adopted in difficult conditions. The need for its adoption was primarily due to insufficient budgetary funding of Russian health care. The introduction of insurance made it possible to preserve the system of medical care for the population, prevent a landslide drop in the level of financing of medical institutions and begin a consistent reform of healthcare.

At the same time, many provisions of this Law do not work, because they are declarative in nature, not supported by the material and technical condition of medical institutions necessary for their implementation and their financing. This led to the development of a new Federal Law, adopted by the State Duma on November 19 and approved by the Federation Council on November 24, 2010.

Federal Law No. 326-FZ of November 29, 2010 (Further - Law N 326-FZ ) entered into force on January 1, 2011, with the exception of provisions that will enter into force on January 1, 2012. The purpose of the law is to strengthen the guarantees of the rights of citizens to free medical care and to regulate relations arising in connection with the implementation of compulsory medical insurance.

Law N 326-FZ will allow gradually, during 2012-2014, to increase funding for health care, ensure a balance between state guarantees for free medical care for the population and financial obligations of the state, strengthen the material and technical base of health care and, as a result, improve the availability and quality of medical care.

Article 4 of Law N 326-FZ the basic principles for the implementation of compulsory medical insurance are established: the availability and quality of medical care provided; guarantees of free medical care to the insured person under compulsory medical insurance programs, regardless of the financial situation of the insurer; autonomy of the financial system.

The legal status and powers of the Federal (FFOMS) and territorial (TFOMS) compulsory medical insurance funds, insurance medical organizations and medical organizations in the compulsory medical insurance system were also determined; their rights, duties and responsibilities; rights and obligations of insured persons and policyholders.

Relations relating to the financial support of compulsory medical insurance have been regulated: the procedure for the formation of compulsory medical insurance funds has been prescribed; the amount of the insurance premium for compulsory medical insurance of the non-working population; period, procedure and terms of payment of insurance premiums; liability for violations in the area of ​​their payment; the procedure for setting tariffs for paying for medical care under CHI; the procedure for the formation and expenditure of funds by an insurance medical organization.

Generally Law N 326-FZ regulates in sufficient detail the rights and obligations of all subjects and participants of compulsory medical insurance, their relationship, provides for the modernization of compulsory medical insurance and is aimed at further development of health care.

Let us consider the main provisions of the Law in more detail.

Insured persons

IN article 10 of the Law N 326-FZ it is established that the insured persons are:

- citizens of the Russian Federation (working and non-working);

- foreigners permanently or temporarily residing in our country, and stateless persons (with the exception of highly qualified specialists and members of their families in accordance with Federal Law No. 115-FZ of July 25, 2002 "On the Legal Status of Foreign Citizens in the Russian Federation" );

Persons entitled to medical care in accordance with the Federal Law of February 19, 1993 N 4528-1 "On Refugees" .

Actually, these same persons were insured before, according to the previous legislation.

Foreigners, incl. citizens of the member states of the Commonwealth of Independent States permanently residing in the Russian Federation had the same rights and obligations in the field of health insurance as Russian citizens, unless otherwise provided by international treaties (Article 8 of Law N 1499-1). Foreign citizens permanently residing in Russia include persons who have the appropriate permit and residence permit issued by the internal affairs authorities.

The income of foreign workers who had a temporary residence permit in Russia was subject to insurance premiums in 2010, so they were also eligible for medical assistance under the CHI policy.

Such workers could receive sick leaves in the polyclinic in case of temporary disability. This is also confirmed by clause 1 of the Procedure for issuing sick leave certificates by medical organizations, approved. by order of the Ministry of Health and Social Development of Russia dated 01.08.2007 N 514 : sick leave certificates are issued to citizens of Russia, as well as to foreigners with a residence permit or a temporary residence permit.

Foreign workers permanently or temporarily residing in the territory of the Russian Federation are entitled to receive temporary disability benefits upon the occurrence of a relevant insured event if they work under an employment contract ( Art. 2 of the Federal Law of December 29, 2006 N 255-FZ "On compulsory social insurance in case of temporary disability and in connection with motherhood" ).

A refugee and members of his family who arrived with him have the right to medical and pharmaceutical assistance on an equal basis with Russian citizens in accordance with federal law, unless otherwise provided for by international treaties of the Russian Federation (subparagraph 7 paragraph 1 of Art. 8 of the Federal Law of February 19, 1993 N 4528-1 "On Refugees" ). An obligatory condition is the establishment by the Federal Migration Service of the legal status of a refugee and the issuance of the appropriate "Certificate of a forced migrant".

Foreign citizens temporarily staying in the Russian Federation are not named in the new Law. They enter the territory of Russia on valid documents and are obliged to register their foreign passports or documents replacing them in the internal affairs bodies in the prescribed manner and leave our country after a certain period of stay. The status of a temporary resident implies that a foreign citizen has a migration card, a document that only confirms the right of a foreign citizen to be on the territory of Russia (clause 1, article 2 of Law N 115-FZ). Since 2010, the amounts of payments and other remuneration under labor and civil law contracts in favor of foreign citizens and stateless persons temporarily residing on the territory of the Russian Federation are not subject to insurance premiums ( sub. 15 p. 1 art. 9 of the Federal Law of July 24, 2009 N 212-FZ "On insurance contributions to the Pension Fund of the Russian Federation, the Social Insurance Fund of the Russian Federation, the Federal Compulsory Medical Insurance Fund and territorial compulsory medical insurance funds" ; Further - Law N 212-FZ ). If a foreign citizen has the status of a temporary resident in the territory of Russia, he is not an insured person and, accordingly, insurance premiums for compulsory pension insurance are not charged for payments in his favor. From Art. 2 Law N 255-FZ it also follows that foreigners and stateless persons temporarily residing on the territory of Russia have not been insured since 2010 and are not entitled to receive compulsory social insurance.

The possibility of voluntary payment of insurance premiums by the employer for such citizens is not provided by law. If the company includes in the employment contract concluded with such an employee a condition for paying him a sick leave and voluntary transfer of contributions, the FSS of Russia will not reimburse these benefits in any case. Letter No. 04-03-11/652 of the Moscow Regional Department of the MHIF dated January 29, 2010 explains that since such persons are not subject to compulsory medical insurance, employers should not issue compulsory medical insurance policies to them. If the policy has already been issued, the document must be returned to the insurance company.

Medical insurance for foreigners temporarily staying in Russia, incl. citizens of the CIS member states, is carried out in the manner determined by Decree of the Government of the Russian Federation of December 11, 1998 N 1488 "On health insurance for foreign citizens temporarily staying in the Russian Federation and Russian citizens when leaving the Russian Federation" , which approved the Regulation on medical insurance of foreign citizens temporarily staying in the Russian Federation.

As a rule, such persons have the opportunity to receive only emergency and emergency medical care free of charge in conditions requiring urgent medical intervention (in case of accidents, injuries, poisoning and acute illnesses). In this case, medical assistance is provided to them at the expense of the budgets of all levels by medical and preventive institutions of the state and municipal health care systems, as well as medical workers or persons obliged to provide first aid by law or a special rule. From the moment when the threat to the life of the patient or the health of others has been eliminated and the transportation of the patient is possible, the payment for the medical care provided is charged as planned.

Planned medical care of all kinds can be provided to citizens of this category only on the basis of voluntary medical insurance or on a paid basis.

A single insurance policy for all territories of Russia

One of the big drawbacks of the existing system is the inability to receive medical assistance under the CHI policy while in another region. At present, the policy of compulsory medical insurance is not uniform for all regions of Russia. Each insurance company printed its own policies for its insured, which had to be changed as it expired. When changing jobs, a person was obliged to hand over the CHI policy to the employer and get a new one where he was employed. This took time, during which the employee, from whose salary contributions to the MHIF were paid, actually had no opportunity to receive medical care. And when moving into the category of unemployed, he had to receive a policy from an insurance medical organization, which, according to the results of the competition, insured unemployed citizens.

Formally, a citizen can still receive medical assistance under a compulsory medical insurance policy not at the place of registration. But hospitals and polyclinics most often, violating the current Law, refuse to admit citizens from other cities and citizens living in another area of ​​the city. This happens for several reasons: firstly, there is no unified database of insured persons, by which it would be possible to determine where the money for the patient will come from, and whether they will come. Secondly, in large regions, such as Moscow or St. Petersburg, the compulsory medical insurance program is much more expensive than in the whole country, hence the reluctance to accept "foreign" patients. In this regard, medical institutions often refuse to take into account policies issued in other regions, and try to treat people from other cities only for money.

Law N 326-FZ provides for the development of basic and territorial CHI programs ( Art. 3 Law N 326-FZ ). Chapter 7 The law specifies which types of assistance are included in each of them. Since 2013, emergency medical care has been included in the basic CHI program, and high-tech - since 2015 ( Art. 51 Law N 326-FZ ). Programs are approved at the federal and regional levels, respectively. The basic program operates on the entire territory of Russia, and the territorial one - within the limits of the subject of the Russian Federation. Subjects will have the right to add types of medical care and insured events that are not included in the CHI to the basic program, and additionally finance them.

To implement throughout the territory of the Russian Federation the rights of citizens to receive free medical care Law N 326-FZ the following is envisaged: starting from May 2011, citizens will be issued compulsory medical insurance policies of a single sample, guaranteeing free medical care under the basic compulsory medical insurance program in any region of the country, regardless of the place of residence of the insured (Article 45). On the territory of the subject of the Russian Federation, where the CHI policy was issued, citizens can count on assistance in the scope of the territorial CHI program (Article 3). The policy can be omitted if emergency medical care is required (clause 2, article 16).

The replacement of issued and valid regional compulsory medical insurance policies with policies of a single sample will be carried out not urgently, but gradually (Article 51).

Until May 1, 2011, if necessary, old-style policies will be issued in the same order, and from May 1, 2011 to January 1, 2012, new uniform policies will be issued. The electronic policy will be valid throughout Russia. Outwardly, the "substitutes" of paper documents familiar to us resemble plastic cards with a chip and are an electronic card of a single sample. This policy is designed to be machine-readable for patient information.

The new termless policy will be valid even if the person did not have time to insure himself with the insurance company. It will serve as a guarantor of medical care in any region of the country, regardless of place of residence, and will be issued to everyone - both working citizens and the unemployed. The replacement of the policy is supposed only due to its loss or wear, change of the last name, first name, patronymic of the insured. When changing the insurance medical organization, place of residence, status of the insured person, replacement is not provided.

CHI policies of the old sample, issued to persons insured under compulsory health insurance before entry into force Law N 326-FZ , are valid until they are replaced with compulsory medical insurance policies of a single sample or universal electronic cards of a citizen of the Russian Federation. All medical institutions after January 1, 2011 are required to accept patients under the old policies.

Policies are subject to replacement if a person wants to change the insurance organization, or their validity expires, or in the event of a change of residence. In order to avoid problems with the provision of medical care, all citizens insured in the MHI system should look at the document and inquire about the expiration date of its validity. The complete replacement of "paper" old-style policies with electronic cards should be completed by January 1, 2014.

From January 1, 2012, the CHI policy will be included in the universal electronic card of a citizen in accordance with Federal Law of July 27, 2010 N 210-FZ "On the organization of the provision of state and municipal services" ( Art. 45 of Law N 326-FZ ).

Moscow will switch to a universal electronic card during 2011. It will begin to replace Muscovites with a compulsory medical insurance policy and a certificate of pension insurance. In addition, with the help of this card it will be possible to pay for travel in public transport and exercise your right to receive most public services. The new electronic document will retain all the possibilities that the social card of a Muscovite provides today.

From 2014, a single universal "three in one" card will operate in Russia, including a medical policy, a pension insurance policy, and information about the benefits due to a person.

Of course, the new policies will allow citizens to receive the necessary assistance on vacation or on a business trip. At the same time, the introduction of a single electronic policy of a new type in Russia requires special preparation: special equipment both for producing a document and for hospitals and clinics to be able to "read" it.

For the first time, a strict rule on the timing of payments for the medical care provided to patients is established by law. Medical institutions have a guarantee of payment for the assistance provided to a nonresident citizen, and they will now be interested in providing it.

In the event of a delay in payment, the insurance medical organization at its own expense pays the medical organization a penalty in the amount of 1/300 of the refinancing rate of the Central Bank of the Russian Federation, effective on the day the delay occurs, from the amounts not transferred for each of its days ( paragraph 7 of Art. 39 of Law N 326-FZ ).

In addition to a single medical policy, the possibility of replacing the usual paper medical records with electronic ones is being discussed. To receive non-resident citizens, the doctor needs a history of his illness. After all, this person was not observed in the clinic, and most often he does not carry a medical history with him. If a medical history were automatically attached to a single policy, it would be great. Better yet, have your medical card online, in electronic form. This is important, especially for those who often travel on business trips. In this case, a doctor from any clinic in the country will be able to get all the information about the state of human health. This reduces the time of diagnosis, which in some diseases can save lives.

At the same time, in some European countries, the use of electronic cards in the global network is prohibited, because. there is no reliable data protection. In addition, information posted on the Internet can become available not only to the doctor. A violation of confidentiality threatens to turn into a lawsuit against a medical institution.

Personalized medical records

The lack of a unified database of insured persons leads to the fact that the number of those insured under compulsory medical insurance exceeds the number of Russian citizens.

In order to implement the rights of citizens to receive free medical care throughout the Russian Federation, it is planned to create a single information space that includes all subjects and participants in compulsory medical insurance, and to introduce personalized accounting of information about insured persons and the assistance provided to them ( ch. 10 of Law N 326-FZ ).

On January 1, 2011, the creation of a unified database will begin, which will allow citizens to receive medical care in any region of Russia. An electronic database of the insured will be created as they apply for medical assistance, as well as replacing old policies with new ones.

A single database will ensure reliability and eliminate duplication of information about the insured. Within two years, the bulk of the insured will be included in this electronic database.

Ideally, thanks to the creation of a single information base, everyone will be able to make an appointment with a doctor without leaving home - from their home computer via the Internet.

Law N 326-FZ the procedure for the implementation of personalized (individual) accounting in the compulsory medical insurance system, as well as the procedures for the interaction of medical, insurance medical organizations and the territorial fund in the system of personalized accounting of information about medical care provided to the insured person.

Determines the procedure for maintaining personalized records in the field of compulsory medical insurance FFOMS ( Art. 7 Law N 326-FZ ).

Article 16 of Law N 326-FZ establishes that insured persons have the right to protection of personal data necessary for maintaining personalized records in the field of compulsory health insurance.

Articles 47And 48The law establishes the procedure for interaction between insurance medical and medical organizations with the TFOMS in maintaining personalized records of information about medical care provided to insured persons, in Art. 49- the procedure for interaction of the territorial body of the PFR with the TFOMS and insurers for non-working citizens.

In pursuance of this Law, Federal Law No. 313-FZ of November 29, 2010 (Further - Law N 313-FZ ), making appropriate changes to personalized (individual) accounting. We will consider it separately.

The choice of insurance organization, clinic and doctor is up to the patient

The role of the insurance organization is somewhat different from the current system. Now the choice of the insurance organization remains with the insured, i.е. the employer for whom the person works, because he pays insurance premiums for the employee. Non-working people are insured by the regional authorities. As a result, it turns out that insurance companies have no motivation to fight for consumers of services.

According to Art. 16 Law N 326-FZ a citizen acquires the right to independently choose an insurance medical organization dealing with CHI. At the same time, the right of the employer and municipal authorities to do so is excluded.

The choice can be made by a citizen who has reached the age of majority. From the day of birth until the day of registration of their birth, children are insured by organizations where their mothers or legal representatives are insured. After the child is registered and until the age of majority, it is insured by insurers chosen by one of the parents or their legal representative.

If a person does not choose a company or does not submit an application to change it, it is considered that he is insured in the organization where the insurance was carried out earlier. The only exception is a change of residence. In this case, within a month, the citizen is obliged to choose a new organization in the absence of the previous insurer in this territory. A person must notify the insurer of a change of residence, last name, first name, patronymic within a month.

If citizens have not chosen an insurer, TFOMS sends information about them to insurers every month before the 10th. The division of the number of citizens between insurance companies is carried out in proportion to the number of insured persons in each of them, and the ratio of working and non-working citizens who have not applied to the medical insurance organization, which is reflected in this information, should be equal. Insurers who have received such information from the TFOMS send a letter to the citizen. It confirms the fact of insurance in this organization and informs about the need to obtain a CHI policy.

The insured person will have the right to replace the insurance medical organization chosen by him with another one. Insurance medical organizations have no right to refuse him such a choice.

True, one should not hope that the number of medical services depends on the choice - they will be the same in all companies. All insurance companies will have contracts with all clinics of the CHI system. Insurance companies will perform intermediary functions, act as defenders of patients, defending their rights, and organize an independent examination of the services provided by doctors. Specialists do not predict a mass transition from one company to another. Most likely, the majority will remain in companies where they are already insured.

As a rule, the desire to change the insurance company arises at critical moments when the patient realizes that in a difficult situation assistance was not provided in full, and the company was unable to protect his rights, i.e. failed to fulfill its basic obligations. The replacement of the insurance medical organization, where the citizen was previously insured, can be carried out once during the calendar year, but no later than November 1. More often - in the event of a change of residence or termination of the agreement on the financial provision of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance - by submitting an application to the newly selected medical insurance organization with which he would like to cooperate. On the basis of this application, the insured person or his representative is issued a compulsory medical insurance policy by the medical insurance organization.

Insurance organizations working with CHI will be tightly controlled. They need stability. To do this, the new Law prescribes a doubling of the authorized capital of such companies - from 30 to 60 million rubles. Insurance medical organizations are not entitled to carry out other activities, except for compulsory and voluntary medical insurance ( Art. 14 Law N 326-FZ ).

Today, medical institutions in most cases are maintained at the expense of budgets of various levels. At the same time, they receive money regardless of how many patients were admitted and cured. And even more so regardless of the quality of the treatment.

The new Law changes this situation - the money will follow the patient, i.e. the service rendered is funded, not the institution.

From the list of medical institutions operating in the CHI system, citizens will be able to choose the hospital where they would like to receive assistance. Their list is available on the official websites of the territorial CHI funds. At the same time, a medical institution included in the register and which has entered into an agreement for the provision of services under the CHI program is not entitled to refuse to provide assistance to the insured person.

Upon a written application, the patient can choose an attending physician in accordance with the legislation of the Russian Federation (after all, the new Law does not cancel the territorial principle of medical care, for example). True, there is one caveat - with the consent of the doctor. If a person lives in one area of ​​the city, but wants to be treated by a doctor working in another area, you need to ask his consent - is he ready to go to the call through the whole city. Therefore, a doctor's call to the house will need to be done in the clinic serving the patient's territory of residence. The right to choose a hospital becomes legal. The polyclinic doctor who writes out the referral will now be obliged to listen to our wishes.

Another requirement of the new Law is that now all medical institutions must have their own websites on the Internet with detailed information.

If we assume that patients still get a real right to choose a polyclinic and a doctor, medical institutions will find themselves in conditions of fierce competition. After all, the more patients, the more money the insurance company will pay the hospital.

The right to choose a doctor and a medical institution has long been enshrined in the Federal Laws "On the Protection of the Health of Citizens" and "On the Medical Insurance of Citizens in the Russian Federation", but in fact this does not happen. Citizens are mostly treated according to the territorial principle: in the municipal polyclinic at the place of residence. And we are not talking about any choice of a medical institution, let alone a doctor. Here it is appropriate to recall birth certificates, which also gave the right to expectant mothers to seek help from any maternity hospital that had vacant places. However, in reality, the promises were empty. Will the same situation repeat itself now?

Fundamental innovation Law N 326-FZ is that not only state (municipal) medical institutions, but also organizations of any organizational and legal form, as well as individual entrepreneurs engaged in private medical practice ( Art. 15 of Law N 326-FZ ). The main thing is that they have the right (license) to carry out medical activities, they must be included in a special register of medical organizations and keep separate records of operations with CHI funds and other operations. The register of such organizations is maintained by the TFOMS and published on the Internet or otherwise. The register indicates the name, address of medical organizations and the list of services provided by them within the framework of the territorial CHI program. The procedure for maintaining, the form and list of information in the register are established by the rules of compulsory medical insurance.

Previously, "private traders" also worked with CHI, but received special permission from the city administration for certain services. Now private clinics can simply apply to join the system.

But here a reasonable question arises: will private clinics be interested in the meager money that the MHIF departments pay for each citizen under the policy? Recall: the annual per capita standard for the state program for the provision of free medical care is 4059 rubles. 60 kop. No one is going to review it yet.

Tariffs for the CHI system are significantly lower than in private clinics, and it is prohibited by law to make a "discount" out of the policy for patients. According to insurers, this is done to protect us from mind manipulation. You should not expect that a person from the street can come with a policy and receive treatment. These clinics will give a referral to a specific service under the state order. For example, the clinic will receive a state order for dental prosthetics for veterans. Then the pensioner will receive a referral to this clinic. The same will happen with complex operations or technologies. The CHI policy may and will be used by private clinics, but in complex treatment, where some of the services will be free, and some - for decent money.

The Law clearly spells out the rights of medical insurance organizations to control the provision of medical care. The protection of the rights of the insured should become the basis in relations with consumers and include such parameters as the selection of a medical organization to provide assistance, managing your client at all stages of its provision and monitoring how it was provided. If a person comes to the hospital with a policy, and they begin to demand money from him for services that are free of charge, he must first call his insurance company with a demand to sort out the situation. And the insurance company becomes a "lawyer", protecting his rights. This is not bringing to court, but proceedings at the earliest stage of the conflict.

Article 16 of Law N 326-FZ entitles patients to compensation for damage caused by an insurance medical or medical organization in connection with their failure to perform or improper performance of their obligations to provide medical care. Article 31 of Law N 326-FZ the procedure for such compensation is determined in a situation where the damage is not related to a severe accident at work. If the latter has occurred, please contact Art. 32 Laws , which established that treatment after a serious injury at work should be at the expense of funds received by the FFOMS in accordance with Federal Law No. 125-FZ of July 24, 1998 "On Compulsory Social Insurance against Occupational Accidents and Occupational Diseases" (Further - Law N 125-FZ ).

Unfortunately, our state practically does not engage in educational activities in the field of patients' rights. We have almost no lawyers involved in medical litigation. In addition, there should be an institution of independent medical experts who could not be influenced by the medical community. After all, this is the only way to give an independent conclusion about the quality and correctness of treatment. No one is talking about such things yet, but in order to properly receive medical services, we must have information on hand, thanks to which we could challenge the wrong actions of doctors and hold those responsible to account. And for this it is necessary to have a really working judicial mechanism, which, alas, does not exist today.

Chapter 9 of Law N 326-FZ a system of examinations of the quality of medical care is being established - the identification of violations in the provision of medical care, incl. assessment of the correctness of the choice of medical technology, the degree of achievement of the planned result and the establishment of cause-and-effect relationships of identified defects in the provision of medical care. It is indicated who can act as an expert. It has been established that a medical organization does not have the right to prevent experts from accessing the materials necessary for conducting a medical and economic examination, an examination of the quality of medical care, and is obliged to provide experts with the requested information. The results of the examination are formalized by the relevant acts in the forms established by the FFOMS.

Based on the results of monitoring the volumes, terms, quality and conditions for the provision of medical care, the measures provided for Art. 41 of Law N 326-FZ and the terms of the contract for the provision and payment of medical care under compulsory medical insurance. In addition to non-payment for poor-quality care, the medical organization will compensate for the harm caused to the patient through its fault.

Financial support

The management structure of the MHI system is changing. The FFOMS is recognized as an insurer within the framework of the implementation of the basic CHI program; from 2012, all medical contributions will be transferred to it. This is a non-profit organization created by the Russian Federation to implement state policy in the field of CHI ( Art. 12 Law N 326-FZ ).

Chapter 5 of Law N 326-FZ the issues of financial support of compulsory medical insurance were settled (including the procedure for the formation of compulsory medical insurance funds); the procedure and terms for payment of insurance premiums are determined; established liability for violations in the area of ​​their payment; the procedure for calculating tariffs for paying for medical care under compulsory medical insurance has been determined.

CHI funds are formed from:

Income from the payment of insurance premiums for CHI;

- arrears on contributions, tax payments;

- accrued penalties and fines;

- federal budget funds transferred to the budget of the Federal Compulsory Medical Insurance Fund in cases established by federal laws, in terms of compensating for shortfalls in income due to the establishment of reduced rates of insurance premiums for compulsory medical insurance; funds from the budgets of the constituent entities of the Russian Federation transferred to the budgets of the TFOMS in accordance with federal and regional legislation;

- income from the placement of temporarily free funds;

- other sources provided for by Russian legislation ( Art. 21 , 26And 27 of Law N 326-FZ ).

The procedure and conditions for the placement of temporarily free funds of the Federal and territorial CHI funds are established by the Government of the Russian Federation ( Art. 29 of Law N 326-FZ ).

For the first time, a rule appeared in the Law indicating that the funds of the MHI fund can be used not only in Russia, but also in medical institutions in foreign countries, but there is no specific information about what kind of medical institutions these will be.

Separate powers of the insurer will be exercised by the TFOMS and insurance medical organizations ( Art. 13 And 14 Law N 326-FZ ).

The legal status of the FFOMS and TFOMS is defined in ch. 6 Law N 326-FZ . It is envisaged to strengthen the role of TFOMS as a controlling organization. Within the framework of his powers, he will carry out checks on the targeted use of compulsory medical insurance funds not only in medical insurance companies, but also in medical organizations, and, regardless of the insurer, carry out all types of medical examinations of cases of treatment of insured citizens ( Art. 40 of Law N 326-FZ ). TFOMS is controlled and subordinated to FFOMS.

The Ministry of Health and Social Development of Russia has already developed a draft model regulation on TFOMS, a draft departmental order of December 6, 2010 on its approval is presented on the official website of the ministry. According to the TFOMS document, it is a non-profit organization created by a constituent entity of the Russian Federation to implement state policy in the field of compulsory medical insurance in the region. The document approves the main tasks, functions and means of TFOMS, as well as the procedure for monitoring their activities and the mechanism for their liquidation.

Organizations, individual entrepreneurs and individuals who are not recognized as individual entrepreneurs are still recognized as insurers for working citizens ( paragraph 1 of Art. 11 Law N 326-FZ ). A separate group includes individual entrepreneurs, private notaries and lawyers. The insured is registered with the territorial bodies of the Pension Fund of the Russian Federation. Features of registration of certain categories of insurers and their payment of insurance premiums for CHI from January 1, 2012 are established by the Government of the Russian Federation. Insurers are payers of mandatory health insurance contributions in accordance with Law N 212-FZ ( Art. 22 of Law N 326-FZ ).

The territorial bodies of the PFR provide information on the payment of insurance premiums for compulsory medical insurance of the working population to the TFOMS in the manner determined by the agreement on information exchange between the PFR and the FFOMS.

The insurers for non-working citizens are the executive authorities of the constituent entity of the Russian Federation ( paragraph 2 of Art. 11 Law N 326-FZ ). Now the regional authorities are transferring money for them to the MHIF according to the residual principle, as much as they can. This leads to an imbalance in the compulsory medical insurance system and, accordingly, to the lack of standards of medical care necessary for Russian citizens.

First Art. 23 And 24 Law N 326-FZ a phased transition to a fixed payment for the non-working population has been established. This payment will be the same for all regions of the Russian Federation due to the fact that it is the same insurance premium as the employer's payments in the CHI system. Article 25 This Law establishes liability for non-payment of these contributions.

In 2011, payments for the non-working population are rigidly fixed at the 2010 level. Starting from 2012, a single compulsory medical insurance tariff for the non-working population will be established for the whole country. The law on establishing payments to the system of compulsory health insurance for the non-working population is scheduled to be adopted in the first half of 2011.

Medical tariffs will become uniform for all insurance medical organizations paying for medical care provided in one medical organization.

The tariff for paying for medical care is established by an agreement between the authorized regional body, TFOMS, representatives of medical and insurance organizations, professional medical associations, trade unions of medical workers ( Art. 30 of Law N 326-FZ ).

The provisions defining the legal status, features of the formation and spending of funds of insurance medical organizations have been clarified. Such funds are divided into targeted and own ( Art. 14 Law N 326-FZ ).

Insurance medical organizations keep separate records of their own funds and funds of compulsory medical insurance intended to pay for medical care. Target funds cannot become the property of the insurance organization ( Art. 28 of Law N 326-FZ ), with the exception of cases stipulated by this Law.

Contract system

A citizen receives free medical care under compulsory medical insurance on the basis of an agreement concluded in his favor by the participants in this form of service.

A medical organization provides services under compulsory medical insurance on the basis of an agreement for the provision and payment of medical care concluded with an insurance organization. A medical organization is not entitled to refuse to provide medical care to insured persons in accordance with the territorial CHI program ( paragraph 5 of Art. 15 of Law N 326-FZ ).

An insurance medical organization sends targeted funds to a medical organization to pay for medical care under such contracts ( paragraph 2 of Art. 28 of Law N 326-FZ ). She receives these funds from TFOMS. Funds are sent to the medical organization initially in advance, unused targeted funds must be returned by the medical organization to the insurer, and then to the TFOMS. Responsibility for misappropriation of funds has been established.

IN Chapter 8 of Law N 326-FZ the system of contracts in compulsory health insurance and the mechanism for organizing control over the volume, timing, quality and conditions of providing medical care to insured persons are defined in detail.

In the standard forms of contracts approved by the Ministry of Health and Social Development of the Russian Federation, these rights and obligations will be specified, and penalties will be provided for each violation of the terms of the contract.

Modernization of healthcare

Since 2011, deductions to the FFOMS will increase by 2%. The money, as you know, will be directed to the modernization of healthcare. Regional modernization programs provide for an increase in the availability of outpatient care, within the framework of which the salary of specialist doctors working in polyclinics should increase. The situation is similar with doctors in hospitals.

Chapter 11 "Final Provisions" of Law N 326-FZ determined: in order to improve the quality and accessibility of medical care provided to the insured, during 2011-2012 the implementation of regional programs for the modernization of healthcare in the constituent entities of the Russian Federation and programs for the modernization of federal state institutions providing medical care will be carried out, norms and rules for the transition period for 2011-2012 are prescribed years.

Of course, a one-time transition "to new rails" is impossible in principle. Currently, the MHIF, insurance companies, and medical institutions are studying Law N 326-FZ . Until the financial flows are debugged, the necessary programs are not prepared, the algorithm of actions is not formed. Everything takes time.

Time will tell whether the working citizen, for whom the FFOMS receives contributions, will become the central figure in healthcare. In the meantime, our system of medical care is set up more for pensioners, and not for working citizens. In other words, the person who can spend the most time queuing in front of the doctor's office gets the most favors.

And all of us are not even interested in how our money comes into the compulsory medical insurance system, how and what it is spent there, what are the costs for administrative staff, maintenance of buildings, all kinds of trips, participation of doctors in conferences, etc. And it's all waste of money. As consumers of this service, as citizens, we do not know anything about this, but we pay.

Changes in legislation in connection with the adoption of the Law on Compulsory Medical Insurance

Law N 313-FZ makes changes to certain legislative acts, in particular to Tax Code of the Russian Federation , Federal laws N 212-FZ, "On the organization of insurance business in the Russian Federation" , " On individual (personalized) accounting in the system of compulsory pension insurance ", " On the circulation of medicines ", Budget Code of the Russian Federation , Code of the Russian Federation on Administrative Offenses .

Let us briefly consider the main changes affecting the activities of organizations and entrepreneurs.

In Law N 212-FZ no mention of TFOMS

Because the Law N 326-FZ since 2012, a single insurer has been established - FFOMS, the mention of territorial CHI funds from January 1, 2012 will be excluded from the title and a number of articles Law N 212-FZ . For example, in Art. 58 and 58.1 of this Law, the mention of TFOMS will be excluded from the text of the tables with a breakdown of insurance rates by extra-budgetary funds. Previously, it was established that from 2012, contributions at a rate of 0% must be paid to this fund. Now it is established that the territories will receive transfers from the FFOMS to finance the powers transferred to the regions in the field of compulsory medical insurance.

IN Tax Code of the Russian Federation benefits for insurers and physicians

IN Tax Code of the Russian Federation changes are being made to clarify the list of benefits in relation to the amounts paid in the system of compulsory health insurance.

First, in accordance with sub. 7 p. 3 art. 149 Tax Code of the Russian Federation VAT is not charged on insurance, co-insurance and reinsurance services rendered by insurance companies. From January 1, 2012, medical insurance organizations participating in compulsory medical insurance do not pay VAT when receiving funds from the TFOMS, if these funds:

- are targeted and transferred on the basis of an agreement on the financial support of CHI;

- are intended for conducting business on compulsory medical insurance;

- are remuneration for the performance of actions stipulated by the agreement on the financial support of compulsory medical insurance.

The same funds are not taken into account in income when determining the income tax base (new sub. 14 p. 1 art. 251 Tax Code of the Russian Federation ). Accordingly, from that date sub. 30 p. 1 art. 251 Tax Code of the Russian Federation lapses, and therefore clause 48.1 of Art. 270 The Code also clarified the list of costs that are not taken into account when calculating income tax.

The expenses will not include funds transferred to medical organizations to pay for medical care to insured persons in accordance with the contract for the provision and payment of medical care.

Article 294.1 of the Tax Code of the Russian Federation , which establishes the features of determining the income and expenses of insurance medical organizations, is set out in a new edition.

Now the funds received from the TFOMS will be included in income if they are intended for conducting a case under compulsory medical insurance or are remuneration under an agreement on financial security of compulsory medical insurance.

Changes in personalized accounting

Law N 313-FZ changes have been made to Federal Law No. 27-FZ of April 1, 1996 "On Individual (Personalized) Accounting in the System of Compulsory Pension Insurance" (Further - Law N 27-FZ ). The preamble of the Law is supplemented by the following provision: personalized accounting under this Law also applies to persons entitled to receive state social assistance, to additional measures of state support in accordance with Federal Law No. 256-FZ of December 29, 2006 "On Additional Measures of State Support for Families with Children" . This record will be maintained for the purposes of compulsory medical insurance by the Pension Fund of the Russian Federation. The FIU will be obliged to submit to the FFOMS information on working insured persons in the system of individual (personalized) accounting, necessary for compulsory medical insurance. The procedure for such an exchange of information will be established by an agreement between the FIU and the FFOMS ( Art. 16 Law N 326-FZ ).

Clarifications have been made and in paragraph 1 of Art. 8 of Law N 27-FZ .

It is indicated that documents in electronic form containing information about the insured persons sent by the insured to the Pension Fund of the Russian Federation must be certified by an electronic digital signature in accordance with Federal Law No. 1-FZ of January 10, 2002 "On Electronic Digital Signature" .

Changes in the position of insurance companies

In particular, from January 1, 2012, the requirements for the minimum amount of the authorized capital of an insurer providing exclusively medical insurance will change (changes in paragraph 3 of Art. 25 of the Law "On the organization of insurance business in the Russian Federation" ).

In accordance with the new edition paragraph 2 of Art. 18 Law N 125-FZ the insurer will be obliged to send to the TFOMS information on the decision made to pay the costs of treatment of the insured immediately after a severe accident at work at the expense of compulsory social insurance against accidents at work and occupational diseases. The form and procedure for sending such information must be approved by the insurer in agreement with the FFOMS.

Other innovations

From January 1, 2012, the procedure and conditions for the provision of interbudgetary transfers and subventions from the FFOMS budget to territorial CHI funds are being adjusted in accordance with Law N 326-FZ (changes made in Budget Code of the Russian Federation ).

IN Federal Law No. 61-FZ of April 12, 2010 "On the Circulation of Medicines" numerous changes are made.

For example, in Art. 44 of this Law establishes that an organization that has received permission to conduct a clinical trial of a medicinal product for medical use is obliged to insure the risk of harm to the life and health of the patient by concluding a compulsory insurance contract. Participation of the patient in such a study in the absence of a compulsory insurance contract is not allowed. The procedure for exercising the rights and obligations of the parties under a compulsory insurance contract is established by standard rules.

Besides, in Art. 71 Law N 313-FZ specified:

- requirements for information submitted by applicants on medical organizations where clinical trials of a medicinal product for medical use are supposed to be conducted, and on the quality of medicinal products;

- requirements for the procedure and conditions for life insurance, health insurance of patients participating in a clinical trial of a medicinal product;

- mechanisms that allow to carry out the procedures for the examination and registration of medicinal products on the basis of documents submitted for registration before September 1, 2010;

- terms of circulation of medicines in packages with marking applied in accordance with the requirements that were in force before September 1, 2010.