of February 5, 2020 No. 65
Some questions of program implementation of the state guarantees of medical attendance of the population in 2020 and the I quarter 2021
According to items 4 and the 5th Section IV "Final and transitional provisions" of the Law of Ukraine "About the state financial guarantees of medical attendance of the population", article 22 of the Law of Ukraine "About the Government budget of Ukraine for 2020", to the Budget code of Ukraine the Cabinet of Ministers of Ukraine decides:
2. Make changes which are applied to resolutions of the Cabinet of Ministers of Ukraine.
3. Recognize invalid resolutions of the Cabinet of Ministers of Ukraine according to the list which is attached.
4. Determine that the Procedure is applied by National service of health:
for primary medical care - from the date of entry into force of this resolution till March 31, 2021;
for the emergency, secondary (specialized), tertiary (highly specialized), palliative medical care, medical rehabilitation, medical care to children up to 16 years, medical care in connection with pregnancy and childbirth - from April 1, 2020 to March 31, 2021;
for reimbursation of medicines for treatment in out-patient conditions of cardiovascular diseases, bronchial asthma and diabetes of the II type (except insulin) - from the date of entry into force of this resolution till March 31, 2021.
for the stationary help to patients with sharp respiratory disease of COVID-19, of SARS-CoV-2, caused by coronavirus - from April 1, 2020 to March 31, 2021;
for the emergency medical care to patients with suspicion or the established disease of sharp respiratory disease of COVID-19, of SARS-CoV-2, caused by coronavirus - from April 1, 2020 to January 31, 2021;
for transitional financial provision of complex provision of medical services by healthcare institutions - till March 31, 2021;
the paragraph of the eighth is excluded according to the Resolution of the Cabinet of Ministers of Ukraine of 13.01.2021 No. 22
5. To the Ministry of Health and National service of health after data processing, provided in forms of the reporting under questions of health protection for 2019 to provide in accordance with the established procedure, in case of need, entering of corresponding changes into the rates and adjusting factors determined according to the procedure.
6. From the effective date of this resolution to provide to Council of Ministers of the Autonomous Republic of Crimea, the regional, Kiev and Sevastopol city public administrations within three days provision by the Ministry of Health of the Autonomous Republic of Crimea, and provide to National service of health, healthcare institutions and physical persons entrepreneurs who obtained the license for implementation of economic activity on medical practice by structural divisions concerning health care of the relevant public administrations the medical services provided by Chapters 2, of 3, 20 and 21 Sections II of the Procedure according to information relatively:
certain center of the emergency medical care and medicine of catastrophic crashes in the territory of the corresponding administrative and territorial unit with which the National service of health signs the agreement on medical attendance of the population according to the program of medical guarantees for rendering the emergency medical care;
changes in structure of network of healthcare institutions of the corresponding administrative and territorial unit which took place during the period from January 1, 2019 to February 1, 2020 that led to change of the planned quantity and structure of the treated cases;
the planned number of persons who will receive anti-retrovirus therapy and to be under medical observation, and the number of children up to 18 months which are given rise by HIV-positive mothers and will be under medical observation, with suppliers of medical services;
the planned number of persons who will receive the replacement supporting therapy, with suppliers of medical services.
7. This resolution becomes effective from the date of its publication and is effective till March 31, 2021, except Chapter 29 of the Procedure which is effective till December 31, 2020.
Prime Minister of Ukraine
Approved by the Resolution of the Cabinet of Ministers of Ukraine of February 5, 2020, No. 65
1. This Procedure determines features of program implementation of the state guarantees of medical attendance of the population in 2020 (further - the program of medical guarantees).
2. Action of this Procedure extends to all healthcare institutions irrespective of pattern of ownership and physical persons entrepreneurs who obtained the license for implementation of economic activity on medical practice and signed the agreement on medical attendance of the population according to the program of medical guarantees with NSZU (further - the agreement), and also to subjects of managing who perform economic activity based on the license for implementation of economic activity on retail trade by medicines which signed the contract on reimbursation with NSZU.
3. In this Procedure terms are used in such value:
base rate - the average cost of medical service calculated as ratio of amount of budgetary funds and the forecast number of medical services in the corresponding direction;
weight coefficient diagnostic - related group - the adjusting factor considering characteristics of complexity of the treated cases and intensity of use of resources for prevention, diagnostics, treatment and medical rehabilitation within one diagnostic - related group of rather total average cost of prevention, diagnostics, treatment and medical rehabilitation of clinical case in the conditions of hospital;
limiting payment amount - the maximum amount provided by the agreement for payment of provision of packet of medical services which the supplier of medical services can receive under the agreement in the corresponding period;
diagnostic - related group - group of clinical cases which are characterized similar (connected with diagnoses) by clinical conditions and similar intensity of use of resources for prevention, diagnostics, treatment and medical rehabilitation in the conditions of hospital;
index of structure of cases - the weighted average value of all weight coefficients diagnostic - related groups on all treated cases for the corresponding period;
kapitatsionny rate - the amount of payment for medical attendance of one patient irrespective of the number of the actual requests of the patient for medical care during the certain period;
limit - the optimum amount of practice of primary medical care established according to the procedure of provision of primary medical care, approved by the Ministry of Health;
packet of medical services - the list of the medical services and medicines necessary for rendering such services, within certain type of medical care to which single specifications, purchase conditions, type of rate and base rate which payment is performed by NSZU according to the agreement are established;
exterritoriality - provision of equal state guarantees for realization by patients of the right to health protection irrespective of the registered place of residence or stay;
the principle of neutrality of the budget - compliance of rates and the planned number of medical services in total amount of the budgetary appropriations provided for program implementation of medical guarantees;
the treated case - complex of the provided medical services to the patient, in case of need the round-the-clock medical observation, on condition of its hospitalization in hospital for one days or for bigger term for prevention and/or diagnostics, and/or treatment, and/or medical rehabilitation which comes to the end with disposal of the patient from hospital (including in case of death in stationary conditions within 24 hours from the moment of hospitalization on condition of documentary confirmation of such cases).
Other terms are used in the values given in Bases of the legislation of Ukraine on health protection, the Law of Ukraine "About the state financial guarantees of medical attendance of the population".
4. The program of medical guarantees includes the packets of medical services connected with provision by exterritoriality:
1) emergency medical care;
2) primary medical care;
3) secondary (specialized) medical care;
4) tertiary (highly specialized) medical care;
5) palliative medical care;
6) medical rehabilitation;
7) medical care to children up to 16 years;
8) medical care in connection with pregnancy and childbirth.
5. Within the program of medical guarantees of NSZU performs reimbursation of medicines according to the list of conditions and medicines (unlicensed names) specified in the Section III of this Procedure according to the Procedure for reimbursation of medicines approved by the resolution of the Cabinet of Ministers of Ukraine of March 17, 2017 No. 152 "About ensuring availability of medicines" (The Official Bulletin of Ukraine, 2017, No. 26, Art. 749; 2019, No. 21, Art. 716).
6. NSZU within the program of medical guarantees signs contracts on medical attendance of the population concerning provision of medical services in the program of medical guarantees, except the medical services included in the list of paid services which are provided in the state and municipal institutions of health care and the highest medical educational institutions, No. 1138 approved by the resolution of the Cabinet of Ministers of Ukraine of September 17, 1996 "About approval of the list of paid services which are provided in the state and municipal institutions of health care and the highest medical educational institutions" (ZP of Ukraine, 1996, No. 18, to Art. 501; The Official Bulletin of Ukraine, 2016, No. 77, the Art. 2567), (except the case determined by Item 40 of the Section I of this list), and medical services which financing is performed at the expense of other programs of the government budget.
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