of December 29, 2020 No. KR DSM-333/2020
About approval of rules of accounting of consumers of medical services and provisions of the right to medical care in system of compulsory social medical insurance
According to the subitem 66) article 7 of the Code of the Republic of Kazakhstan "About health of the people and health care system" PRIKAZYVAYU:
1. Approve the enclosed rules of accounting of consumers of medical services and provision of the right to medical care in system of compulsory social medical insurance.
2. To provide to department of coordination of compulsory social medical insurance of the Ministry of Health of the Republic of Kazakhstan in the procedure established by the legislation of the Republic of Kazakhstan:
1) state registration of this order in the Ministry of Justice of the Republic of Kazakhstan;
2) placement of this order on Internet resource of the Ministry of Health of the Republic of Kazakhstan after its official publication;
3) within ten working days after state registration of this order submission to Legal department of the Ministry of Health of the Republic of Kazakhstan of data on execution of the actions provided by subitems 1) and 2) of this Item.
3. To impose control of execution of this order on the supervising vice-Minister of Health of the Republic of Kazakhstan.
4. This order becomes effective from the date of its first official publication.
Minister of Health of the Republic of Kazakhstan
A. Tsoi
No. KR DSM-333/2020 are approved by the Order of the Minister of Health of the Republic of Kazakhstan of December 29, 2020
1. These rules of accounting of consumers and provision of the right to medical care in system of compulsory social medical insurance (further – Rules) are developed according to the subitem 66) of article 7 of the Code of the Republic of Kazakhstan "About health of the people and health care system" and determine procedure accounting of consumers within system of compulsory medical insurance (further – OSMS).
2. The basic concepts used in these rules:
1) The Government for Citizens State corporation (further - the State corporation) - the legal entity created according to the decision of the Government of the Republic of Kazakhstan for rendering the state services according to the legislation of the Republic of Kazakhstan, the organization of work on reception of applications on rendering the state services and issue of their results to uslugopoluchatel by the principle of "one window", ensuring rendering the state services electronically;
2) information exchange - process of acceptance and data transmission from one information system to another;
3) payers of assignments and (or) fees (further - payers) - persons performing calculation, deduction, transfer, payment of assignments and (or) fees in Fund according to the procedure, established by the Law of the Republic of Kazakhstan of November 16, 2015 "About compulsory social medical insurance" (further - the Law);
4) fund of social medical insurance (further - Fund) - the non-profit organization making accumulation of assignments and fees, and also performing purchase and fee of the subjects of health care providing medical care in amounts and on conditions which are provided by the agreement of purchase of medical services, and other functions determined by the laws of the Republic of Kazakhstan;
5) information system of Fund (further - IS of Fund) - the information system providing conducting processes of Fund in electronic format;
6) the consumer of medical services in system of compulsory medical insurance (further - the consumer) - the physical person having according to the Law the right to medical care in the OSMS system.
3. According to article 5 of the Law in the OSMS system persons for whom it was performed the payment of assignments and (or) fees in Fund and also exempted from payment of fees in Fund according to Item 7 of article 28 of the Law have the right to medical care.
4. Accounting of consumers within the OSMS system is performed by Fund in IS of Fund based on supplied or the information of the State corporation arriving from information systems of state bodies of the Republic of Kazakhstan, data on the military personnel, the staff of the special state and law enforcement agencies represented in electronic format.
5. Data exchange between information systems of state bodies of the Republic of Kazakhstan, IS of Fund is performed in electronic form through the allocated or open channels of communication, including the Internet, according to the requirements established by the legislation of the Republic of Kazakhstan on informatization, on the state secrets and personal data protection. The data constituting the state secrets of the Republic of Kazakhstan, and also office information of limited distribution are not subject to information exchange.
6. Data on category of consumers, except for the data provided by Chapter 3 of these rules are updated daily in the automated mode.
7. Sources of forming of the these persons specified in Chapter 2 of these rules, including the foreigners and stateless persons who are constantly living in the territory of the Republic of Kazakhstan, foreigners and members of their families which are temporarily staying in the territory of the Republic of Kazakhstan in accordance with the terms of the international treaty ratified by the Republic of Kazakhstan if other is not provided by the laws or international treaties:
1) data from information system of the Ministry of Public Education of the Republic of Kazakhstan (further – MT of RK);
2) data from information system of the Ministry of science and the higher education (further – MHBO PK);
3) data of the state database of the Ministry of Justice of the Republic of Kazakhstan (further – MYU of RK);
4) data from information system of the Ministry of Labour and Social Protection of the population of the Republic of Kazakhstan (further – MTSZN RK);
5) data from information system of the Ministry of Health of the Republic of Kazakhstan (further – MZ RK);
6) data from the centralized automated database of the Ministry of Internal Affairs of the Republic of Kazakhstan (further – the Ministry of Internal Affairs of RK);
7) data from information system of Committee on legal statistics and special accounting of the Prosecutor General's Office of the Republic of Kazakhstan (further – to KPSIS GP RK).
8. Accounting of consumers in IS of Fund it is performed in the automatic mode based on the data arriving from the State corporation, except for categories of the consumers specified in Chapter 3 of these rules.
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