of December 29, 2012 No. 910
About approval of Rules of payment for the provided medical care to the population subjects of health care of district value and the village on complex per capita rate within the guaranteed amount of free medical care
According to the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system", the Rules of the choice of the service provider on rendering the guaranteed amount of free medical care and compensation of its costs approved by the order of the Government of the Republic of Kazakhstan No. 1358 of October 25, 2012, the Rules cost recovery to the organizations of health care at the expense of budgetary funds approved by the order of the Government of the Republic of Kazakhstan of December 7, 2009 No. 2030, I ORDER:
1. Approve Rules of payment for the provided medical care to the population by subjects of health care of district value and the village on complex per capita rate within the guaranteed amount of free medical care according to appendix to this order.
2. To local authorities of public administration of health care of areas when implementing payment for the provided medical care to the population subjects of health care of district value and the village on complex per capita rate within the guaranteed amount of free medical care to be guided by these rules.
3. To the republican state company on the right economic maintaining "The republican center of development of health care" of the Ministry of Health of the Republic of Kazakhstan (Kulzhanov M. K.) provide information and technical maintenance of the information system "Rural Health Care" on permanent basis.
4. To impose control of execution of this order on the vice-Minister of Health of the Republic of Kazakhstan Kurmashalneva A. D.
5. This order becomes effective since January 1, 2013.
Minister of Health of the Republic of Kazakhstan
S. Kairbekova
Appendix
to the order of the Minister of Health of the Republic of Kazakhstan of December 29, 2012 No. 910
1. These rules for the provided medical care to the population are developed by subjects of health care of district value and the village on complex per capita rate within the guaranteed amount of free medical care (further - Rules) according to the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system", the Rules of the choice of the service provider on rendering the guaranteed amount of free medical care and compensation of its costs approved by the order of the Government of the Republic of Kazakhstan No. 1358 of October 25, 2012, the Rules of cost recovery to the organizations of health care at the expense of budgetary funds approved by the order of the Government of the Republic of Kazakhstan of December 7, 2009 No. 2030.
2. Rules determine payment procedure of delivery of health care by subjects of health care of district value and the village by complex per capita rate within the guaranteed amount of free medical care (further - GOBMP).
3. These rules extend to the following participants of process:
the subjects of health care of district value and the village providing medical care within the guaranteed amount of free medical care (further the rural organization of health care);
local authorities of public administration by health care of areas, the cities of republican value and the capital (further - UZ) performing purchase, payment and control of the provided medical care within GOBMP;
the territorial departments of Committee of control of medical and pharmaceutical activities of the Ministry of Health of the Republic of Kazakhstan (further - TD KKMFD) exercising the state control in the field of health care in the sphere of rendering medical services;
The committee of payment of medical services of the Ministry of Health of the Republic of Kazakhstan and its territorial departments (further - TD to WHOM) exercising control, coordination and monitoring of implementation and execution of target current transfer on delivery of health care to the population by subjects of health care of district value and the village within the guaranteed amount of free medical care including control of amount of the provided stationary and hospital-replacing medical care;
The republican state company on the right of economic maintaining "The republican center of development of health care" of the Ministry of Health of the Republic of Kazakhstan (further - RTsRZ) performing information and technical maintenance of the information system "Rural Health Care" (further - IS "Rural Health Care"), "The electronic register of inpatients" (daleeregistr) and SUKMU, assessment of the treated cases of the stationary and hospital-replacing help and organizational and methodical work with the rural organizations of health care;
the organization determined by the Government of the Republic of Kazakhstan which object of activity are the organization and carrying out purchases of medical equipment for further transfer of health care to the rural organization on the terms of financial leasing (further - the lessor).
4. The basic concepts used in these rules:
1) the information system "Rural Health Care" (further - IS "Rural Health Care") - electronic system of accounting of processing and data storage of delivery of health care and financing of the rural organization of health care;
2) the Electronic register of inpatients (further - ERSB) - electronic system of accounting of processing and data storage of rendering stationary and hospital-replacing medical care;
3) the Quality management system of medical services (further - SUKMU) - electronic system of financing of the organization of health care when rendering the stationary and hospital-replacing help;
4) complex per capita rate for delivery of health care to the population by subjects of health care of district value and the village (further - complex per capita rate) the cost of complex of medical services for providing GOBMP on established by authorized body in the field of health care (daleeupolnomochenny body) to the list of forms of medical care counting on one person attached to the rural organization of health care approved by the administrator of the budget programs on behalf of UZ;
5) the accounting period - the period of time equal to one calendar month, except for January, 2013 which is expanded in connection with transition of part of the period of December, 2012;
6) the commission on fee - the permanent collegiate organ created by UZ from number of persons employed of BONDS, TD to the LUMP, TD of KKMFD and RTsRZ for implementation of payment for the rendered medical services within GOBMP.
5. Payment for the provided medical care to the population of the rural organization of health care (further - payment) is performed on complex per capita rate at the expense of means of the republican budget in the form of target current transfers and means local budgets based on the contract for rendering medical services to the population by the subject of health care of the district value and the village concluded between UZ and the rural organization of health care within the provided means (daleeosnovny the agreement).
6. The complex per capita rate provides GOBMP by the following types of medical care: pre-medical, qualified, specialized, medico-social which appear in the following forms:
1) primary health care;
2) consulting and diagnostic help;
3) emergency medical service;
4) hospital-replacing help;
5) stationary help.
7. The complex per capita rate includes the costs connected with activities for delivery of health care for the above-stated types and forms within GOBMP according to technique of forming of rates and costs planning on the medical services rendered within GOBMP approved by the order of the Minister of Health of the Republic of Kazakhstan of November 26, 2009 No. 801.
The complex per capita rate is created depending on structure of the rural organizations of health care and includes the following forms of medical care approved by UZ:
1) primary health care, it is advisory the diagnostic help, emergency medical service; hospital-replacing help, stationary help;
2) primary health care, it is advisory the diagnostic help, emergency medical service; hospital-replacing help;
3) primary health care, it is advisory the diagnostic help, the hospital-replacing help;
4) emergency medical service, hospital-replacing, stationary medical care;
5) hospital-replacing, stationary medical care.
8. The complex per capita rate counting on one person a month is determined by division of the amount of the annual amount of financing (less the amount of the cases provided on payment which did not enter the account register for December, 2012) on number of people, attached to the rural organization of health care or living in this area, and divided for 12 (twelve) months.
Calculation of the complex per capita rate created in the forms of medical care specified:
- in subitems 1), 2) and 3) of part two of Item 7 it is performed on number of people, attached to the rural organization of health care;
- in subitems 4) and 5) Item 7 parts two - on number of people, living in this area.
The complex per capita rate for the rural organization of health care providing medical care in the form of stationary and hospital-replacing is calculated proceeding from the number of the people living in this area.
The rural organization of health care provides all complex of medical services to the population within GOBMP according to standards in the field of health care within the amounts of the signed basic agreement.
9. Compensation of leasing payments is performed by UZ on condition of rendering medical services with use of the medical equipment acquired on the terms of financial leasing under the agreement of financial leasing signed by the rural organization of health care with the lessor.
10. The responsible person of the rural organization of health care on whom the personal responsibility for maintaining medical statistics and forming of the reporting is conferred (further - the Responsible person), based on primary medical documentation approved by authorized body:
- monthly enters aggregated data on rendering into IS "Rural Health Care" out-patient and polyclinic, emergency medical service;
- daily enters into ERSB and confirms data, including vypisny to the epikrizena is later than the day following disposal of the patient from hospital on the basis of the following medical records: the inpatient (form 003/at), sick day hospital (form 003-3/y), stories of childbirth (form 096/at), stories of development of the newborn (form 097/at) (further - medical records).
By results of input in ERSB the statistical card disposed from hospital is created (forms 066/at, 066-1/at, 066-2/at, 066-3/at, 066-4/at) and vypisny epikriz the treated patient form - 027/at).
11. The responsible person of the rural organization of health care on whom the personal responsibility for conducting financial accounting and forming of the financial reporting is conferred (further - the Responsible person), based on primary financial documentation till the 30th of the following behind the accounting period, for November and December till December 25 performs data entry in IS "Rural Health Care" on:
to structure of the income for the rendered medical services to the population subjects of health care of district value and the village according to appendix 1 to these rules;
to expense structure for the rendered medical services to the population subjects of health care of district value and the village according to appendix 2 to these rules;
to the differentiated payment of workers according to appendix 3 to these rules;
to advanced training and retraining of personnel according to appendix 4 to these rules.
12. The rural organization of health care enters into IS "Rural Health Care" data on structure and capacity of the organization, personnel structure no later than the 5th following reporting quarter in time (the fourth quarter - till December 25 of the current year), and provides their updating on permanent basis.
13. By results of data entry in IS "Rural Health Care" the quarterly report on indicators of assessment of the achieved results of work of the rural organization of health care according to appendix 5 to these rules (assessment daleeindikator) is created.
14. The rural organization of health care in case of use of the medical equipment acquired on the terms of financial leasing fills in the sheet of use of the medical equipment acquired on the terms of financial leasing:
when rendering stationary medical care in form 066-2/y;
when rendering the consulting and diagnostic help in form 025/at in the form of appendix in form according to appendix 6 to these rules.
15. The rural organization of health care enters into IS "Rural Health Care" aggregated data about use of the medical equipment acquired on the terms of financial leasing from primary medical documentation according to appendix 6 to these rules.
16. The confirmations of correctness of input this later in IS "Rural Health Care" and ERSB, except as specified input in ERSB of results of histologic and patomorfologichesky researches are not subject to adjustment.
After confirmation of input health care by the rural organization data in IS "Rural Health Care" and in ERSB, electronic options become available to daily assessment of UZ, RTsRZ, TD KOMU and TD KKMFD.
17. Quality control and amount of medical service is carried out:
1) on the basis of the automated selection of the treated cases in the round-the-clock and day hospitals from SUKMU according to the list of the cases which are not subject to payment, including partially, approved by authorized body in the field of health care according to appendix 7 to these rules (further - the List);
2) by means of examination of primary medical documentation intended for data recording about the state of health of the individuals reflecting nature, amount and quality of the rendered medical services (further - the medical record), by request of medical records from the rural organization of health care.
When conducting examination of the stationary and hospital-replacing help the request of medical records from the rural organization of health care is performed by results of the automated selection of SUKMU.
18. The rural organization of health care at the request of the state bodies exercising quality control and amount of medical services within GOBMP submits medical records, other documents and their copies till three working days.
In cases with lethal outcome the rural organization of health care sends medical records with appendix of the pathoanatomical diagnosis to TD KKMFD according to the inventory.
19. RTsRZ in SUKMU daily carries out assessment of 20% of the treated cases which are subject to payment with automatic selection of target groups for quality monitoring procedure:
- cases of complications, including postoperative;
- cases from the disease outcomes "deterioration", "without changes";
- cases of discrepancy of clinical and morphological diagnoses.
Following the results of assessment of RTsRZ creates the list of the cases of hospitalization which are subject to quality control after assessment of RTsRZ according to appendix 8 to these rules (further - the list of RTsRZ) which electronic version is available to daily assessment of TD KKMFD, and KKMFD on paper assured by the signature of the first head and under seal, in time no later than one working day of the month following the accounting period represents to TD.
20. TD KKMFD in SUKMU attaches the expert opinion on lethal outcome of inpatients according to appendix 9 to these rules to results of expert evaluation of quality of medical services and represents to UZ no later than three working days of the month following the accounting period in time.
21. KKMFD represents to TD to UZ results of the scheduled and unscheduled inspections which are carried out within the state control in the sphere of rendering medical services including examination of overall performance of the medical equipment acquired on the terms of financial leasing, in time no later than three working days from the moment of the end of examination.
KKMFD enters results of scheduled and unscheduled inspections of quality control of the stationary and hospital-replacing help of TD into SUKMU.
22. Following the results of quality control and amount in SUKMU in the automated type the summary list of cases by results of quality control and amount of medical services GOBMP according to appendix 10 to these rules (the daleesvodny list) is created.
The TD to WHOM represents to UZ the summary list certified by signatures of the first heads of TD to the LUMP and TD KKMFD and under seal, in time no later than three working days of the month following the accounting period, except for the first quarter 2013 on which summary list is submitted no later than April third, 2013 in time.
23. The TD to WHOM by results of monitoring of activities of the rural organizations of health care quarterly creates the expert opinion on indicators of assessment of the achieved results of work of the rural organization of health care according to appendix 11 to these rules and represents to UZ in time no later than the fifth following reporting quarter (the fourth quarter - till December 20 of the current year) signed by the first head and under seal.
24. RTsRZ within information and technical maintenance of program complexes of IS "Rural Health Care", ERSB and SUKMU checks the database of the rural organizations of health care for logical and technical mistakes, also within organizational and methodical work checks correctness of data entry and correctness of calculation, including when forming indicators of assessment, and confirms their correctness in IS "Rural Health Care" no later than the second following reporting quarter in time (the fourth quarter - till December 15 of the current year).
25. The rural organization of health care transfers to UZ the account register of the rendered medical services created in IS "Rural Health Care" within GOBMP (further - the account register) and appendices to it according to appendix 12 to these rules, signed by the first head and under seal no later than one working day following the accounting period in time.
Appendix 1 to accounts register when using the medical equipment acquired on the terms of financial leasing is represented the rural organization of health care in case of rendering medical services on the medical equipment acquired on the terms of financial leasing.
Appendix 2 to accounts register "Indicators of assessment of the achieved results of work of the rural organization of health care" is represented the rural organization of health care following the results of reporting quarter.
26. The rural organization of health care monthly together with accounts register represents the following registers about amount of the rendered medical services approved with RTsRZ to UZ:
the register of the rendered services of primary health care according to appendix 13 to these rules;
the register of the rendered consulting and diagnostic services according to appendix 14 to these rules;
the register of the rendered services of emergency medical service according to appendix 15 to these rules;
the personified register of the written-out patients which are given stationary and hospital-replacing help according to appendix 16 to these rules.
27. Payment for the medical care provided in form of the stationary and hospital-replacing help, to the rural organizations of health care in the cases which did not enter the account register for December, 2012 including cases in which quality control and amount of medical services is not carried out, is performed by UZ on the rates approved by authorized body in the field of health care under the act of the executed services based on the following documents:
the account register for the rendered medical services within the guaranteed amount of free medical care provided by the rural organization of health care for form according to appendix 1 to Rules of payment for the rendered medical services within the guaranteed amount of free medical care performed at the expense of means of the republican budget, the approved Minister of Health of the Republic of Kazakhstan of January 27, 2012 No. 57 (further - the order MZ RK No. 57);
the protocol of agreement performance on rendering medical services within the guaranteed amount of free medical care provided to TD to WHOM in form according to appendix 5 to the order MZ RK No. 57.
28. OUSE based on the account register, the summary list and expert opinions of TD of KKMFD and TD of KOMU in IS "Rural Health Care" creates the protocol of agreement performance on rendering medical services within GOBMP to the population by the subject of health care of district value and the village (further - the protocol of execution) according to appendix 17 to these rules.
The protocol of execution is considered and signed by the commission on fee.
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The document is not valid from February 11, 2014 according to Item 1 of the Order of the deputy. The Minister of Health of the Republic of Kazakhstan of February 11, 2014 No. 83