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The document ceased to be valid since  July 31, 2017 according to Item 2 of the Order of the Minister of Health of the Republic of Kazakhstan of June 7, 2017 No. 397

I.O'S ORDER. MINISTER OF HEALTH AND SOCIAL DEVELOPMENT OF THE REPUBLIC OF KAZAKHSTAN

of July 30, 2015 No. 638

About approval of Rules of the choice of the service provider on rendering the guaranteed amount of free medical care and compensation of its costs

(as amended on 29-12-2016)

According to item 4 of article 34 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system" PRIKAZYVAYU:

1. Approve the enclosed Rules of the choice of the service provider on rendering the guaranteed amount of free medical care and compensation of its costs.

2. To committee of payment of medical services of the Ministry of health and social development of the Republic of Kazakhstan (to Kurmanov A.M.) provide:

1) state registration of this order in the Ministry of Justice of the Republic of Kazakhstan;

2) within ten calendar days after state registration of this order the direction it the copy on official publication in periodic printing editions and information system of law of Ad_let;

3) placement of this order on Internet resource of the Ministry of health and social development of the Republic of Kazakhstan;

4) within ten working days after state registration of this order in the Ministry of Justice of the Republic of Kazakhstan submission to Department of legal service of the Ministry of health and social development of the Republic of Kazakhstan of data on execution of the actions provided by subitems 1), 2) and 3) of this Item.

3. To impose control of execution of this order on the first Vice-Minister of health and social development of the Republic of Kazakhstan Kairbekova of Page Z.

4. This order becomes effective after day of its first official publication.

Acting minister of health care and social development of the Republic of Kazakhstan

B. Nurymbetov

It is approved

Acting minister of national economy of the Republic of Kazakhstan

July 31, 2015

 

T. Zhaksylykov

Approved by the Order of the acting minister of health care and social development of the Republic of Kazakhstan of July 30, 2015 No. 638

Rules of the choice of the service provider on rendering the guaranteed amount of free medical care and compensation of its costs

1. General provisions

1. These rules of the choice of the service provider on rendering the guaranteed amount of free medical care and compensation of its costs (further - Rules) are developed according to item 4 of article 34 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system" (further - the Code about health).

Rules determine procedure for the choice of the service provider by rendering the guaranteed amount of free medical care (further - GOBMP) to citizens of the Republic of Kazakhstan and oralmans and compensations of its costs at the expense of budgetary funds, except for the organizations of health care:

1) being public institutions;

2) actionees of the state task;

3) the citizens of the Republic of Kazakhstan rendering treatment according to Rules of the direction on treatment abroad at the expense of budgetary funds approved by the order of the Minister of health and social development of the Republic of Kazakhstan of June 30, 2015 No. 544, registered in the Register of state registration of regulatory legal acts for No. 11795;

4) rendering treatment to the citizens of the Republic of Kazakhstan and oralmans applying for medical treatment abroad in the conditions of the domestic medical organizations, compensation by which it is performed according to the procedure, determined by the subitem 81) of Item 1 of article 7 of the Code about health.

2. The basic concepts used in these rules:

1) attachment of citizens to the organizations of primary health care - registration of obligations of the organizations of primary health care (further - PHC) on rendering PHC and realization of the rights of citizens to its obtaining within GOBMP;

2) potential subcontractor - the subject of health care applying for rendering part of obligations of the supplier under the contract for rendering GOBMP;

3) the potential supplier - the subject of health care applying for rendering GOBMP;

4) observers are representatives of regional chambers of National chamber of entrepreneurs of the Republic of Kazakhstan of Atameken, non-profit organization and the public associations representing the interests of patients and subjects of health care in this region, labor unions of workers of health care;

5) the commission on attachment - the permanent collegiate organ created by UZ for determination of potential suppliers of PHC for participation in campaign of free attachment of citizens of the Republic of Kazakhstan and oralmans to the subjects of health care rendering PHC (further - campaign for attachment), according to these rules;

6) the administrator of the budget programs (further - the administrator) - the Ministry of health and social development of the Republic of Kazakhstan or management of health care of areas, cities of Astana and Almaty (further - UZ);

7) the subject of informatization in the field of health care (further - the subject of informatization) - the legal entity performing activities and entering legal relationship in the sphere of informatization in the field of health care regarding information and technical maintenance of information systems of health care including ensuring information security and organizational and methodical work with subjects of health care, provisional estimate of the treated cases;

8) authorized body in the field of health care (further - authorized body) - the state body performing management in the field of protection of public health, medical and pharmaceutical science, medical and pharmaceutical education, drug circulation, products of medical appointment and medical equipment, control of quality of medical services;

9) the subject of health care - the organization of health care, or the physical person practising private medicine and pharmaceutical activities;

10) again entered health care facility - the object constructed at the expense of budgetary funds, for the first time put in operation, the control of which is transferred the organizations of health care which grants the license for implementation of the related activity for this object;

11) the commission - the permanent collegiate organ created by the customer for carrying out the choice of suppliers and subcontractors according to these rules;

12) the application for participation - the application for participation in the procedure of the choice of the supplier provided by the potential supplier or the application for participation in campaign for attachment provided by the potential supplier of PHC or the application for participation in the procedure of the choice of subcontractors provided by potential subcontractor.

13) subcontractor - the subject of health care included in the electronic register of subcontractors with which the agreement of sub contracting is signed;

14) the choice of subcontractors - the procedure consisting of complex of the interconnected consecutive actions directed to determination of compliance of potential subcontractors to requirements of these rules for inclusion in the electronic register;

15) the electronic register of subcontractors (further - the electronic register) - the electronic register of the subjects of health care determined by the commission conforming to requirements of Rules imposed on potential subcontractor and allowed to rendering GOBMP based on the agreement of sub contracting;

16) the agreement of sub contracting - the civil agreement signed between subcontractor and the supplier for execution of part of obligations of the supplier under the contract for rendering GOBMP;

17) the supplier - the subject of health care with whom the contract for rendering GOBMP is signed;

18) the potential supplier of PHC - the subject of health care applying for rendering PHC within GOBMP;

19) production base - the place of rendering medical services according to appendix to the license;

20) the customer - territorial department of Committee of payment of medical services of the Ministry of health and social development of the Republic of Kazakhstan (further - TD to WHOM) or UZ performing the choice of the service provider on rendering GOBMP at the expense of means of republican or local budgets according to these rules;

21) tasksetter - the approved list of medical services with indication of their cost according to Item 5 of article 35 of the Code about health;

22) the choice of the service provider of GOBMP (further - the choice of the supplier) - the procedure consisting of complex of the interconnected consecutive actions directed to determination of compliance of potential suppliers to requirements of Rules and placement of GOBMP with the conclusion of contracts for rendering GOBMP;

23) the contract for rendering GOBMP (further - the agreement) - the civil contract for rendering GOBMP signed between the customer and the supplier;

24) the agreement of intent on rendering GOBMP (further - the agreement of intention) - the civil agreement signed between the potential supplier and subcontractor;

25) placement of GOBMP - determination of amounts of GOBMP by the commission within the means provided by funding plans of the budget programs (subprogrammes) for obligations and payments of the administrator, to potential suppliers.

2. Procedure for the choice of the service provider of the guaranteed amount of free medical care

Paragraph 1. Basic provisions of the choice of the service provider of GOBMP

3. The choice of the service provider of GOBMP is performed:

at the expense of means of the republican budget for the following types of medical care:

pre-medical;

qualified, specialized, high-technology medical service, medico-social which appear in the following forms:

1) the out-patient and polyclinic help including:

primary health care;

consulting and diagnostic help with the direction of the specialist of primary health care and profile specialists;

2) stationary medical care in the direction of the specialist of primary health care or the medical organization, according to the emergency indications – regardless of direction availability, including rendering health care by the republican organizations:

medical services by the patient: mental, oncological diseases and tuberculosis, alcoholism, drug addiction and toxicomania;

medical services in sanatoria;

3) hospital-replacing medical care in the direction of the specialist of primary health care or the medical organization, including rendering health care of medical services by the republican organizations by the patient: mental, oncological diseases and tuberculosis, alcoholism, drug addiction and toxicomania;

4) recovery treatment and medical rehabilitation;

at the expense of means of the local budget, including the target current transfers allocated from the republican budget to regional budgets, budgets of the cities of Astana and Almaty by types and forms of medical care, except for rendering GOBMP performed at the expense of means of the republican budget.

4. The choice of the supplier is performed with respect for the principles:

1) ensuring availability of GOBMP;

2) realization of the free choice by citizens of the Republic of Kazakhstan and oralmans of the subject of health care;

3) providing with the supplier of rational expenditure of the money used for implementation of activities for rendering GOBMP;

4) provisions to potential suppliers of equal opportunities for participation in the procedure of the choice of the supplier;

5) publicity and transparency of the procedure of the choice of the supplier;

6) fair competition among potential suppliers;

7) territorialities (arrangement of production base of the supplier in the place of rendering GOBMP specified in the notice on implementation of the procedure of the choice of the supplier).

5. The choice of the supplier is performed according to the decision of the customer:

1) based on the individual funding plan approved by the administrator according to obligations and (or) the legal decision of permanent advisory advisory body under authorized body;

2) on GOBMP placed not in full;

3) on the released amount of GOBMP as a result of non-execution and (or) not proper execution by suppliers of undertaken obligations under the signed contracts for rendering GOBMP;

4) on the allocated additional money on rendering GOBMP, including at the expense of the means released by results of quality control and amount, except for allocations of additional money which are placed the customer without holding procedure of the choice of the supplier, in cases:

value additions of rates, including owing to review of types of the high-technology medical services approved according to Item 2 of article 42 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system" (further – the Code);

changes of number and (or) gender and age structure of the attached population to the subject of health care rendering PHC;

changes of the amount on stimulation of workers of the subject of the health care rendering PHC on the basis of the achieved indicators of resulting result, according to the Rules of encouragement of employees of the organizations of health care participating in rendering complex of actions within the guaranteed amount of free medical care, approved by the order of the acting minister of health care of the Republic of Kazakhstan of May 29, 2015 No. 429 (it is registered in the Register of state registration of regulatory legal acts of the Republic of Kazakhstan for No. 11526);

allocation of additional money for compensation of the rendered medical services over the provided amount of GOBMP as a result of the free choice by the population and (or) growth emergency and emergency medical service;

on compensation of leasing payments for the medical equipment acquired on the terms of financial leasing within GOBMP;

on determination by the customer of need of rendering additional amount of services;

for again entered health care facilities conforming to requirements imposed to potential suppliers by these rules;

for the pilot organizations.

5-1. The choice of the supplier within the current financial year in connection with allocation of additional resources is performed according to the decision of the customer among suppliers with whom contracts for rendering GOBMP for the current financial year, and (or) are signed with involvement of new suppliers.

6. Requirements imposed to the potential supplier:

1) to have legal capacity (for legal entities), civil capacity to act (for physical persons);

2) to be solvent, not to have tax debt;

3) not to be subject to insolvency proceeding or liquidation;

4) to have material and manpower.

7. The potential suppliers accredited in health sector have the privilege to the conclusion of the service provision agreement GOBMP.

8. The procedure of the choice of the service provider of GOBMP consists of the following stages:

1) the choice of the potential supplier of PHC for participation in campaign for attachment;

2) the choice of potential subcontractor of services GOBMP for inclusion in the electronic register of potential subcontractors;

3) choice of the service provider of GOBMP and placement of GOBMP.

Paragraph 2. Procedure for the choice of the potential supplier of PHC for participation in campaign for attachment

9. The elections of the potential supplier of PHC for participation in campaign for attachment are held by UZ for determination of compliance (discrepancy) of the potential supplier of services GOBMP to the requirements imposed to the potential supplier according to Item 6 and confirmed by the submitted documents, stipulated in Item 13 these rules.

The campaign for attachment is performed according to the Rules of attachment of citizens to the organizations of primary health care approved by the order of the Minister of health and social development of the Republic of Kazakhstan of April 28, 2015 No. 281, registered in the Register of state registration of regulatory legal acts for No. 11268 (further - the order No. 281).

Potential suppliers of PHC participate in campaign for attachment.

10. Forming of structure of the commission on attachment and rules of its work of UZ performs similar to Items 44 - 57 these rules.

The commission on attachment determines compliance (discrepancy) of the potential supplier to requirements of Rules for participation in campaign for attachment.

11. OUSE informs potential suppliers of PHC on implementation of the procedure of determination of compliance (discrepancy) of potential suppliers for participation in campaign for attachment in one month prior to its beginning by submission of the announcement of order taking for participation in the procedure of the admission to participation in campaign for attachment in form according to appendix 1 to these rules which is published in the periodic printing edition distributed in the territory of the capital, city of republican value, the respective area, and the UZ Internet resource (further - the announcement of holding campaign for attachment).

12. The potential supplier of PHC provides in UZ the application for participation in the procedure of determination of potential suppliers for participation in campaign of free attachment of citizens of the Republic of Kazakhstan and oralmans to the subjects of health care giving primary health care in form according to appendix 2 to these rules in time, certain UZ, but at least ten working days from the date of placement of UZ of the announcement of holding campaign for attachment.

13. The potential supplier of PHC attaches the following documents to the application for participation:

1) notarially attested copies:

certificates or certificate of state registration (re-registration) of the legal entity (the electronic version of the reference notarially is not witnessed);

the document granting the right to implementation of business activity without formation of legal entity issued by the relevant state body (for physical person);

the trust management agreement (in case of its availability);

licenses for occupation medical activities and the appendices to them confirming the right of the potential supplier of PHC to rendering the appropriate medical care (electronic the license and appendices to it notarially is not witnessed);

2) copies:

the identity document (for physical person);

the charter (if in the charter the list of founders, participants or shareholders is not specified, are also represented the statement about the list of founders, participants or the copy of the foundation agreement, or the statement from the register of shareholders);

certificates on accreditation in health sector (in case of its availability);

3) data on qualification of health workers with medical education in form according to appendix 3 to these rules (further – data on qualification of personnel) (in the presence of the certificate on accreditation granted according to Rules of accreditation of health care, approved by the order of the Minister of health and social development of the Republic of Kazakhstan of March 10, 2015 No. 127 (it is registered in the Register of state registration of regulatory legal acts of the Republic of Kazakhstan for No. 10735) these data are not represented).

The potential supplier of PHC who is not resident of the Republic of Kazakhstan in confirmation of its compliance to requirements imposed to the potential supplier according to Item 6 of these rules submits the documents provided by this Item.

The application for participation and documents attached to it are signed by the head of the potential supplier of PHC.

The application for participation is provided before the expiration of the final term specified in the announcement, to the secretary of the commission on attachment purposely in the stitched type with the numbered pages without corrections and blots, the signature of the head certified on the last page and under seal (in the presence).

Provision of the application for participation and the documents attached to it, the representative of the potential supplier of PHC based on the power of attorney on the right of application for participation, by the witnessed signature of the head of the potential supplier of PHC and under seal (in the presence) is allowed.

14. Acceptance and registration of the application for participation are performed by the secretary of the commission in the magazine of registration of applications for participation in the procedure of determination of potential suppliers of primary health care for participation in campaign of free attachment of citizens of the Republic of Kazakhstan and oralmans to the subjects of health care giving primary health care in form according to appendix 4 to these rules which is numbered, strung together and on the last page is assured by the signature of the head and is under seal.

15. To the potential supplier of PHC after registration of the application for participation by the secretary of the commission on attachment it is issued:

the receipt on documents acceptance in form according to appendix 4-1 to these rules;

the receipt on refusal in documents acceptance in form according to appendix 4-2 to these rules in cases:

1) the application for participation and documents attached to it are drawn up in an inadequate way;

2) the incomplete document package according to the list, stipulated in Item 13 these rules is applied to the application for participation.

16. The commission on attachment within three working days from the date of the expiration of final term of submission of applications for participation by results of consideration of applications for participation of potential suppliers of PHC makes the decision on compliance (discrepancy) of potential suppliers of PHC to requirements imposed to the potential supplier according to Item 6 of these rules for participation in campaign of attachment of citizens of the Republic of Kazakhstan and oralmans to the subjects of health care giving primary health care which is drawn up by the protocol in form according to appendix 5 to these rules.

17. The commission on attachment determines potential suppliers of PHC, not conforming to requirements of Item 6 of these rules, and recognizes them not allowed to campaign for attachment in cases:

1) submissions of doubtful documents and information in documents, stipulated in Item 13 these rules;

2) discrepancies to the declared medical care to the data specified in the submitted documents;

3) arrangements of production base of the potential supplier or its representation (in case of application for participation by representation) specified in the submitted documents out of the territory determined by the customer in the notice on implementation of the procedure of the choice of the supplier.

18. Based on the decision of the commission on attachment the commission chairman announces the list of potential suppliers of PHC:

to conforming requirements of Item 6 of these rules imposed on the potential supplier of PHC, and allowed to participation in campaign for attachment;

to not conforming requirements of Item 6 of these rules imposed on the potential supplier of PHC, and not allowed to participation in campaign for attachment.

18-1. The minutes abstract about compliance (discrepancy) to requirements imposed on the potential supplier for participation in campaign of attachment of citizens of the Republic of Kazakhstan and oralmans to the subjects of health care giving primary health care in form according to appendix 5-1 to these rules is issued to UZ to potential suppliers of PHC.

19. OUSE from the date of acceptance by the commission on decision attachment:

within three calendar days publishes the list of the potential suppliers of PHC allowed to participation in campaign for attachment with indication of the place of their stay and contact telephone numbers in the periodic printing edition distributed in the territory of the capital, city of republican value, the respective area, and the UZ Internet resource;

in time no later than one working day sends to the subject of informatization minutes abstract for provision to the potential suppliers of PHC allowed to participation in campaign for attachment, the password and login of access to the Registr Prikreplennogo Naseleniya portal (further - RPN).

20. The subject of informatization represents the password and login of access to the RPN portal to the responsible person of the potential supplier of PHC allowed to participation in campaign for attachment, in time no later than one working day prior to the campaign for attachment.

21. The potential supplier of PHC allowed to participation in campaign for attachment sends to the subject of informatization the copy of the order on appointment of the responsible person on whom the personal responsibility for maintaining the RPN portal according to the procedure is conferred No. 7 determined by the order of the acting minister of health care of the Republic of Kazakhstan of January 5, 2011 "About approval of the Regulations on organization activity of health care, giving out-patient and polyclinic help", registered in the Register of state registration of regulatory legal acts for No. 6774.

22. Before holding campaign for attachment, the potential suppliers of PHC allowed to participation in campaign for attachment carry out information and explanatory work among the population.

23. OUSE no later than December 1 of the current year sums up the results of campaign for attachment and provides the commissions on attachment the list of potential suppliers of PHC with indication of the number of the population attached to them registered in the RPN portal with allocation of the potential suppliers of PHC for the first time participating in campaign for attachment.

24. The commission on attachment within ten working days from the date of completion of the period of campaign for attachment according to the subitem 4) Item 11 of Rules of rendering primary health care and Rules of attachment of the citizens to the organizations of primary health care approved by the order of the Minister of health and social development of the Republic of Kazakhstan of April 28, 2015 No. 281 (it is registered in the Register of state registration of regulatory legal acts of the Republic of Kazakhstan for No. 11268) considers results of campaign of attachment and makes the decision which is drawn up by the protocol on results of holding campaign of attachment of citizens of the Republic of Kazakhstan and oralmans to the subjects of health care giving primary health care in form according to appendix 5-2 to these rules:

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