ORDER OF THE MINISTRY OF HEALTH OF THE REPUBLIC OF MOLDOVA

of May 28, 2015 No. 400/219

About approval of Methodological regulations of application in 2015 of the Single program of compulsory medical insurance

According to provisions of the Law on health protection No. 411-XIII of March 28, 1995, the Order of the Government No. 1387 of December 10, 2007. "About approval of the Single program of compulsory medical insurance", with subsequent changes and amendments, the Ministry of Health based on item 9 of the Regulations on the organization and functioning of the Ministry of Health approved by the Order of the Government No. 397 of May 31, 2011 and National medical insurance company based on item 29 of the item e) the charter approved by the Order of the Government No. 156 of February 11, 2002, PRIKAZYVAYEM:

1. Approve Methodological regulations of application in 2015 of the Single program of compulsory medical insurance (further – Methodological regulations) according to appendix.

2. To heads of the medical and sanitary organizations providing medical care within compulsory medical insurance to directors of territorial agencies of National medical insurance company to respect the Methodological rules approved by this order.

3. To heads of the medical and sanitary organizations providing medical care within compulsory medical insurance to advertize in the places available to patients and visitors, information concerning agreement number and date of its conclusion with National medical insurance company, range and type of the services provided on its basis according to provisions of Methodological regulations, and the list of services to which insured and uninsured persons in this organization have the right.

4. The manager of management of primary, fast and communitarian medical care, management of stationary medical care and management of the budget, finance and insurance to provide advisory and methodical support for the purpose of realization of provisions of the Methodological regulations approved by this order.

5. Of 29.12.2014 "About approval of Methodological regulations of application in 2015 of the Single program of compulsory medical insurance" to cancel the order No. 1490/672-A.

6. We impose control over accomplishment of this order on ourselves.

Appendix

to the Order of the Ministry of Health and National medical insurance company of the Republic of Moldova of May 28, 2015 No. 400/219-A

Methodological regulations of application in 2015 of the Single program of compulsory medical insurance

Chapter I. General provisions

1. Methodological regulations of application in 2015 of the Single program of compulsory medical insurance (further – Methodological regulations) are developed according to provisions of the Law on health protection No. 411-XIII of March 28, 1995, the Law on compulsory medical insurance No. 1585-XIII of February 27, 1998 and the Single program of compulsory medical insurance (further – the Single program) approved by the Order of the Government No. 1387 of December 10, 2007 with subsequent changes and amendments, and also the Law No. 74 of 12.04.2015. "About funds of compulsory medical insurance for 2015".

2. Methodological regulations determine the basic principles of the organization of medical services and payment of the corresponding services in the types provided by the Single program provided within compulsory medical insurance by the medical and sanitary organizations which signed the contract with National medical insurance company.

3. Methodological regulations determine conditions of provision of medical care at each level and each type, payment method and criteria of the conclusion of contracts with authorized suppliers in system of compulsory medical insurance depending on the financial parameters determined by the Law No. 74 of 12.04.2015. "About funds of compulsory medical insurance for 2015".

4. The regulations of conditions of provision of medical care for each type of the help and the services rendered within compulsory medical insurance pursue the aim of ensuring fair access to medical care at all levels with respect for the sequence and possibility of its provision in the amount established by the Single program for all persons which are in the territory of the Republic of Moldova on legal causes.

5. In case of uninsured persons the amount and conditions of provision of medical services at the level of fast pre-hospital medical care and primary medical care, and also at the level of specialized out-patient and stationary medical care in case of socially caused diseases with high risk for public health covered at the expense of means of funds of compulsory medical insurance according to the legislation are established by the Single program and these Methodological regulations.

The list of socially caused diseases representing high risk for public health and subjects to treatment within the specialized out-patient help and in stationary conditions includes:

a) tuberculosis;

b) psychoses and other intellectual and behavioural variations;

c) alcoholism and drug addiction;

d) the confirmed malignant diseases of blood and new growth;

e) precancer conditions *, revealed within screening researches, organized according to the regulations approved by the Ministry of Health and National medical insurance company;

f) HIV / SPID-infektion and syphilis;

g) acute viral hepatitis A, botulism, viral, bacterial and parasitic meningitis and meningoentsefalita, pandemic flu, chicken pox, measles, leptospirosis, malaria, typhoid and paratyphoid, sypny typhus, cholera, tetanus, anthrax, brucellosis, hemorrhagic fever, kulikhoradka, epidemic parotitis, rage, trichinosis, plague, iyersinioz, tulyaremiya, diphtheria, poliomyelitis and rubella.

And treatment will be provided to uninsured persons with above-mentioned diseases of research, consultation free of charge, including observation after the carried-out treatment, profile doctors according to their competence and family doctors.

6. Regulations of payment methods and the conclusion of contracts with suppliers of medical services pursue the aim of ensuring justice and proportionality in payment process for the provided medical services in different types of medical care depending on amount of the means which are saved up in funds of compulsory medical insurance, and efficiency of suppliers based on criteria of the conclusion of contracts with NMSK.

7. Methodological regulations are applied and are obligatory for all subjects of compulsory medical insurance approved by the Law No. 1585-XVIII of February 27, 1998 on compulsory medical insurance, other existing normative and legal acts including all suppliers of the medical services which signed the contract with National medical insurance company.

Chapter II. Conditions of provision of medical care for each type of medical care and the medical services rendered within compulsory medical insurance

8. The organization of medical care within compulsory medical insurance is performed according to the following general terms:

a) both in case of disease, and in case of preventive visit person at first addresses with the identity certificate and/or the policy of compulsory medical insurance the family doctor who provides necessary medical care in the amount established by the Single program and these Methodological regulations;

b) in all cases when untimely rendering medical services endangers life of the patient and/or surrounding his faces or can represent heavy consequences for the state of health of the patient / or public health, emergency medical service appears any doctor from any medical and sanitary organization, irrespective of the legal form of the organization which signed the contract with National medical insurance company, in the long mode before stabilization of the state of health of the patient and/or transfer on treatment to other medical institution;

c) fast pre-hospital medical care and primary medical care is provided to all persons, including those which have no status of insured person, citizens of the Republic of Moldova, in the amount established by the Single program and these Methodological regulations including purpose of the compensated medicines in the amount established by the existing regulations without arrangement on payment for rendering these services;

d) the status of person in system of compulsory medical insurance (insured or uninsured) is checked by the authorized health workers in information system, using identification number from the identity certificate or insurance policy number;

e) in all cases when rendering emergency medical service is necessary, information on the status of person in system of compulsory medical insurance is requested/is checked only upon termination of rendering emergency medical service;

f) in case of urgentny medico-surgical conditions when person needs specialized out-patient and/or stationary medical care, consultation/hospitalization is performed in the direction of the family doctor, service of fast pre-hospital medical care, the profile specialist doctor and according to the address of person without the direction;

g) the planned specialized out-patient help is provided in district and local government offices, according to the territorial principle, based on the direction issued by the family doctor (form 027/e) if the patient needs medical care, but there are no conditions specified in the paragraph of b) this Item, and the planned specialized out-patient help is provided in organizations of tertiary level, it is provided based on the statement direction (F-027/e), issued and filled in accordance with the established procedure with the specialist doctor from the territory, according to the principles stated in the Section "Specialized Out-patient Medical Care";

h) planned stationary medical care is provided:

1) in district and local government offices, according to the territorial/zone principle, based on the direction issued by the family doctor (form 027/e) if the patient needs medical care, but there are no conditions specified in the paragraph of b) this Item;

2) in republican organizations based on the direction issued by the profile specialist doctor (form 027/e) if the patient needs medical care, but there are no conditions specified in the paragraph of b) this Item;

3) in departmental and private medical institutions based on the direction issued by the family doctor or the profile specialist doctor (form 027/e) if the patient needs medical care, but there are no conditions specified in the paragraph of b) this Item.

9. Expenses on the medical services rendered to insured persons within the specialized out-patient and stationary help in the cases described in paragraphs of e) and f) 8, become covered by the item from means of funds of compulsory medical insurance.

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