of July 21, 2016 No. 596/404-A
About approval of methodological regulations of application of the Single program of compulsory medical insurance
According to provisions of the Law on health care No. 411 of March 28, 1995, the Law on compulsory medical insurance No. 1585 of February 27, 1998, the Order of the Government No. 1387 of December 10, 2007 "About approval of the Single program of compulsory medical insurance" with further 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 the item 29 to lit.a) the Charter approved by the Order of the Government No. 156 of February 11, 2002, PRIKAZYVAYUT:
1. Approve Methodological regulations of application of the single program of compulsory medical insurance, according to appendix to this order.
2. To directors of territorial agencies of National medical insurance company to provide to heads of the medical and sanitary organizations providing medical care within compulsory medical insurance observance of the Methodological regulations approved by this order.
3. To heads of the medical and sanitary organizations providing medical care within compulsory medical insurance to place in available places for patients and visitors information: agreement number and date of its conclusion with National medical insurance company, about 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. To provide to the manager of management of primary, fast and communitarian medical care, the manager of management of stationary medical care, the manager of management of the budget, finance and insurance provision of advisory and methodical support for the purpose of realization of provisions of the Methodological regulations approved by this order.
5. To impose control over accomplishment of this order on the deputy minister Mrs. Liliana Jaschan and the deputy director of NMSK Grossu Aksenti Mrs. Diana.
Minister of Health
CEO of National medical insurance company
to the Order of the Ministry of Health and National medical insurance company of the Republic of Moldova of July 21, 2016 No. 596/404
1. Methodological regulations of application of the Single program of compulsory medical insurance (further - Methodological regulations) are developed according to provisions of the Law on health care 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, all with further changes and amendments.
2. Methodological regulations determine the basic principles of the organization of medical services and payment of the corresponding services in 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 of suppliers in system of compulsory medical insurance depending on policy in the field of health care and the established health protection priorities.
4. The regulations of conditions of provision of medical care for each type of the help and the medical services rendered within compulsory medical insurance pursue the aim of ensuring fair access 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 conditions.
5. Methodological regulations establish conditions of delivery of health care, including at the level of primary medical care, and also for 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.
6. 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.
7. The main conditions of delivery of health care for each type of medical care and the medical services provided within compulsory medical insurance, the following:
1) 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;
2) in all cases when untimely delivery of health care 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 of 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;
3) fast pre-hospital medical care and primary medical care are 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;
4) the compensated medicines are written out to insured persons, the psychotropic, anticonvulsive, antidiabetic medicines except for compensated which are written out to uninsured persons, according to medical indications according to the order No. 492/139 of 22.04.2013, Art. 2 of the item 4 (b);
5) the status of person insured/uninsured is checked by the authorized health workers in the information system "Compulsory medical insurance" NMSK, using identification number (IDNP) from the identity certificate of person or insurance policy number;
6) in all cases when rendering emergency medical service is necessary, information on the status of person in system of compulsory medical insurance (insured/uninsured) is requested/is checked only upon termination of rendering emergency medical service;
7) 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;
8) 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) (or records of the family doctor in the medical out-patient record if consultation is requested by the profile doctor
the specialist in the same or other medical institution in the territory) if the patient needs medical care, but there are no conditions specified in the subitem 2) of this Item;
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