Articles with tag: «health insurance organizations»
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2019 № 6 New rules of obligatory medical insurance: major changes
The rules of obligatory health insurance regulate legal relations of subjects and participants of compulsory health insurance. New rules of obligatory health insurance developed by the Ministry of health of Russia in accordance with the recommendations of the Ministry of justice. The essence of these recommendations was not to make regular changes to the existing rules of obligatory health insurance, but to approve new rules of obligatory health insurance. To a large extent, these changes are associated with the Informatization of health care, with the advent of legislative regulation of the use of telemedicine technologies. Most of the changes affect the order of calculation of the value of sanctions applied to the medical organisations in the mandatory medical insurance system. In turn, these changes reflect the desire to reduce the financial burden on state (municipal) institutions and make it easier for them to achieve the level of wages provided for by the "may" presidential Decrees of 2012.
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2019 № 4 The review of judicial practice on the payment of over-planned volumes of medical care in the system of compulsory health insurance
Despite rather rigid legislative norms concerning payment of the medical care rendered over the volumes allocated by the Commission on development of the territorial program of CHI, and also the developed practice of rela- tionship between the medical organizations – on the one hand and the insurance medical organizations, territorial funds of CHI – on the other hand, judicial practice often demonstrates other approaches. Although the current legislation does not imply payment of over-planned volumes of medical care, the courts often take the side of medical organizations. Thus, the current judicial practice illustrates the existence of problems in this area. This article is devoted to the review of judicial practice in the matter of payment for over-planned volumes of medical care in the system of compulsory health insurance.
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2018 № 3 Topical issues of arbitration practice in the CHI system (the experience of Saint-Petersburg)
The current legislation in the system of compulsory health insurance has opened wide opportunities for participation in this system of medical organizations of any organizational and legal form. However, this has led to an increase in the number of economic disputes in the compulsory health insurance system. In particular, the number of lawsuits is increasing on new grounds: the amount of medical care; payment for medical care provided in excess of these volumes. The defendants in the claims are not only the insurance medical organizations and territorial funds of the MLA, but also the Commission, which develop territorial programs of compulsory medical insurance and are not legal entities. Court practice in many cases violates the logic of legislation on compulsory health insurance. This article is devoted to the consideration of these problems for recommendations to improve the legislation