See the direction ticket for the runway. The procedure for applying for the provision of high-tech medical care (HMP). How to find out the CHI policy number by last name and other useful information

1. The attending physician of the medical organization where the patient is being examined or treated (for example, a polyclinic at the place of residence) determines the indications and draws up a package of documents for issuing a coupon for the provision of high-tech medical care.
2. If the patient is referred for HTMC at the expense of the federal budget, then the package of documents is delivered to the health authority of the subject of the Russian Federation (Ministry of Health of the Territory; for residents of St. If the patient is sent to provide high-tech medical care at the expense of compulsory medical insurance, the package of documents is delivered to a medical institution that will provide high-tech medical care (the receiving medical institution).
3. The submitted documents are considered by the Medical Commission of the health management authority of the territory or the Medical Commission of the host MD.
4. When the commission makes a positive decision, a special registration form “Coupon for the provision of HTMC” is issued for the patient. At present, the "Ticket for the provision of VMP" is electronic, which means that all stages of obtaining VMP by the patient, copies of extracts and examination results are recorded in an electronic account, and the stages of obtaining VMP can be tracked by specialists on the Internet.
5. After the commission makes a decision on the date of hospitalization, the health authority of the territory where the patient lives and the patient himself are informed (usually through the institution that sent him for further treatment). When referring patients for HTMC at the expense of the federal budget, if the patient belongs to the privileged category and has not refused the package of social services, he also has the right to free travel to the clinic and back at the expense of the Social Insurance Fund. The patient is given a voucher for receiving VMP with the signature of an official.

If a patient, without going through all of the above steps, directly contacts our clinic, then the medical commission of our institution can make a positive decision to provide this patient with medical care within the framework of the VMP. This can only happen if there are vacant places in our clinic according to the plan for the provision of HTMC in various profiles approved at the beginning of the year. In this case, the patient is referred for a consultation with a specialist in the profile of the disease to obtain a conclusion on the presence of indications and draw up a package of documents for VMP.

The package of documents for issuing a coupon for VMP (in accordance with the Order of the Ministry of Health of the Russian Federation dated December 29, 2014 No. 930n) includes:

referral to hospitalization for the provision of VMP;
a detailed extract from medical records;
a copy of the passport of a citizen of the Russian Federation (copy of the first page and registration);
a copy of the compulsory medical insurance policy (CHI);
a copy of the certificate of compulsory pension insurance (SNILS) - required;
consent of the patient to the processing of personal data

After the documents are drawn up by specialists, they are delivered either to the territorial health authorities via electronic communication in the specialized information system of the Ministry of Health of the Russian Federation (VMP at the expense of the federal budget), or to the medical care organization department of our clinic (VMP at the expense of compulsory medical insurance). Within 10 days, a "Ticket for the provision of VMP" is issued for the patient.

After issuing a coupon and if there are free volumes for providing HTMC, patients are invited for hospitalization in the order of priority.

Find out on the basis of what documents the VMP coupon is issued, which organizations are eligible to provide services and how to join the program. The information will allow you to navigate in matters of high-tech assistance and avoid problems when working with documents.

Read in the article:

What is VMP

VMP is a high-tech medical care, which is provided for the treatment of patients with complex and serious diseases. Services involve the use of expensive equipment, the latest developments and innovative technologies.

List of types of high-tech medical care

Diseases subject to treatment on coupons, VMP codes for 2019 are reflected in the Decree of the Government of the Russian Federation of December 19, 2016 No. 1403 "On the Program of State Guarantees of Free Medical Assistance to Citizens for 2017 and for the planning period of 2018 and 2019".

The Decree lists 1435 types of VMP, which include:

microsurgery;
video thoracoscopic operations;
radiological interventions;
laser, intensive therapy;
transplantation of organs and tissues, etc.

Reference:most often, patients need therapeutic, surgical and combined treatment.

Not all types of high-tech medical care are provided within the CHI system. The second section of the Resolution reflects the list of diseases financed from the federal budget from the Compulsory Medical Insurance Fund, other intergovernmental transfers. To start treatment outside of compulsory medical insurance, the patient also receives a VMP coupon. The patient must be prepared for a long wait in line, as the number of places is sharply limited.

How to apply for a voucher for the provision of VMP for a patient

The decision on the need for treatment is made in the polyclinic hospital to which the patient belongs at the place of registration. It is necessary to prove the fact of a serious illness, collect a package of documents and undergo an additional examination. The final decision on whether to issue a VMP coupon or not is made at the regional level within 10 days.

If the outcome is positive, the papers are sent to an institution where high-tech medical care will be provided. The clinic commission has the right to consider the documents for another 10 days when applying electronically or 3 days for a personal consultation.

Important! To get a coupon for high-tech assistance not included in the basic program, they apply to the Department of Health or the local branch of the Ministry of Health, and not to the clinic at the place of registration.

List of documents for issuing a VMP coupon

List of documents for the provision of high-tech medical care for all persons:

the conclusion of the chief freelance specialist of the Ministry of Health on the profile of the disease, which indicates that the person needs to be provided with HTMC. In conclusion, they write the type of assistance, the name of the federal center where the person will be treated;
an extract from the outpatient card of the patient in printed form with a description of the results of the examinations;
direction indicating the diagnosis code according to ICD-10;
pictures and discs with the results of examinations - they are sent by a medical organization to the Ministry of Health by e-mail.

All adult patients (18 years of age and older) will need:

passport of a citizen of the Russian Federation;
compulsory medical insurance policy;
SNILS;
in the presence of disability - certificates of medical and social examination;
consent to the processing of personal data.

Children under 18 will need:

birth certificate, from the age of 14 - a passport;
compulsory medical insurance policy;
SNILS;
certificates of medical and social expertise;
consent to the processing of personal data from parents, guardians;
parent's or guardian's passport.

As soon as the package of documents is collected, the person responsible for the provision of HTMC in the clinic sends it to the Ministry of Health of the region. The patient cannot do this on his own. After that, the patient will find out the necessary information in the hospital to which he is attached, and if there is a coupon - on the open portal of high-tech medical care. In addition, the site can track the quota for the VMP.

Important! If a person needs immediate help, and there is no time to prepare documents, he receives treatment, and then collects papers. But in this case, the VMP is only for one site, for example, a vital operation is performed, and the accompanying problems are eliminated later.

In general, several months pass from the moment of submission of documents to the start of treatment. Most often, emergency hospitalization is not possible due to the fact that there is a long queue for the VMP. Many patients do not even wait for help, as their disease is recognized as insufficiently serious or incurable.

If assistance was denied, the patient has the right to contact the Federal Ministry of Health. A voucher for VMP can be issued after consideration of the complaint, if a positive decision is made. In the case when the patient is not entitled to high-tech assistance for a number of reasons, he is offered alternative methods of treatment.

Which clinics provide assistance with VMP coupons

High-tech medical care included in the basic program of compulsory medical insurance is provided by organizations included in the register.
Assistance not included in the basic CHI program is provided by:

Federal State Institution of the Ministry of Health of the Russian Federation in accordance with the List (part 6 of article 34 of Law No. 323-FZ; clause 1 of the Order of the Ministry of Health of Russia of December 28, 2015 No. 1014n);
medical organizations, the list of which is approved by the authorized executive body of the constituent entity of the Russian Federation (health management body, HMO) (part 7 of article 34 of Law No. 323-FZ; clauses 7, 8 of the Order).

The medical organization to which the patient is referred must be connected to the coupon assistance program, have a license and meet a number of criteria. At the same time, it is required to leave an application for participation annually at a strictly allotted time.

How to become a member of the basic CHI program

Organizations wishing to provide high-tech assistance next year are required to send a notification to the territorial fund by September 1 of the current year. The document is considered if it is drawn up in accordance with all the rules. What information to indicate and in what form to prepare the paper is indicated in the OMS Rules.

The territorial fund checks the documents and the medical organization for compliance with the criteria. A clinic representative has the right to be present during the inspection. If everything is in order, the foundation assigns a registry number to the institution and sends a notification by e-mail within 2 business days.

How to become a participant in the provision of assistance outside the MHI

The Ministry of Health compiles a list of organizations specializing in the provision of services outside the CHI program annually. If the clinic claims to be included in the register, it must submit documents before June 1 of the current year.

Reference: a complete list of documents, selection criteria are presented in the Rules for the formation of the list (Government Decree No. 1160 dated November 12, 2016).

Members of the expert council, which includes specialists from the Ministry of Health, FAS, Roszdravnadzor, FFOMS, FMBA, FANO and institutions, analyze the papers and issue a verdict. The council informs the clinic of its decision within five working days. If it is negative, the representative of the institution can appeal against it.

Reference: if you want to check whether an organization is included in the registry or not, visit the VMP portal. The site provides a search for medical organizations by type of high-tech assistance.

How much money is allocated for treatment on the basis of VMP coupons

The Prime Minister annually reviews and approves the list of diseases and deviations, types and methods of treatment. The Resolution specifies the standards of financial costs per unit of volume (the cost of the procedure performed), as well as the amount of appropriations. Most types of high-tech assistance are estimated at between 50,000 and 200,000 rubles.

100.8 billion rubles are allocated in the budget for 2019 for the provision of HCW outside compulsory medical insurance:

94.6 billion rubles - for federal medical institutions;
6.4 billion rubles - subsidies for the regions.

For the treatment of many diseases, patients do not have enough allocated funds, so they can only count on receiving a quota, and not on covering all costs. If the cost of the service exceeds the allowable limit, the patient takes part of the material costs himself or refuses assistance.

How clinics are funded

For high-tech assistance under compulsory medical insurance, funds are allocated to territorial funds in the form of subventions, and for VMP not under the state program they are directly accrued from federal institutions. The regional budget participates in financing in rare cases.

The regional commission distributes the amount of assistance between clinics. Members of the commission take into account the norms for high medical care, the volume of consumption of medical care in the institution, the number of insured persons attached to the hospital, etc. An amount is allocated for the treatment of patients, which is required by law and is reflected in the Resolution (from 50 to 200 thousand rubles in 2019).

Important! Private clinics, which can also provide HCW from February 13, 2019, receive subsidies only if they are licensed and included in the register. The procedure for granting subsidies is approved in the Decree of the Government of January 29, 2019 No. 56.

What can organizations spend money on?

Basic compulsory medical insurance program

The medical organization receives an amount that can be spent on the purchase of software, databases, communications, firefighting measures, security, checking devices, etc. That is, the medical organization has the right to spend the funds accrued for the provision of assistance under the VMP coupons for general business needs.

Providing assistance with VMP coupons outside the MHI

The cost standard includes not only general business needs, but also funds for assistance, including doctors' salaries, medicines, the purchase of movable property, etc.

Regardless of the basis on which a medical organization provides high-tech assistance, it is obliged to report on treatment and spending. If shortcomings are found, the institution is deprived of a license, and subsequently its management cannot apply for participation in the program.

If you plan to provide high-tech care, develop your medical staff so that the qualifications of doctors meet the requirements. Enroll them in refresher courses at the Qualification and Training Assessment Center No. 1. , their duration and time of training.

More materials

The compulsory health insurance policy does not cover all types of treatment and the state allocates additional funds, the amount of which is limited. Read this article to learn how to get a quota for an operation in Moscow in 2019 and what high-tech medical care (HTMC) is.

High-tech medical care - what is it

VMP is a medical care that, due to the complexity of the disease, can only be provided in a specialized medical institution, where there are appropriate specialists and equipment.

High-tech medical care includes:

oncology
cardiovascular surgery
Maxillofacial Surgery
otorhinolaryngology
rheumatology
ophthalmology
pediatrics
thoracic surgery
traumatology and orthopedics
organ and tissue transplantation
urology
endocrinology
abdominal surgery
combustiology
obstetrics and gynecology
gastroenterology
dermatovenereology
hematology
neurology
neurosurgery

The list of diseases eligible for the quota is annually approved by order of the Ministry of Health of the Russian Federation.

What is an operation quota and how does it relate to VMP

In official documents, there is no such thing as a "quota". A synonym for "receiving a quota" can be considered a referral to receive high-tech medical care at the expense of the federal budget.

In 2018, VMP will be provided to citizens of the Russian Federation mainly at the expense of compulsory medical insurance (CHI). In practice, this may mean that the majority will be treated at the place of residence, and the decision to send the patient to another region, for example, to Moscow, will be taken only as a last resort.

How to get a quota for treatment in Moscow

For non-residents, this procedure may be somewhat more complicated, due to the need to coordinate high-tech medical care in another region. In general, the scheme consists of three stages - the passage of three medical commissions:

at the place of residence
in the regional health department
at the hospital where the treatment will take place

You can start registration both with an independent selection of a medical institution, and with the collection of documents and the delivery of the necessary tests at the clinic at the place of residence.

If you decide to choose a medical institution on your own, you will be better able to navigate the timing and be more confident in the quality of treatment.

A voucher for the provision of VMP must be issued at the regional department of health.

Documents for obtaining a quota for treatment

In general, the following documents will suffice:

extracts from a medical institution, conclusions of specialists with the results of analyzes and studies
original and photocopy of the CHI policy
certificate of compulsory pension insurance and its photocopy
original and photocopy of the passport
for the child's birth certificate and its copy

Where to get a quota for a resident of Moscow

To obtain a coupon for the provision of VMP, you can contact the Department of Health of the city of Moscow, at the address: Moscow, 2nd Shemilovsky lane, house 4 "A", building 4

Some time later, after submitting the documents, an employee of the health department will inform you of the coupon number and the clinic for treatment, if you have not chosen it in advance.

The coupon is an electronic document and its status can be controlled on the website: talon.rosminzdrav.ru

How long can I get a quota for treatment?

Unfortunately, there are no clear regulations here, it all depends on the specific case. A response to the provision of VMP must be given within 10 days. After that, the waiting period for treatment can last from several days to several months.

Is quota treatment free?

Theoretically, yes, treatment should be completely free. Even the road to the place of treatment and accommodation can be paid, not to mention medicines. Unfortunately, in life, not everything goes as smoothly as we would like, so it is better to be prepared for unforeseen expenses in advance.

Treatment according to the "quota" of the VMP

High-tech medical care (HCH) is medical care with the use of high technologies for the treatment of complex diseases. It includes both medical and diagnostic services that are performed in a specialized hospital. Every year, the Ministry of Health approves a list of medical institutions and a list of diseases for which VMP is provided. The program to provide high medical care to Russian citizens was launched back in 1994. Then the Government of Russia issued a special resolution on the allocation of a certain amount from the federal budget for the provision of high-tech medical care for each individual patient. This is called "quota". At present, the Ministry of Health of Russia has abandoned such a concept as "quotas for high-tech medical care." Now it is customary to talk about the volume of VMP, since quotas do not sound quite correct in relation to people with serious illnesses. Previously, funding for the VMP came only from the federal budget, but, starting in 2014, funds began to be raised from the compulsory medical insurance funds (CHI). Everything related to high-tech assistance is under the jurisdiction of the Russian Ministry of Health. It is this body that annually determines the number of "quotas" that each medical institution will receive. Medical institutions cannot exceed this plan and treat more patients than the Ministry of Health has planned.

Absolutely every citizen of the Russian Federation has the right to receive free high-tech medical care. The main reason for obtaining VMP is medical indications.

Diseases for which you can get high-tech medical care

Currently, high-tech medical care is provided in more than 20 areas, which include: abdominal surgery, obstetrics and gynecology, gastroenterology, hematology, dermatovenereology, neurology, combustiology (treatment of severe burn injuries), neurosurgery, oncology, otorhinolaryngology, ophthalmology, pediatrics, rheumatology, cardiovascular surgery, thoracic surgery (surgery of diseases of the chest), traumatology and orthopedics, organ and tissue transplantation, urology, maxillofacial surgery, endocrinology.

In the Clinic of Coloproctology and Minimally Invasive Surgery, high-tech medical care is provided in the treatment of the following diseases:

ONCOLOGY:

surgical treatment of rectal cancer of all stages;
laparoscopic and open nerve-sparing operations with extended lymph node dissection;
operations with resection of adjacent organs for locally advanced forms of cancer;
sphincter-preserving operations of any complexity;
removal of early forms of rectal cancer without abdominal surgery through the anal canal;
removal of the primary tumor with simultaneous resection of distant metastases in stage 4 cancer;
surgical treatment of colon cancer of all stages;
laparoscopic and open operations with extended lymph node dissection;
surgical treatment of recurrent colon cancer;
surgical treatment of extraorganic (retroperitoneal) tumors.

SURGERY:

surgical treatment of familial adenomatous polyposis;
surgical treatment of nonspecific ulcerative colitis;
surgical treatment of complex fistulas of the rectum;
surgical treatment of rectal prolapse, rectocele;
surgical treatment of presacral cyst;
surgical treatment of anal sphincter insufficiency;
surgical treatment of recto-vaginal fistulas;
surgical treatment of complicated diverticular disease of the colon;
reconstructive and restorative operations for end intestinal stoma.

How to get a VMP quota?

A voucher for the provision of HTMC is issued by the regional ministry or department of health at the place of registration of the patient. To do this, the patient must provide a referral from their doctor with an established diagnosis and the results of the necessary examinations. Based on these documents, the specialist of the VMP department in the ministry or department himself determines which medical institution to send the patient for treatment.

If the patient already knows in which of the clinics he wants to undergo treatment, then he must first contact this clinic, provided that this clinic has been allocated "quotas" for VMP, and receive a conclusion drawn up in a special way that he is shown to perform high-tech medical care in this hospital. With this conclusion, the patient applies to the regional ministry or department of health, where they issue a coupon for VMP to the indicated clinic.

Despite the fact that the rules stipulate the need for the patient to personally contact the regional health department, in practice this is not always required. Therefore, if a patient from a distant region, for example, from Siberia, comes to Moscow to a clinic of his choice, and doctors give him a conclusion that high-tech medical care is indicated for him, the patient does not need to go back to his region and take this conclusion personally. The clinic specialists themselves will send an electronic copy of the conclusion to the regional health authority and receive a response on the issuance of a coupon for the provision of HTMC. It usually takes 1-2 days.

The procedure for obtaining a VMP quota for treatment at the KKMC Clinic

Step 1.

Personally

The patient personally addresses us at the Clinic with the results of his examinations, he is consulted by the doctor of the Clinic and establishes that the treatment of the patient's disease can be performed according to the VMP. After that, a conclusion is issued on the need and possibility of such treatment.

remotely

The patient is in another region and has the results of tests and examinations in his hands. He contacts our Clinic remotely - by phone, e-mail, through the online appointment form, and sends us copies of his examinations (electronically or by fax). Doctors of the Clinic of Coloproctology and Minimally Invasive Surgery review the received documents and make a preliminary conclusion on whether this patient is indicated for treatment using high-tech medical care. If the doctor of our clinic decides that the patient is indicated for VMP, then a conclusion is drawn up on the official letterhead of the Clinic.
Step 2

On one's own

The patient takes the received conclusion to the regional ministry or department of health at the place of registration. The regional authority draws up a coupon for VMP for treatment in our Clinic and sends it to us in electronic form. The process of issuing a coupon takes 1-2 days.

With the help of clinic administrators

The specialists of our Clinic forward the conclusion on the need to provide HTMC to the regional department at the place of registration of the patient and in return receive a voucher for HTMC, which gives the right to treat this patient.
Step 3

Hospitalization in the Clinic.

Hospitalization is possible on the day of the patient's appeal.

What is included in the GMP "quota"?

The referral for the provision of high-tech medical care, which is issued to the patient, “covers” all treatment at a specialized medical center, including stay in the hospital during the hospitalization period, medicines and consumables provided for by the standards. All this is included in the cost of providing high-tech medical care, which means it is free for the patient. The examination necessary to establish a diagnosis and prepare for surgery is usually not covered by the "quota", since according to the orders for VMP, the patient must be admitted for treatment already fully examined at the place of residence.