Unofficial translation
Footnote. Abolished by the Decree of the Government of the Republic of Kazakhstan dated 08/29/2023 No. 731 (effective after ten calendar days after the date of its first official publication).In accordance with subparagraph 5-1) of Article 10 of the Law of the Republic of Kazakhstan dated November 16, 2015 "On Compulsory Social Medical Insurance", the Government of the Republic of Kazakhstan HEREBY RESOLVES to:
1. Approve the attached Rules for the formation and use of the reserve of the social health insurance fund to cover unforeseen expenses.
2. This Resolution shall be enforced ten calendar days after the date of its first official publication.
|
Prime Minister of the Republic of Kazakhstan |
B. Sagintayev |
| Approved by Resolution No.915 of the Government of the Republic of Kazakhstan dated December 29, 2017 |
RULES
for the formation and use of the reserve of the social health insurance fund to cover unforeseen expenses
Footnote. The Rules as amended by Resolution No. 661 of the Government of the Republic of Kazakhstan dated 14.10.2020 (shall be enforced after the date of its first official publication).
Chapter1. General provisions
1. These Rules for the formation and use of the reserve of the social health insurance fund to cover unforeseen expenses (hereinafter - the Rules) have been developed in accordance with subparagraph 5-1) of Article 10 of the Law of the Republic of Kazakhstan dated November 16, 2015 “On Compulsory Social Medical Insurance” (hereinafter – the Law) and define the procedure for the formation and use of the reserve of the social health insurance fund directed to cover unforeseen expenses.
2. The following concepts shall be used in these Rules:
1) social health insurance fund (hereinafter referred to as the fund) - a non-profit organization that accumulates deductions and contributions, and also purchases and pays for the services of healthcare entities that provide medical care in the volume and on the terms provided for in the contract for medical services procurement, and other functions, determined by the laws of the Republic of Kazakhstan;
2) the period of unforeseen expenses coverage (hereinafter referred to as the coverage period) - a period of no more than 6 months from the date of termination or cancellation of the state of emergency in the territory of the Republic of Kazakhstan in accordance with the Law of the Republic of Kazakhstan dated February 8, 2003 “On the state of emergency” or a social, natural and man-made emergency in accordance with the Law of the Republic of Kazakhstan dated April 11, 2014 “On civil protection”;
3) the authorized healthcare body (hereinafter - the authorized body) - the central executive body that exercises management and cross-sector coordination in public health protection, medical and pharmaceutical science, medical and pharmaceutical education, circulation of medicines and medical devices, quality control of medical services;
4) healthcare entities - healthcare organizations, as well as individuals engaged in private medical practice and pharmaceutical activities;
5) unforeseen expenses - expenses directed to pay for medical care services in the system of compulsory social health insurance in connection with the population’s growing need in medical services during the state of emergency time in the Republic of Kazakhstan and coverage period from the date of termination or cancellation in the territory of the Republic of Kazakhstan of the state of emergency and (or) after the liquidation of the social, natural and man-made emergency consequences, which could not be planned in the formation of expenses for the corresponding financial year due to their unforeseen nature, and requiring urgent financing in the corresponding financial year;
6) fund reserve – the means provided by the fund for the current financial year to finance unforeseen expenses during the coverage period, formed on a monthly basis.
Chapter 2. Formation of the fund reserve to cover unforeseen expenses
3. Calculation of the fund's reserve to cover unforeseen expenses on a monthly basis on the first day of each month shall be made by the fund according to the following formula:
RRF = (OT + VZ) x R,
where:
RRF – is the fund’s reserve as of the reporting date;
OT -is the amount of deductions in the system of compulsory social health insurance;
VZ - is the amount of contributions received in the system of compulsory social health insurance;
R - the interest rate of the fund’s reserve, established by Resolution No. 914 of the Government of the Republic of Kazakhstan dated December 29, 2017 “On establishing the size of the reserve of the social health insurance fund to cover unforeseen expenses.”
OT, VZ are calculated over the last 12 (twelve) months preceding the reporting date.
The amount of the monthly accrual of the reserve is equal to the difference between the calculated values of the reserve on the reporting date and the reserve on the previous date.
The reporting date is the first day of the month for which the fund's reserve calculation is made. The previous date is the first day of the month preceding the month for which the fund’s reserve is calculated.
4. The used amount of the fund's reserve to cover unforeseen expenses shall be replenished by the fund to the amount established by the Government of the Republic of Kazakhstan, by monthly calculation, in accordance with paragraph 3 of these Rules, and transferred starting from the month following the month in which it was used.
5. Unused during the current financial year funds of the reserve for unforeseen expenses shall be transferred to the next financial year.
Chapter 3. The use of the fund's reserve in the conditions of social, natural and man-made emergency situations cancellation, termination or withdrawal of the state of emergency
6. The decision to use the reserve to pay for services in the system of compulsory social health insurance (hereinafter referred to as CSHI) after the cancellation of the social, natural and man-made emergency situation, termination or cancellation of the state of emergency shall be taken by the fund in agreement with the authorized body.
The authorized body shall consider the fund’s proposal on the need to use the reserve within 3 (three) business days from the date of its receipt and notify the fund of the decision taken.
The fund shall inform healthcare entities about the decision made when using the reserve within 2 (two) business days from the date of the decision, indicating the types of medical care in the CSHI system.
The healthcare entities within 10 (ten) business days from the date of approval by the authorized body of the decision on the need to use the reserve after the cancellation of the social, natural and man-made emergency, termination or cancellation of the state of emergency, shall form an application for payment for additional volumes of medical services given the population’s growing need in medical services for the coverage period (hereinafter - the application), in accordance with the form of Appendix 1 to these Rules, and direct it for approval to the local executive bodies of regions, cities of republican status and the capital. Calculation of the amount of the need for services by medical care types and volumes in the compulsory health insurance system shall be attached to the application.
7. Local executive bodies, within 5 (five) working days from the date of the application receipt, shall coordinate or return it without coordination, indicating the grounds for refusing to agree on the medical care types and volumes.
After elimination of objections the healthcare entities shall re-send an application for approval to the local executive bodies of regions, cities of republican status and the capital.
8. The healthcare subjects, within 3 (three) business days after agreement with local executive bodies of regions, cities of republican status and the capital, but no later than three months from the date of social, natural and man-made emergency situation cancellation, termination or cancellation of the state of emergency, shall apply to the fund.
9. The fund, within 10 (ten) business days from the date of the ended deadline for applications referred to in paragraph 8 of these Rules, shall make a decision on using the fund's reserve.
The decision to use the fund's reserve shall be made on the following conditions:
expired period for which the emergency situation or state of emergency was introduced;
presence of an application/applications of healthcare entities;
substantiation of the causal connection of the declared types and volumes of medical care with the social, natural and man-made emergency situation, the state of emergency;
a rise in the population's need for medical services after the liquidation of the social, natural and man-made emergency consequences, termination or cancellation of the state of emergency.
10. The fund shall distribute the fund's reserve means among the healthcare entities as prescribed by the rules for the procurement of services from healthcare entities for the provision of medical care within the guaranteed volume of free medical care and (or) within compulsory health insurance system, approved by the authorized body (hereinafter - the procurement rules).
The allocated means from the fund's reserve to cover unforeseen expenses shall be used by healthcare entities exclusively to cover the costs associated with the provision of medical services in the compulsory health insurance system during the coverage period.
Chapter 4. The use of the reserve during the state of emergency
11. The decision to use the reserve to pay for services in the compulsory medical insurance system during the state of emergency shall be taken by the fund in agreement with the authorized body.
The authorized body shall consider the fund’s proposal on the need to use the reserve within 3 (three) business days from the date of its receipt and notify the fund of the decision made.
The fund shall inform the healthcare entities about the decision made in the use of the reserve within 2 (two) business days from the date of the decision, indicating the types of medical care in the CSHI system.
The health care subjects shall, within 2 (two) business days from the date of approval by the authorized body of the decision on the need to use the reserve during the state of emergency, draw an application in accordance with the form of Appendix 2 to these Rules, and direct it for approval to the local executive bodies of regions, cities of republican status and the capital. The application shall be supplemented by calculation of the amount of the need for services by medical care types and volumes in the compulsory health insurance system.
12. Local executive bodies of regions, cities of republican status and the capital, within 2 (two) business days from the date of the application receipt, shall coordinate it and send it to the healthcare entities or return the application without approval, indicating the grounds for refusing to agree on the medical care types and volumes.
After elimination of the objections the health care entities shall re-send an application for approval to the local executive bodies of regions, cities of republican status and the capital.
13. The healthcare entities, within 2 (two) working days after coordination with the local executive bodies of regions, cities of republican status and the capital, shall direct the application to the fund.
14. The fund, within 2 (two) working days from the date of filing the application from the healthcare entities referred to in paragraph 13 of these Rules, shall decide on the amount of the means from the fund's reserve for use.
The decision to use the fund's reserve shall be made on the following conditions:
adopted regulation declaring a state of emergency;
presence of an application/applications of healthcare subjects;
substantiation of the causal connection of the declared medical care types and volumes in a state of emergency;
the growing need of the population for medical services during the state of emergency.
15. The fund shall distribute the means from the fund's reserve among healthcare entities in the manner prescribed by the procurement rules.
The allocated funds from the fund's reserve to cover unforeseen expenses during the state of emergency shall be used by healthcare entities exclusively to cover the costs associated with the provision of medical services in the compulsory medical insurance system.
| Appendix1 to the Rules for the formation and use of the reserve of the social health insurance fund to cover unforeseen expenses |
|
| The form |
Application for payment of additional volumes of medical services associated with increase in the population's need for medical services for the coverage period
Coverage period: | date of start and end |
Regulatory legal act on introducing emergency situation/state of emergency: | name, date and number |
Regulatory legal act on cancellation of the state of emergency / termination or cancellation of the state of emergency: | name, date and number |
Amount of unforeseen expenses: | amount in KZT in words |
Attachment: |
1)approval of the local executive body of the region, the city of republican status and the capital; |
The head of the healthcare entity: _________________________________
(signature, full name, date)
Seal (if any)
| Appendix 2 to the Rules for the formation and use of the reserve of the social health insurance fund to cover unforeseen expenses |
|
| The form |
Application for procuring additional medical services volumes associated with increase in the population's need for medical services for the coverage period
Coverage period: | date of start and end |
Regulatory legal act on introducing emergency situation/state of emergency: | name, date and number |
Amount of unforeseen expenses: | amount in KZT in words |
Attachment: |
1)approval of the local executive body of the region, the city of republican status and the capital; |
The head of the healthcare entity: _________________________________
(signature, full name, date)
Seal (if any)
