Transition from MSECs to expert teams: the government adopted a resolution
Kyiv • UNN
The government has adopted a resolution to liquidate medical and social expert commissions and transfer their functions to expert teams. Starting from January 1, 2025, disability assessments will be conducted in cluster hospitals.
At a meeting on November 15, the Cabinet of Ministers adopted a resolution regulating the liquidation of medical and social examinations and the transfer of their powers to expert teams for functional assessment. This was stated by Health Minister Viktor Lyashko during a telethon, UNN reports.
We managed to do a lot of things in a month. A draft law on the medical part of the MSEC reform was developed. The government sent it to the Parliament, and the Committee on National Health approved it for consideration in the Parliament. We expect it to be on the agenda next week. (...) Today we adopted a resolution "Some issues of introducing an assessment of a person's daily functioning", which describes the details of what will be introduced from January 1, 2025, when the MSECs will cease to exist
the resolution approves:
- regulations on expert teams to assess the daily functioning of a person;
- the procedure for assessing the person's daily functioning;
- criteria for sending a person to assess the daily functioning of a person;
- the procedure for functioning of an electronic system for assessing the daily functioning of a person;
- criteria for determining disability.
According to the resolution, starting from January 1, 2025, the examination conducted to determine disability will be carried out by expert teams to assess the person's daily functioning. The teams may include doctors or rehabilitation specialists who are authorized to conduct assessments of daily functioning.
Assessment of the daily functioning of a person is organized in cluster and super-cluster healthcare institutions.
The document also provides that the assessment will be carried out using an electronic system.
"The powers, rights and obligations of medical and social expert commissions to conduct medical and social expertise, as well as the powers, rights and obligations of the Central Medical and Social Expert Commission of the Ministry of Health shall be terminated on December 31, 2024," the resolution says.
After the liquidation of Msecs, consideration of referrals that have not been completed before the termination of the commissions ' powers is terminated.
In addition, if the government adopts the resolution by December 25, the MSECs will not start reviewing referrals from the MCC for medical and social examination until December 31. These referrals are being prepared for transfer to the relevant healthcare facility.
The Cabinet will also recommend to the NACP to amend the list of positions with high and increased corruption risks by adding doctors and rehabilitation specialists who previously served as MSEC members and who will work as part of expert teams.
procedure for assessing the daily functioning of a person
According to the resolution, it is planned to change the procedure for assessing the daily functioning of a person. In particular, the assessment of persons sent to pass the expert commission in connection with long-term temporary disability is carried out in order to determine the need to extend temporary disability or establish disability.
The assessment is organized in a healthcare facility that has approved a list of doctors and rehabilitation specialists who are authorized to conduct the assessment. The list of doctors will be approved by the Ministry of Health.
The evaluation is carried out by expert teams, the composition of which is formed individually for each case.
These commissions include doctors who:
- carry out medical practice or provide rehabilitation assistance in the field of health care;
- meet other requirements established by law.
"The assessment of persons from among active or former servicemen of the SBU or intelligence agencies is carried out by the Center for assessing the functional state of persons," the resolution says.
Doctors and rehabilitation specialists who are not eligible to be part of expert teams and conduct assessments of daily functioning are:
- they held the positions of chairmen of medical and social expert commissions;
- committed corruption or corruption-related offenses;
- have a criminal record for committing any intentional criminal offense, regardless of the removal or repayment of such a criminal record.
Lyashko talks about the first dismissals of MSEC officialsOct 23 2024, 03:56 AM • 116151 view
Information about doctors and rehabilitation specialists who are authorized to conduct assessments is published on the official website of the relevant healthcare institution.
The doctor who referred the person for evaluation cannot be part of the expert team, but they can be present at the patient's request.
Evaluation of people will be carried out in an electronic direction, which is formed by:
- by the attending physician after carrying out the necessary diagnostic, therapeutic and rehabilitation measures;
- chairman of the Military Medical Commission.
If it is not technically possible to use the electronic system, the referral will be made using paper documents.
It is noted that some cases of patients will be sent to different hospitals. In particular, cases of patients suffering from tuberculosis are sent for consideration by expert teams created on the basis of regional phthisiopulmonological centers/supercluster healthcare institutions in the phthisiopulmonological direction.
Cases of patients suffering from mental and behavioral disorders are referred to expert teams established on the basis of supercluster healthcare facilities in the psychiatric field.
Cases of patients suffering from neoplasms are sent for consideration by expert teams created on the basis of supercluster healthcare institutions in the oncological field.
"An electronic referral is formed and sent to the health care institution where the assessment is carried out, taking into account its workload, as well as the wishes of the person in respect of whom the referral is formed, regarding territorial accessibility and geographical location in electronic form using the functionality of the electronic system," the document says.
The electronic referral must contain the following information: :
- information about the person sent for the assessment (last name, first name, patronymic; gender; identification code; date of birth; address of residence; information about the presence or absence of disability; phone number);
- medical history;
- the state of the person when referring for evaluation;
- diagnosis when referred for evaluation; the basis for referral for evaluation;
- information about the doctor who sent it.
Copies of documents must be submitted to the electronic referral:
- passport and identification code;
- military ID card or temporary certificate of a person liable for military service, or assigned;
- medical documents related to the disease or state of health, according to which the person is sent for evaluation.
review of electronic referrals
After the healthcare facility receives an electronic referral, it is reviewed by the administrator. The healthcare facility may authorize several persons to act as administrators.
After receiving the referral, the administrator checks them for the completeness of the information provided; determines the necessary list of specialties of doctors and/or specialists in the rehabilitation of the expert team, and also determines the possible form of consideration by the expert team - in person, in absentia, using methods and means of telemedicine or at the place of stay/treatment of the person).
After the administrator accepts the electronic referral for consideration, information about the form, date and time of consideration is sent to the person by e-mail (if any), and will also be displayed in the electronic system for the doctor who sent it.
In the electronic system, the doctor will not see the composition of the expert team.
The administrator can return the referral back if there are errors in the information, the necessary documents are missing, or the quality of copies of documents is poor, which makes it impossible to get acquainted with them.
evaluation procedure
Until the day of consideration of the case, members of the expert team do not have access to the case in the electronic system. The person who was sent for evaluation does not have access to the personal composition of the expert team that will carry out the assessment.
Consideration of the case must be carried out no later than 30 calendar days from the date of electronic referral. Decisions are made by the expert team on the day of consideration of the case, except in cases where additional examination is necessary.
During the review, members of the expert team examine all submitted documents, as well as relevant medical records confirming the state of health of the person contained in the electronic health system.
Decisions are made collectively by a majority vote of the expert team members. In case of equal distribution of votes, the vote of the presiding judge in this case is decisive.
The review of the expert team is recorded in the relevant protocol, which is signed in the electronic system by each team member by applying a Qualified Electronic Signature.
The review protocol of the expert team should contain the following information:
- date and place of the review;
- form of review;
- the surname, full name and patronymic (if any) of each member of the expert team conducting the evaluation, with a note on who is presiding;
- surname, proper name and patronymic (if any) of the person in respect of whom the assessment is carried out;
- last name, first name and patronymic (if any) of other persons present during the review;
- method of participation of each person in the proceedings;
- list of decisions to be taken in accordance with the direction;
- results of a person's examination in case of a face-to-face or on-site review;
- a brief description of the statements of each person during the consideration of each item of decisions that are made;
- the opinion of each member of the expert team on the final decision to be made based on the results of the assessment;
- information about the voting of members of the expert team based on the results of the assessment;
- a decision made by the expert team based on the results of the assessment, including the motivational part.
The reasoned position of a member of the expert team who disagrees with the decision of the expert team should be set forth in the minutes of the expert team's consideration.
In absentia, an assessment can be carried out if a person has malignant neoplasms that have Stage III – IV, diseases of the blood and hematopoietic organs, cerebrovascular diseases complicated by hemiplegia, paraplegia or tetraplegia, with the absence of limbs, as well as liver diseases, congenital malformations.
evaluation results
Based on the results of the assessment, the expert team can make a decision in which it will be established:
- degree of restriction of a person's vital activity;
- determining the need to extend temporary disability;
- disability, fixing the causes and time of its occurrence in accordance with the documents confirming this;
- degree of professional disability (as a percentage);
- the need for constant care.
After the assessment, acceptance and signing in the electronic system, an extract with the decision is sent to the person's email address, as well as recommendations that are part of an individual rehabilitation program for a person with a disability (if a disability is established). An extract from the decision made is also displayed in the electronic system for the doctor who sent it.
Also, the decision to establish disability or the degree of disability will be sent to the shopping center and joint venture.
Appealing against decisions
Decisions of expert teams on the evaluation results can be appealed. The complaint must be submitted by a person in paper form to the Center for assessing the functional state of persons, or in electronic form through an electronic system by contacting the complainant's doctor.
when you need to pass the assessment
According to the decree, people will be sent for evaluation in the following cases:
- the onset of the re-inspection period set by the MSEC or re-evaluation by the expert team, indicating the terms of re-inspection/evaluation;
- if the patient has a persistent or irreversible disease (the disease lasts at least 12 months, or it is expected to last at least 12 months or lead to premature death of the person).
disability identification criteria
The basis for recognizing a person as a person with a disability is the presence of the following mandatory conditions::
- persistent disorders of the body – the disease lasts at least 12 months, or it is expected to last at least 12 months or lead to the death of a person, and there is a minimal chance of significant improvement in the condition, even if the best available treatment is used;
- life restriction-a person has a moderate (1st degree), pronounced (2nd degree) or significant (3rd degree) degree of restriction of the ability to self-service, movement, orientation, control of their behavior, communication, training, performance of work;
- need to take social protection measures — a person needs support in everyday life, namely, received rehabilitation services, palliative care, provision of technical and other rehabilitation facilities, provided with medicines for use on an outpatient basis and/or medical devices for use on an outpatient basis and in a domestic environment.
The disability group will be determined depending on the degree of disorder of the functions of organs and systems of the body and the restriction of its vital activity and will be divided into:
- the first (I), which is divided into subgroups A and B depending on the degree of loss of health by persons with disabilities and the amount of need for constant outside care, assistance or supervision;
- second (II);
- third (III).
The first disability group is established if a person has a significant degree (degree 3) of restriction of one or more criteria of a person's life activity. Group I includes persons with the most severe state of Health, who are completely incapable of self-service, need constant outside supervision, care or assistance, are completely dependent on other persons to perform vital social and household functions, or who are partially capable of performing certain elements of self-service.
Subgroup A of Disability Group I includes persons with an exceptionally high degree of loss of Health, which leads to the need for constant outside supervision, care or assistance of other persons and the actual inability to self-care.
Subgroup B I of disability group includes persons with a high degree of loss of Health, which causes significant dependence on other persons in the performance of vital social and household functions and partial inability to perform certain elements of self-service.
The second group of disability is established if the person has a pronounced degree (degree 2) of restriction of one or more criteria of human life activity. Disability Group II may also include persons who have two or more diseases that lead to disability, the consequences of trauma or birth defects and their combinations, which together cause a pronounced (2 degree) restriction of a person's life and working capacity.
The third group of disability is established for persons with a moderate degree (1 degree) of restriction of one or more criteria of human life, which are caused by a disease, the consequences of injuries or congenital malformations.
Disability is established for the following terms:
- for persons with anatomical defects, other irreversible disorders of the functions of organs and systems of the body – indefinitely;
- for persons undergoing a re-examination and having a disability of Group 1 for 5 years-indefinitely;
- for persons with oncological and oncohematological diseases with an unfavorable prognosis - for 5 years;
- for persons with severe chronic diseases - for 5 years;
- for persons who are assigned Disability Group 3 for the first time – 1 year;
- for persons who are assigned Disability Group 2 for the first time – 2 years;
- for persons undergoing a re – examination, disability is established for a period of 1-3 years.
The appendices to the resolution indicate a list of anatomical defects and diseases in which the disability group is established without a re-examination period. In particular, the list contains 88 diseases. You can get acquainted with the list of diseases at Link.
Also, a disability will be established for 5 years if a person has the following diseases:
- respiratory system, severe course with chronic respiratory failure of the 3rd degree;
- circulatory systems, chronic heart failure of stage IIb – III;
- chronic kidney disease stages 4 – 5;
- HIV infection;
- type 1 or 2 diabetes mellitus;
- systemic lupus erythematosus with kidney damage;
- Alzheimer's disease;
- multiple sclerosis.
recall
The Ministry of Health has put up for public discussion a draft law on reforming the medical and social expert commission. The draft law provides for the elimination of Housing Departments, the introduction of expert examinations in cluster and super-cluster hospitals, changes in the procedure for referral to commissions, and much more.
The Cabinet of ministers submitted to the Verkhovna Rada an announced draft law on the reform (liquidation) of the MSEC.
In a comment to UNN MP, deputy chairman of the Committee on National Health, medical care and health insurance Oksana Dmitrieva said that, "given that it was immediately submitted to the committee in order to quickly bring it to the hall, I believe that at the next meeting we will consider it."
