The second phase of medical reform: how can private institutions join?

The reform of the medical sector in Ukraine is progressive. The essence of the reform is to introduce a program of medical guarantees for the population. Institutions provide medical services to the public free of charge, and the state pays for such services based on contracts concluded with institutions.

The medical reform is based on the Law on State Financial Guarantees of Public Health Services (hereinafter – the Law), whose final and transitional provisions provide for the gradual introduction of the reform on the different levels of medical care.

Since 2018, medical reform has been implemented for the primary level. And on April 1, 2020, reform is to be implemented at other levels.

There is not much time left until April 1, but not all utilities are ready for reform. Due to this, in some regions, the postponement of the date of implementation of the second stage of reform was initiated. The Minister of Health has also stated the need for additional time to prepare for the second stage.

However, no decisions on postponing the date of the second stage have been made, and therefore – everything should happen according to plan.

 

Medical Guarantee Program

The state guarantees payment not for all medical services, but only for those provided by the Medical Guarantee Program. In the future, the program will be approved by the Parliament in the law on the state budget. The current law abolishes this rule for 2020 and stipulates that the amount of expenditures is set by the government based on available financial resources.

Considering the experience of some social payments (pensions) in Ukraine, it is possible that a similar norm will not yet be in one law on the state budget.

 

National Health Service of Ukraine (NHSU)

The reform is being implemented through the National Health Service, coordinated by the government through the Minister of Health. The NHSU was created by the Cabinet of Ministers on December 27, 2017, to provide state financial guarantees for health care.

NHSU is the body authorized to conclude a health care agreement with institutions.

 

Requirements for service providers

The law provides for the possibility of entering into an agreement on public health care with the NHSU by a healthcare institution of any form of ownership, and even an individual entrepreneur.

So – private institutions can join the reform and after concluding the contract with the NHSU – receive funds for medical services provided from the state budget.

To be eligible for service providers, you must:

  • be registered as a legal entity or individual entrepreneur;
  • have a valid license for medical practice;
  • have the necessary material and technical base that complies with industry standards and equipment plates approved by the Ministry of Health;
  • ensure accessibility for persons with disabilities and other low-mobility groups;
  • meet the criteria for the relevant budget program.

The health care provider must be connected to the Central Database of the Electronic Health Care System. Accordingly, there is a need for computerization.

The connection is made through MIS (medical information systems). The list of MISs connected to the Central Database of the Electronic Health Care System can be found on the website of the Central eHealth Ukraine database administrator.

 

Contract with the National Health Service

Announcements for the conclusion of contracts (with descriptions of medical services, requirements for specialization and number of specialists, list of equipment) can be found on the website of the NHSU.

The essential terms of such a contract are the scope of services (as well as medicines), the procedure, terms and conditions of payment, the address of provision of services, the rights and obligations of the parties, their liability, the term of the contract and reporting. The Cabinet of Ministers approves the Standard Form of the Contract and the procedure for its conclusion.

Once the contract is concluded, the National Health Service publishes it on its website within 5 days.

Payment for services will be made to the account of the institution based on reports submitted by the institution to the electronic system.

The second phase of medical reform: how can private institutions join?
Author
You may like
A new law on virtual assets: the picture is formed, but without details. On September 8, 2021, the Verkhovna Rada has finally adopted the long-awaited law "On Virtual Assets", which clarified many ambiguous points. This is especially true for the status of cryptocurrency and the rules of its circulation in the country. Let`s take a closer look at novelties. An ambiguous term Let's start with what the legislator actually means by "virtual assets". There are the following features:  they are an intangible good (cannot be represented on tangible media)  fall under the list of objects of civil rights (that is, they can be owned and be disposed of)  represent an electronic form of a set of data (essentially, they are blocks of information put in order);  the existence and circulation of assets are due to software tools (specific electronic environment). From these features we can draw the following conclusion: virtual assets are not limited to cryptocurrency. Digital currency is part of the concept, but other instruments, such as tokens, NFTs, or even in-game items, fall under the definition. Actually, the actual existence of most digital products, having a certain value, is due to the software environment (ecosystem), either it is blockchain technology, a trading platform, or an online game server. It should be noted that the attempt to define virtual assets was already made in the adopted Law of Ukraine in counteracting money laundering. In this act, they understand it as digital means of payment, which goes against the new definition. As a result, there are now two different explanations for virtual assets, which causes significant confusion not only in regulation but also in interpretation. It is definitely necessary to expect clarifications from competent state bodies. Let's return to the new law. Its application covers legal relations in which the "Ukrainian element" is present:  provider or recipient of services represented in Ukraine;  an agreement according to which the turnover of virtual assets is carried out in accordance with Ukrainian legislation;  the acquirer of assets (or both counterparties) is a resident(s) of Ukraine. The law also introduces an interesting division of all virtual assets into two groups: secured and unsecured. Here again, there is a problem of interpretation. The first category includes products exchanged for (state) currency, the second category includes instruments that can be exchanged only for other digital assets. There is an alternative opinion: that the turnover of secured assets is supported by real goods (money or other property), while unsecured ones are not supported by anything. The latter interpretation is the most credible, as the new law stipulates that virtual assets are NOT means of payment. Moreover, they cannot be exchanged for real goods, be they property, services or money. This significantly narrows the potential for the use of virtual assets not only for commercial but also for civilian purposes. About obligatory licensing The new law states that in some cases, the use of virtual assets will require licensing. The 4 types of activity are mentioned:  storage and management of virtual assets (or its` keys)  servicing of exchange operations with virtual assets (both for other analogues and for real goods);  translation of digital assets;  any intermediary services. A list is quite impressive, but there are some important exclusions:  if your service works with cryptocurrency wallet (it means users can dispose of accumulations into cryptocurrency independently);  If your service works on smart contracts or decentralized protocol, based on which internal transfers are performed. As to intermediary services, everything is more compicated. Actually, any mediation is based on the public share offering. That is why it is subject to licensing. How to get a license? A company that wishes on legal grounds to engage in virtual assets must satisfy legislative requirements. The key role is played by the minimum amount of the statutory capital, which equals 1,19 million hryvnyas (for non-residents it is 5,95 million hryvnyas) in case of storage and administration. For other types of activity (trading, translation and mediation services) the minimum size of the statutory capital amounts to 595 thousand hryvnyas (for non-residents is 2,98 million hryvnyas). The order of the registration of license:  to compose an application and prepare documents.  to pay state fee (68-136 thousand hryvnyas for residents and 340-680 thousand hryvnyas is for non-residents).  to pend review of the request (30 days).  to get a license. The duration of the license is 1 year. No norms about the continuation of legal force of permission are set (we are expecting amendments or explanations from the Ministry of Digital transformation of Ukraine). Notably that non-residents must pay a far greater sum, than domestic companies. The Ukrainian legislator obviously encourages an internal market, getting rid of a strong foreign presence (that, in fact, coincide with modern politics of the state on the whole). Together with an application, the following documents must be prepared: The access code to the copy of the Statute of the company (or the foundation agreement) kept in an electronic file in the database of the Unified State Register of Enterprises and Organizations (USREO);  Funding sources of the statutory capital (where the money are taken from);  confirmation of the actual injection of money;  information about beneficiaries (special attention must be paid to business reputation);  the information about the director and founders;  the check about payment of state fee;  the internal regulations, in accordance with which ones, the privacy policy rules are regulated. In the terms of volume of necessary documentation of licensing is very alike with complete registration of legal entity. It is understood that the state wants the severe adjusting of activity of organizations that will engage in virtual assets. Is it already possible to get a license? The adoption of the law by the parliament is a significant step forward in adjusting and legal market of virtual assets creation in Ukraine. However, the new rules haven`t come into effect yet - their term of introduction depends on making amendments in the Internal Revenue Code. It is yet unknown, when a legislator will decide to enter the renewed system of taxation for such assets. Being "IT-hub" and territory, where cryptocurrency enjoys large popularity, the question of taxes must be decided maximally safely. Despite the presence of obvious gaps in interpretation, a new law on virtual assets gives the official narrative of what takes place and that, how the legal relationships related to cryptocurrency will be regulated. It is to be hoped that in the nearest time the Ministry of digital information will give out the detailed explanations concerning debatable norms.
20/01/2022

We will
call you