Russian Federation

ORDER of the Ministry of Health and Social Development of the Russian Federation dated 04.12.2009 N 951n "ON APPROVAL OF THE LIST OF DOCUMENTS THAT MUST BE PRESENTED BY THE INSURER FOR DECISION MAKING BY THE TERRITORIAL BODY OF THE SOCIAL INSURANCE FUND OF THE RUSSIAN FEDERATION ON THE ALLOCATION OF THE NECESSARY FUNDS FOR PAYMENT OF INSURANCE COVER"

1. A written statement from the policyholder, which must contain:

1) name and address of the insured - a legal entity or surname, first name, patronymic, passport details, address of permanent residence of the insured - an individual;

2) registration number of the policyholder;

3) an indication of the amount of funds required to pay the insurance coverage.

2. Calculation of accrued and paid insurance premiums for compulsory social insurance in case of temporary disability and in connection with maternity and for compulsory social insurance against industrial accidents and occupational diseases, as well as expenses for the payment of insurance coverage (form 4-FSS of the Russian Federation ), submitted in the form approved by Order of the Ministry of Health and Social Development of the Russian Federation dated November 6, 2009 N 871н (registered by the Ministry of Justice of the Russian Federation on December 22, 2009, N 15798), for the corresponding period, confirming the accrual of expenses for the payment of insurance coverage .

3. Copies of documents confirming the validity and correctness of expenses for compulsory social insurance (for benefits for temporary disability, pregnancy and childbirth - a certificate of incapacity for work, filled out in the prescribed manner, with the benefit calculated; for a one-time benefit for women registered in medical institutions in early stages of pregnancy - a certificate from the antenatal clinic or other medical institution that registered the woman in the early stages of pregnancy (up to 12 weeks); for a one-time benefit at the birth of a child - a certificate of the birth of a child in the established form, issued by the civil registry authorities, and in in the case of the birth of a child outside the Russian Federation - a document legalized in the prescribed manner, confirming the birth of the child, with a translation into Russian certified in the prescribed manner, a certificate from the other parent’s place of work about non-receipt of benefits for a monthly child care benefit - documents provided for in parts; and Article 13 of the Federal Law of December 24, 2006 N 255-FZ “On compulsory social insurance in case of temporary disability and in connection with maternity”; for social benefits for burial - a death certificate issued by the civil registry office), the accuracy of which is certified in the prescribed manner - for insurance premium payers who apply reduced insurance premium rates based on the clause (with the exception of insurance premium payers making payments and other remuneration to individuals who are disabled people of group I, II or III) and (or) part 2 of article 57 of the Federal Law of July 24, 2009 N 212-FZ "On insurance contributions to the Pension Fund of the Russian Federation, the Social Insurance Fund of the Russian Federation, the Federal compulsory medical insurance fund and territorial compulsory medical insurance funds" (Collected Legislation of the Russian Federation, 2009, No. 30, Art. 3738).

Judicial practice and legislation - Order of the Ministry of Health and Social Development of Russia dated December 4, 2009 N 951n (as amended on October 28, 2016) On approval of the list of documents that must be submitted by the insurer for the territorial body of the Social Insurance Fund of the Russian Federation to make a decision on the allocation of the necessary funds for the payment of insurance coverage

The Social Insurance Fund of the Russian Federation (hereinafter - the Fund) informs that by order of the Ministry of Labor and Social Protection of the Russian Federation dated October 28, 2016 N 585n (registered with the Ministry of Justice of Russia on November 16, 2016 N 44347) (hereinafter - order N 585n) changes were made to the List of documents , which must be submitted by the insured for the territorial body of the Social Insurance Fund of the Russian Federation to make a decision on the allocation of the necessary funds for the payment of insurance coverage, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 4, 2009 N 951n.

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One of the most common and dangerous infections is the disease caused by Koch's mycobacteria- tuberculosis. It is considered socially significant because it is very contagious and it is difficult to protect yourself from infection.

According to statistics 97% of the adult population The planet is faced with tuberculosis; several million people are infected every year around the world.

In Russia, since the early 90s, the incidence of tuberculosis has increased significantly and in some regions has reached epidemic proportions.

Therefore, the state is taking all measures to combat this infection; regulations have been developed and approved regulating the work of the anti-tuberculosis service at all stages.

Basic laws on the treatment of tuberculosis, guaranteeing mandatory provision of care to patients

In its work, the TB service is based on a number of laws and regulations, the main of which are:

• Federal Law “On preventing the spread of tuberculosis in the Russian Federation” N 77 of 2001;
• Federal Law “On the fundamentals of protecting the health of citizens in the Russian Federation” of 2011.

Orders of the Ministry of Health, Government resolutions, guidelines and other by-laws have been adopted, including:

• Order No. 932n of November 2012“On approval of the Procedure for providing medical care to patients with tuberculosis”;
• Order No. 951 of December 2014“On the approval of the method. recommendations for improving the diagnosis and treatment of respiratory tuberculosis”;
• Russian Government Decree No. 892“On the implementation of the Federal Law “On preventing the spread of tuberculosis”;
• Resolution of the Chapter. rank doctor of Russia, adopted in 2013 No. 60“On approval of SP 3.1.2.3114-13 “Prevention of tuberculosis.”

Basic document

The basis for the work of phthisiatric service in Russia is Federal Law “On preventing the spread of tuberculosis”. It describes all forms of support for patients with the disease, including primary detection, conservative and surgical treatment, observation at a dispensary, sanatorium rehabilitation of patients, prevention and measures to maintain a normal sanitary level, and also defines rules for those who, due to their work, come into contact with tuberculosis .

The document establishes the responsibilities of both self-government bodies, medical organizations at all levels, and citizens themselves to take measures to prevent the further spread of tuberculosis.

Regional or municipal self-government bodies are obliged to ensure that the prescribed norms of the law are observed and the incidence of tuberculosis in the assigned territory is reduced. An effective system has been created in Russia specialized anti-tuberculosis institutions, who provide step-by-step assistance to patients, this network includes:

• phthisiology office at health care facilities;
• tuberculosis dispensary;
• specialized hospital;
• tuberculosis sanatorium.

Photo 1. Top view of the buildings of the anti-tuberculosis dispensary in the Sverdlovsk region.

Detects cases of tuberculosis infection in animals and prevents infection through agricultural products veterinary service And agricultural supervision. All companies participating in the implementation of the program to combat tuberculosis infection must be licensed and have a document confirming the right to engage in relevant activities. Any medical organizations, both public and private, must send a message to the sanitary inspection authorities about all detected cases of tuberculosis.

The executors of the federal law are all organizations operating in the field of anti-tuberculosis care, medical institutions, including managers and staff. Any citizen can appeal the actions of medical workers to a higher authority, to a regulatory organization or to the court and prosecutor's office. Persons who violate federal law are subject to:

• disciplinary punishments;
• administrative penalties;
• criminal liability.

Features of providing anti-tuberculosis care, is treatment possible on an outpatient basis?

Help regulated by law includes not only medical intervention, but also Events in the social sphere, since the spread of tuberculosis is facilitated by the low standard of living of patients, unsanitary conditions, poor nutrition and other factors of social ill-being.

Patients who receive such assistance have the right to demand compliance with medical confidentiality, except for information directly related to tuberculosis or ongoing anti-epidemic measures. Tuberculosis infection requires long-term treatment, sometimes more than twelve months, but for the entire period of therapy sick leave is issued And the patient's workplace is retained.

All drugs necessary for the treatment of tuberculosis are provided to patients for free, regardless of whether they are inpatient or outpatient, they undergo treatment. In addition, when a patient with an open form of infection does not have a separate room in the apartment or lives in a dormitory, municipal authorities are obliged provide him with separate housing or improve living conditions.

Important! For the purpose of prevention, all newborns are subject to mandatory BCG vaccination; an annual examination of the population is carried out using the Mantoux test, Diaskintest and fluorography.

Phthisiological care is provided in several stages:

• stationary;
• sanatorium;
• outpatient.

The best treatment for the primary case is stationary. It allows for the most complete diagnosis, selection of adequate treatment for the infection and monitoring of the dynamics.

After which the patient is transferred to sanatorium stage treatment, and only after achieving stable remission, under surveillance at the place of residence. However, in some cases it is possible to complete the entire course on an outpatient basis, at a dispensary. This method of treatment is permitted:

• patients with small forms, without isolation of bacilli;
• patients requiring long-term maintenance therapy after hospitalization;
• tuberculosis-infected children, if chemoprophylaxis is prescribed.

There is no fundamental difference in treatment regimens between the outpatient option and the inpatient option. Observed at home, the patient must visit the dispensary regularly, confirm that you regularly take prescribed medications. If the health care provider detects a violation of the regimen or the patient’s condition worsens, then will require hospitalization.

A compromise form is considered to be a day stay in a hospital, which allows you to monitor the implementation of prescriptions, organize proper nutrition and exclude cross-infection of tuberculosis.

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Forced treatment of tuberculosis patients

According to the law, any TB care is provided to all citizens without exception, in some cases voluntarily, and sometimes without the consent of patients.

If there is a threat of the spread of tuberculosis, the necessary examination is carried out without prior consent, since refusing it may expose not only the person himself, but also those around him, to the risk of infection.

Dispensary observation (“D” - observation) does not depend on the wishes of the patient or his relatives. The decision on whether a person is subject to such observation is made by a commission of medical specialists. If “D” accounting is necessary, the patient is informed about this in writing. Observation is carried out on an outpatient basis at the place of residence.

All patients with open forms of tuberculosis, unclear diagnosis, all tuberculosis-infected children and adolescents, as well as persons who have experienced complications of BCG are subject to such observation. Termination of observation occurs only after a verdict has been rendered medical anti-tuberculosis commission.

If, during dispensary observation of a patient, cases of violation of the sanitary regime are identified or the patient systematically does not appear for examinations, refuses examination and treatment, then a decision is made to forced hospitalization patient. It is possible only after the relevant court ruling has been made. The diagnostic and treatment algorithms for the compulsory method do not differ at all from the voluntary method.

Photo 2. Schematic illustration of how a patient with tuberculosis infects a healthy person. When you cough or sneeze, an infection enters the air and, through a sigh, enters the intact lungs.

Forced hospitalization is not a punishment; it is needed to fully cure a patient from tuberculosis, who cannot adequately assess the severity of his condition and poses a threat to infecting others.

Other documents regulating the work of TB specialists, orders 951, 932n

In addition to laws, policies in the fight against tuberculosis infection are determined by orders of the Ministry of Health, in particular No. 951, approving the methodological recommendations on which diagnostic studies and treatment of tuberculosis are carried out.

According to this order subject to mandatory examination:

• children with a turn, with a positive Mantoux test, if it exceeded the previous one by more than six mm, with hyperergic or questionable test results;
• adults, if pathology was detected during fluorographic or x-ray examination;
• HIV-infected people with cough or fever of unknown etiology;
• patients with chronic lung diseases with long and frequent periods of exacerbation and lack of effect from the treatment;
• citizens who, during any treatment or examination, show signs of tuberculosis infection.

Diagnostic methods currently used are strictly regulated and include:

• microscopic studies;
• sowing biological material on nutrient media;
• determination of sensitivity to certain antibiotics;
• molecular studies: polymerase chain reaction, immunoblotting, enzyme immunoassay;
• X-ray and radiation methods;
• endoscopy.

Immunodiagnosis (Mantoux test) is distinguished, which is a screening method of examination and is used mainly in children.

The diagnostic research algorithm includes those methods that are available in a medical institution of the appropriate level.

In the municipal health care facility it is microscopy And sputum culture with sensitivity determination, X-ray of the lungs, determination of mycobacterial DNA.

All manipulations are carried out in compliance with sanitary and epidemiological requirements. If the results are positive, the patient is consulted by a TB doctor, and then the patient is transferred to a specialized anti-tuberculosis hospital.

The regional hospital has a wider range of diagnostic capabilities. Not only the above studies are carried out here, but also bronchoscopy, computed tomography.

Specialized tuberculosis institutions are required to conduct all studies two or three times, and if necessary, resort to biopsy and surgical diagnostic methods. When conducting diagnostics, medical staff of institutions are obliged to use personal protective equipment, comply with the sanitary and epidemiological regime, and prevent contact of a tuberculosis patient with other patients.

Treatment regimens for tuberculosis have been developed and approved by order of the Ministry of Health of the Russian Federation. Medical workers do not have the right to deviate from the five accepted regimes, but the choice is made based on sensitivity of bacilli to drugs, presence of concomitant diseases, side effects for a specific patient. The treatment regimen is prescribed by a commission of medical specialists. The staff of medical institutions are obliged to organize the daily intake of tuberculosis medications by patients and monitor its continuity.

The procedure for providing anti-tuberculosis care, types of specialized TB institutions, their equipment and staffing have been approved by order of the Ministry of Health No. 932n, published in November 2012

Consequences of unauthorized actions

All citizens, including regulatory authorities, medical institutions, social services, as well as patients themselves and their family members, must take the necessary measures in the fight against a socially dangerous infection. A violation of a patient’s rights is considered if information about his health is transmitted the essence of the manipulations being performed is not explained to third parties or the patient himself or prescribed medications, do not tell the purpose and possible complications of treatment. A serious violation is sale of anti-tuberculosis drugs to patients at the dispensary.

Attention! All medications are provided completely free of charge!

One of the violations is the adoption of a decision on “D” - observation by the doctor alone, without sufficient grounds and without the involvement of a medical commission. You can file a complaint about improper actions of health workers to higher organizations, supervisory authorities or to court.

All participants in the process of providing anti-tuberculosis care bear all types of liability from administrative to criminal for failure to comply or violation of the law. Including a fine may be imposed on patients who do not comply with the requirements of epidemiologists or ignore treatment.