The Republic of Latvia Cabinet of Ministers 1996 December 24 Regulation No 485 in Riga (No. 61.41. ¤) healthcare financing rules Issued in accordance with the constitutional procedure laid down in article 81 of Cabinet of Ministers issued on 30 august 1994 rule no. 177 "treatment" (4) (I). the terms used in the rules 1. compulsory health insurance — national compulsory social insurance fund, which guarantees members of medical assistance costs within the country.
2. minimum Service — the State compulsory health insurance services the minimum or base program (medical-aid minimum) to be provided to members of the national sickness insurance compulsory health insurance funds.
3. the contributions — national single direct payment, which treatment the patient has a right to charge for outpatient visits, treatment of the authority the person's home visit or a day spent in the hospital.
4. payment of participation — the State defined a single patient or third-party payment for medical treatment service of up to 15% of the service within the minimum medical services cost.
5. Third party: the meaning of these provisions, institution, person or a private insurance company that covers the patient's participation in the settlement in place of the person concerned.
6. the sickness funds — an independent legal entity that provides services to members of the local minimum pay to the organisation and monitoring.
7. the sickness funds Member-a person who is entitled to a minimum of service and which is registered in the register of members of the sickness funds.
II. General questions 8. these provisions define the population health funding arrangements, as well as the types of treatment services and the extent to which these rules determine the extent of the country's budget is paid and the national specialty health care budget (hereinafter referred to as the "special budget") and medical services.
9. The medical services in accordance with the procedure laid down in these provisions receive Latvian citizens, aliens and stateless persons who have been granted a personal code and registered in the population register.
10. Foreign citizens and persons without citizenship who are not registered in the population register, the territory of the Republic of Latvia provides health care and medical expertise of the Court shall be borne by the foreign national or the insurance company, if international agreements provide otherwise, or the natural or legal person who, by signing invitation for obtaining entry visas, guaranteed that will cover the necessary foreign citizens health care expenses.
11. The funds necessary for the paying-up of minimum service consists of: 11.1. personal income tax revenue in the current year the State budget law;
11.2. the national budget allocations in accordance with the current year's State budget law;
11.3. the patient's contribution;
11.4. the participation fee that is payable by the person or the place, a third party;
11.5. other third party payments.
12. Medical expenses for the services of the institutions in the minimum medical services not less than 80% of the medical costs borne by sickness funds in accordance with the agreements. Sickness insurance shall lay down the procedure for the formation of the Cabinet of Ministers.
13. Medical authority has the right to charge the patient contribution lats of 0.20 outpatient visits the institution, 0.40 lats, of treatment person's home visit and 0.45 lats, of the Hospital (rehabilitation institution) days. This duty applies to national programs and services included in the minimum medical services.
14. From these provisions referred to in paragraph 13 the patient contributions exempt: 14.1. children under a year old;
14.2. children with disabilities under the age of 16 years;
14.3. children up to 16 years if treatment is received inpatient services (rehabilitation institutions);
14.4. children and students — preventive inspections in schools and kindergartens;
14.5. all citizens — in preventive inspections prescribed by the Minister of welfare;
14.6. children, children, children's, family shelters, child care center, orphanage, specialized institutions of children with disabilities and boarding school students;
9.1. all citizens, if emergency medical treatment is received this rule 22.1. in the cases referred to in point;
14.8. pregnant women if you receive with pregnancy and postnatal observation and the progress of pregnancy related treatment services;
9.3. the people who are on compulsory military service;
14.10. the incarcerated persons;
14.11. the national specialized centres and local nursing home (Center) in the care of persons.
15. Treatment services for a minimum of services contained in the treatment of patient participation payment is charged, not exceeding 15% of the cost of treatment provided by the service. This duty is set out in the Minister of welfare and uniform across the country.
16. From this provision for the participation referred to in paragraph 15 of the payment should: 16.1. children under the age of 18 years;
16.2. pregnant women, if you receive with the pregnancy and pregnancy related treatment processes;
16.3. needy persons recognized as such by law established;
16.4. the people who are on compulsory military service;
16.5. any patient if you receive emergency medical assistance;
16.6. the incarcerated persons;
16.7. repressed persons and the Chernobyl nuclear power plant accident in the liquidation of the effects of the victim.
17. payment shall be made for the participation of the person concerned, or in place of, the third party in accordance with the agreements.
18. the participation fee for this rule 16, paragraph category population medical authority in all cases bear the sickness of this rule 11.1 and 11.2 referred to. Sickness funds revenue are updated in the following way: 18.1. payment for participation in this rule 16.4. category referred conducts the population Ministry of defence and Ministry of Internal Affairs;
18.2. the participation fee for this provision 10.3. category referred conducts the population Ministry of internal affairs.
19. the sickness fund, by contract with the medical service provider, provides medical services payment according to the sickness funds pay the medical costs.
20. Expenditure on consultations, as well as the star, laboratory, diagnostic and the functional endoscopic studies, which carried out a crime victim prettiesisko persons in the differential diagnosis, as the medical examiner of assignment shall be borne by the applicant for inspection. Tiesmedicīnisk chapter of the interregional space maintenance expenses are covered from the minimum resources for the service.
III. minimum Service 21. minimum Service determines the population of therapeutic help to be the minimum amount that the medical authorities should ensure the State compulsory health insurance funds.
22. minimum Service includes the following types of assistance: therapeutic 22.1. emergency medical assistance after receiving the call to provide emergency medical teams in the following cases: 22.1.1. accidents, accidents, disasters, natural disasters, severe mechanical injury, electrocution, lightning damage, extensive burns and frostbite, Sun and heat stroke, drowning, choking, respiratory tract foreign bodies and other body sites where the endangered the life of the victim;
22.1.2. poisoning;
22.1.3. injury or sudden illness on a street, public place, business or institution;
22.1.4. sudden illness, and during the course of the chronic disease exacerbation, threatening the patient's life: 22.1.4.1. cardiovascular disease with pain, choking or suffocation of seizures, cold sweat, heart rhythm disturbances, fainting;
22.1.4.2. peripheral vascular disease with sudden pain in the hands or feet, hands or feet cold, pallor;
22.1.4.3. the Central and peripheral nervous system disease with sudden disturbance of consciousness, seizures, faint, head and back pain, paralysis and other disabilities;
22.1.4.4. the stomach, gastrointestinal illness, with sudden sharp pain in the abdomen, vomiting, cold sweat, continuous diarrhea;
22.1.4.5. urinary tract disease with sudden pain in the lumbar and sacral region or acute disorders of urination;
22.1.4.6. acute mental disorders accompanied by aggressive actions or attempted suicide;
22.1.4.7. origin of any bleeding or expressed expressed allergic reactions;
22.1.4.8. asthma attack;
22.1.5. patient express transfer needed according to diagnosis and (or) health severity: 22.1.5.1. for stationary or from one hospital to another hospital, if the appropriate assignment or the doctor on call;
22.1.5.2. delivery hospital mothers;

22.2. the acute disease and exacerbation of chronic disease diagnosis, treatment and dynamic observation;
22.3. the mental state of the tuberculosis patients, and outpatient care and prevention;
22.4. the attendance and treatment nursing home whose health condition does not allow you to visit the treatment services (travel expenses are not covered);
22.5. pregnant women and dēļnieč observation, not help giving birth, help in cases of pathological pregnancy;
22.6. the sexually transmitted infection, and contagious skin disease prevention, diagnosis and treatment;
14.1. the specific and non-specific and specific immunotherapy in vaccination according to the Health Minister established procedures;
22.8. the autopsy and biopsy material, the operation of pathological examination, except infection, tuberculosis, oncological and haematological disease in cases where the charge for the investigation to be covered from the State budget funds;
14.2. zobārstniecisk help children under the age of 18 years and jauniesaucam: primary prevention of teeth 22.9.1., except silant;
22.9.2. secondary prevention of teeth, except for dental fillings with light hardening materials and endodontij more than one tooth (except dental injury cases);
22.9.3. the initial orthodontic consultations and treatment to severe bite abnormality;
22.9.4. treatment of the face and jaw area injuries and inflammation, which causes functional disturbances, as well as in cases of injuries without functional interference, if the patient is approached by first aid within 24 hours;
22.10. asinskomponent preparation of public procurement in excess of the guaranteed quantity of blood components;
22.11. carrying out health screening, Health Minister in the order;
12/22 with treatment. the security features, the purchase of which the Cabinet of Ministers appointed a relief;
22.13. medical treatment of injuries and occupational disease;
22.14. operations scheduled (planned operations are entitled to sickness funds determining quotas and lines as well as other forms of payment conditions);
22.15. rehabilitation therapy after the initial disease, chronic illness or injury aggravated children under the age of 16 years;
22.16. medical assistance for Chernobyl nuclear power plant accident consequences liquidation victims, groups 1 and 2 disabled persons and politically repressed persons in accordance with the legislation.
IV. Treatment, expenses not covered by the sickness fund 23. Sickness from the State compulsory health insurance funds do not cover the costs of such treatment services: 23.1. zobārstniecisk assistance, except that the provisions referred to in paragraph 14.2.;
23.2. the hospital treatment in the planned surgery or chronic diseases without a referring physician assignment;
23.3. the consulting and investigations planned surgery or chronic diseases without a referring physician assignment;
23.4. outpatient injection to skin, Hypodermic, intramuscular and intravenous (except when giving emergency medical aid; medical assistance for oncologic and diabetic patients and children aged up to 14 years). Outpatient injection to pay the order approved by the Minister of welfare;
14.6. the first medical preventive measures necessary for their work;
14.7. the periodic medical examinations necessary for the improvement of working conditions and the nature of the work;
23.7. treatment in sanatoria and resorts;
14.8. abortion without medical or social indications;
14.9. anonymous treatment and prevention measures (with the exception of AIDS and syphilis investigation discovery);
23.10. seksoloģisk treatment;
23.11. the provision of medical assistance in different public events;
23.12. representative services;
23.13. homeopathic treatment;
23.14. Visual acuity of corrective optics for the purchase of products;
23.15. psychotherapeutic assistance;
23.16. the medical institutions provide increased service and minimum service in the non-treatment services. Service standard of treatment services approved by the Minister of welfare;
23.17. the vaccination, which is not fixed by order of the Minister of welfare;
23.18. the preventive medical examinations and others, if they are not associated with medical indications (such as opinion on the health situation, the head of transport for medical examination);
23.19. apreibum of alcohol and drugs in the treatment of inspection bodies;
23.20. the in-patient treatment (temporary social care in case of sickness), which the illness or injury does allow outpatient treatment (based on treating doctor's opinion);
23.21. the rehabilitation of the second stage.
24. treatment services provided in compliance with the minimum of services, conformity of persons from participation in payment and contributions from the patient but categories of residents, as well as emergency medical care in the hospital down the length of the treating doctor or the medical service provider under these rules. The correctness of the decision is controlled by the relevant sickness funds kontrolārst, Ministry of welfare and medical care availability inspection quality control inspection or external expert. In the event of a dispute, the question shall be determined by the Ministry of welfare.
V. national health care programme, sub-programme and measure the pay arrangements 25. national health care programs are paid from State budget funds in accordance with the current year's State budget law.
26. the national health care programme, subprogramme and the payment from the State budget funds in accordance with the established procedure, the Minister of welfare, provides the State compulsory health insurance fund Centre (hereinafter referred to as the "Central Fund"). Central Fund is a national institution that performs compulsory health insurance funding administration.
27. the national health care programme, sub-programmes and measures of quantitative and qualitative indicators is determined by the Cabinet of Ministers. Welfare Minister approved the national programme managers and performers and establishing the State order (program) allocation method, as well as ensure control of the implementation.
28. the national health care programme, sub-programmes and measures, part of the medical assistance, settlement, accounting, reporting and quality control procedures established, in accordance with the laws and regulations between the treatment provider and the Central Fund. A sample of the agreement approved by the Minister of welfare. Central Fund accounts with the artist about the actual amount of work (the measures).
29. the order in which patients are sent to drug treatment services national programmes, sub-programmes and measures, approved by the Minister of welfare.
Vi. State compulsory health insurance funds and medical billing services 30. State compulsory health insurance funds take the Central Administration of the Fund.
31. the Central Fund, which provides for a minimum fee, the service consists of: 31.1. individual income tax in the current year by the State budget law of personal income tax revenue each week including the Treasury;
19.4. every week, without the mediation of the Treasury transferred personal income tax part of the current year's State budget to the extent of the law those authorities which have concluded contracts with the Ministry of Finance on individual income tax revenue collection in the special procedure;
31.3. in accordance with the General grant part of the general revenue base for the current year in the State budget to the extent stipulated by law that every month, including the Ministry of welfare.
32. the Central Fund from funds transferred to 0.5% including Exchange Fund reserve fund used: 32.1. unplanned change in the number of patient cases associated with epidemics and population morbidity;
32.2. the enforcement of international agreements;
32.3. public information activities;
32.4. the sickness funds and medical service providers contracts execution control;
32.5. the measures relating to the State compulsory health insurance.
33. The provisions referred to in paragraph 32 of the use of the funds approved by the order of the Minister of welfare.
34. the Central Fund after you created the Central Fund, the reserve fund in accordance with the welfare of the criteria approved by the Minister shall transfer the remaining funds of funds, according to the number of members of the sickness funds, taking into account the Welfare Minister's Office the members approved by the age and sex structure of the corresponding differential treatment factors.
35. the register of members of the Fund shall lay down the procedure for the formation of the Cabinet of Ministers.
36. the sickness funds treatment services provided to members, which include the minimum of services, treatment according to the contract concluded between the payment of sickness.
37. the sickness funds received from the Central Fund, uses: 37.1. the sickness funds and the development of the reserve fund;
37.2. outpatient services (family doctor) services for payment of treatment;

37.3. services provided by the hospital treatment;
23.2. to cover the payments, determined in accordance with the contract between the sickness funds and the sickness funds pay pharmacies treatment value under the Cabinet of Ministers regulations on preferential treatment for patients in the outpatient treatment;
37.5. paid for emergency medical assistance;
23.4. starpkas settlement;
37.7. operation of the sickness funds — up to 2% of this rule 11.1 and 11.2. the funds referred to in point (about the approval of the Central Fund, taking into account the recommendation of the Minister of welfare).
38. the sickness funds and development funds in the reserve include: up to 4.5% from 38.1. Central Fund of funds received;
38.2. the monthly revenue surplus of funds over expenses.
39. the sickness fund and the reserve fund is used: 24.3. unscheduled monthly change in the number of patients;
24.4. the sickness funds pay the medical service parts, if you have met with the Central Fund, the conditions of the contract;
39.3. medical technology procurement laws and regulations.
40. Each medical institution providing the service within the minimum medical services to citizens, have the right to contract with just one Fund. The minimum service medical billing services, medical institutions of the country determines the Welfare Minister.
41. For emergency medical assistance to the sickness funds with service providers settled: 41.1. in accordance with the contract between the sickness funds and the medical service provider for a set amount of treatment services;
41.2. the emergency medical teams, the number of outings, taking into account the cost of one trip.
42. For outpatient medical services provided by the sickness funds with medical service providers settled: 42.1. for each treatment individually in accordance with the established medical criteria for the evaluation of the service according to a points to a particular payment;
26.2. after kapitācij (the resources allocated to general practice doctor, depending on the number of recipients of services of treatment);
42.3. in applying the mixed option, the payment for the treatment and services provided kapitācij key elements.
43. On the inpatient medical services provided by the sickness funds with service providers settled: 43.1. for each treatment individually;
26.8. to cover treatment for a specific patient diagnosis;
43.3. the treatment directs a hospital authority in-patient treatment services provided by the Department to pay the planned proportion of directly under contract for a fixed amount of treatment services.
44. Billing for this rule 41, 42 and 43 of treatment services listed in an agreement concluded between the Central Fund and the health insurance funds, and the contract concluded between the sickness funds and the medical establishment.
45. Starpkas settlement: 45.1. payment of the costs of treating patients who receive outpatient treatment or assistance sent to inpatient treatment, if the medical authorities have concluded agreements with other providers, taken using the starpkas billing system;
45.2. the State compulsory health insurance funds to be taken only with sickness, and confirm the order of the Central Fund.
46. If the expenses for the treatment of citizens services are greater than the funding laid down in the contract, the amount of overrun that occurred beyond the Central Fund of the contract conditions, sickness cover from its own funds.
47. The Central Fund shall have the right to stop the transfer of funds of funds, it has violated the Central Fund for the requirements of the contract. Central Fund shall inform the Ministry of Welfare of the contract execution.
48. in accordance with the law "On local governments" authorities promote in its territory of health care systems and medical treatment institutions of enterprise development.
VII. Accounts and controls 49. If a central fund is the absence of sickness funds for the full amount of these provisions and procedures laid down in paragraph 34, the sickness fund at the beginning of each month to the authorities of the appropriate treatment in contracts paid in advance funds up to 50% of the cost of treatment services provided in the previous month. Settlements for citizens medical assistance to medical institutions are made within 10 days after receipt of the payment of the required documents in the order they are received.
50. in accordance with the law "on budget and financial management" article 30 of the medical institutions, regardless of their property and businesses shall submit to the sickness funds in the uniform format for reporting on the State compulsory health insurance funds according to regulations and the central fund rules established.
51. the sickness funds collects medical reports submitted by the authorities and in accordance with the Central Fund agreement entered into shall submit to the Central Fund, this report is a summary of the income of the funds and the use made of the minimum pay for the service.
52. the Central Welfare Fund in the order of the Minister shall submit the relevant authorities reports on specific budget funds, as well as reports on State programs and services to the minimum.
53. the sickness funds provide citizens with information on government programs and services, as well as their minimum pay.
54. the Central Fund controls the accounts between the sickness funds and the medical authorities.
55. the State compulsory health insurance issues related disputes the Central Fund created the appearance of a dispute to the Commission. The Commission approves the provisions of Welfare Minister.
56. the sickness funds and the Central Fund for the State's mandatory health insurance related to the availability of funds, the statement of expenditure.
VIII. Transition issues 57. the Central Fund to the national sickness fund is established. To create a central fund set out in these provisions of the central functions of the Fund carried out a national sickness fund.
58. Until the establishment of the Fund does the existing territorial (local) sickness funds.
59. the sickness funds for establishing the register of members of the Central Fund dedicated budgetary resources be divided into territorial (local) health insurance funds, through the National Statistics Committee data on the number and composition of the population of the Republic of Latvia districts and cities.
60. Be declared unenforceable: 60.1. The Cabinet of Ministers of 7 March 1995, the provisions of no. 49 "Sickness of the creation" (Latvian journal, 1995, no. 39);
60.2. The Cabinet of Ministers of 14 May 1996, Regulation No 171 "health care funding arrangements in 1996" (Latvia's journal, 1996, nr. 86).
61. the rules shall enter into force on January 1, 1997.
Prime Minister in: environmental protection and regional development Minister, Deputy Prime Minister a. Gorbunov Welfare Minister v. Makarova in the