Announcement on the activities undertaken by the Fund during the imposed measure to prevent the spread and suppression of Covid – 19 (Coronavirus) in the part of the operation of healthcare institutions
ANNOUNCEMENT
on the activities undertaken by the Fund for the duration of the imposed measure to prevent the spread and suppression of the infection from Covid – 19 (Coronavirus) in the part of the operation of healthcare institutions
In connection with the need to undertake additional measures and activities for prevention of the spread of Covid – 19 (Coronavirus), the Management Board of the Fund adopted the following measures and recommendations for healthcare institutions that have concluded an agreement with the Fund:
Exercise of the right to sick leave and payment of salary compensation
Extension of sick leave on all grounds, the selected doctor may perform on the basis of a telephone call from the insured person. In doing so, in order for the doctor to issue the proposal for incapacity for work (PSR form), they should retrieve through the “Moj Termin” system the latest report, or discharge letter, issued by a specialist from the relevant healthcare institution. Whereas the consiliary opinion should be scanned by the selected doctor and submitted by e-mail to the Fund.
If sick leave needs to be extended beyond 2 months for the first time, the selected doctor and the First-Level Medical Commission will decide on the latest valid report/discharge letter from a specialist on the basis of which the previous sick leave was issued, without referring the insured person for an examination at a clinic in order to obtain a new specialist report or consiliary opinion.
The selected doctor when opening new sick leave on any grounds, may issue the ISR form for up to 15 days (instead of up to 7 days as before), without adhering to the Criteria for diagnostic procedures and assessment of temporary incapacity for work due to illness and injury. These measures do not apply to opening new sick leave for healthcare workers employed in the healthcare sector. In order to open new sick leave for a healthcare worker employed in the healthcare sector, the selected doctor should perform a direct examination of the patient, while respecting the Criteria for diagnostic procedures and assessment of temporary incapacity for work due to illness and injury.
After the expiry of 15 days, extension of sick leave is performed on the basis of a specialist report. This means that in such cases the insured person should be referred to a higher level of healthcare, in accordance with evidence-based medicine.
The selected doctor submits the PSR form and the report from a specialist/consiliary opinion/discharge letter electronically to a special e-mail address of the responsible person in the regional service of the Fund.
Attachment: List of contact persons in the regional services of the Fund
The responsible person from the Fund forwards the documents received electronically from the selected doctor by e-mail to the Medical Commission of the Fund. The assessment of incapacity for work issued by the Medical Commission of the Fund can be viewed by the selected doctor on the Fund portal in the section “Request for patients - issuing an ISR form”. The selected doctor informs the insured person by telephone about the extension of the sick leave.
Example: from the Portal of “Request for patients - issuing an ISR form”
Criteria for issuing sick leave (Criteria for diagnostic procedures and assessment of temporary incapacity for work due to illness and injury)
1. When issuing temporary incapacity for work for diseases of the respiratory system (J00-J99 as the primary diagnosis), the Criteria for diagnostic procedures and assessment of temporary incapacity for work due to illness and injury will not be applied.
2. When opening new sick leave for all other diagnoses and sick leave on any grounds, the selected doctor may issue the ISR form for up to 15 days (instead of up to 7 days), without adhering to the Criteria for diagnostic procedures and assessment of temporary incapacity for work due to illness and injury. These measures do not apply to opening new sick leave for healthcare workers employed in healthcare institutions. In order to open new sick leave for a healthcare worker, the selected doctor should perform a direct examination of the patient, while respecting the Criteria for diagnostic procedures and assessment of temporary incapacity for work due to illness and injury. For extension of sick leave after the 15th day, the insured person is referred to a higher level of healthcare.
Provision of healthcare services in primary healthcare
1. During the period of duration of the measure, selected doctors should not call insured persons for preventive examinations. For this period, the targets will be considered fully met. This means that the planned number of targets is shown as fully completed.
2. In the absence of the selected doctor due to illness or isolation, the healthcare services are provided by the regular substitute doctor. In the event of illness or isolation of the regular substitute doctor, the Fund will enable, without limitation, the appointment of a second substitute doctor, and if necessary another substitute doctor. In doing so, the selected doctor informs the Fund by e-mail about the change that has occurred. The doctor is obliged to display in a visible place the name, surname and contact telephone number of the substitute doctor.
3. Payment of capitation for sick leave up to 30 days is made by the Fund.
In a case where the incapacity for work lasts more than 30 days, the regular substitute doctor may continue to provide healthcare services to the insured persons of the doctor who is on longer-term sick leave even after the expiry of 30 days. In doing so, payment of capitation to the substitute doctor is made in the amount of 70% of the capitation of the doctor who is on sick leave (with the obligation to take over the nurse, if she is at work).
4. If, during the period while the temporary measure lasts, the medical team remains without a nurse, and the healthcare institution cannot complete the team, the doctor provides the healthcare services without a nurse, informs the Fund thereof, and the Fund continues to pay capitation compensation as for a complete team.
Issuing prescriptions for medicines at the expense of the Fund
1. General practitioners should not prescribe medicines on prescription without medical indications, at the insistence of insured persons. Any prescribing of medicines without medical indications will be subject to professional medical supervision by the Ministry of Health.
2. The selected doctor may issue a prescription for chronic therapy even when the recommendation from the specialist/discharge letter is older than one year
3. Prescriptions for chronic therapy should be issued by the selected doctor for 6 months
4. Prescriptions for acute therapy may be prescribed by the selected doctor for medicines in a quantity sufficient for up to 14 days, in the doctor’s opinion
5. Prescribing prescriptions for low-molecular-weight heparin ENOXAPARIN and NADROPARIN:
Selected gynaecologists
Selected gynaecologists may prescribe ampoule therapy clexane or fraxiparin for pregnant women who need to start receiving it for the first time and for patients for whom continuation of the same is required on the basis of D-dimer results and ultrasound findings and confirmation from a specialist transfusiologist or specialist gynaecologist from a hospital or clinic, obtained by e-mail. Patients do not need to go in person to the specialist doctor; instead, the selected doctor obtains the medical opinion by e-mail from the relevant hospital or clinic. The medical opinion does not need to be in a special form/document, but only written in an e-mail message to the selected gynaecologist. For the purpose of reimbursement, the selected doctor is obliged to print the electronic message containing the medical opinion of the specialist from the hospital or clinic, as a replacement for a specialist report. We repeat that the patient does not need to go to the specialist doctor for a recommendation for clexane or fraxiparin.
Selected general medicine doctors
Selected general medicine doctors may prescribe ampoule therapy clexane or fraxiparin for patients for whom continuation of the same is required on the basis of D-dimer results and confirmation from a specialist transfusiologist or specialist from a hospital or clinic, obtained by e-mail. Patients do not need to go in person to the specialist doctor; instead, the selected doctor obtains the medical opinion by e-mail from the relevant hospital or clinic. The medical opinion does not need to be in a special form/document, but only written in an e-mail message to the selected doctor. For the purpose of reimbursement, the selected doctor is obliged to print the electronic message containing the medical opinion of the specialist from the hospital or clinic, as a replacement for a specialist report. We repeat that the patient does not need to go to the specialist doctor for a recommendation for clexane or fraxiparin.
Healthcare services from specialist-consultative healthcare and general dentistry
1. Due to preventing the spread of the Coronavirus, healthcare institutions from specialist-consultative healthcare and general dentistry should work during the scheduled working hours and provide healthcare services only in urgent cases.
2. During the period of validity of the measures, if healthcare institutions from specialist-consultative healthcare cannot provide healthcare services to insured persons within the established monthly compensation, they will be able to use the unused funds after the end of the measure, that is, until the end of the year.
Certification of orthopaedic aids
If the insured person has a specialist report and a finding, assessment and opinion older than 1 year, their validity is extended until 31.05.2020. In doing so, the selected doctor may prescribe certificates for the need for an orthopaedic aid only for the stated period.
The certificates for orthopaedic aids continue to remain certified at the counters of the regional services, due to the existence of technical obstacles for them to be certified by the selected doctor or specialist doctor.
The certified certificate will be delivered by the Fund ex officio by post to the insured person at their home address, or if the insured person has left a contact telephone number, they will be informed by SMS message of the certification number of the certificate. Regardless of the manner in which the insured person is informed about the certified certificate (in paper form or with the certification number received by SMS), the required aid may be collected, with proof of identification, from the orthopaedic provider of their own choice.”
Mode of operation of the Fund with healthcare institutions
Receipt of requests from healthcare institutions related to any status changes in accordance with the agreement or conclusion of a new agreement may be performed in one of the following ways:
- scanned documents should be submitted to [email protected] in the Fund,
- by post or
- in exceptional cases at a counter designated for receipt of documents
The prepared agreements, annexes to agreements and notification will be delivered by post to the address of the healthcare institutions.
The Fund actively follows the recommendations of the WHO and implements all measures of the Government in order to protect the health of the population for prevention of the spread of Covid – 19 (Coronavirus).