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How the successor to the MSEC makes decisions

Цей матеріал також доступний українською

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Photo: perinatalcenter.com.ua

Photo: perinatalcenter.com.ua

Starting January 1, 2025, the medical and social expert commission(MSEC) was replaced by expert teams of doctors. The decision of the expert team on the assessment of the person's daily functioning (ECDF) is a document that is adopted after analyzing the person's health status, the degree of impairment and their needs. It is the result of a comprehensive assessment and includes conclusions and recommendations aimed at providing the necessary support. The Ministry of Health has provided details.

The decision-making process by the expert team consists of several stages to ensure that the assessment is thorough and objective.

Inclusion of the case in the queue

After receiving the case, the administrator of the healthcare facility:

  • Checks the documents for completeness and compliance. If they are in compliance, the case is included in the queue for review by the expert team.
  • Returns thecase for revision if deficiencies are found (incomplete information, lack of supporting documents, poor quality of copies).
  • Notifies theperson of the form, date and time of the case review.

Detailed criteria for referral for evaluation can be found at this link. The list of reasons for returning the case is described in paragraph 27 of the Procedure for assessing the daily functioning of a person, approved by the Resolution of the Cabinet of Ministers of Ukraine of 15.11.2024 No. 1338. First of all, this is a failure to comply with the requirements of paragraphs 21 and 22 of the said Assessment Procedure.

Evaluation by an expert team

Assessment by an expert team is a key stage that provides a comprehensive analysis of a person's health status, functional capabilities and needs.

1. Document analysis: the expert team gets access to the case file on the day of the assessment.

2. Examination of the patient (if necessary): the expert team can examine the patient and, if necessary, refer him or her for additional medical examination.

More information about all forms of case review by expert teams can be found at this link.

3. Focus on functional capabilities: the expert team pays special attention during the assessment:

  • The degree of impairment of the functioning of organs and systems of the body.
  • The impact of these impairments on the ability to perform daily activities.
  • The need for rehabilitation, social support or other services.

4. Individual approach to the assessment:

  • Each case is considered separately.
  • The composition of the expert team is formed according to the diagnosis of the person.
  • If necessary, doctors of narrow specialization are involved.

This process provides a complete overview of a person's health status and functional needs, which allows us to make an objective decision and develop recommendations for further support.

Decision-making

The decision-making process of the expert team involves a clear and structured procedure aimed at ensuring objectivity, transparency and accuracy.

1. Case review

On the day of the case review, the expert team gets access to all the necessary information about the person to be evaluated. Doctors carefully study the documents and materials provided, including medical reports, examination results, and additional data.

2. Collegiality of decision-making

The decision of the expert team is made jointly by all its members. In the process of discussion, each doctor has an equal right to vote, which ensures collegiality and consideration of the opinion of each specialist. If the votes are equally distributed, the final decision is made by the presiding physician whose specialty corresponds to the case profile.

3. Formation and signing of the protocol

All the results of the assessment, including conclusions and decisions made, are recorded in the protocol of the expert team's review. The document is signed by each team member using an electronic signature, which gives the protocol official status and legal force.

4. Appointment of additional examinations

The expert team may prescribe additional medical examinations to clarify the person's health status. For this purpose, the presiding physician forms an electronic referral in the electronic healthcare system.

A person may be referred for additional examinations only once. The exception is when the results of such an examination reveal new conditions, diagnoses or disorders of the body's structure and functions that were not indicated in the medical documentation attached to the referral.

Types of decisions made

The expert team makes decisions according to the needs of the person. The main ones include:

Establishment or non-establishment of disability, determination of its cause, time of onset and duration.

Extension of temporary disability.

Determining the degree of loss of professional ability to work (in percentage terms).

Determining the need for special means of transportation(car, electric scooter) and contraindications to their use.

Determination of the scope and types of auxiliary means of rehabilitation: technical rehabilitation equipment and medical devices.

Establishment of a causal link between death and an occupational disease in order to provide payments and benefits to the family members of the deceased (if necessary).

Recommendations that are part of the individual rehabilitation program for a person with a disability (IRP):

Medical component: rehabilitation in the field of healthcare, provision of auxiliary rehabilitation equipment, medical devices, sanatorium and resort treatment.

Social component: social and household rehabilitation, applying to authorized bodies for social services, state aid or pensions.

Labor component: workplace arrangement, vocational rehabilitation, retraining or career guidance.

Educational component: psychological and pedagogical rehabilitation, referral to inclusive resource centers for a comprehensive developmental assessment.

The expert team is obliged to make a decision within 30 calendar days from the moment the case is included in the queue. If a person is referred for an additional examination, the 30-day review period starts from the date of completion of this examination.


Receiving a decision

The decision is entered into the electronic system for assessing the person's daily functioning, and the patient can receive it in a convenient way:

  • Immediately during the assessment.
  • By e-mail specified during the submission of documents or by letter.

After the decision of the expert team is made, the implementation of its recommendations and the provided support measures begins.


Appealing the decision

In case of disagreement with the decision of the expert team, the patient has the right to appeal it. A clear mechanism is provided for this purpose. A complaint can be filed with the Center for the Assessment of the Functional Status of a Person at the following address: 1-A Feodosii Makarevskyi Lane, Dnipro, 49005, Ukraine. Read more about the appeal by the Evaluation Center.

The deadline for filing an appeal is 40 calendar days from the date of sending an extract from the decision to the complainant (his/her authorized representative).

Possible situations and algorithms for their resolution

1. The patient did not appear for the assessment

If the patient does not appear for an in-person or remote assessment, it is necessary to clarify the reason for the absence (by contacting the patient or his/her representative). In case of valid reasons, the assessment may be rescheduled.

2. Force majeure circumstances

Force majeure circumstances are situations that make it impossible to conduct the evaluation due to extraordinary and insurmountable force (e.g., shelling, etc.). In such cases:

The schedule of meetings of expert teams is updated, and the queue for consideration of cases is adjusted according to the circumstances.

3. Conflict of interest

A conflict of interest occurs when a doctor's public duties conflict with his/her private interests.

What is not a conflict of interest:

  • If the doctor has consulted the patient in the past and was not the patient's attending physician.
  • If the doctor had the status of a treating physician, but did not participate in the diagnosis with which the patient came for evaluation.

If a conflict of interest is detected, the doctor is obliged to notify the administrator, and his or her participation in the case is terminated. More details can be found in the NACP's explanations.

4. Expressing disagreement when signing the protocol

The members of the expert team may leave a comment in the protocol if they disagree with the decision.

The decision of the expert team is a key step in providing medical, social and rehabilitation support aimed at improving the quality of life of a person and his/her adaptation in society.

Ігор Льов

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