The new services benefiting the uninsured from July 1

The National Health Insurance House announced that from Monday, July 1, uninsured people will benefit from various services. We want to detect serious diseases, such as cancer, hepatitis B and C, and HIV/AIDS in pregnant women.

Here are the services you can benefit from if you are not insured. Photo: shutterstock (Archive)

The main novelty of the amendments and additions to the Framework Contract (1) that will enter into force from July 1 this year will consist in the introduction of service packages that insured and uninsured people can benefit from, on the main levels of medical assistance, in order to detect some serious conditions, namely cancer, chronic hepatitis B and C, and HIV/AIDS in pregnant women. So:

In primary health care it is provided that family doctors to be able to send uninsured people to analyzes and specialist consultations settled by the health insurance company, if they suspect that the patient in question may have an oncological disease.

Family doctors will also be able to issue referral tickets for uninsured people, in order to test them for the hepatitis B and C viruses, as well as for the HIV virus in pregnant women, the respective analyzes also to be settled by the CAS. Given the seriousness of these diseases, it is imperative to detect the cases of infection with the respective viruses as soon as possible, in order to take the necessary medical measures, and the people detected as infected will benefit from access to specific therapies.

Following the preventive consultations from the minimum package in the primary health care, family doctors will issue referral tickets for paraclinical investigations for uninsured people. it is stated in the press release of CNAS.

Other services benefiting uninsured people

Also, the uninsured will also benefit from services in ambulatory clinical specialty healthcare.

And in specialized ambulatory medical care services will be provided to uninsured persons for the detection and confirmation of the diagnosis of an oncological condition, respectively, consultations, diagnostic procedures and medical services for case-diagnosis purposes. Outpatient specialist doctors will also be able to issue referral tickets for tests and to health units with beds, for day hospitalizations, in order to confirm the oncological condition.

In order to widen the access of patients, both insured and uninsured, to the complex case-diagnosis services in the ambulatory, the condition imposed on providers who perform such services to have both a clinical specialty outpatient clinic and a hospital structure of day in that specialty. Exceptions are made by providers who contract types of services for which this condition is absolutely necessary, such as, for example, case-diagnostic services given to high-risk pregnant women.

At the same time, the possibility is created that some medical services for the purpose of case diagnosis can be provided by mobile medical units and medical caravans, in order to allow people from isolated areas access to services for the early detection of oncological conditions, such as breast and cervical cancer .

Correlated with the novelties of the service packages at the level of primary and specialized care in the clinical outpatient clinic, paraclinical service providers will be able to perform and settle the tests prescribed for uninsured people on the referral tickets issued by family doctors and specialist doctors, and hospital units will be able to settle the day hospitalization services granted to uninsured persons with suspicion of an oncological condition, to confirm the diagnosis.

We remind you that the legislation already provides for the possibility of including uninsured people in the national health programs after confirmation of the respective diagnosis, these people also being insured without paying the contribution, if they do not generate income”. it is also specified in the relevant communication.

Specialized psychological services for insured persons

Instead, in order to make the fight against cancer more efficient, new services will be introduced that will benefit the insured.

Since the state of mind of the patient is very important in the progress and success of oncological treatment, in order to make the fight against cancer more efficient, new services related to ambulatory medical care of clinical specialty are introduced, intended for insured persons. These will be specialized psychological services, provided by psychologists with complementary training in psycho-oncology: consultations, counselling, clinical assessment and establishing the psychological intervention plan. Psycho-oncological services can be recommended by doctors specialized or super-specialized in oncological surgery, medical oncology, hematology, pediatric oncology and hematology, radiotherapy, as well as by doctors who provide outpatient palliative care services. Until June 30, 2025, there will be a transition period in which psychological services can still be provided to cancer patients and by psychologists without complementary training in psycho-oncology.

Some of the changes concern the implementation of the measures falling under the CNAS in the National Plan to prevent and combat cancer in Romania, approved by Law no. 293/2022, with subsequent amendments and additions. In accordance with this plan, as of July 1 this year, the way of reporting and settlement of services provided to people with suspected oncology, but also to cancer patients, at the level of certain categories of medical service providers under contract with insurance companies will also change. health. The respective providers will keep separate records of the services provided to the mentioned persons, and the financing of these services will also be done separately, through additional documents to the existing contracts. In this way, not only will it be possible to highlight the funds used to detect and fight cancers, but there will also be a much clearer picture of all the services performed for this purpose.

For the oncological diagnostic services provided to uninsured persons, financing will not be made from the contributions paid by the insured, but from the state budget, through the budget of the Ministry of Health, through transfers to FNUASS. In the same way, the testing of uninsured people will be financed in order to detect chronic hepatitis B and C, as well as HIV infection in pregnant women”, announces CNAS.

“They will contribute substantially to the detection of serious conditions”

“For the implementation of the expected novelties in practice, in the period up to July 1 of this year, changes and additions to some normative acts subsequent to the framework contract will be published:

  • to the methodological rules for the application of the framework contract, in which all the announced measures will be detailed;
  • to the MS/CNAS orders regarding referral tickets for paraclinical investigations, respectively to clinical medical services/admission ticket and how to complete these documents – new forms for such tickets will be required, with headings appropriate to the changes foreseen in the Contract- framework;
  • to the CNAS Order regarding the supporting documents regarding the reporting of the activity carried out by providers of medical services and medicines;
  • to the MS/CNAS Order regarding the registration and statistical reporting of patients who receive medical services under continuous hospitalization and day hospitalization.
  • At the same time, the current values ​​of the points for primary and specialized outpatient medicine, as well as the reference ceiling for dental medical assistance, will be maintained in the third quarter of the current year.” CNAS also transmitted.

We are convinced that the novelties of the Framework Contract will contribute substantially to the detection of serious conditions in their early stages, when the chances of them being treated and the patient continuing his normal life are much higher. These novelties were submitted to public debate in decision-making transparency and were the subject of a series of meetings of the CNAS management with partners in the medical system provided for by Law no. 95/2006, and some provisions were reformulated taking into account the proposals received“, stated Valeria Herdea, president of CNAS.