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ORDER NO.1011

Steps needed to obtain funds for undergoing treatment abroad, on the basis of Order No. 50 of 2004, modified by Order No. 1011 of June 2011 (for medical services that are not reimbursed by the National Health Insurance Fund).

 tutorial

Pasii parcursi de un dosar prin Ordinul 50/2004 modificat cu Ordinul 1011/2011 – Steps undergone by a file according to Order No. 50 of 2004, modified by Order No. 1011 of June 2011

Medicul curant: Raport medical tratament strainatate – Attending physician: Medical report for treatment abroad

Pacientul depune un dosar – The patient submits a file

Directia Sanitara – Nr. inregistrare dosar – Public Health Authority – File registration no.

Transmitere dosar pentru: – The file is sent for:

examinare pacient – examining the patient

recomandare clinici – recommending clinics

2 zile de la inregistrare – 2 days since registration

Comisia de specialitate: Recomandare clinici – Specialty commission: Clinic recommendation

Obtinere Oferte pret clinici strainatate – Obtaining price offers from foreign clinics

DSP sau Pacient – Public Health Authority (PHA) or Patient

Trimitere dosar – File submission

Maxim: 21 zile de la inregistrare – Maximum: 21 days since registration

Ministerul Sanatatii: Aprobarea fondurilor – Ministry of Health: Approval of funds

Maxim: 20 de zile de la primire dosar – Maximum: 20 days since receiving the file

Instiintare – Notification

Directia Sanitara: – Public Health Authority

transfer fonduri – funds transfer

corespondenta clinica strainatate – foreign clinical correspondence

The patient

(alternatively, one of their relatives – up to the 4th degree – or their legal representative):

1. will request a medical referral letter or a medical report from the attending physician, clearly stating that the treatment/transplant needed by the patient cannot be done in Romania (including the reasons, e.g. there is no donor bank, the technique necessary is not available in Romania, etc.) and recommending the patient to undergo the treatment/transplant in a clinic abroad.
 
CAUTION
: The medical referral letter/report must include the signature of the attending physician and the stamp of the healthcare facility where the patient was treated.

2. will submit the following documents to the local Public Health District Authority, in order to have the medical file needed to obtain funding drawn up:
– an application for sending the patient abroad for treatment
– the medical referral letter (as an original) from the attending consultant physician, regarding the undergoing of the treatment abroad
– the discharge summary

– blood or other medical tests
– a copy of the patient’s ID card
– a copy of the medical record, clearly stating the diagnosis

CAUTION: The file will receive a registration number from the Public Health Authority; using this number, the patient will be able to request information regarding the status of the file. (Order No. 1011 of 2011, Art. 2; Par. 2)
 
3. will meet the Territorial commission for medical evaluation, after the file has been sent by the Public Health Authority (the file will be sent within 2 weekdays from its submission date)

4. if the Territorial commission approves the medical file for treatment abroad, the patient (their relative/legal representative) can (after having established this in writing with the Public Health Authority) correspond directly with the foreign clinics recommended by the Commission (Order No. 1011 of 2011, Art. 3; Par. 4)

5. the correspondence (consisting of the official documents, with the header and signature of the clinic, as an original, faxed copy or scanned e-mailed, as should be the case) will be sent to the Public Health District Authority within a maximum of 7 weekdays (from the date of the treatment/transplant agreement received by the Territorial commission) and will include at least the following details:
– The name of the clinic
– Its address
– The main contact
– The clinic’s phone number, fax and e-mail address
– The clinic’s bank account number
– The name of the patient
– The diagnosis
– The cost of the patient’s medical evaluation
– The cost of the therapeutic procedure applied
– The cost of the patient’s post-treatment hospitalization
– The cost of one day of hospitalization

– The total costs
– The conditions for paying for the treatment
– The date for which the patient has been scheduled to be admitted in the hospital for treatment/transplant (Order No. 1011 of 2011, Art. 3; Par. 4, Par. 5 and Par. 6)

6. In the case of medical emergencies, based on the recommendations of the local Specialty commissions and on the approval received from the commission within the Ministry of Health, the patient can be treated abroad on their own expense, and, within 3 days from returning to the country, will request the Public Health Authority to reimburse their expenses for covering the costs of the treatment/transplant, hospitalization and transport, based on justificative documents.
CAUTION: a retroactive reimbursement is only possible if an advance approval exists.

7. Upon returning to the country, the patient (their relative/legal representative) is required to present the justificative documents for the treatment/transplant expenses to the Public Health District Authority, within 3 days from returning

8. The patient is required to see the attending physician that recommended undergoing treatment abroad within 14 workdays from returning to the country or at every appointment. (Order No. 1011 of 2011, Art. 12; Par. 1)

9. In case the patient deceases, their family is required to notify the Public Health District Authority within 7 days, so as to draw up the expense reimbursement.

 

State administrations:

1. The Public Health District Authority is required to send the patient’s file to the territorial Specialty commission, in a maximum of 2 weekdays from the date on which all the documents were submitted by the patient. (Order No.1011 of 2011, Art. 3; Par. 3)

2. The Territorial commission will examine the patient and decide if sending him/her abroad for treatment is appropriate
a. The Specialty commission will communicate their decision in writing to the Public Health District Authority, in
 a maximum of 7 weekdays from the examination of the patient. (Order No. 1011 of 2011, Art. 4; Par. 3)
– If the Specialty commission decides that the patient needs to be sent abroad for treatment, they will communicate their decision to the Public Health District Authority within
 one weekday since the examination of the case was completed. (Order No. 1011 of 2011, Art. 4; Par. 2)
– If the case is rejected, the Territorial commission will communicate the decision to the Public Health District Authority, which will notify the patient within 
2 weekdays, recommending treatment within a Romanian hospital (Order No. 1011 of 2011, Art. 4; Par. 4)
b. The Specialty commission establishes the clinics that are to be contacted in order to obtain price offers

3. The correspondence with the clinics recommended by the Territorial commission will be managed:
a. by the Public Health District Authority, or
b. following a written agreement, by the patient (their relative/legal representative)

The correspondence with said clinics will regard obtaining:
– an appointment for the treatment/transplant necessary
– the cost
– the payment conditions for the treatment/transplant
If after
 7 weekdays none of the clinics has answered the request or the answers were negative, the Public Health District Authority will notify the Territorial specialty commission within a maximum of 2 weekdays from getting the response, and the commission will nominate other clinics. (Order No. 1011 of 2011, Art. 3; Par. 4, Par. 7)
 
4. The Public Health District Authority will send the file to the General Medical Assistance Authority within the Ministry of Health, based on its emergency level, in a maximum of 24 hours since receiving the price offers from the clinics. (Order No. 1011 of 2011, Art. 4; Par. 5) The file will include answers from at least two of the recommended clinics and proofs of having initiated correspondence with all the clinics recommended by the Territorial specialty commission.

a. Cases representing medical emergencies or with an increased (major) vital risk will be sent to the Ministry of Health within 7 weekdays from the day when the Public Health District Authority received the proceeding regarding the clinics from the Territorial commission. (Order No. 1011 of 2011, Art. 3; Par. 8)
b. Cases that are not registered as representing medical emergencies of increased (major) vital risk by the territorial specialty commission will be sent to the Ministry of Health within
 10 weekdays from the date when the Public Health District Authority received the proceeding nominating the clinics from the Territorial commission (Order No. 1011 of 2011, Art. 3; Par. 9)

CAUTION: The file will receive an entry number from the Ministry of Health; the patient should ask for said number and know it, in order to be able to request details on the status of their file.
 
5. The Public Health Authority is required to inform the Ministry of Health if there are any dysfunctions that delay the process of drawing up the file by more than 22 weekdays, and the Ministry of Health is to intervene in a maximum of 2 weekdays from registering the notification. (Order No. 1011 of 2011, Art. 4; Par. 9)
 
6. The decision of sending the patient abroad for treatment is adopted after the file has been examined by a commission of the Ministry of Health. The commission must make a decision and communicate it to the Public Health Authority within a maximum of 20 weekdays from the date when the file was registered at the Ministry of Health.

7. If the funding requests exceed the monthly funds allotted by the Ministry of Health, the priority criteria are:
– the vital risk linked to the evolution of the disease
– the estimated benefits to the patient (Order No. 1011 of 2011, Art. 5; Par. 5)

8. After the file has been approved by the commission of the Ministry of Health, the file will be forwarded, if necessary, to the Ministry of Labor, if said ministry is to handle part of the expenses, or directly to the Government, in order for the Government Resolution to be released.

9. The Government Resolution will be published in the Official Gazette, and the Ministry of Health will send a notification to the Public Health District Authority, which will pay the selected clinic.

10. The transport expenses for people accompanying the patients are only reimbursed for minors aged 0-6 years old. (Order No. 1011 of 2011, Art. 4; Par. 8)