Draft bill #12178 of November 4, 2024 

Status: sent for review to the Committee on National Health, Medical Care, and Health Insurance of the Verkhovna Rada 

Cosponsors: Cabinet of Ministers of Ukraine 

Who is affected: people with disabilities, doctors, rehabilitation specialists, Ministry of Health, Pension Fund, National Agency on Corruption Prevention, medical social expertise commissions (МSECs), Ministry of Social Policy, and Ministry of Digital Transformation 

Summary: 

Assessment of the daily functioning of a person 

  • replaces the system of medical social expertise (МSEC) with an assessment of the daily functioning of a person (hereinafter — assessment) 
  • assessment will be conducted to determine if there are impairments in the functioning of a person’s body that complicate their daily life 
  • the assessment will be a part of the medical examination. It will be conducted for individuals who have illnesses or conditions that meet the criteria qualifying them to undergo such a procedure 
  • a referral for assessment will be issued by a physician of primary or specialized care or the head of a military medical commission. This will be done with the patient’s consent registered via the electronic healthcare system 
  • the assessment process will involve determining the extent of impairment of a person’s physical, mental, intellectual, and sensory functions. Special methods and criteria approved by the Ministry of Health will be used 
  • results of the assessment will be submitted to the electronic healthcare system (who and when will do this will be determined additionally by the Cabinet of Ministers) 
  • a person will have the right to appeal against the result of the assessment 
  • in case when a disability is confirmed, the assessment results will be formulated taking into account the requirements for creating an individual rehabilitation plan
  • depending on the list of reasons that will be additionally approved by the Cabinet of Ministers, the assessment or its separate stages will be conducted in several ways: 
    • with mandatory physical participation (in person) 
    • in absentia (remotely) 
    • via video call (telemedicine) 
    • at the location or facility where the person is treatment 
  • it will be allowed to record the assessment process on audio or video — upon request by the individual or their legal representative. It will not be allowed to disclose these recordings without the written consent of the patient. The retention period for recordings will be at least 10 years. It will be possible to use the recordings as evidence if a decision based on the assessment results is contested 
  • assessments will be conducted by expert teams formed in cluster and supercluster healthcare institutions (i.e., those operating at the level of communities or higher). 

Expert teams 

  • for each case, an expert team of doctors and rehabilitation specialists with expertise relevant to the required assessment will be formed. Specialists will be selected via the electronic healthcare system 
  • the team may include doctors and rehabilitation specialists who: 
    • meet the unified qualification requirements set by the Ministry of Health 
    • practice medicine or provide rehabilitation assistance within the healthcare system 
    • have their information published on the official website of the hospital, confirming their right to work in expert teams 
    • medical specialists will not be allowed to be members of expert teams and conduct assessments if they: 
    • have held positions as heads of МSECs 
    • are listed in the Unified State Register of Individuals Who Committed Corruption or Corruption-Related Offenses ʼhave a criminal record for any intentional criminal offense, regardless of whether such a conviction has been expunged or canceled 
  • if an expert team establishes disability and/or a degree of loss of professional capacity, it will be obligated to inform the territorial office of the Pension Fund about this fact. 

Medical conclusion on temporary disability 

  • a medical conclusion on temporary disability will be issued in cases of: 
    • illness or injury 
    • pregnancy or childbirth 
    • rehabilitation 
    • prosthetics 
    • the need for temporary care of a sick family member or child 
    • quarantine 
    • sanatorium or resort treatment 
    • the need to temporarily transfer an employee to another job due to illness 
  • the medical conclusion on temporary disability will be valid for the duration of the person’s condition. 

Rehabilitation 

  • rules will be established for creating an individual rehabilitation plan for people with disabilities, which will include four sections: 
    • results of the daily functioning assessment 
    • social services provision plan 
    • individual educational pathway 
    • employment plan. 

What is right: 

  • the process of assessing a person’s daily functioning is aimed at determining their abilities considering not only limitations but also capabilities. This aligns with the assessment standards of the international classification of functioning 
  • cluster and supercluster hospitals, where expert teams will be formed, are multidisciplinary establishments that have various specialists and are connected to the electronic healthcare system. Recordings stored in the electronic system will allow for better tracking of decisions concerning the establishment of the disability status 
  • doctors who have been heads of МSECs or have been criminally prosecuted or suspected of corruption will not be allowed to participate in expert teams 
  • individual rehabilitation systems will help to identify what assistance a person needs for better adaptation in life, education, work, and daily activities 
  • cases when the assessment can be conducted remotely will be defined in the law 
  • the option to record commission meetings will allow to appeal against actions or inaction of expert team members 
  • the option to involve a lawyer or other legal representative in the assessment is provisioned. 

What is wrong: changes in the composition of a commission, its name, or even the introduction of the electronic healthcare system do not resolve the corruption problem: both patients and commission members can still be interested in bribes for a fabricated diagnosis or falsification of results. Even patients with valid reasons for obtaining status are now forced to pay for “promoting” their group or delaying reassessment (sometimes even for obtaining the disability status they are legally entitled to). Simple replacement of МSECs with new commissions will not make the situation with under-the-table payments to doctors and the submission of false data into the electronic system better than it is now. 

Alternative solution: 

  • to digitalize the submission process as the primary tool for processing and recording medical data concerning disabilities that will include a system for preventing and detecting suspicious appeals and conclusions 
  • to distribute functions among various state bodies or delegate part of the powers to independent experts, which will reduce the risk of power abuse. The reform of the MSECs should be gradual and balanced, include reevaluation and retraining of employees. Otherwise, there is always a risk that the old institution will be recreated under a new name. 

How to help the legislator: proposals concerning the draft bill can be sent to the Committee on National Health, Medical Care, and Health Insurance of the Verkhovna Rada. 

Background information: on October 22, 2024, a presidential decree came into effect, enacting the decision by the National Security and Defense Council to combat corruption and other violations related to the designation of disability status. The President ordered to dissolve МSECs by January 1, 2025. 

Additional information: 

  • explainer by Iryna Korzhenkova: Why is it not so simple to eliminate the medical social expertise commissions and was the NSDC’s decision necessary to do that? A lawyer’s explanation 
  • Ok, So What? podcast: MSECs will disappear, but that’s not certain