Regulations

Tasks and functions of NHIF activities

7. The most important task of the National Health Insurance Fund is to implement compulsory health insurance in accordance with the procedure established by legal acts, to properly represent the interests of the insured and to implement the provisions of the program of the Government of the Republic of Lithuania in this field:

7.1. Ensures the payment of the costs of preventive medical care, medical assistance, medical rehabilitation, nursing, social services and services assigned to personal health care, as well as the provision of personal health examination services from the budget of the Compulsory Health Insurance Fund (CHIF) through territorial health insurance funds (THIF) on the grounds and under the conditions established by the Law on Health Insurance;

7.1 1 . Pays the costs of renting medical devices (measures) necessary for the insured to ensure home health care on the grounds and under the conditions established by the Law on Health Insurance;

7.2. prepares and submits to the Ministry of Health the draft budget of the Compulsory Health Insurance Fund (its revision), forecasts indicators of the budget of the Compulsory Health Insurance Fund for the next two years and sets of annual budget execution and financial reports of the Compulsory Health Insurance Fund under the conditions and terms established by the Law on Health Insurance and other legal acts;

7.3. Manages the Register of Persons insured with compulsory health insurance in accordance with the procedure established by the Law on Health Insurance, the Law on Management of State Information Resources, the Law on Patients' Rights and Compensation for Health Damage, the regulations of the Register of persons insured with compulsory health insurance and other legal acts.

7.4. implements the budget of the Compulsory Health Insurance Fund;

7.5. disposes of the funds of the budget of the Compulsory Health Insurance Fund;

7.6. in coordination with the Ministry of Health, forms a reserve from the budget of the Compulsory Health Insurance Fund and uses it in accordance with the procedure established by the Government;

7.7. invests temporarily free funds of the Compulsory Health Insurance Fund in accordance with the procedure established by the Law on Health Insurance;

7.8. establishes territorial health insurance funds after harmonizing the number of territorial health insurance funds and their territorial activity zones with the Ministry of Health; approves their regulations and supervises their activities;

7.9. performs audits of territorial health insurance funds or, in accordance with the procedure established by legal acts, enters into agreements with audit companies regarding the audit of territorial health insurance funds;

7.10. reimburses the costs of reimbursable medicines and medical aids in accordance with the procedure established by the Ministry of Health;

7.11. reimburses the costs of prosthetics of limbs, joints and organs, acquisition of prostheses and centrally paid medicines and medical aids in accordance with the procedure established by the Ministry of Health;

7.12. pays the costs of personal health care services in accordance with the procedure established by the Ministry of Health;

7.13. organizes and implements the process of pricing personal health care services, calculates the basic prices of personal health care services paid from the budget of the Compulsory Health Insurance Fund and, with the approval of the Compulsory Health Insurance Council, submits them to the Minister of Health for approval;

7.14. in coordination with the Ministry of Health, envisages the development directions and long-term strategy of compulsory health insurance;

7.15. prepares and submits to the Ministry of Health for approval the strategic activity plans (programs) of the State Health Insurance Fund, revises them, implements them and submits reports on their implementation;

7.16. establishes indicators of the functioning of the compulsory health insurance system and monitors this system in accordance with them;

7.17. Performs the managers functions in the compensated and non-compensated medical products and compensated medical help measure price declaration and price-list conclusion information system „iDrug“, in relation to the medical drugs and compensated medical help measures price declaration and pricing conclusion;

7.18. in accordance with the procedure established by legal acts, provides an opinion on the issues of Compulsory Health Insurance;

7.19. manages, uses and disposes of property transferred by the state or municipalities without violating the rights and interests of laws and other persons;

7.19 1 . performs the functions of the Advance patient registration information system manager in accordance with its competence;

7.20. performs other functions assigned to it.
Source of information: Minister of Health of the Republic of Lithuania, 2003 January 23 order no. V-35 “On Approval of the Regulations of the State Health Insurance Fund under the Ministry of Health”.

Purpose and functions of the THIF

11. The purpose of the THIF is to guarantee, through the disposal of the part of the budget of the Compulsory Health Insurance Fund transferred to it by the National Health Insurance Fund, the provision of health care services to persons with compulsory health insurance (hereinafter - insured), the cost of purchasing medicines and medical aids, reimbursement of the costs of the purchase of prostheses of limbs, joints and organs and the cost of prosthetics services, the costs of services provided and the purchase of medicines and medical aids issued, as well as the compensation of rental of medical equipment necessary for insured persons to receive home care.

12. In order to achieve its operational goal, the THIF performs the following functions:

12.1. According to the order established in the Civil Code and the Ministry of Health, concludes contracts with health care institutions, pharmacies and health insurance and entities, mentioned in article 262 of the Law, at the authorization of the National Health Insurance Fund with entities mentioned in article 262 of the Law,  compensate in due time and per order specified in such contracts the costs for health care services provided to the people insured by the compulsory health insurance (hereinafter - insured), as well as the costs of issued medicines and medical assistance measures, as well as costs of rental for medical measures, which are needed to ensure the patient's healthcare at home.

12.2. In accordance with the procedure established by the Law on Health Insurance, reimburse the insured for the costs of purchasing medicines and medical aids, the costs of medical rehabilitation and sanatorium treatment, the costs of acquiring prostheses of limbs, joints and organs and the costs of prosthetics services;

12.3. maintains the Register of Persons insured with compulsory health insurance;

12.4. finances municipal health programs;

12.5. analyses and evaluates data on the health status of the population of county municipalities and trends in the demographic structure of the population;

12.6. controls the quantity, quality and compliance of personal health care services paid for from the budget of the Compulsory Health Insurance Fund in its area of activity, the legality of prescribing and dispensing medicines and medical aids, as well as the issues related to the provision of these services, the activities of health care institutions, pharmacies and economic entities referred to in Article 26 2 of the Law on Health Insurance;

12.7. informs the institution, its founder, the National Health Insurance Fund, and, if necessary, other institutions about the violations established during the control, demand liability and elimination of the violations from the offender;

12.8. checks whether the accounts of health care institutions, pharmacies and economic operators referred to in Article 26 2 of the Law on Health Insurance, and, if authorized by the National  Health Insurance Fund , the undertakings referred to in Article 26 1 of the Health Insurance Fund, as well as related accounting and other documents related to it;

12.9. Controls the availability and adequacy of personal health care services provided to the insured in accordance with the procedure and conditions established by the Ministry of Health;

12.10. in accordance with the Civil Code and other legal acts and agreements, recovers damages caused to the Compulsory Health Insurance Fund from health care institutions, pharmacies, economic entities referred to in Article 26 2 of the Law on Health Insurance, and when authorized by the National Health Insurance Fund recovers from undertakings referred to in Article 26 1 of the Law on Health Insurance and imposes penalties;

12.11. performs financial and economic analysis of the trends in the use of budget funds of the Compulsory Health Insurance Fund and the structure, availability and quality of health care services in its area of activity;

12.12. publishes information on its activities, notifies the insured about the provided personal health care services, the procedure and conditions for the provision thereof;

12.13. protects rights and legitimate interests in courts and other state institutions in accordance with the procedure established by legal acts;

12.14. perform functions and one-time assignments not provided for in these Regulations, but assigned by the National Health Insurance Fund;

12.15. performs other functions established by laws, these regulations and other legal acts.
Source of information: 30 April 2021 Director of the National Health Insurance Fund under the Ministry of Health Order no. 1K-141 “On Approval of the Regulations of Territorial Health Insurance Funds”.