NHIF to also audit hospitals regarding staff salaries

The NHIF is to also audit hospitals regarding staff salaries. This is proposed in a draft bill to amend and supplement the Health Insurance Act, published by the Ministry of Health for public consultation. These changes are being made in connection with the implementation of the National Recovery and Resilience Plan.

The project “Increasing the Attractiveness of Health Professions and Promoting a More Balanced Distribution of Health Specialists Across the Country” requires an amendment to the Health Insurance Act to include the professional organization of nurses, midwives, and related health professionals in the regular negotiation process with the NHIF.

A provision is being established whereby, during negotiations regarding activities performed by healthcare professionals, the Bulgarian Medical Association (BMA) shall invite representatives of the Bulgarian Association of Health Professionals in Nursing (BAHPN) to participate. According to the Ministry of Health, this will fulfill the requirements of the Recovery and Resilience Plan. Legal regulations will also be created to ensure that the BAHPN’s opinion is heard during the negotiation process for the National Framework Agreement.

In connection with the control activities carried out by the NHIF, an explicit legal basis is being established:

Audits by the Fund are to be carried out in coordination with other competent institutions.

The NHIF’s commitment is to coordinate simultaneous audits of the performance of individual contracts with medical care providers across various institutions. The Ministry of Health specifies that, in addition to the comprehensiveness of the audit, this will also reduce the administrative burden on the audited entities. Currently, control authorities exercise their powers for the same reasons sequentially, which hampers the operations of healthcare facilities.

Experts from the Bulgarian Pharmaceutical Union (BPU) may be present during audits conducted by the NHIF/RHIF. However, they must not have a contractual relationship with the audited retail medicinal product trader (pharmacy). According to the Ministry of Health, this is the way to achieve compliance and equality, analogous to the roles of the BMA and BDA in audits. The experts will provide written opinions, which will be an integral part of the audit report.

Control powers for the NHIF/RHIF are explicitly defined.

If the changes take effect, they will audit the documentation regarding the labor and social security relations of hospital employees. This is done to ensure compliance with an existing legal requirement: namely, that the basic salaries of medical specialists in these healthcare facilities are no less favorable than those provided for in the Collective Labor Agreement for the “Healthcare” sector.

Currently, there is a legal requirement to align the remuneration of medical specialists with the provisions of the Collective Labor Agreement. However, as stated in the explanatory memorandum to the bill, there is no specifically defined control power for the NHIF/RHIF in this area.

You can view the bill and its explanatory memorandum here.