Child Disability Order 1024 in April. The Ministry of Labor “overestimated” the disabled: experts on new criteria for disability

After monitoring the application of the classifications and criteria used in the implementation medical and social expertise citizens by federal state institutions of medical and social expertise, approved. Order of the Ministry of Labor and social protection Russian Federation dated September 29, 2014 No. 664n, in fact, after a year of application, the Order of the Ministry of Labor and Social Protection of the Russian Federation No. 1024n dated December 17, 2015 approved new classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination .
On February 2, the Order of the Ministry of Labor and Social Protection of the Russian Federation dated December 17, 2015 No. 1024n “On the classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination” (Order No. 1024n) came into force.
A change in the approach to determining disability has led to the fact that during the re-examination, not all citizens with disabilities remained in this status. At the same time, the subjective factor was not excluded during the medical and social examination and the establishment of disability. It turned out that many seriously ill citizens, most of whom were children, were not recognized as disabled and did not receive appropriate treatment and rehabilitation opportunities.
The main purpose of issuing Order No. 1024n was to specify approaches to assessing the severity of impaired body functions and criteria for establishing disability, including for children, to clarify the wording of impaired functions, which should have eliminated their unequal interpretation in different regions and further objectified approaches to medical treatment. social expertise.
Order No. 1024n included such diseases and defects that occur in children, such as insulin-dependent diabetes mellitus, which occurs in childhood, cleft lip and palate (cleft lip and palate), phenylketonuria, bronchial asthma occurring in childhood.
The new Order No. 1024n defines the main types of persistent disorders of the functions of the human body caused by diseases, the consequences of injuries or defects, and the degree of their severity, as well as the main categories of human life and the severity of the limitations of these categories.
As in Order No. 664n, six main groups of types of persistent disorders of the functions of the human body have been identified: violations of mental functions; violations of language and speech functions; violations of sensory functions; disorders of neuromuscular, skeletal and movement-related functions; disorders of the cardiovascular, respiratory, digestive, endocrine systems and metabolism, blood system and immune system, urinary function, function of the skin and related systems; violations caused by physical external deformity.
The algorithm for estimating the severity of persistent impairments to the functions of the human body due to diseases, the consequences of injuries or defects has also been retained - as a percentage in the range from 10 to 100, with a step of 10%. There are still four degrees of severity of persistent violations of the functions of the human body - I degree - violations in the range from 10 to 30%, II degree - violations in the range from 40 to 60%, III degree - violations in the range from 70 to 80%, IV degree - violations in the range from 90 to 100%.
There is no fundamental difference in the establishment of disability groups. But, in Order No. 1024n there is no clear statement of the wording of the criteria that would be clear not only to an ITU specialist, but also to an ordinary citizen or doctor medical organization who referred the patient to ITU.
Suppose, according to paragraph 8 of Order No. 1024n, the criterion for establishing disability is a health disorder with II or more pronounced degree of persistent impairment of the functions of the human body (in the range from 40 to 100 percent), due to diseases, consequences of injuries or defects, leading to restriction 2 or 3 degrees of severity of one of the main categories of human life activity or 1 degree of severity of two or more categories of human life activity in their various combinations that determine the need for his social protection.
According to paragraph 9, the criteria for establishing disability groups are applied after the disability is established for a citizen in accordance with the criterion for establishing disability, provided for in paragraph 8 of this. And then specifically for disability groups, the categories of life activity corresponding to a particular disability group are not indicated.
So, in paragraph 10 it is stated: the criterion for establishing the first group of disability is a violation of human health with IV degree of severity of persistent violations of the functions of the human body (in the range from 90 to 100 percent), due to diseases, consequences of injuries or defects.
Clause 11 states: the criterion for establishing the second group of disability is a violation of human health with III degree of severity of persistent violations of body functions (in the range from 70 to 80 percent), due to diseases, consequences of injuries or defects.
Paragraph 12 states: the criterion for establishing the third group of disability is a violation of human health with II degree of severity of persistent violations of body functions (in the range from 40 to 60 percent), due to diseases, the consequences of injuries or defects.
In paragraph 13. The category "disabled child" is established if the child has II, III or IV degree of severity of persistent violations of body functions (in the range from 40 to 100 percent) caused by diseases, the consequences of injuries and defects.
That is, Order No. 664n clearly indicated the correspondence between the severity of persistent violations of the functions of the human body and the severity of restrictions on the categories of human life activity.
In Order No. 1024n there is no clear concept that the II degree of severity of persistent violations of body functions (in the range from 40 to 60 percent) can correspond to the 1st degree of severity of two or more categories of human life in their various combinations.
For example, when establishing the third disability group, persistent impairments of statodynamic functions of the II degree of severity (in the range from 40 to 60 percent) may correspond to the 1st degree of severity of the category of movement and self-service (or the 1st degree of severity of the category labor activity and movement), etc.
It would be clearer if the old criteria were left in Order No. 1024n, adding only a range of percentages.
For children, as well as in Order No. 664, and in Order No. 1024n, there is also no clear concept for establishing the category of a disabled child.
Thus, according to paragraph 13 of the new Order No. 1024n, the category "disabled child" is established if the child has II, III or IV degree of severity of persistent violations of body functions (in the range from 40 to 100 percent) caused by diseases, consequences of injuries and defects. From which it can be understood that a child, like an adult, should have a disability group.
Order No. 1024n, as well as Order No. 664n, includes the most common diseases. But, in Order No. 1024n, they indicated that “if the annex to these classifications and criteria does not provide for a quantitative assessment of the severity of persistent violations of a particular function of the human body due to diseases, the consequences of injuries or defects present in the person being examined, then the severity of persistent violations functions of the human body in percentage terms is established by the federal government agency medical and social expertise in accordance with paragraphs three - six of this paragraph based on the clinical and functional characteristics of diseases, the consequences of injuries or defects that caused the above violations, the nature and severity of complications, the stage, course and prognosis of the pathological process. That is, it still remains unclear where to get the clinical and functional characteristics of diseases that are not in the List. Probably, as before, from the generally accepted classifications of dysfunctions adopted in clinical practice, of which there are many. That is, it turns out - again a subjective approach.
Thus, on the one hand, the New Classifications and Criteria corrected many shortcomings of the previous classifications and criteria. On the other hand, there are many questions that require clarification on the part of higher organizations on the part of federal institutions of medical and social expertise.

On the classifications and criteria used in the implementation of the medical and social examination of citizens by federal state institutions of medical and social examination (as amended on 07/05/2016)

(Registered in the Ministry of Justice of Russia on January 20, 2016 N 40650)

In accordance with subparagraph 5.2.105 of the Regulations on the Ministry of Labor and Social Protection of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 19, 2012 N 610 (Collected Legislation of the Russian Federation, 2012, N 26, Art. 3528; 2013, N 22, 2809; N 36, item 4578; N 37, item 4703; N 45, item 5822; N 46, item 5952; 2014, N 21, item 2710; N 26, item 3577; N 29 , item 4160; N 32, item 4499; N 36, item 4868; 2015, N 2, item 491; N 6, item 963; N 16, item 2384), I order:

1. Approve the attached classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination.

2. Recognize invalid the order of the Ministry of Labor and Social Protection of the Russian Federation of September 29, 2014 N 664n On the classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination (registered by the Ministry of Justice of the Russian Federation on November 20, 2014 city, registration N 34792).

CLASSIFICATIONS AND CRITERIA USED IN THE IMPLEMENTATION OF MEDICAL AND SOCIAL EXAMINATION OF CITIZENS BY FEDERAL STATE INSTITUTIONS OF MEDICAL AND SOCIAL EXAMINATION

I. General provisions

1. Classifications used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination determine the main types of persistent disorders of the functions of the human body due to diseases, the consequences of injuries or defects, and the degree of their severity, as well as the main categories of human life and degree the severity of the limitations of these categories.
2. The criteria used in the implementation of the medical and social examination of citizens by federal state institutions of medical and social examination determine the grounds for establishing disability groups (the category of a disabled child).

II. Classifications of the main types of persistent disorders of the functions of the human body and the degree of their severity

3. The main types of persistent disorders of the functions of the human body include:

violations of mental functions (consciousness, orientation, intelligence, personality traits, volitional and incentive functions, attention, memory, psychomotor functions, emotions, perception, thinking, high-level cognitive functions, mental functions of speech, sequential complex movements);
violations of language and speech functions (oral (rhinolalia, dysarthria, stuttering, alalia, aphasia); written (dysgraphia, dyslexia), verbal and non-verbal speech; impaired voice formation);
violations of sensory functions (vision; hearing; smell; touch; tactile, pain, temperature, vibration and other types of sensitivity; vestibular function; pain);
disorders of neuromuscular, skeletal and movement-related (static-dynamic) functions (movements of the head, trunk, limbs, including bones, joints, muscles; statics, coordination of movements);
dysfunction of cardio-vascular system, respiratory system, digestive, endocrine systems and metabolism, blood and immune systems, urinary function, skin function and related systems;
violations caused by physical external deformity (deformities of the face, head, torso, limbs, leading to external deformity; abnormal openings of the digestive, urinary, respiratory tract; violation of body size).

4. The degree of severity of persistent violations of the functions of the human body due to diseases, the consequences of injuries or defects, is estimated as a percentage and is set in the range from 10 to 100, in increments of 10 percent.

There are 4 degrees of severity of persistent violations of the functions of the human body:

I degree - persistent minor violations of the functions of the human body due to diseases, consequences of injuries or defects, in the range from 10 to 30 percent;
II degree - persistent moderate violations of the functions of the human body due to diseases, consequences of injuries or defects, in the range from 40 to 60 percent;
III degree - persistent pronounced violations of the functions of the human body due to diseases, consequences of injuries or defects, in the range from 70 to 80 percent;
IV degree - persistent, significantly pronounced violations of the functions of the human body, caused by diseases, the consequences of injuries or defects, in the range from 90 to 100 percent.
The degree of severity of persistent violations of the functions of the human body, caused by diseases, consequences of injuries or defects, is established in accordance with the quantitative assessment system provided for in the appendix to these classifications and criteria.

Application

to classifications and criteria,

used in the implementation

medical and social expertise

citizens by federal state

medical and social institutions

examination, approved by order

Ministry of Labor and Social

protection of the Russian Federation

QUANTITATIVE SYSTEM FOR ASSESSING THE DEGREE OF EXPRESSION OF PERSISTENT FUNCTIONAL DISTURBANCES OF THE HUMAN BODY DUE TO DISEASES, CONSEQUENCES OF INJURIES OR DEFECTS (IN PERCENTAGE, WITH RESPECT TO THE CLINICAL AND FUNCTIONAL CHARACTERISTICS OF PERSISTENT FUNCTIONAL DISTURBANCES)

N p / p	Classes of diseases (according to ICD-10)	Blocks of diseases (according to ICD-10)	Names of diseases, injuries or defects and their consequences	Category ICD-10 (code)	Clinical and functional characteristics of persistent disorders of body functions caused by diseases, consequences of injuries or defects	Quantification (%)
...	...	...	...	...	...	...
3	Diseases of the digestive organs (class XI) and pathology affecting primarily the digestive organs presented in other classes of diseases			K00 - K93
Note to point 3. Quantification of the severity of persistent dysfunction digestive system of the human body, caused by diseases, consequences of injuries or defects, is based mainly on an assessment of the severity of digestive dysfunction (protein-energy insufficiency). Other factors of the pathological process are also taken into account: the form and severity of the course, the activity of the process, the presence and frequency of exacerbations, the prevalence of the pathological process, the inclusion of target organs, the need for immune suppression, the presence of complications.
3.8	Other diseases of the digestive system		K90 - K93
3.8.1		Malabsorption in the intestine.
		Celiac disease (gluten enteropathy, intestinal infantilism)
Note to subclause 3.8.1. A quantitative assessment of the severity of persistent disorders of the functions of the digestive and immune systems of the human body caused by celiac disease is based mainly on an assessment of the severity (severity) and frequency of diarrheal syndrome, weight and height indicators (within the 3rd centile or outside the 3rd centile), the level of intellectual development child, achieving compensation against the background of adherence to the agliadin diet.
3.8.1.1					Typical form without diarrheal syndrome, no nutritional decline or slight nutritional decline within 10-20% of target body weight (within 3 centiles), compensation achieved with agliadin diet	10 - 30
3.8.1.2					Hidden, subclinical form with a decline in nutrition (more than 30% of the required body weight); deficient states, impaired physical development (short stature)	40 - 60
3.8.1.3					Hidden, subclinical form with a decline in nutrition (more than 30% of the required body weight); deficient states, impaired physical development, progressive decline in intelligence with impaired mental development, the addition of a secondary infection	70 - 80
...	...	...	...	...	...	...

MINISTRY OF LABOR AND SOCIAL PROTECTION OF THE RUSSIAN FEDERATION

ORDER

ON CLASSIFICATIONS AND CRITERIA,

USED IN THE IMPLEMENTATION OF MEDICAL AND SOCIAL EXAMINATION

MEDICAL AND SOCIAL EXPERTISE

1. To approve the attached classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination.

2. Recognize invalid the order of the Ministry of Labor and Social Protection of the Russian Federation of September 29, 2014 N 664n "On the classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination" (registered by the Ministry of Justice of the Russian Federation 20 November 2014, registration N 34792).

M.A.TOPILIN

Approved

order of the Ministry of Labor

and social protection

Russian Federation

CLASSIFICATIONS AND CRITERIA,

USED IN THE IMPLEMENTATION OF MEDICAL AND SOCIAL EXAMINATION

CITIZENS BY FEDERAL STATE INSTITUTIONS

MEDICAL AND SOCIAL EXPERTISE

I. General provisions

2. The criteria used in the implementation of the medical and social examination of citizens by federal state institutions of medical and social examination determine the grounds for establishing disability groups (categories "disabled child").

II. Classifications of the main types of persistent disorders

functions of the human body and the degree of their severity

3. The main types of persistent disorders of the functions of the human body include:

violations of mental functions (consciousness, orientation, intelligence, personality traits, volitional and incentive functions, attention, memory, psychomotor functions, emotions, perception, thinking, high-level cognitive functions, mental functions of speech, sequential complex movements);

violations of language and speech functions (oral (rhinolalia, dysarthria, stuttering, alalia, aphasia); written (dysgraphia, dyslexia), verbal and non-verbal speech; impaired voice formation);

violations of sensory functions (vision; hearing; smell; touch; tactile, pain, temperature, vibration and other types of sensitivity; vestibular function; pain);

disorders of neuromuscular, skeletal and movement-related (static-dynamic) functions (movements of the head, trunk, limbs, including bones, joints, muscles; statics, coordination of movements);

dysfunctions of the cardiovascular system, respiratory system, digestive, endocrine systems and metabolism, blood and immune systems, urinary function, skin function and related systems;

violations caused by physical external deformity (deformities of the face, head, torso, limbs, leading to external deformity; abnormal openings of the digestive, urinary, respiratory tract; violation of body size).

There are 4 degrees of severity of persistent violations of the functions of the human body:

I degree - persistent minor violations of the functions of the human body due to diseases, consequences of injuries or defects, in the range from 10 to 30 percent;

II degree - persistent moderate violations of the functions of the human body due to diseases, consequences of injuries or defects, in the range from 40 to 60 percent;

III degree - persistent pronounced violations of the functions of the human body due to diseases, consequences of injuries or defects, in the range from 70 to 80 percent;

IV degree - persistent, significantly pronounced violations of the functions of the human body, caused by diseases, the consequences of injuries or defects, in the range from 90 to 100 percent.

The degree of severity of persistent violations of the functions of the human body, caused by diseases, consequences of injuries or defects, is established in accordance with the quantitative assessment system provided for in the appendix to these classifications and criteria.

If the annex to these classifications and criteria does not provide for a quantitative assessment of the severity of persistent violations of a particular function of the human body due to diseases, consequences of injuries or defects that the person being examined, then the severity of persistent violations of the functions of the human body in percentage terms is established by the federal state institution medical and social expertise in accordance with paragraphs three - six of this paragraph based on the clinical and functional characteristics of diseases, the consequences of injuries or defects that caused the above violations, the nature and severity of complications, the stage, course and prognosis of the pathological process.

In the presence of several persistent violations of the functions of the human body due to diseases, consequences of injuries or defects, the degree of severity of each of these violations in percentage is separately assessed and established. First, the maximum percentage violation of a particular function of the human body is established, after which the presence (absence) of the influence of all other persistent violations of the functions of the human body on the most pronounced violation of the function of the human body is determined. In the presence of this influence, the total assessment of the degree of dysfunction of the human body in percentage terms may be higher than the most pronounced violation of body functions, but not more than 10 percent.