Reform of Medical and Social Expert Commissions (MSECs): Transition to a Modern System of Assessment of Functioning of Persons with Disabilities

Background information: The Medical-Social Expert Commissions (MSEC) system was introduced in 1992 as a replacement for the Soviet-era disability assessment framework. While it sought to modernise the approach to disability status, over the decades, it became increasingly outdated and overly bureaucratic:

• Patients faced significant barriers to accessing necessary assessments, with a process heavily reliant on excessive paperwork, in-person visits, and prolonged waiting times.
• The rigid structure of MSECs, the lack of interdisciplinary expertise, and limited digitalisation further exacerbated inefficiencies, leading to delays in disability recognition and access to the support.
• Recognising these challenges, the Ukrainian government initiated a comprehensive reform to transition from MSECs to a more modern, patient-centred system, based on functionality assessment, aligning it with international standards and reducing bureaucratic obstacles.

As of September 2023, the Ministry of Social Policy reported that the number of persons with certified disabilities had increased to 7.4% of the population, equating to approximately 3 million individuals.

• This marks an increase of 300,000 persons over 18 months.
• It's important to note that actual numbers may be higher, potentially aligning with the international disability prevalence rate of 16%, as estimated by the World Health Organization¹.

Recent developments: On 1 January 2025, Law №4170-IX came into force, replacing MSECs with Expert Teams for Functionality Assessment (Expert Teams). The reform modernises Ukraine’s approach to disability² assessment by shifting from a rigid, bureaucratic system to a more flexible, patient-centred model, focusing on everyday functionality of the person rather than on limitations to labour capacity. The below overview includes key accompanying legislative changes within the reform:

• Decree №1317 – was terminated, used to regulate the previous legal framework for MSECs.

1 “Ukraine Human Development Update: Disability and Inclusion”, World Bank.

https://documents1.worldbank.org/curated/en/099032824073057091/pdf/P1812361d6feb006c1a506192390987152a.pdf?utm_source=ch atgpt.com

2 Disability statuses affected by the reform: general disability, disability due to war, disability due to explosive ordinances, disability due to consequences of ATO, disability due to consequences of Revolution of Dignity, disability due to WW2, disability due to Covid, disability due to consequences of radiation hazard from Chornobyl, disability due to orphan diseases, disability due to industrial accidents or occupational diseases and those related to labour duties. (Procedures for disabilities from childhood and children with disabilities remain intact and are planned to be included into the reform at later stages.)

• Decree №1338 – established the new system of Expert Teams for Functionality Assessment.
• Order of the Ministry of Health №2022 – appointed the Centre for Functionality Assessment as the primary institution overseeing the new system.
• Decree №306 – remained in force, retaining provisions on the causal linkage of disability and injuries resulting from war or hostilities.
• Order of the Ministry of Veterans Affairs №184 remained in force, maintaining the Interagency Commission responsible for determining the linkage of injuries to war and hostilities.
• International Classification of Diseases, Tenth Revision (ICD-10) – was integrated in the national legal framework to ensure compliance with the global standards and guidelines.

As of January 2025, 1.5 million cases, including archived assessments, have been transferred from MSECs to Expert Teams, with over 44,000 cases scheduled for review in the first quarter of 2025.

• The system currently has 32,000 active users (implementing staff, not including patients), 1,500 Expert Teams consisting of 6,200 specialists across 293 healthcare facilities, supported by 800 administrators³.

For the further implementation of the reform, relevant ministries must:

• By mid-2025, develop and submit legislative proposals, defining the gradation of functional impairments and necessary support in their respective sectors (Ministry of Social Policy – in everyday life, Ministry of Economy – in labour, Ministry of Education – in education, etc.).
• Ensure the integration of the International Classification of Functioning, Disability, and Health (ICF) into sectoral standards and procedures.
• Ministry of Health by the end of the 2^nd quarter of 2025 will develop objective criteria, manuals and guidelines for functionality assessment procedures.

³ Ministry of Health Data Dashboard. https://moz.gov.ua/uk/ekopfo

⁴ Enables interagency state access to patient’s information, ensuring actionless data transition for patients who request any types of social support and assistances, while also providing enhanced fraud protection and authorization means, as all actions and changes are recorded within the system.

5 Applications from abroad are still possible with procedures varying, based on signed Interstate Social Protection Treaties or general procedures in case of their absence.

6 All documents issued by MSEC before the reform remain valid until the designated terms for reassessment, meaning all provided aid remains in force. If the certificate is lost, patients should apply to Pension Fund for documents recovery.

This Legal Alert is produced thanks to the financial support of the German Federal Foreign Office.

Some of the terminology used in this issue of the Legal Alert was taken from draft laws or current legislation. The contents of this Legal Alert are the sole responsibility of the author/authors. The views expressed herein should not be taken, in any way, to reflect the official opinion of the German Federal Foreign Office or the Danish Refugee Council (DRC). Neither the German Federal Foreign Office nor DRC is responsible for any use that may be made of the information it contains.

7 Reassessment is the process of re-evaluating a person's disability status or functional limitations to determine whether their condition has changed and if adjustments to their status, support, or rehabilitation plan are necessary. It ensures that individuals receive appropriate assistance based on their current medical and functional state.