Thông tư 15/2015/TT-BYT

CIRCULAR

PROVIDING GUIDANCE ON MEDICAL EXAMINATION AND TREATMENT COVERED BY HEALTH INSURANCE FOR HIV-POSITIVE PEOPLE AND PEOPLE USING HIV/AIDS-RELATED HEALTH CARE SERVICES  

Pursuant to the Law on health insurance;

Pursuant to the Law on Medical examination and treatment;

Pursuant to the Law on HIV/AIDS prevention;

Pursuant to the Decree No. 63/2012/NĐ-CP dated August 31, 2012 by the Government defining the functions, tasks, powers and organizational structure of the Ministry of Health;

Pursuant to the Decree No. 105/2014/NĐ-GOVERNMENT dated November 15^th, 2014 by the Government providing guidance on a number of articles of the Law on health insurance;

The Minister of Health promulgates this Circular providing guidance on medical examination and treatment covered by health insurance for people living with HIV and people using HIV/AIDS-related health care services as follows:

Article 1. Governing scope and regulated entities

1. Health insurance-covered medical facilities.

2. Health insurance-covered medical facilities treating HIV-positive people with antiretroviral drugs (ARV).

3. Medical facilities treating infected people with ARV according to the regulations in the Circular No. 09/2011/TT-BYT dated January 26^th, 2011 by the Minister of Health.

4. People having health insurance who are HIV-positive or use HIV/AIDS-related medical services.

5. This Circular does not apply to HIV-positive people having health insurance who are in detentions, temporary detentions, compulsory education establishments, reform schools, compulsory rehabilitation centers, social protection establishments.

Article 2. General regulations

1. HIV-positive people having health insurance who receive medical examination and treatment and people having health insurance who use HIV/AIDS related medical services shall have the benefits of health insurance policyholders within the limits prescribed by regulations of law on health insurance.

2. HIV-positive people having health insurance that are treated with ARV at a medical facility may continue receiving the HIV/AIDS examination and treatment at the same facility according to the regulations in the Circular No. 32/2013/TT-BYT dated October 17, 2013 by the Minister of Health in order to ensure convenient treatment, maintaining the stability and effectiveness in HIV/AIDS treatment and prevention.

3. The payment of cost of medical examination and treatment between the medical facilities and social insurance organization shall comply with the legislations in health insurance. The Health insurance fund does not cover the examination and treatment for people covered by health insurance that has been covered by the state budget (according to national medical target program, ODA projects, etc.) or other lawful capitals.

Article 3. Contract for health insurance-covered examination and treatment

1. Health insurance-covered medical facilities shall add the provisions about HIV/AIDS diagnosis and treatment to the annual contract for health insurance-covered examination and treatment according to the regulation in this Circular with the social insurance organization.

2. Any medical facility treating people with ARV that is affiliated to medical centers of districts, HIV/AIDS prevention centers, preventive medical centers of provinces and other medical facilities eligible for providing medical services according to the legislations shall sign a contract with a social insurance organization for the provision and payment for medical examination and treatment service for HIV/AIDS infected people.

3. Polyclinic hospital of districts or medical centers of districts, agencies, units being under a contract with the social insurance organization for providing health insurance-covered medical service at local medical facilities shall add the provisions about HIV/AIDS examination and treatment to the contract for health insurance-covered medical examination and treatment at local medical facilities.

Article 4. Initial registration of health insurance

1. HIV-positive people having health insurance may register health insurance at a medical facility according to the regulations in the Circular No. 37/2014/TT-BYT dated 17/11/2014 by the Minister of Health.

2. HIV-positive people having health insurance may register health insurance-covered at any local health insurance-covered facility that provides HIV/AIDS examination and treatment services.

3. HIV-positive people having health insurance may change the initial health insurance-covered facility on the first day of any quarter and according to the regulations on health insurance of the health insurance issuer.

Article 5. Transfer between medical facilities

1. The transfer of health insurance covered medical facilities shall comply with the regulation in Articles 8 and 9 of the Circular No. 37/2014/TT-BYT dated 17/11/2014 by the Minister of Health.

2. The transfer between medical facilities of communes, districts, provinces and central medical establishments according to management decentralization specified in the Circular No. 09/2011/TT-BYT dated January 26, 2011 by the Minister of Health.

Article 6. Scope and level of health insurance benefits

1. HIV-positive people having health insurance who use HIV/AIDS related medical services shall have benefits according to the legislation on health insurance.

2. Regarding people having health insurance who are HIV-positive or use HIV/AIDS related medical services, Health insurance funds shall cover the cost of:

a) Medicine (including ARV), chemicals, medical equipment, technical services within the coverage of Health insurance funds;

b) HIV testing for women who are in pregnant or childbirth according to professional request in case such expense is not covered by any other funds;

c) Abortion on HIV women;

d) HIV diagnosis and testing, ARV and other HIV/AIDS examination and treatment services for children of HIV women;

dd) HIV testing in medical examination and treatment (excluding HIV testing for people who donate body parts, sperm, ovule);

e) HIV testing, treatment with antiretroviral drugs for HIV-exposed people, people accidentally infected with HIV (excluding occupational HIV infection covered by the state budget);

g) Preventive treatment for opportunistic infections.

Article 7. Organization of implementation

1. Services of health of provinces:

a) Direct the affiliated medical facilities to perform the activities prescribed in this Circular;

b) Preside over, cooperate with social insurance establishments of provinces in providing guidelines for initial registration of health insurance for HIV-positive people;

c) Preside over, cooperate with social insurance establishments of provinces in providing guidelines for the performance of contract for health insurance-covered medical services at facilities that are eligible for treating people with ARV according to the regulations;

d) Cooperate with relevant organizations in disseminating and guiding HIV-positive people having health insurance to comply with the legislations on health insurance, legislations on HIV/AIDS prevention and the provisions of this Circular.

2. Social insurance of provinces shall sign the contract for health insurance-covered examination and treatment and pay the costs of health insurance-covered examination and treatment for HIV-positive people and people who use HIV related medical services according to the guidance in this Circular and the provisions of laws on health insurance, HIV/AIDS examination and treatment and other relevant legislations.

3. Every medical facility specified in Clauses 1, 2 and 3 Article 3 of this Circular shall:

a) Provide health insurance-covered examination and treatment for HIV-positive people and people having health insurance who use HIV/AIDS related medical services, ensuring the benefits of people having health insurance according to the regulations;

b) Provide HIV/AIDS diagnosis and treatment according to the guidelines for HIV/AIDS diagnosis and treatment and guidelines for management and treatment for HIV-positive people and HIV-exposed people issued by the Ministry of Health;

c) Cooperate with social insurance in paying the cost of health insurance-covered medical care according to the legislations on health insurance and the regulations in this Circular.

Article 8. Terms of reference

1. Circular No. 09/2011/TT-BYT dated January 26^th, 2011 by the Minister of Health providing guidance on requirements and expertise of medical facilities treating people with ARV.

2. Circular No. 32/2013/TT-BYT dated October 17^th, 2013 by the Minister of Health providing guidance on the management and treatment for HIV-positive people and HIV exposed people.

3. Circular No. 37/2014/TT-BYT dated November 17^th, 2014 by the Minister of Health providing guidance on initial registration of health insurance and health insurance-covered examination and treatment line transfer.

If any of the references above is replaced or amended, the new one shall prevail.

Article 9. Effect

1. This Circular comes into effect from August 15^th, 2015;

2. Difficulties that arise during the implementation of this Circular should be reported to the Ministry of Health for consideration and solution.