Thông tư 37/2014/TT-BYT

CIRCULAR

GUIDING THE REGISTRATION FOR INITIAL MEDICAL CARE AND TRANSFER OF HEALTH INSURANCE-COVERED MEDICAL FACILITIES

Pursuant to the Law on Health insurance No. 25/2008/QH12 dated November 14^th 2008 and Law on amendments to the Law on Health insurance No. 46/2014/QH13 dated June 13^th 2014;

Pursuant to the Law on Medical examination and treatment No. 40/2009/QH12 dated November 23^rd 2009;

Pursuant to Decree No. 105/2014/ND-CP dated November 15^th 2014 by the Government providing guidance on the implementation of a number of articles of the Law on Health insurance;

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

The Minister of Health promulgates the Circular guiding the initial registration for medical care and transfer of health insurance-covered medical facilities

Chapter I

REGISTRY FACILITIES FOR INITIAL HEALTH INSURANCE-COVERED MEDICAL CARE

Article 1. Medical facilities of communes and similar facilities

1. Medical facilities of communes, wards and towns.

2. Cottage hospitals, medical facilities, medical rooms of agencies, units and organizations.

3. Independent private clinics of family doctors.

4. Military-civil medical facilities; military-civil clinics.

5. Military medical facilities of battalions and similar.

Article 2. Medical facilities of districts and similar facilities

1. Grade III, grade IV and ungraded polyclinics.

2. Grade III, grade IV ungraded national hospitals of traditional medicine.

3. Grade III, grade IV and ungraded specialized hospitals with polyclinic departments.

4. Medical center of districts with function of medical care.

5. Polyclinics; regional polyclinics.

6. Police clinic of central-affiliated cities and provinces.

7. Military medical centers.

8. Military clinics; Military - civil clinics.

9. Grade III, grade IV and ungraded polyclinics affiliated to the Ministry of National Defense.

10. Grade III, grade IV and ungraded military-civil polyclinics.

Article 3. Medical facilities of provinces and similar facilities

1. Grade II and lower grade polyclinics affiliated to the Ministry of Health.

2. Grade I and grade II polyclinics affiliated to the Department of Health or affiliated to Ministries/Authorities (excluding grade I polyclinics affiliated to the Department of Health that the Ministry of Health assigns to be the highest medical facilities affiliated to the Ministry of National Defense).

3. Grade II specialized clinics affiliated to the Ministry of Health, grade I and grade II specialized clinics affiliated to the Department of Health having polyclinic departments.

4. Grade I and grade II hospitals of pediatrics/hospitals of obstetrics and pediatrics affiliated to the Department of Health that are not assigned to be the highest medical facilities by the Ministry of Health.

5. Grade I/grade II private polyclinics or similar.

6. Grade I and grade II hospitals of traditional medicine affiliated to the Department of Health and other Ministries/Authorities.

7. Grade I/grade II private hospitals of traditional medicine or similar.

8. Clinics affiliated to Officials’ health care boards of central-affiliated cities and provinces.

9. Grade II polyclinics affiliated to the Ministry of Health.

10. Grade II military-civil clinics.

Article 4. Central medical facilities and similar facilities

1. Special grade or grade I polyclinics affiliated to the Ministry of Health.

2. Grade I polyclinics affiliated to the Department of Health or Ministries/Authorities that the Ministry of Health assigns to be the highest facilities.

3. Grade I specialized clinics affiliated to the Ministry of Health with polyclinic departments (excluding the National hospital of pediatrics).

4. Huu Nghi hospital, Thong Nhat hospital and Da Nang C hospital affiliated to the Ministry of Health.

5. Special grade or grade I polyclinics affiliated to the Ministry of National Defense.

6. Military Institute of Traditional Medicine.

Article 5. Conditions for initial health insurance-covered medical facilities

1. Medical facilities shall have licenses for operation according to law provisions.

2. Medical practitioner shall have practice certificates according to law provisions.

3. Medical facilities specified in clauses 1, 2, 4 and 5 Article 1 of this Circular shall have sufficient human resources, facilities, equipment, ensuring to satisfy normal healthcare demands and provide first aid and emergency care, supply and dispense medicines within professional tasks.

4. Independent private clinics of family doctors shall satisfy conditions for issuance of licenses for operation applicable to independent private clinics of family doctors prescribed by the Ministry of Health.

5. Polyclinics:

a) There shall be at least 02 (two) specialities for internal medicine and surgical medicine; polyclinics providing pediatric healthcare, apart from such specialities, shall have pediatric speciality;

b) The number of full-time doctors shall be conformable;

c) The examination, treatment, first aid and technical services in medical care shall be conformable to professional scope approved by competent authorities;

d) The supply and dispensing of medicines, chemicals and medical equipment for health insurance-covered medical care according to regulations.

Chapter II

REGISTRATION FOR INITIAL HEALTH INSURANCE-COVERED MEDICAL CARE

Article 6. Registration for initial health insurance-covered medical care at medical facilities of communes or districts

People having health insurance may register for initial health insurance-covered medical care (hereinafter referred to as initial medical care) at any of medical facilities specified in Articles 1 and 2 of this Circular, regardless of administrative division.

Article 7. Registration for initial health insurance-covered medical care at medical facilities of provinces or central medical facilities

1. Any people having health insurance may register for initial medical care at grade I or grade II hospitals of districts where he/she lives.

2. Any people having health insurance may register for initial medical care at any of medical facilities specified in clauses 1, 2, 3, 4, 5, 6, 7, 9 and 10 Article 3 and Article 4 of this Circular as follows:

a) He/she lives permanently/temporarily for definite time or works in a district/town/provincial-affiliated city that does not have medical facilities specified in Articles 1 and 2 of this Circular or has medical facilities unconformable with conditions for initial medical care for people having health insurance according to regulations of the Director of the Department of Health after agreeing with the Director of Social insurance of central-affiliated city/province;

b) Any people lives permanently/temporarily for definite time or works in a district/town/provincial-affiliated city may register for initial medical care at medical facilities specified in clauses 1, 2, 3, 4, 5, 6, 7, 9 and 10 Article 3 and Article 4 of this Circular according to regulations of the Director of the Department of Health after agreeing with the Director of Social insurance of central-affiliated city/province

3. Any people having health insurance may register for initial medical care at any of medical facilities specified in Article 6, Clauses 1 and 2 Article 7 of this Circular or register for initial medical care at another medical facility as follows:

a) Any people eligible for of health management and healthcare service according to the Guidance No. 52/HD/BTCTW dated 02/12/2005 by Central Organization Board of Communist Party may register for initial medical care at Huu Nghi Hospital, Thong Nhat Hospital or Da Nang C Hospital affiliated to the Ministry of Health or other medical facilities specified in Article 3 (excluding Clause 4) and Article 4 of this Circular;

b) Any people eligible for health management and healthcare service for officials of provinces/cities may register for initial medical care at clinics affiliated to Officials’ health care boards of central-affiliated cities and provinces or medical facilities specified in clauses 1, 2, 3, 5, 6, 7, 9 and 10 Article 3 of this Circular;

c) Any people meritorious to the revolution, people aged 80 or older may register for initial medical care at medical facilities specified in clauses 1, 2, 3, 5, 6, 7, 9 and 10 Article 3, clauses 1, 2, 3 and 6 Article 4 of this Circular;

d) Kids under 6 may registered for initial medical care at medical facilities specified in clauses 1, 2 and 4 Article 3 of this Circular;

dd) Any member of military forces who retires may register for initial medical care at any of health insurance-covered medical facilities specified in Clauses 9 and 10 Article 3 and Clauses 5 and 6 Article 4 of this Circular.

4. Any person having health insurance who is living in island communes/island districts may register for initial medical care at the most convenient medical facility in mainland, in case there are not any medical facilities specified in Articles 1, 2, 3 and 4 of this Circular on such island communes/island districts.

Chapter III

TRANSFER OF HEALTH INSURANCE-COVERED MEDICAL FACILITIES

Article 8. Transfer between health insurance-covered medical facilities

1. Any person having health insurance card may be transferred between medical facilities according to regulations of the Ministry of Health.

2. The case when a person having health insurance register for initial medical care at a medical facility of commune to a grade I or grade II hospital of district where he/she lives is considered conformable transfer of medical facilities.

3. From January 01^st 2016, any person having health insurance who registers for initial medical care at a medical facility of commune or a polyclinic or a hospital of district may receive health insurance-covered medical care at a medical station of commune or a polyclinic or a hospital of district in the same division.

4. Regarding emergency treatment, after the emergency care, patients shall be provided with resident treatment at departments of medical facilities receiving them or sent to another medical facility for further treatment according to specialist requests.

Article 9. Procedures for transfer between health insurance-covered medical facilities

1. Any medical facilities shall comply with regulations on transfer between medical facilities regulated by the Ministry of Health.

2. Use of transfer paper for people having health insurance card:

a) If a patient is sent to another medical facility, only the transfer paper of the medical facility in charge of transferring the patient is required;

b) If the patient receives medical care at a medical facility different from the one he/she has registered as the initial health insurance-covered medical facility and is sent to another medical facility, only the transfer paper of the medical facility transferring the patient is required;

c) The transfer paper is effective for 10 working days from the day it is signed;

d) If a person having health insurance card gets a disease/group of disease and cases specified in the appendix enclosed with this Circular, the transfer paper shall be effective until the end of a calendar year (December 31^st of the same year). If after December 31^st of such year, the patient still receives resident treatment at the medical facility, then the transfer paper shall be effective until such resident treatment finishes.

3. Use of re-examination appointment slip: a re-examination appointment slip shall be use 01 (one) time according to the time specified in the slip.

4. Regarding emergency care: the emergency conditions of the patient shall be assessed, determined and recorded by the person who receives the patient (doctor or physician assistant)

5. The case when a patient is transferred with a concurrent disease or a newly arisen disease other than those mentioned on the transfer paper and the receiving facility provide treatment for such disease within specialist conditions is considered conformable medical care.

6. If a person having health insurance is on a business trip or is a student or an itinerant worker or residents temporarily for less than 12 months in another area, he/she may receive medical care at a medical facility in such area that is at similar level to the medical facility written on his/her health insurance card. If there is not any similar medical facility in such area, such person may choose a medical facility that provides initial health insurance-covered medical care.

Chapter IV

IMPLEMENTARY CLAUSE

Article 10. Responsibilities of the Department of Health

1. Preside over, cooperate with social insurance of central-affiliated cities and provinces, medical facilities affiliated to the Ministry of Health and Ministries/Authorities having offices located in their provinces to:

a) Determine and make a list of medical facilities eligible for providing initial health insurance-covered medical care prescribed in this Circular;

b) Provide guidance on the registration for initial medical care for entities specified in Clause 4 Article 7 of this Circular;

c) Provide guidance on the transfer between medical facilities for people having health insurance according to the law provisions.

2. Preside over, cooperate with social insurance of central-affiliated cities and provinces, medical facilities affiliated to the Ministry of Health and relevant Ministries/Authorities in regulating entities having health insurance to register for initial medical care specified in Articles 6 and 7 of this Circular according to the actual conditions of their provinces and capability of medical facilities.

3. Direct the affiliated medical facilities to implement the regulations in this Circular.

Article 11. Responsibilities of medical facilities

1. Provide medical care, carry out the transfer between medical facilities and ensure the interests of health insurance policyholders according to regulations.

2. Depending on the operation of their units, heads of medical facilities shall assign people to confirm promptly the receipt of patients that are transferred.

Article 12. Responsibilities of Medical facilities affiliated to Ministries

1. Medical Service Corps - the Ministry of National Defense:

a) Direct and guide medical facilities affiliated to the Ministry of National Defense eligible for providing initial medical care to register with the local Department of Health;

b) Provide guidance on health insurance-covered medical care at military/military-civil medical facilities affiliated to the Ministry of National Defense.

2. Medical department - the Ministry of Public Security: Direct and guide medical facilities affiliated to the Ministry of Public Security eligible for providing initial medical care to register with the local Department of Health.

3. Medical offices of other Ministries/Authorities:

a) Direct and guide medical facilities affiliated to the Ministries/Authorities eligible for providing initial medical care to register with the local Department of Health;

b) Provide guidance for the registration for initial medical care and organize the health insurance-covered medical care according to the regulations.

Article 13. Responsibilities of social insurance of central-affiliated cities and provinces

1. Conclude the contract for medical services covered by health insurance with medical facilities eligible for providing initial medical care according to the list approved by the Department of Health.

2. Cooperate with the Department of Health in guiding health insurance policyholders to register or modify the initial medical facilities according to regulations in clauses 1 and 2 Article 10 of this Circular.

3. Provide guidance on medical care for people having health insurance cards as prescribed in clause 6 Article 9 of this Circular.

Article 14. Transitional clause

Any people having health insurance who has registered for initial medical care at the facility written on the health insurance card before the effective date of this Circular shall be continue receiving medical care at such facility until there is modification of the registered initial medical facility according to the guidance in this Circular.

Article 15. Effect

1. This Circular comes into effect from January 01^st 2015.

2. Circular No. 10/2009/TT-BYT dated August 14^th 2009 by the Minister of Health is annulled by the effect of this Circular.

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