Công văn 3100/BYT-BH

Pursuant to Law on Health Insurance and guiding documents;

Pursuant to Point a Clause 7 Article 1 of Resolution No. 16/NQ-CP dated February 8, 2021 of the Government on costs for medical quarantine, examination, treatment and specific policies in COVID-19 epidemic;

Ministry of Health hereby provides provisional guidelines for settling costs for medical examination and treatment covered by health insurance for individuals owning health insurance cards during concentrated quarantine period and other cases during COVID-19 epidemic as follows:

1. Settle medical examination and treatment costs for individuals who own health insurance cards and are experiencing concentrated medical quarantine due to COVID-19 that must undergo medical examination and treatment in medical examination and treatment establishments under health insurance:

1.1. State budget shall pay for medical examination and treatment resulting from COVID-19, including: costs for medical examination, hospital beds, technical services, medicine, blood, intravenous fluid, etc. according to guidelines of Ministry of Health;

1.2. Healthcare Insurance Fund shall settle costs for medical examination and treatment for other diseases within scope of insurance liability and amount similar to cases of medical examination and treatment in appropriate level, except for costs under Point 1.1. of this Clause;

1.3. Individuals owning health insurance cards shall pay partially covered costs and costs beyond coverage of health insurance (if any) according to regulations and law on health insurance.

2. In case medical examination and treatment establishments utilize health insurance must organize concentrated quarantine under decisions of competent authorities or are assigned by competent authorities to provide medical examination and treatment for persons infected or suspected to have been infected with COVID-19, Departments of Health shall cooperate with Social Security of provinces and central-affiliated cities:

2.1. Instruct applicants for initial medical examination and treatment under health insurance in the medical examination and treatment establishments to apply for initial medical examination and treatment in other establishments within provinces and cities;

2.2. Instruct medical examination and treatment establishments to transfer patients to establishments in other levels for medical examination and treatment depending on epidemic situations.

Cases specified under this Clause are defined to be medical examination and treatment covered by health insurance in appropriate levels.

3. For patients who have been prescribed, issued with medicines, medical equipment, provided with treatment, issued with notice of re-examination appointment or medical examination number, medical records for re-examination appointment (hereinafter collectively referred to as “notice of re-examination appointment”) by medical examination and treatment establishments but are unable to arrive for re-examination:

3.1. Medical examination and treatment establishments that have prescribed, issued medicines, medical equipment, provided treatment and issued notice of re-examination appointment are responsible for:

a) informing and guiding patients to select appropriate medical examination and treatment establishments to receive re-examination, medicines, medical equipment and treatment.

b) guiding medical examination and treatment establishments where the patients are undergoing quarantine or other medical examination and treatment establishments to conduct re-examination, issue medicines, medical equipment and treatment for the patients; delivering medicine or cooperating with pharmaceutical companies in delivering medicine, medical equipment to other medical examination and treatment establishments for re-examination, issuance of medicine, medical equipment and treatment for patients in case these establishment lack medicine or medical equipment for medical examination and treatment for illnesses that require re-examination.

3.2. Patients may use notice of re-examination appointment of medical examination and treatment establishments that issue the notice in other medical examination and treatment establishments accepting health insurance under guidelines of the issuing establishments and guidelines of Departments of Health, local Social Security where the patients reside or undergo quarantine to receive medical examination and treatment.

In case epidemic has ceased, patients may use notice of re-examination of medical examination and treatment establishments that issue medicine and medical equipment to receive medical examination and treatment in medical examination and treatment establishments that delivery medicine and medical equipment

These cases are defined to be medical examination and treatment covered by health insurance in appropriate levels.

3.3. Medical examination and treatment establishments accepting health insurance that provide medical examination, medicine, medical equipment and medical treatment for patients are responsible for:

a) producing, storing documents on medical examination, treatment, medicine and medical equipment as per the law, consolidating and sending to social security agencies (that have entered into contracts for medical examination and treatment under health insurance with the establishments);

b) uploading data on health insurance assessment system according to Decision No. 4210/QD-BYT dated September 20, 2017 of Ministry of Health on output data standards and format in managing, assessing and paying medical examination and treatment fees under health insurance, in which:

- On Schedule XML1: in field 17 MA_NOI_CHUYEN, specify code of medical examination and treatment establishments that issue notice of re-examination appointment; in the field 113 TEN_BENH, specify: “medical examination, medical treatment and issuance of medicine according to notice of re-examination appointment and treatment guidelines of (name of medical examination and treatment establishment)”.

Example: Bach Mai Hospital which has code of medical examination and treatment establishment accepting health insurance of 01929 has previously issued notice of re-examination appointment to a patient who, due to the epidemic, arrives at General Hospital of Province A to receive medical examination and treatment, in field 17 MA_NOI_CHUYEN, specify: 01929; in field 13 TEN_BENH General Hospital of Province A, specify: “medical examination, medical treatment and issuance of medicine according to notice of re-examination appointment and treatment guidelines of Bach Mai Hospital”.

- In case a medical examination and treatment establishment receives medicine and medical equipment from another medical examination and treatment establishment that issues notice of transfer, on Schedule XML2: in field 3 MA_THUOC, specify code of the medical examination and treatment establishment that issues notice of re-examination appointment; code of medicine attached to Decision No. 7603/QD-BYT dated December 25, 2018 of Minister of Health on list of code for general use in management of medical examination, treatment and health insurance payment affairs (edition No. )

6). These codes are separated by an underscore (_).

Example: Bach Mai Hospital which has code of medical examination and treatment establishment accepting health insurance of: 01929 has previously issued notice no re-examination appointment which includes delivery of Ciclosporin immunosuppressive drug (code: 40.405) to General Hospital of Province A, in field 3 MA_THUOC General Hospital of Province A, specify: “01929_40.405”.

Medical examination and treatment establishments shall agree with social security agencies that enter into contracts for provision of medical examination and treatment under health insurance prior to implementation to guarantee extraction and transfer of electronic data and payment of medical examination and treatment fees.

c) collecting fees and paying for medicine sent from medical examination and treatment establishments and medical equipment for those used for patients (if any);

d) paying medicine costs to medical examination and treatment establishments that have transferred medicine and medical equipment, including costs sharing with the patients (if any).

dd) in case the epidemic ceases or quarantine finishes, medical examination and treatment establishments that previously issued medicine and medical equipment shall issue notice of re-examination appointment or notice of transfer and guide patients to receive medical examination and treatment in medical establishments that deliver medicine. This case shall be considered to be in appropriate levels.

3.4. Medical stations of communes receiving and issuing medical equipment to patients are responsible for producing and storing documents on issuance of medicine and medical equipment as per the law, consolidating fees and sending to medical examination and treatment establishments (which have entered into contracts with social security agencies for providing medical examination and treatment under health insurance in the medical stations of communes).

3.5. Medical examination and treatment establishments (that have entered into contracts with social security agencies for providing medical examination and treatment under health insurance in medical stations of communes) shall consolidate fees and send to social security agencies.

3.6. Social security agencies (that have entered into contracts with medical examination and treatment establishments which receive and use medicine, medical equipment on patients for providing medical examination and treatment under health insurance) shall:

a) pay medical examination and treatment fees for medical examination and treatment establishments as per applicable laws;

b) pay medicine and medical equipment costs medical examination and treatment establishments which have received medicine and medical equipment from medical examination and treatment establishments which transfer medicine and medical equipment, and used for patients, these costs are included in additional costs of medical examination and treatment establishments (if any).

4. Use notice of re-examination appointment during epidemic period of competent authorities or medical establishments which must be quarantined or patients who must be quarantined: Individuals with health insurance card owning notice of re-examination appointment may receive re-examination regardless of appointment time on the notice of re-examination appointment. In this case, health insurance assessment system of social security agencies shall not require satisfaction of the field: re-examination date.

5. Estimation and prescription of treatment medicine during COVID-19 management.

5.1. Doctors and physicians shall rely on patients’ conditions to prescribe amount of medicine for patients who are the elderly and patients requiring prolonged treatment (no longer than 90 days.

5.2. Medical examination and treatment establishments must provide the patients with their phone number.

5.3. Medical examination and treatment establishments shall rely on amount of patients arriving and receiving treatment in the establishments to procure and reserve medicines (focusing on specialized medicine for cardiovascular diseases, diabetes mellitus, etc.).

6. In case persons with health insurance cards receive medical examination, treatment and are not required to undergo medical quarantine as per conclusion of medical establishments, the Healthcare Insurance Fund shall pay for medical examination and treatment as per health insurance laws.

7. Consolidation of schedules to request payment for medical examination and treatment under health insurance shall conform to Decision No. 6556/QD-BYT dated October 30, 2018 of Minister of Health on Schedule on medical examination and treatment costs applicable in medical examination and treatment establishments and Annex guiding completion of schedule on medical examination and treatment costs. Medical establishments must not separate cost components of each patient with health insurance cards across multiple different schedules.

8. Departments of Health shall cooperate with social security of provinces and central-affiliated cities in guiding patients to receive medical examination and treatment in provinces and cities depending on epidemic situations.

Settlement of costs for medical examination and treatment covered by health insurance for individuals owning health insurance cards during concentrated quarantine period and other cases during COVID-19 epidemic according to this Official Dispatch begins from February 8, 2021.

This Official Dispatch replaces Official Dispatch No. 2146/BYT-BH dated April 17, 2020 of Minister of Health providing provisional guidelines for settling costs for medical examination and treatment covered by health insurance for individuals owning health insurance cards during concentrated quarantine period and other cases during COVID-19 epidemic and Official Dispatch No. 2276/BYT-BH dated April 24, 2020 of Minister of Health on amendment to Clause 3 of Official Dispatch No. 2146/BYT-BH providing guidelines on settling costs for medical examination and treatment covered by health insurance related to COVID-19 management.

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