CIRCULAR

AMENDING AND SUPPLEMENTING REGULATIONS ON REIMBURSEMENT OF COSTS OF COVERED MEDICAL SERVICES

Pursuant to the Law on Health Insurance No. 25/2008/QH12 dated November 14, 2008 as amended by the Law No. 46/2014/QH13 dated June 13, 2014;

Pursuant to the Law on medical examination and treatment No. 40/2009/QH12 dated November 23, 2009;

Pursuant to the Law on statistics No. 85/2015/QH13 dated November 23, 2015;

Pursuant to the Government’s Decree No. 75/2017/ND-CP dated June 20, 2017 defining functions, tasks, powers and organizational structure of the Ministry of Health;

At the request of the Directors/ Directors General of the Legal Department, the Department of Health Insurance, Department of Planning and Finance, Agency of Health Examination and Treat, and Traditional Medicine Administration of Vietnam;

The Minister of Health promulgates a Circular amending and supplementing regulations on reimbursement of costs of covered medical services .

...

...

...

1. Point i Section 2 of Working regulations of the Medical Imaging Department regarding duties of medical imaging physicians and technicians is amended as follows:

“ Health facilities shall keep hard copies or soft copies of medical imaging films, except outpatient treatment cases.

- Information about the medical imaging of an inpatient must be included in Medical record and Medical imaging record of the health facility.

- If a patient is referred to a higher-level hospital, medical imaging films shall be sent together with the outward referral form. To be specific: the physician of the initiating hospital shall sign copies of transferred medical imaging reports and write information relating to the transfer of medical imaging films in written requests for medical imaging (including X-ray, CT and MRI request forms, X-ray, CT and MRI reports) corresponding to the transferred films and medical record kept at the hospital.

- If an outpatient gets medical imaging, the medical imaging film and report shall be delivered to that outpatient. The outpatient or his/her representative must make certification of receipt of medical imaging films by signing:

+ The medical record of the health facility (the number of received films must be specified) if the outpatient is not eligible for health insurance benefits; or

+ The payment slip of costs of medical services (the number of received films must be specified) if the outpatient is eligible for health insurance benefits”.

2. Point d is added to Clause 3 Part II. Table of contents of Form of medical record as follows:

“-D: Form of “Disclosure of inpatient medical services: 1 type"

...

...

...

Guidelines for use of surgical operation/medical procedure notes are amended as follows:

“- With regard to surgical operations, the surgical operation note in which description of the surgical operation must be included shall be used;

- With regard to medical procedures that require general anesthesia or must be performed in operating rooms or medical procedures related to blood vessels (excluding injection and infusion) or respiratory tracts:  The medical procedure note which may contain description of the performed medical procedure (if necessary) shall be used.

- With regard to other medical procedures:  The surgical operation/medical procedure notes are not required but the patient’s medical record must contain the physician order and contents of provided medical services which must be certified by the signature of the patient or his/her representative after each treatment stage.”

Article 3. Amendments to the Circular No. 28/2014/TT-BYT dated August 14, 2014 of the Minister of Health introducing statistical indicators used in healthcare sector

Definition in Indicator 20-Average length of stay is amended as follows:

 “Inpatient day: A day in which the inpatient medical record is prepared, and the patient receives at least one of the following medical services, monitoring, diagnosis, treatment or care of patient.”

Article 4. Amendments to the Circular No. 40/2014/TT-BYT dated November 17, 2014 of the Minister of Health promulgating the list of modern medicines covered by health insurance fund

The list of modern medicines promulgated together with the Circular No. 40/2014/TT-BYT is amended as follows:

...

...

...

2. The name “Calci-3-methyl-2-oxovalerat + calci-4-methyl-2- oxovalerat + calci-2-methyl-3-phenylpropionat + calci-3-methyl-2-oxobutyrat + calci-DL-methyl-2-hydroxy-4-methylthiobutyrat + L-lysin acetat+ L-threonin + L-tryptophan+ L-histidin + L-tyrosin+ Nitơ + calci” at the ordinal number 1039 of column 2 is changed into “Calci-3-methyl-2-oxovalerat + calci-4-methyl-2-oxovalerat + calci-2- 0X0-3-phenylpropionat + calci-3-methyl-2-oxobutyrat + calci-2-hydroxy-4- methylthiobutyrat + L-lysin acetat + L-threonin + L-tryptophan + L-histidin + L- tyrosin + Nitơ + calci”.

Article 5. Amendments to the Circular No. 05/2015/TT-BYT dated March 17, 2015 of the Minister of Health promulgating the list of oriental medicines, herbal medicines and traditional ingredients covered by health insurance fund

The list of oriental medicines and herbal medicines is amended as follows:

1. The name “Diệp hạ châu, Nhân trần, cỏ nhọ nồi, Râu ngô/Râu bắp, (Kim ngân hoa), (Nghệ)” (“Herba Phyllanthi urinariae, Herba Adenosmatis caerulei, Eclipta alba Hassk., Styli et stigmata Maydis, (Flos Lonicerae), (Rhizoma Curcumae longae)”) at the ordinal number 26 of columne 1 is changed into “Diệp hạ châu, Nhân trần, cỏ nhọ nồi, (Râu ngô/Râu bắp), (Kim ngân hoa), (Nghệ)” (“Herba Phyllanthi urinariae, Herba Adenosmatis caerulei, Eclipta alba Hassk., (Styli et stigmata Maydis), (Flos Lonicerae), (Rhizoma Curcumae longae)”).

2. The name “Diệp hạ châu, Xuyên tâm liên, Bồ công anh, Cỏ mực” (“Herba Phyllanthi urinariae, Herba Andrographitis paniculatae, Herba Lactucae indicae, Eclipta alba Hassk”) at the ordinal number 28 of column 1 is changed into “Diệp hạ châu/Diệp hạ châu đắng, Xuyên tâm liên, Bồ công anh, cỏ mực” (“Herba Phyllanthi urinariae/ Herba Phyllanthi amari, Herba Andrographitis paniculatae, Herba Lactucae indicae, Eclipta alba Hassk”).

3. The name “Kim ngân hoa, Nhân trần, Thương nhĩ tử, Nghệ, Sinh địa, Bồ công anh, Cam thảo” (“Flos Lonicerae, Herba Adenosmatis caerulei, Fructus Xanthii strumarii, Rhizoma Curcumae longae, Radix Rehmanniae glutinosae, Herba Lactucae indicae, Radix Glycyrrhizae”) at the ordinal number 34 of column 1 is changed intp “Kim ngân hoa, Nhân trần/Nhân trần tía, Thương nhĩ tử, Nghệ, Sinh địa, Bồ công anh, Cam thảo” (“Flos Lonicerae, Herba Adenosmatis caerulei/ Adenosma bracteosum Bonati, Fructus Xanthii strumarii, Rhizoma Curcumae longae, Radix Rehmanniae glutinosae, Herba Lactucae indicae, Radix Glycyrrhizae”).

4. The name “Độc hoạt, Quế chi/Quế nhục, Phòng phong, Đương quy, Tế tân (Dây đau xương), Xuyên khung, Tần giao, Bạch thược, Tang ký sinh, Sinh Dịa/Thục địa/Địa hoàng, Đỗ trọng, Ngưu tất, Phục linh/Bạch linh, Cam thảo, (Đảng sâm/Nhân sâm)” (“Radix Angelicae pubescentis, Ramulus Cinnamomi/Cortex Cinnamomi iners, Radix Saposhnikoviae divaricatae, Radix Angelicae sinensis, Herba Asari (Caulis Tinosporae tomentosae), Rhizoma Ligustici wallichii, Radix Gentianae macrophyllae, Radix Paeoniae lactiflorae, Loranthus parasiticus (L.) Merr, Radix Rehmanniae glutinosae/ Radix Rehmanniae glutinosae praeparata/ Rhizoma Alismatis, Cortex Eucommiae, Radix Achiranthis bidentatae, Poria, Radix Glycyrrhizae , (Radix Campanumoeae/Radix Ginseng)”) at the ordinal number 58 of column 1 is changed into “Độc hoạt, Quế chi/Quế nhục, Phòng phong, Đương quy, Tế tân/Dây đau xương, Xuyên khung, Tần giao, Bạch thược, Tang ký sinh, Sinh Dịa/Thục địa/Địa hoàng, Đỗ trọng, Ngưu tất, Phục linh/Bạch linh, Cam thảo, (Đảng sâm/Nhân sâm)” (“Radix Angelicae pubescentis, Ramulus Cinnamomi/Cortex Cinnamomi iners, Radix Saposhnikoviae divaricatae, Radix Angelicae sinensis, Herba Asari/Caulis Tinosporae tomentosae, Rhizoma Ligustici wallichii, Radix Gentianae macrophyllae, Radix Paeoniae lactiflorae, Loranthus parasiticus (L.) Merr, Radix Rehmanniae glutinosae/ Radix Rehmanniae glutinosae praeparata/ Rhizoma Alismatis, Cortex Eucommiae, Radix Achiranthis bidentatae, Poria, Radix Glycyrrhizae , (Radix Campanumoeae/Radix Ginseng)”).

5. The name “Chỉ thực, Nhân sâm/Đảng sâm, Bạch truật, Bạch linh/Phục linh, Bán hạ, Mạch nha, Hậu phác, Cam thảo, Can khương, Hoàng liên, (Ngô thù du)” (“Fructus Aurantii immaturus, Radix Ginseng/Radix Campanumoeae, Rhizoma Atractylodes macrocephalae, Poria, Rhizoma Typhonii trilobati, Fructus Hordei germinates, Cortex Cinnamomi iners, Radix Glycyrrhizae , Rhizoma Zingiberis, Rhizoma Coptidis, (Fructus Evodiae rutaecarpae)”) at the ordinal number 88 of column 1 is changed into “Chỉ thực, Nhân sâm/Đảng sâm, Bạch truật, Bạch linh/Phục linh, Bán hạ, Mạch nha, Hậu phác, Cam thảo, Can khương, Hoàng liên/Ngô thù du” (“Fructus Aurantii immaturus, Radix Ginseng/Radix Campanumoeae, Rhizoma Atractylodes macrocephalae, Poria, Rhizoma Typhonii trilobati, Fructus Hordei germinates, Cortex Cinnamomi iners, Radix Glycyrrhizae , Rhizoma Zingiberis, Rhizoma Coptidis/Fructus Evodiae rutaecarpae”).

6. The name “Toan táo nhân, Đương quy, Hoài sơn, Nhục thung dung, Kỷ tử, Ngũ vị tử, ích trí nhân, Hổ phách, Thiên trúc hoàng, Long cốt, Xương bồ, Thiên ma, Đan sâm, Nhân sâm, Trắc bách diệp” (“Semen Zizyphi jujubae, Radix Angelicae sinensis, Tuber Dioscoreae persimilis, Herba Cistanches, Fructus Lycii, Fructus Schisandrae, Fructus Alpiniae oxyphyllae, Amber, Concretin silicea Bambusa, Os Dracois, Rhizoma Acori, Rhizoma Gastrodiae elatae, Radix Salviae miltiorrhizae, Radix Ginseng, Platycladus orientalis (L.) Franco”) at the ordinal number 141 of column 1 is changed into “Toan táo nhân, Đương quy, Hoài sơn, Nhục thung dung, Kỷ tử, Ngũ vị tử, ích trí nhân, Hổ phách, Thiên trúc hoàng, Long cốt, tiết xương bồ, Thiên ma, Đan sâm, Nhân sâm, Trắc bách diệp” ((“Semen Zizyphi jujubae, Radix Angelicae sinensis, Tuber Dioscoreae persimilis, Herba Cistanches, Fructus Lycii, Fructus Schisandrae, Fructus Alpiniae oxyphyllae, Amber, Concretin silicea Bambusa, Os Dracois, Anemone altaica Fisch., Rhizoma Gastrodiae elatae, Radix Salviae miltiorrhizae, Radix Ginseng, Platycladus orientalis (L.) Franco”).

...

...

...

8. The name “Tỳ bà diệp, Cát cánh, Bách bộ, Tiền hồ, Tang bạch bì, Thiên môn, Bạch linh/Phục linh, Cam thảo, Hoàng cầm, (Cineol/Menthol)” (“Folium Eriobotryae japonicae, Radix Platycodi grandiflori, Radix Stemonae tuberosae, Radix Peucedani, Cortex Mori albae radicis, Radix Asparagi, Poria, Radix Glycyrrhizae , Radix Scutellariae, (Cineol/Menthol)”) at the ordinal number 158 (column 1) is changed into “Tỳ bà diệp, Cát cánh, Bách bộ, Tiền hồ, Tang bạch bì, Thiên môn, Bạch linh/Phục linh, Cam thảo, Hoàng cầm, Cineol, (Menthol)” (“Folium Eriobotryae japonicae, Radix Platycodi grandiflori, Radix Stemonae tuberosae, Radix Peucedani, Cortex Mori albae radicis, Radix Asparagi, Poria, Radix Glycyrrhizae , Radix Scutellariae, Cineol, (Menthol)”).

9. The name “Đảng sâm, Bạch linh, Bạch truật, Cam thảo, Thục địa, Bạch thược, Đương quy, Xuyên khung, ích mẫu” (“Radix Campanumoeae, Poria, Rhizoma Atractylodes macrocephalae, Radix Glycyrrhizae , Radix Rehmanniae glutinosae praeparata, Radix Paeoniae lactiflorae, Radix Angelicae sinensis, Rhizoma Ligustici wallichii, Herba Leonuri japonica”) at the ordinal number 196 of column 1 is changed into “Đảng sâm, Bạch linh/Phục linh, Bạch truật, Cam thảo, Thục địa, Bạch thược, Đương quy, Xuyên khung, ích mẫu” (“Radix Campanumoeae, Poria, Rhizoma Atractylodes macrocephalae, Radix Glycyrrhizae , Radix Rehmanniae glutinosae praeparata, Radix Paeoniae lactiflorae, Radix Angelicae sinensis, Rhizoma Ligustici wallichii, Herba Leonuri japonica”).

10. The name “Mã tiền, Huyết giác, Ô Dầu, Đại hồi, Long não, Một dược, Địa liền, Nhũ hương, Đinh hương, Quế, Gừng, Methyl salicylat, Gelatin, Ethanol” (“Semen Strychni, Lignum Dracaenae cambodianae, Radix Aconiti, Fructus Illicii veri, Folium et lignum Cinnamomi camphorae, Myrrha, Rhizoma Kaempferiae, Gummi resina Olibanum, Flos Syzygii aromatici, Cinnamomum obtusifolium Nees., Zingiber offcinale Rose, Methyl salicylat, Gelatin, Ethanol”) at the ordinal number 223 of column 1 is changed into “Mã tiền, Huyết giác, ô Dầu, Đại hồi, Long não, Một dược, Địa liền, Nhũ hương, Đinh hương, Quế, Gừng, Methyl salicylat, Glycerin, Ethanol” ” (“Semen Strychni, Lignum Dracaenae cambodianae, Radix Aconiti, Fructus Illicii veri, Folium et lignum Cinnamomi camphorae, Myrrha, Rhizoma Kaempferiae, Gummi resina Olibanum, Flos Syzygii aromatici, Cinnamomum obtusifolium Nees., Zingiber offcinale Rose, Methyl salicylat, Glycerin, Ethanol”).

11. The Vietnamese name of ingredient “Đương quy (Toàn quy)” at the ordinal number 296 column 1  is changed into  “Đương quy (Toàn quy, Quy đầu, Quy vỹ/quy râu)”.

12. The origin of the ingredient “Thục Dịa” at the ordinal number 301 of column 1 is changed from “N” into “N-B”.

Article 6. Amendments to the Circular No. 41/2015/TT-BYT dated November 16, 2015 providing amendments to the Circular No. 41/2011/TT-BYT dated November 14, 2011 of the Minister of Health providing guidelines for issuance of practicing certificates to healthcare practitioners and operating licenses to health facilities

1. Article 7a is amended as follows:

“Article 7a.   Scope of practicing specified on the practicing certificate

1. The scope of practicing shall be specified on the practicing certificate according to specialty groups prescribed in the Appendix 4b enclosed with this Circular.

...

...

...

The person in charge of technical and professional aspects of a health facility shall consider and decide in writing which medical services/procedures a healthcare practitioner may provide at that health facility according to the scope of practicing specified on the practicing certificate, certification, diploma or other qualification and capacity of that healthcare practitioner.

2. Appendix 4b enclosed with the Circular No. 41/2015/TT-BYT is amended as follows:

 “1. General medicine physicians: Examination and treatment of diseases of the general medicine specialty.  

1b. Rehabilitation physicians.”

Article 7. Amendments to the Circular No. 35/2016/TT-BYT dated September 28, 2016 of the Minister of Health promulgating the list of medical services covered by health insurance fund, payment percentages and conditions

1. Point b Clause 1 Article 3 is amended as follows:

 “b) These services are provided according to professional procedures approved by competent authorities. To be specific:

- Health facilities must apply professional documents providing guidelines for diagnosis, treatment and technical procedures adopted by the Ministry of Health or internally issued by the head of the health facility (according to professional guidelines and technical procedures adopted by the Ministry of Health as well as actual conditions of the health facility).

- With regard to medical services for which guidelines or technical procedures are not yet promulgated by the Ministry of Health, the head of the health facility shall formulate and issue professional guidelines or technical procedures for internal use by referring to official sources of documents which have been scientifically proven and are conformable with actual conditions of the health facility.

...

...

...

2. The example in Point b Clause 3 Article 4 is amended as follows:

“E.g.:  A patient is eligible to receive reimbursement of 95% of medical service costs and has undergone full-body CT scan (without using radiocontrast media).

In case CT scan is performed with the aim of evaluating tumor staging or multiple traumatic injuries in a patient, the payment shall be made using the cost of full-body CT scan (without using radiocontrast media) service, i.e. VND 6,606,000. To be specific:

- Payment made by the health insurance fund: VND 6,606,000 x 95% = VND 6,275,700.

- Co-pay made by the patient: VND 6,606,000 x 5% = VND 330,300.

In other cases of CT scan, payment shall be made using the cost of 1-32 slice CT scan (without using radiocontrast media) service, i.e. VND 536,000. To be specific:

- Payment made by the health insurance fund: VND 536,000 x 95% = VND 509,200.

- Co-pay made by the patient: VND 536,000 x 5% = VND 26,800.- The patient must not pay for the difference = VND 6,606,000 - VND 536,000 = VND 6,070,000."

3. Clause 2 Article 5 is amended as follows:

...

...

...

4. The ordinal numbers 1, 10 and 14 of the List No. 1 – Medical services with payment conditions and percentages are amended as follows:

No.

Medical service/ Group of medical services

Payment conditions

Payment percentage and service price

1.

Emergency dialysis

Emergency dialysis is required in the following cases:

...

...

...

b) A patient has hyperkalemia and ECG abnormalities found or has the level of potassium in the blood above 6,5 meq/L;

c) A patient with kidney failure suffers from uremic syndrome: pericardial effusion and/or unexplained encephalopathy;

d) A patient has a severe metabolic acidosis (pH < 7,1);

dd) A patient has alcohol, drug or glycol poisoning.

e) In other poisoning cases, the patient must undergone dialysis after the medical consultation.

- If a catheter is used, payment shall be made according to the cost of “Emergency artificial kidney”.

- If a catheter is not used (because AVF may be used), payment shall be made according to the cost of "Emergency artificial kidney" minus (-) VND 130,000 (equivalent to 1/4 of catheter service cost). 

10

Tests for determining tumor markers by radioimmunotherapy or biochemical technique.

...

...

...

- CA 125 test: Ovarian cancer;

- CA 15-3 test: Breast cancer;

- CA 19-9 test: pancreatic, gallbladder cancer;

- CA 72-4 test: Gastric cancer;

- CEA test: Carcinoma

- Payment shall be made according to the costs of “Test for tumor marker by biochemical technique”;

- No payment is made in case other test results/medical imaging reports have been used for determining or evaluating treatment of cancer.  Payment shall be also made in case tests are made for monitoring treatment outcomes or predicting risk of relapse or metastasis of cancer.

11

hs-CRP test

...

...

...

a) A patient has suspected bacterial infections with at least 02 of the following 04 symptoms:

- Body temperature < 36°C or > 38,3°C;

- Rapid heart rate: 90 beats/minute;

- Respiratory rate: > 22 breaths/minute or PaCO2 <32 mmHg;

- WBC count: >12G/L, or < 4G/L, or > 10% immature (band) forms.  For children: A child has suspected bacterial infection, body temperature < 36°C or > 38,3°C and heart rate or respiratory rate exceeding age-related physiological limitations.

b) Neonatal infections;

c) Coronary artery disease, heart attack;

d) Dermatitis, autoimmune diseases.

Payment shall be made according to the cost of relevant medical service.

...

...

...

Procalcitonin test [Level of procalcitonin in blood]

1. Procalcitonin test helps diagnose and monitor serious bacterial infections if the patient has one of the following signs:

- Sequential Organ Failure Assessment (SOFA) score: > 2;

- A patient has suspected bacterial infections with at least 2 of the following 3 symptoms:  Respiratory rate > 22 breaths/minute; Systolic pressure < 100 mmHg; Glasgow Coma Scale (GCS) score < 13.

2. For children:

- Procalcitonin test helps the diagnosis and monitoring of sepsis;

- Procalcitonin test helps monitor and predict sequential organ failure in case the patient has multiple organ dysfunction.

Payment shall be made according to the cost of relevant medical service.

...

...

...

+ Payment is made on the basis of 01 procalcitonin test for every 24 hours to follow a patient with septic shock;

+ Payment is made on the basis of 01 procalcitonin test for every 48 hours to follow a patient with serious infection;

+ No payment is made in case there are reasonable grounds to believe that symptoms have been controlled and value of Procalcitonin test is 02 times less than the reference value.  

Other bacterial contamination cases.

Payment shall be made according to the cost of CRP/hs-CRP test.

CRP/hs-CRP test is ordered at the same time or after the Procalcitonin test has been finished for diagnosing and monitoring patients with serious infections.

Only costs of Procalcitonin test shall be reimbursed; No payment shall be made for costs of CRP/hs-CRP test.

14.

Cataract surgery by phaco and femtosecond laser with or without IOL/ Cataract surgery by phaco

...

...

...

- The health facility has the ophthalmology ward. Cataract surgery for one-eyed patients must be performed at provincial- or central-level health facilities or health facilities of Rank II or higher.

- Cataract surgeon must be a doctor specializing in ophthalmology or higher and possess a certificate of phaco technician;

b) The patient with cataract has a visual acuity of > 3/10:

- The health facility must have the ophthalmology ward and must be a provincial- or central-level health facility or a health facility of Rank II or higher;

- Cataract surgeon must be a level 1 specialist doctor in ophthalmology or higher and possess a certificate of phaco technician;

Note: The visual acuity of 3/10 (expressed in decimals) is equivalent to the visual acuity of 20/80 (of Snellen scale).

Payment shall be made according to the cost of “Cataract surgery by Phaco”.

4. The ordinal numbers 12, 13, 39 and 65 of the List No. 2 – Medical services with payment conditions are amended as follows:

No.

...

...

...

Payment conditions

12

Arthroscopy

Arthroscopy service must be provided at a hospital or health center that has inpatient services and is permitted by a competent authority to provide treatment of musculoskeletal diseases and arthroscopy included in the list of medical services/procedures of health facilities approved by a competent authority; it must be performed by a doctor who has a practicing certificate in one of the following specialties, including general internal medicine, internal medicine subspecialties, medical imaging, surgery, surgical specialties, pediatrics, and traditional medical doctor, and must have a certificate of completion of training course in arthroscopy issued by a training institution or hospital (approved by the Ministry of Health).

13

Joint injection (joint/  tendons/ entheses/ fascia/ paravertebral/ epidural injection)

No more than 3 injection sites will be made in each treatment stage; only one injection is administered in a single site; and no more than 3 treatment stages will be given every 12 months.

18

Rehabilitation services

...

...

...

2. Payment will be made for no more than 06 rehabilitation services per day. To be specific:

a) Payment will be made for no more than 03 movement therapy services per day; if techniques like whole body movement technique are employed, payment will be made for no more than 02 techniques per day;

c) Payment will be made for no more than 02 occupational therapy services per day;

c) Payment will be made for no more than 02 speech therapy services per day;

d) Payment will be made for no more than 04 physical therapy services per day.

39

Swallowing exercises

This medical service must be provided by a medical practitioner who has completed a training course of at least 03 months in physical therapy and rehabilitation provided by a training institution designated by the Ministry of Health.  No more than 03 payments will be made for each treatment of a patient with one of the following problems:

a) After surgery or radiotherapy of oral cavity, pharynx and esophagus;

...

...

...

c) Motor neural diseases caused by polio or Guillain-Barré syndrome;

d) Parkinson's disease;

dd) Amyotrophic lateral sclerosis.

65

Other MRI scans

Director of each health facility shall stipulate and inform social insurance agencies of cases in which MRI scan is required.

In case the Director of the health facility fails to stipulate cases in which MRI scan is required, he/she must directly or authorize another person to give approval for each specific case.  Medical consultation may be carried out before approval, if it is deemed necessary.

Article 8. Amendments to the Circular No. 04/2017/TT-BYT dated April 14, 2017 of the Minister of Health promulgating the list of medical supplies covered by health insurance fund, payment percentages and conditions

1. Point c Clause 2 Article 3 is amended as follows:

...

...

...

E.g.:  The purchase price of a drug-eluting stent A of a health facility is VND 40,000,000; the payment of the drug-eluting stent as prescribed in Column 5 of the List of medical supplies provided in the Appendix 01 hereof is VND 36,000,000. A patient has been hospitalized to receive stenting of 03 drug-eluting stents A at this health facility. Costs of medical supplies other than stents which are not included in the costs of medical service, medical examination, and bed days or the lump-sum cost of each case (hereinafter referred to as “other medical supplies”) is VND 15,000,000; payment of these medical supplies is not prescribed in Column 5 of the List of medical supplies provided in the Appendix 01 hereof.

- If the patient has a valid health insurance card, is eligible to receive reimbursement of 100% of costs of medical services, and uses medical services from a health facility of appropriate level, total payment of cost of medical supplies in each single provision of medical supplies to the patient as described in Example 1 illustrating Point b Clause 2 Article 3 is VND 54,450,000. The sum of cost of a drug-eluting stent A according to the payment specific in Column 5 of the List of medical supplies provided in the Appendix 01 hereof and costs of other medical services: VND 36,000,000 + VND 15,000,000 = VND 51,000,000; this amount is smaller than VND 54,450,000. The health insurance fund shall make the following payments for the patient:

+ Payment of costs of the first stent and other medical supplies: VND 51,000,000;

+ Cost of the second stent: 1/2 x VND 40,000,000 = VND 20,000,000 exceeding VND 18,000,000. Thus, the health insurance fund shall make payment of VND 18,000,000 for the second stent. + No payment will be made for the third stent.

Thus, total payment of medical supplies in each single use of medical service made by the health insurance fund is: VND 51,000,000 + VND 18,000,000 = VND 69,000,000;

If the patient uses medical services from a central-level health facility of inappropriate level, total payment made by the health insurance fund for costs of medical supplies in each single use of medical service is:  (VND 51,000,000 + VND 18,000,000) x 40% = VND 27,600,000;

If the patient uses medical services from a provincial-level health facility of inappropriate level, total payment made by the health insurance fund for costs of medical supplies in each single use of medical service is:  (VND 51,000,000 + VND 18,000,000) x 60% = VND 41,400,000;

- If the patient has a valid health insurance card, is eligible to receive reimbursement of 80% of costs of medical services, and uses medical services from a health facility of appropriate level but his/her accumulated period of contributions to the health insurance fund is still not longer than 5 years, the sum of cost of a drug-eluting stent A according to the payment specific in Column 5 of the List of medical supplies provided in the Appendix 01 hereof and costs of other medical services: VND 36,000,000 + VND 15,000,000 = VND 51,000,000; this amount is smaller than VND 54,450,000.

The health insurance fund shall make the following payments for the patient:

...

...

...

+ Payment for the second stent: VND 18,000,000;

+ No payment will be made for the third stent.

Thus, total payment of medical supplies in each single use of medical service made by the health insurance fund is: VND 51,000,000 x 80% + 18.000.000 = VND 58,800,000”.

If the patient uses medical services from a central-level health facility of inappropriate level, total payment made by the health insurance fund for costs of medical supplies in each single use of medical service is:  (VND 51,000,000 x 80% + VND 18,000,000) x 40% = VND 23,520,000.

If the patient uses medical services from a provincial-level health facility of inappropriate level, total payment made by the health insurance fund for costs of medical supplies in each single use of medical service is:  (VND 51,000,000 x 80% + VND 18,000,000) x 60% = VND 35,280,000.”

2. The Appendix 01 – List of medical supplies covered by the health insurance fund is amended as follows: 

a) The ordinal number 35, code N03.01.030 is changed from “Bơm tiêm truyền áp lực các loại, các cỡ” (“High pressure syringes of all sizes”) into “Bơm tiêm, bơm tiêm truyền áp lực các loại, các cỡ” (“Syringes, high pressure syringes of all sizes”);

b) The ordinal number 262, code N07.04.050 is changed from “Dụng cụ, máy cắt, khâu nối tự Dộng sử dụng trong kỹ thuật Doppler các loại, các cỡ (bao gồm cả bộ Dầu dò Doppler Dộng mạch búi trĩ)” (“Automatic ablation and suture tools or devices of all sizes used in Doppler technique (including hemorrhoidal artery probes)”) into “Dụng cụ, máy cắt, khâu nối tự Dộng các loại, các cỡ (bao gồm cả ghim khâu máy)” (“Automatic ablation and suture tools or devices of all sizes (including staplers)”).

Article 9. Amendments to the Circular No. 23/2011/TT-BYT dated June 10, 2011 of the Minister of Health providing guidelines for use of drugs by health facilities with inpatient services

...

...

...

“a) Disclose information relating the drugs daily taken by each patient by informing them before they use drugs and requesting them or their relatives to make certification by signing the public statement of daily inpatient services (using the form provided in the Appendix 01 enclosed with this Circular).  The public statement of daily inpatient services is hung at the head or foot of the patient bed.”

Article 10. Effect

1. This Circular comes into force from March 01, 2018.

2. The following regulations of the Decision No. 1895/1997/QD-BYT dated September 19, 1997 of the Minister of Health will be abrogated:

a) Point i Section 2 of Working regulations of the Medical Imaging Department;

b) The following phrases " Đã hội chẩn toàn bệnh viện, đối với bệnh viện hạng III; hội chẩn toàn khoa hoặc liên khoa, đối với bệnh viện hạng I và II; sau khi hội chẩn có chỉ định cho người bệnh chuyển viện” in Point a Section 3 Part II of regulations on hospital transfer.

3. Definition in Indicator 20 - Average length of stay prescribed in the Circular No. 28/2014/TT-BYT dated August 14, 2014 is abrogated.

4. Medicines in the ordinal numbers 636 and 1039 Column 2 of List of modern medicines covered by health insurance fund enclosed with the Circular No. 40/2014/TT-BYT dated November 17, 2014 of the Minister of Health are abrogated.

5. The following regulations of the Circular No. 05/2015/TT-BYT dated March 17, 2015 of the Minister of Health are abrogated:

...

...

...

b) Medicine in the ordinal number 296 of Column 1 of List of oriental medicines and herbal medicines;

c) The origin of the medicine in the ordinal number 301 of Column 1 of List of oriental medicines and herbal medicines;

6. The following regulations of the Circular No. 41/2015/TT-BYT dated November 16, 2015 of the Minister of Health are abrograted:  

a) Article 7a;

b) Clause 1 of Appendix 4b.

7. The following regulations of the Circular No. 35/2016/TT-BYT dated September 28, 2016 of the Minister of Health are abrograted: 

a) Point b Clause 1 Article 3;

b) Clause 2 Article 5;

c) Sections 1, 10 and 14 of the List No. 1 – Medical services with payment conditions and percentages;

...

...

...

8. The following regulations of the Circular No. 04/2017/TT-BYT dated April 14, 2017 of the Minister of Health are abrograted: 

a) Point c Clause 2 Article 3;

b) The ordinal number 35, code N03.01.030;

c) The ordinal number 262, code N07.04.050.

9. Point a Clause 1 Article 6 of the Circular No. 23/2011/TT-BYT dated June 10, 2011 of the Minister of Health is abrogated.

Article 11. Transition

1. The reimbursement of costs of covered medical services for patients who have received medical services before the effective date of this Circular and those who have hospitalized before the effective date of this Circular but discharged after the effective date of this Circular shall comply with legislative documents promulgated before the effective date of this Circular.

2. If a hospital does not have physicians, bachelors or technicians who have graduated from higher education courses in medical imaging, X-ray or testing, it shall appoint its employees to attend training courses in these specialties or recruit persons with scope of practicing in these specialties so as to meet professional requirements as regulated by January 01, 2021. 

Article 12. Terms of reference  

...

...

...

Article 13. Implementation

Chief of Office of the Ministry of Health, Directors/ Directors General of Departments/Authorities affiliated to Ministry of Health, Directors of Departments of Health of provinces or central-affiliated cities, heads of health agencies affiliated to Ministries and relevant agencies are responsible for the implementation of this Circular.

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

PP. MINISTER
DEPUTY MINISTER




Pham Le Tuan

Thông tư 50/2017/TT-BYT về sửa đổi quy định liên quan đến thanh toán chi phí khám bệnh, chữa bệnh do Bộ trưởng Bộ Y tế ban hành