Decree 75/2023/ND-CP amend Decree 146/2018/ND-CP detailing Law on Health Insurance

DECREE

Amending and supplementing a number of articles of the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance

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Pursuant to the Law on Organization of the Government dated June 19, 2015; the Law Amending and Supplementing a Number of Articles of the Law on Organization of the Government and the Law on Organization of Local Administration dated November 22, 2019;

Pursuant to the Law on Health Insurance dated November 14, 2008, and the Law Amending and Supplementing a Number of Articles of the Law on Health Insurance dated June 13, 2014;

At the proposal of the Minister of Health,

The Government hereby promulgates the Decree amending and supplementing a number of articles of the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance.

Article 1. Amending and supplementing a number of articles of the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance

1. To amend and supplement a number of clauses of Article 3 as follows:

a) To amend and supplement Clause 8 as follows:

“8. Persons entitled to monthly social allowance and assistance under the law on the elderly, people with disabilities or social assistance.”;

b) To amend and supplement Point a Clause 9 as follows:

“a) Members of poor households measured by poor household criteria for the 2022-2025 period as defined in the Government’s Decree No. 07/2021/ND-CP dated January 27, 2021, promulgating multidimensional poverty standards for the 2021-2025 period (hereinafter referred to as Decree No. 07/2021/ND-CP), and other decisions issued by competent agencies amending, supplementing or replacing poverty standards applied in each period;”;

c) To add Clause 20 after Clauses 18 and 19 which were added under Clauses 1 Article 183 of the Government’s Decree No. 131/2021/ND-CP dated December 30, 2021, detailing, and providing measures to implement the Ordinance on Preferential Treatment of Persons with Meritorious Services to the Revolution as follows:

“20. People in safe zone communes and revolutionary safe zones during the resistance war against the French and Americans, currently residing in safe communes in the revolutionary zones during the resistance against the French and American, whose information has been updated in the National population database and resident database, other than those specified in Clauses 1, 2 and 3, Article 12 of the Law on Health Insurance.”.

2. To amend and supplement a number of clauses of Article 4 as follows:

a) To amend and supplement Clause 1 as follows:

“1. Members of households living in near poverty measured based on poor household criteria for the 2022-2025 period as defined in Decree No. 07/2021/ND-CP, and other decisions issued by competent agencies amending, supplementing or replacing near-poor household criteria applied in each period.”;

b) To amend and supplement Clause 4 as follows:

“4. Members of agriculture, forestry, fishery and salt-making households with an average living standard measured based on criteria for households with an average living standard for the 2022-2025 period as defined in Decree No. 07/2021/ND-CP, and other decisions issued by competent agencies amending, supplementing or replacing criteria for households with an average living standard applied in each period.”;

c) To add Clause 5 after Clause 4 as follows:

“5. “Ethnic minorities currently living in communes of Region II, Region III, and extremely difficult villages in ethnic minority and mountainous areas for the 2016-2020 period, and such communes are no longer on the List of communes in Region II, Region III, and extremely difficult villages in ethnic minority and mountainous areas for the period 2021-2025 in accordance with the Prime Minister’s decision.”.

3. To amend and supplement a number of clauses of Article 8 as follows:

a) To amend and supplement Points a and b Clause 1 as follows:

“a) 100% of health insurance premiums, for persons of households living in near poverty in poor district areas under the Prime Minister’s decisions and other documents issued by competent agencies;

b) At least 70% of health insurance premiums, for the persons defined in Clauses 1, 2 and 5 Article 4 of this Decree;”;

b) To amend and supplement Clause 3 as follows:

“3. Based on their local budget capacity and other lawful funding sources, provincial-level People’s Committees may propose to provincial-level People’s Councils for decision on:

a) A state budget support rate higher than the minimum rate prescribed at Points b and c Clause 1 Article 8 of this Decree;

b) A state budget support rate for the persons ineligible for the rate prescribed in Clause 1 Article 8 of this Decree;

c) The persons eligible for support and co-payment support rate for health insurance-covered medical care costs for health insurance participants when going for medical examination and treatment.”.

4. To amend and supplement a number of clauses of Article 9 as follows:

a) To amend and supplement Clause 2 as follows:

“2. For the persons defined in Clauses 3, 5, 8, 11, 12, 18, 19 and 20 Article 3 of this Decree: The labor, invalids and social affairs agency shall quarterly transfer money from the funding source for implementation of preferential policies toward persons with meritorious services to the revolution or the funding source for implementation of social protection policies to the health insurance fund. Before December 15 every year at the latest, the labor, invalids and social affairs agency shall complete the payment and transfer of money of that year to the health insurance fund.”;

b) To amend and supplement Clause 3 as follows:

“3. For the persons defined in Clauses 1, 4, 6, 7, 9, 10, 13, 14 and 17 Article 3, and the persons defined in Clauses 1, 2 and 5 Article 4, of this Decree:

a) The social insurance agency shall quarterly sum up the number of health insurance cards issued and health insurance premiums wholly or partially paid by the state budget according to Form No. 1 in the Appendix to this Decree, and send it to the finance agency for transferring money to the health insurance fund under Clause 9 of this Article;

b) The time for calculating payable health insurance premiums is prescribed as follows: For the insured included in a list every year, health insurance premiums shall be calculated from January 1; for the persons additionally included in the list in the year, health insurance premiums shall be calculated from the date stated in the competent state agency’s decision approving such list;

c) In case the health insurance participant is missing, lost or no longer resides in Vietnam, the health insurance premiums shall be calculated from the time of contribution to the time of stopping the contribution under the list of reduced contribution announcement made by the competent agency”.

5. To amend and supplement Points a and e Clause 1 Article 14 as follows:

a) To amend and supplement Point a as follows:

a) 100% of the costs, for the persons defined in Clauses 3, 4, 5, 8, 9, 11, 17 and 20 Article 3 of this Decree;”;

b) To amend and supplement Point e as follows:

“e) 95% of the costs, for the persons defined in Clause 1 Article 2, Clauses 12, 18 and 19 Article 3, and Clauses 1, 2 and 5 Article 4, of this Decree;”.

6. To amend and supplement Clause 1 Article 15 as follows:

“1. To receive medical care, an insured shall produce his/her photo-stuck health insurance card or citizen identity card; if the health insurance card has no photo, he/she shall also produce a photo-stuck personal identification paper issued by a competent agency or organization or a written certification given by the commune-level Public Security agency or another paper certified by the education institution that manages the insured; or other lawful personal identification papers; or level-2 electronically-identified papers in accordance with the Government's Decree No. 59/2022/ND-CP dated September 5, 2022, on electronic identification and authentication.”.

7. To amend and supplement a number of clauses of Article 21 as follows:

a) To amend and supplement Clause 1 as follows:

“1. Rights of health establishments:

a) To perform rights specified in Article 42 of the Law on Health Insurance and the law on medical examination and treatment;

b) To receive timely information provision when the health insurance assessment information system detects an increase in health insurance-covered medical care cost that is high compared to the average cost of the health establishments of the same class, same level, same specialty to promptly review, verify, and take appropriate adjustment solutions.”;

b) To amend and supplement Point a Clause 2 as follows:

“a) To perform responsibilities specified in Article 43 of the Law on Health Insurance and responsibilities specified by the law on medical examination and treatment;”;

c) To amend and supplement Point b Clause 2 as follows:

b) To comply with the law on medical examination and treatment, professional instructions provided by the Ministry of Health, and the laws relating to procurement, bidding to supply qualified drugs, chemicals, medical supplies and technical services in an effective and economic manner;”;

d) To add Points dd and e after Clause 2 as follows:

“dd) To establish the information technology infrastructure, upgrade and consolidate the hospital management software to strictly comply with the law on input and output data standards, electronic data extraction, digital transformation and e-transactions in the medical sector;

e) To review and promulgate in a timely manner procedures and professional guidance in providing medical examination and treatment services covered by health insurance, measures to prevent abuse and profiteering of health insurance funds according to competence; organize inspection and review of payment of health insurance-covered medical care costs as prescribed by law; proactively detect, review, and verify increased health insurance-covered medical care costs at the establishment according to recommendations and warnings of the social insurance agency and make appropriate adjustments.”.

8. To amend and supplement Clause 3 Article 24 as follows:

“3. Payment principles:

a) Medical care costs, costs of bedside services, technical and laboratory services used for patients within the scope of benefits and the level of health insurance benefits of participants shall be paid according to the actual quantity used for the patients at their prices according to current regulations;

b) Costs of medicines, chemicals and medical supplies not yet included in health insurance-covered medical care service fees, or used in technical services for which the health insurance-covered medical care costs have not been issued, used for patients within the scope of benefits and the benefit levels of health insurance participants shall be paid according to the actual quantity used at their purchase prices in accordance with the law on bidding;

c) Costs of blood and blood preparations shall be paid under the guidance of the Minister of Health.”.

9. To amend and supplement Article 36 as follows:

“Article 36. Making of financial plans and finalization

1. Annually, the Vietnam Social Security shall make financial plans on revenues and expenditures, expenses for the management and investments from temporarily idle amounts of the health insurance fund. The Ministry of Finance shall assume the prime responsibility for, and coordinate with the Ministry of Health in, examining and submitting such plans to the Prime Minister for assignment.

2. Making and assigning health insurance-covered medical care cost estimates and notifying the expected expenditures for health insurance-covered medical care:

a) The Vietnam Social Security shall make a health insurance-covered medical care cost estimate for the following year (including estimates of the Social Insurance of the Ministry of National Defence and Social Insurance of the Ministry of Public Security), and send it to the Ministry of Finance before August 30 every year. The Ministry of Finance shall assume the prime responsibility for, and coordinate with the Ministry of Health in, summarizing and submitting the Prime Minister for assignment of health insurance-covered medical care cost estimates from the revenue estimates and provisional fund to the Vietnam Social Security;

b) Based on the estimates assigned by the Prime Minister, the Vietnam Social Security shall assign health insurance-covered medical care cost estimates to the Social Insurance of the Ministry of National Defence and Social Insurance of the Ministry of Public Security, provincial-level social insurance agencies within the scope of 90% the national health insurance revenue estimates;

c) Based on the health establishments’ proposals, provincial-level social insurance agencies shall notify the expected expenditures for health insurance-covered medical care to health establishments (such expected expenditures shall not be used as a basis for the temporary payment, payment or finalization of health insurance-covered medical care costs of health establishments in cases in excess of expected expenditures). In case where the health establishment has the expected expenditures during the year increased or decreased in comparison to the announced ones, it shall send a document to the provincial-level social insurance agency before October 15 every year for summarization and adjustment within the scope of assigned estimates of the provincial-level social insurance agency;

d) In case of the total estimated expenditures for health insurance-covered medical care of health establishments, the estimated expenditures for health insurance-covered medical care of the Social Insurance of the Ministry of National Defence, the Social Insurance of the Ministry of Public Security during the year increased or decreased compared to the estimate assigned by the Vietnam Social Security, provincial-level social insurance agencies, Social Insurance of the Ministry of National Defence, Social Insurance of the Ministry of Public Security shall summarize and send them to the Vietnam Social Security before October 30 every year to consider adjusting between provinces and centrally-run cities and the Social Insurance of the Ministry of National Defense and Social Insurance of the Ministry of Public Security.

The Vietnam Social Security shall summarize and consider adjusting health insurance-covered medical care cost estimates between provincial-level Social Insurance, Social Insurance of the Ministry of National Defence, and Social Insurance of the Ministry of Public Security within the estimate assigned by the Prime Minister before November 15 every year as a basis for adjusting the estimated expenditures for health insurance-covered medical care of health establishments.

3. Additional allocation of funding for health insurance-covered medical care for health establishments in case their actual costs for health insurance-covered medical care, after being evaluated by social insurance agencies, are higher than the estimated expenditures (including the amount notified at the beginning of the year and the amount adjusted during the year), and higher than the health insurance-covered medical care estimates assigned by the Vietnam Social Security:

a) Provincial-level social insurance agencies shall assume the prime responsibility for, and coordinate with provincial-level Departments of Health and health establishments, in reviewing and determining the expenses for health insurance-covered medical care in excess of the estimated expenditures to be paid, and additionally allocating funding for health establishments.

b) In case the estimates assigned by the Vietnam Social Security are not enough for additional allocation to health establishments, provincial-level social insurance agencies, the Social Insurance of the Ministry of National Defence and Social Insurance of the Ministry of Public Security shall summarize and submit to the Vietnam Social Security for considering additional allocation of funding for health insurance-covered medical care.

4. In case the total actual expenses for health insurance-covered medical care during the year are higher than the estimates assigned by the Prime Minister, the Vietnam Social Security shall additionally allocate funding for health insurance-covered medical care to pay for health establishments from provisional sources, and summarize reports and send them to the Council for Social Insurance Management, the Ministry of Finance, the Ministry of Health and the Prime Minister.

In case the provisional health insurance fund is not enough for additionally allocating funding for medical care for provinces and centrally-run cities, the Social Insurance of the Ministry of National Defence and Social Insurance of the Ministry of Public Security, agencies shall comply with Clause 3 Article 35 of this Decree.

5. Advance payment, payment and finalization of health insurance-covered medical care costs for health establishments shall be carried out on a quarterly basis in accordance with Clauses 1 and 2 of the Law on Health Insurance.

6. On an annual basis, before October 1, the Vietnam Social Security shall summarize and make health insurance fund finalization reports of the previous year in accordance with Article 32 of the Law on Health Insurance.”

10. To amend and supplement a number of clauses of Article 42 as follows:

a) To amend Point g Clause 1 as follows:

“g) Provide regulations and guide the interconnection of data on test results, diagnostic imaging, functional exploration and information on the treatment of patients holding health insurance cards.”;

b) To add Point i after Point h Clause 1 as follows:

“i) Direct health establishments and centralized procurement units to strictly implement regulations related to procurement and bidding to ensure timely supply of drugs, chemicals and medical supplies within the scope of benefits of health insurance participants, improving thrifty practices and preventing waste. Direct health establishments to comply with the provisions of the law on medical examination and treatment and professional instructions of the Ministry of Health; legal regulations related to the provision of medical technical services to ensure quality, efficiency and savings. Review and update according to practical requirements the lists, conditions, scope, and payment rates for drugs, supplies, technical services, and goods within the payment scope of the health insurance fund to ensure effective management and use of funds”.

c) To amend and supplement Point d Clause 5 Article 42 as follows:

“d) Complete the information technology system to receive, assess and promptly notify health establishments of, health insurance-covered medical care data; ensure the accuracy, safety and confidentiality of information and benefits of related parties; proactively review, detect and send timely warning information to health insurance-covered health establishments about increased health insurance-covered medical care costs compared to the average cost of medical health establishments of the same class, same level, and same specialty.”

Article 2. Amending and supplementing a number of articles of the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance

1. To replace forms No. 5, 6 and 7 provided in the Appendix to the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance, with forms No. 5, 6 and 7 provided in the Appendix to this Decree.

2. To repeal Clause 16 Article 3 of the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance.

3. To repeal Clauses 4, 5 and 6 Article 24 of the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance.

Article 3. Effect

1. This Decree takes effect from December 3, 2023.

2. Provision of Clause 1, Points a and b Clause 2, Clauses 3, 4, 5 and 6 Article 1 of this Decree shall be applied from October 19, 2023.

3. The state budget shall provide 36-month support to persons specified at Point c Clause 2 Article 1 of this Decree from November 1, 2023.

4. Provision of Clause 8 Article 1 and Clause 3 Article 2 of this Decree shall be applied from January 01, 2019. The payment and finalization of health insurance-covered medical care costs from January 1, 2019, shall comply with Articles 30 and 31, Clause 2 Article 32 of the Law on Health Insurance and Clause 8 Article 1 of this Decree.

Article 4. Transitional provisions

Health insurance participants visiting health establishments for treatment before the effective date of this Decree and discharging from health establishments from the effective date of this Decree shall receive payment from the health insurance fund within the scope of benefits and benefit levels specified in the Law on Health Insurance, provisions of Points b, c, d, dd, g and h Clause 1, Clauses 2, 3, 4 and 5 Article 14 of Decree No. 146/2018/ND-CP and Clause 5 Article 1 of this Decree.

Article 5. Implementation responsibility

Ministers, heads of ministerial-level agencies, heads of government-attached agencies, chairpersons of People’s Committees of provinces and centrally-run cities, and related organizations and individuals shall implement this Decree./.

* All Appendices are not translated herein.