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 of October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance^[1] 

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

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

At the proposal of the Minister of Health;

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

Article 1. To amend and supplement a number of articles of the Government’s Decree No. 146/2018/ND-CP of October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance (below referred to as Decree No. 146/2018/ND-CP)

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 social relief in accordance with the law on the elderly, people with disabilities or social relief.”;

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

“a/ Members of poor households measured by standards of poor households specified in the Government’s Decree No. 07/2021/ND-CP of January 27, 2021, promulgating multidimensional poverty standards for the 2021-2025 period (below referred to as Decree No. 07/2021/ND-CP) and other documents issued by agencies competent to amend, supplement or replace poverty standards applicable to each period;”;

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

 “20. People who have lived in communes in former revolutionary bases during the anti-French resistance war or anti-American resistance war and are permanently residing in communes in former revolutionary bases during the anti-French resistance war or anti-American resistance war and whose information has been included in the National Population Database and Residence 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 near-poverty households measured by the near-poverty household standards for the 2022-2025 period specified in Decree No. 07/2021/ND-CP, and other documents issued by competent agencies competent to amend, supplement or replace near-poverty household standards applicable to 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 by the better-off household standard for the 2022-2025 period specified in Decree No. 07/2021/ND-CP, and other documents issued by competent agencies competent to amend, supplement or replace the better-off household standard applicable to each period.”;

c/ To add Clause 5 below Clause 4 as follows:

“5. Ethnic minority people currently living in region-II or region-III communes and villages with particularly difficult conditions in ethnic minority and mountainous areas in the 2016-2020 period which are no longer on the list of region-II or region-III communes and villages with particularly difficult conditions in ethnic minority and mountainous areas in the 2021-2025 period under 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/ The whole amount of health insurance premiums, for members of near-poverty households currently residing in poor districts under the Government’s decision and other documents of competent agencies;

b/ At least 70% of health insurance premiums, for the persons specified 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:

a/ A health insurance premium support rate higher than the minimum support rate specified at Points b and c, Clause 1, Article 8 of this Decree;

b/ A health insurance premium support rate for persons ineligible for the support rate specified in Clause 1, Article 8 of this Decree;

c/ Persons eligible for support and support rates for co-payment of health insurance-covered medical examination and treatment expenses for the insured upon receiving 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 specified in Clauses 3, 5, 8, 11, 12, 18, 19 and 20, Article 3 of this Decree, the labor, invalids and social affairs agency shall transfer on a quarterly basis funds from the funding source for the implementation of preferential policies toward persons with meritorious services to the revolution or the funding source for the implementation of social protection policies to the health insurance fund. Before December 15 every year, the labor, invalids and social affairs agency shall complete the remittance and transfer of funds of that year to the health insurance fund.”;

b/ To amend and supplement Clause 3 as follows:

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

a/ Every quarter, the social insurance agency shall make a sum-up report on the number of health insurance cards issued and health insurance premiums wholly or partially paid by the state budget according to Form No. 1 provided in the Appendix to this Decree, and send it to the finance agency for transfer of funds into the health insurance fund under Clause 9 of this Article;

b/ Payable health insurance premiums shall be calculated from January 1, for the insured on an annual list; or the date stated in the competent agency’s decision approving such list, for those additionally included in such list during the year;

c/ In case the insured is dead, missing or no longer resides in Vietnam, payable health insurance premiums shall be calculated from the time of premium payment to the time of premium payment cessation under the list of the insured eligible for premium reduction 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/ The whole amount of medical examination and treatment expenses, for the persons specified 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 medical examination and treatment expenses, for the persons specified 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 examination and/or treatment, an insured shall produce his/her photo-stuck health insurance card or citizen identity card. If his/her health insurance card bears 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 office or another paper certified by the educational institution that manages the insured; other lawful personal identification papers; or level-2 electronic identification papers specified in the Government’s Decree No. 59/2022/ND-CP of 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 exercise the rights provided in Article 42 of the Law on Health Insurance and regulations on medical examination and treatment;

b/ To be promptly provided with information when the health insurance assessment information system detects an increase in the health insurance-covered medical examination and treatment expenses that is higher than average expenses of medical examination and treatment establishments of the same rank, same level and same specialty in order to promptly review, verify, and take appropriate adjustment solutions.”;

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

“a/ To fulfil the 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 regulations on medical examination and treatment, professional guidance of the Ministry of Health, and relevant regulations on procurement and bidding for supply of quality medicines, chemicals, medical supplies and technical services in an efficient and economic manner;”;

d/ To add Points dd and e to Clause 2 as follows:

“dd/ To establish the information technology infrastructure system, upgrade and improve hospital management software in order to properly implement the regulations on input and output data standards, electronic data extraction, digital transformation and e-transactions in the field of health;

e/ To review and promptly promulgate professional processes and guidance for health insurance-covered medical examination and treatment, measures to prevent abuse and profiteering of the health insurance fund according to their competence; to organize inspection and review of the payment of health insurance-covered medical examination and treatment expenses in accordance with law; to proactively detect, review and verify increased health insurance-covered medical examination and treatment expenses at establishments based on recommendations or cautions of social security agencies, and make appropriate adjustments.”.

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

“3. Payment principles:

a/ Expenses for medical examination services, daily hospital bed services, medical technical and testing services for patients within the scope and at the level of benefits of the insured shall be paid according to the number of services actually provided to the patients at the charge rates specified in current regulations;

b/ Expenses for medicines, chemicals and medical supplies not yet included in health insurance-covered medical examination and treatment service charge rates or technical services for which the health insurance-covered medical examination and treatment service charge rates have not been issued for patients within the scope and at the level of benefits of the insured shall be paid according to the number of services actually provided to the patients at the charge rates specified in the bidding law;

c/ Expenses for 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 account finalization

1. Annually, the Vietnam Social Security shall make financial plans on revenues and expenditures, and expenses for the management of, and investment 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. To make and assign health insurance-covered medical examination and treatment expense estimates and notify the estimated health insurance-covered medical examination and treatment expense amount, as follows:

a/ The Vietnam Social Security shall make a health insurance-covered medical examination and treatment expense estimate for the subsequent year (including social insurance estimates of the Ministry of National Defense and 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 it to the Prime Minister for assignment of health insurance-covered medical examination and treatment expense estimates based on the estimated revenue (collected health insurance premium) amount and the contingency fund to the Vietnam Social Security;

b/ Based on expense estimates assigned by the Prime Minister, the Vietnam Social Security shall assign health insurance-covered medical examination and treatment expense estimates to the social security agencies of the Ministry of National Defense and the Ministry of Public Security, and provincial-level social security agencies within 90% of health insurance premiums estimated to be collected nationwide;

c/ Upon request of medical examination and treatment establishments, provincial-level social security agencies shall notify estimated health insurance-covered medical examination and treatment expenses to such medical examination and treatment establishments (not to be used as a basis for the advance payment, payment or account finalization of health insurance-covered medical examination and treatment expenses of such establishments in case of any excess in the estimated expenses). In case estimated expenses in a year of a medical examination and treatment establishment see an increase or a reduction compared to the notified ones, such establishment shall send a document to a provincial-level social security agency before October 15 every year for summarization and adjustment within the scope of the assigned estimate of the provincial-level social insurance agency;

d/ In case total estimated health insurance-covered medical examination and treatment expenses of health establishments and estimated health insurance-covered medical examination and treatment expenses of social security agencies of the Ministry of National Defense and the Ministry of Public Security in a year see an increase or a reduction compared to the estimates assigned by the Vietnam Social Security, provincial-level social security agencies, and social security agencies of the Ministry of National Defense and the Ministry of Public Security shall summarize and send them to the Vietnam Social Security before October 30 every year for consideration and adjustment between provinces/centrally run cities and the social security agencies of the Ministry of National Defense and the Ministry of Public Security.

The Vietnam Social Security shall summarize, consider adjusting health insurance-covered medical examination and treatment expense estimates between provincial-level social security agencies and social security agencies of the Ministry of National Defense and the Ministry of Public Security within the estimates assigned by the Prime Minister before November 15 every year for use as a basis for adjusting estimated health insurance-covered medical examination and treatment expenses of health establishments.

3. To additionally cover  health insurance-covered medical examination and treatment expenses for health establishments in case their actual health insurance-covered medical examination and treatment expenses in a year, after being assessed by social security agencies, are higher than the estimated ones (including the amount notified at the beginning of the year and the amount adjusted during the year) and higher than health insurance-covered medical examination and treatment expense estimates assigned by the Vietnam Social Security, as follows:

a/ Provincial-level social security agencies shall assume the prime responsibility for, and coordinate with provincial-level Departments of Health and health establishments in, reviewing and determining health insurance-covered medical examination and treatment expenses in excess of the estimated expenses to be paid, and additionally cover expenses for health establishments.

b/ In case the estimates assigned by the Vietnam Social Security is not enough to additionally cover expenses of health establishments, provincial-level social security agencies and social security agencies of the Ministry of National Defense and the Ministry of Public Security shall summarize and submit them to the Vietnam Social Security for considering and additionally covering health insurance-covered medical examination and treatment expenses.

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

In case the contingency fund is not enough to additionally cover medical examination and treatment expenses for provinces and centrally run cities and social security agencies of the Ministry of National Defense and the Ministry of Public Security, agencies must comply with Clause 3, Article 35 of this Decree.

5. Advance payment, payment and finalization of health insurance-covered medical examination and treatment expenses for health establishments shall be carried out on a quarterly basis under Clauses 1 and 2, Article 32 of the Law on Health Insurance.

6. Before October 1 every year, the Vietnam Social Security shall sum up and make finalization reports on the health insurance fund of the preceding year under 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 guidance on the interconnection of data on test results, diagnostic imaging, functional probing and information on the medical examination and treatment of the insured.”;

b/ To add Point i below Point h, Clause 1 as follows:

“i/ Direct health establishments and centralized procurement units in properly implementing regulations on procurement and bidding in order to ensure timely supply of medicines, chemicals and medical supplies within the scope of benefits of the insured, improving thrift practices and preventing waste; direct health establishments in complying with regulations on medical examination and treatment and professional guidance of the Ministry of Health, and regulations on provision of medical technical services in a quality, efficient and economical manner; review and update according to practical requirements lists, conditions, scope and payment rates for medicines, medical supplies, technical services and goods eligible for payment by the health insurance fund in order to ensure effective management and use of the fund”.

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

“d/ Improve the information technology system to receive, assess and promptly notify health establishments of, health insurance-covered medical examination and treatment data, ensuring the accuracy, safety and confidentiality of information and benefits of related parties; proactively review, detect and send timely cautions to health insurance-covered health establishments about any increase in health insurance-covered medical examination and treatment expenses compared to the average expense level of health establishments of the same rank, same level and same specialty.”

Article 2. To amend and supplement a number of provisions of Decree No. 146/2018/ND-CP

1. To replace Form No. 5, Form No. 6 and Form No.7 provided in the Appendix to Decree No. 146/2018/ND-CP with Form No. 5, Form No.6 and Form No.7 provided in the Appendix to this Decree.

2. To annul Clause 16, Article 3 of Decree No. 146/2018/ND-CP.

3. To annul Clauses 4, 5 and 6, Article 24 Decree No. 146/2018/ND-CP.

Article 3. Effect

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

2. Clause 1; Points a and b, Clause 2; and Clauses 3, 4, 5 and 6, Article 1 of this Decree apply from October 19, 2023.

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

4. Clause 8, Article 1; and Clause 3, Article 2, of this Decree shall apply from January 1, 2019. The payment and finalization of health insurance-covered medical examination and treatment expenses from January 1, 2019, must comply with Articles 30 and 31, and Clause 2, Article 32, of the Law on Health Insurance, and Clause 8, Article 1 of this Decree.

Article 4. Transitional provisions

For the insured who are hospitalized for medical treatment before the effective date of this Decree but then discharged on or after the effective date of this Decree, the health insurance fund shall pay their medical examination and treatment expenses within the scope and at the level of benefits in accordance with the Law on Health Insurance and Points b, c, d, dd, g and h, Clause 1, and 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 provincial-level People’s Committees, and related organizations and individuals shall implement this Decree.-

On behalf of the Government
For the Prime Minister
Deputy Minister
TRAN HONG HA

* The Appendix to this Decree is not translated.