Circular No. 04/2017/TT-BYT dated April 14, 2017 of the Ministry of Health on the schedule, rates and conditions of payment of costs of covered medical supplies to health insurance participants

THE MINISTRY OF HEALTH

Circular No. 04/2017/TT-BYT dated April 14, 2017 of the Ministry of Health on the schedule, rates and conditions of payment of costs of covered medical supplies to health insurance participants

Pursuant to the Law on Health Insurance;

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

Pursuant to the Government s Decree No. 105/2014/ND-CP dated November 15, 2014 on specifying and guiding the implementation of a number of articles of the Law on Health Insurance;

Pursuant to the Government s Decree No. 70/2015/ND-CP dated September 1, 2015 on specifying and guiding the implementation of a number of articles of the Law on Health Insurance applied to the People’s Army, Police and Ciphering officers;

Upon the request of the Director of the Health Insurance Department,

The Minister of Health hereby issues the Circular promulgating the schedule, rates and conditions of payment of costs of covered medical supplies to health insurance participants.

Article 1. Schedule of medical supplies of which health insurance coverage is provided for health insurance participants

1. The Schedule of medical supplies of which health insurance coverage is provided for health insurance participants, which is prescribed in the Appendix 01 hereto attached, shall comprise medical consumables, man-made alternatives, replacements, implants and dedicated devices or accessories (hereinafter referred to as medical supplies).

2. The Schedule of medical supplies given in the Appendix 01 hereof shall serve as the basis for the health insurance fund’s payment of costs of medical supplies to health insurance participants in accordance with Laws on Heath Insurance.

Article 2. Compilation and use of the Schedule of medical supplies of which health insurance coverage is provided for health insurance participants at healthcare service establishments

1. The Schedule of medical supplies used at health care service establishments must be compiled based on the Schedule of medical supplies given in the Appendix 01 hereto attached; demands for medical examination and treatment services; available personnel competence and capacity of medical equipment; list of medical technical services (hereinafter referred to as medical services) that has been approved by competent authorities and were actually consumed in the previous year according to the rules of safety, rationality, efficiency, conformity to medical service demands, relevance to payment capability of the health insurance fund; must prefer medical supplies that are domestically manufactured, have reasonable quality and prices.

2. After arriving at contractor selection results, healthcare service establishments shall send social security authorities the following documents for payment purposes:

a) The list of schedules of medical supplies of which costs have not been charged into prices of medical services, medical examination services and treatment bed days or lump-sum prices for specific visits of patients at healthcare service establishments, which is compiled by completing the form given in the Appendix No.02 hereto attached (both in a written document and electronic excel file format);

b) The decision on approval of the contractor selection plan and the decision on approval of results of selection of medical supplies contractors (both in a document and electronic excel file format).

3. If non-public healthcare service establishments choose to apply Article 52 of the Law on Procurement for their purchases of medical supplies, they must compile the list of schedules of medical supplies of which costs have not been charged into prices of medical services, medical examination services and treatment bed days or lump-sum prices for specific visits of patients at these establishments by completing the form given in the Appendix No.02 hereto attached and submit it to the relevant social security authority.

Article 3. General payment guide

1. The health insurance fund shall not make separate payments for medical supplies of which costs have been charged into prices of medical services, medical examination services, treatment bed days or lump-sum prices for specific visits of patients.

2. The health insurance fund shall make payments for medical supplies of which costs have not been charged into prices of medical services, medical examination services, treatment bed days or lump-sum prices for specific visits of patients as follows:

a) Payment bases shall be composed of:

- Actual quantity of medical supplies consumed by patients;

- Purchase prices of medical supplies prescribed by laws on procurement; if purchase prices of medical supplies are higher than the health insurance fund s payment or coverage amounts specified in the 5^thcolumn of the Schedule of medical supplies of the Appendix 01 hereto attached, payment bases shall be payment or coverage amounts specified in the 5^thcolumn of the Schedule of medical supplies of the Appendix 01 hereto attached;

- Conditions, rates and amounts of payment which are specified in the 5^thcolumn of the Schedule of medical supplies in the Appendix 01 hereto attached;

- Scope and level of health insurance coverage which are specified in laws on health insurance;

b) The amount of payment of total cost of medical supplies in each use of medical service shall not exceed 45 months base pay amount; this regulation shall not apply to medical supplies for which rates of payment are prescribed in the 5^thcolumn of the Schedule of medical supplies in the Appendix 01 hereto attached;

Example 1(Illustration of Point b Clause 2 Article 3): The amount of payment of total cost of medical supplies for a single use of medical services by an insured patient during the period when the statutory base pay equals VND 1,210,000 shall be calculated as follows:

- If this patient is the participant in the health insurance program who is entitled to a cover for 100% of medical examination and treatment costs, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 45 x 100% x 1,210,000 = VND 54,450,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 95% of medical examination and treatment costs, but whose accumulated consecutive period of health insurance participation is not more than 5 years, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 45 x 95% x 1,210,000 = VND 51,727,500;

- If this patient is the participant in the health insurance program who is entitled to a cover for 95% of medical examination and treatment costs and whose accumulated consecutive period of health insurance participation is more than 5 years:

+ If this patient has not yet made any co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as 45 x 95% x 1,210,000 = VND 51,727,000;

+ If this patient has already made co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services of which the amount has reached 6 months base pay amount, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as 45 months’ base pay amount equal to VND 54,450,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs, but whose accumulated consecutive period of health insurance participation is not more than 5 years, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 45 x 80% x 1,210,000 = VND 43,560,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs and whose accumulated consecutive period of health insurance participation is more than 5 years:

+ If this patient has not yet made any co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as (45 x 80% x 1,210,000) + (45 x 20% - 6) x 1,210,000 = VND 47,190,000;

+ If this patient has already made co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services of which the amount has reached 6 months base pay amount, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as 45 months’ base pay amount equal to VND 54,450,000.

Example 2(Illustration of Point a, b Clause 2 Article 3: If total cost of medical supplies is greater than 45 months’ base pay amount): During the period when the base pay amount per a month is VND 1,210,000, it is presumed that the patient is provided with 01 medical supply (item A) and 02 medical supplies (item B) for his/her single use of medical services. If the purchase price of item A is VND 50,000,000 and its amount of payment covered by the health insurance fund as specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached is VND 42,000,000; the purchase price of item B is VND 10,000,000 and its amount of payment covered by the health insurance fund as specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached is unidentified,

total cost of medical supplies (cost of item A is calculated based on the amount of payment specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached and cost of item B is calculated based on its purchase price) for his/her single use of medical services shall be calculated as 42,000,000 x 1 + 10,000,000 x 2 = VND 62,000,000. As this cost is greater than 45 month’s base pay amount (VND 54,450,000), the health insurance fund shall agree with the amount of payment for total cost of medical supplies to insured patients entitled to different levels of coverage which is the same as that amount of payment specified in Example 1 (Illustration of Point b Clause 1 Article 3).

Example 3(Illustration of Point a, b Clause 2 Article 3: If total cost of medical supplies is less than 45 months’ base pay amount): The patient is provided with 01 medical supply (item A), 02 medical supplies (item B) and 03 medical supplies (item C) in his/her single use of medical services. If the purchase price of item A is VND 40,000,000 and its amount of payment covered by the health insurance fund as specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached is VND 35,000,000; the purchase price of item B is VND 3,000,000 and its amount of payment covered by the health insurance fund as specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached is unidentified; the purchase price of item C is VND 2,000,000 and its amount of payment covered by the health insurance fund as specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached is unidentified.

Total cost of medical supplies (cost of item A is calculated based on the amount of payment specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached and cost of item B and item C is calculated based on their purchase prices) for his/her single use of medical services shall be calculated as 35,000,000 x 1 + 3,000,000 x 2 + 2,000,000 x 3 = VND 47,000,000. As this cost is less than 45 months’ base pay amount (VND 54,450,000), the health insurance fund shall cover it for the patient as follows:

- If this patient is the participant in the health insurance program who is entitled to a cover for 100% of medical examination and treatment costs, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 47,000,000 x 100% = VND 47,000,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 95% of medical examination and treatment costs, but whose accumulated consecutive period of health insurance participation is not more than 5 years, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 47,000,000 x 95% = VND 44,650,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 95% of medical examination and treatment costs and whose accumulated consecutive period of health insurance participation is more than 5 years:

+ If this patient has not yet made any co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as 47,000,000 x 95% = VND 44,650,000;

+ If this patient has already made co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services of which the amount has reached 6 months base pay amount, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be equal to VND 47,000,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs, but whose accumulated consecutive period of health insurance participation is not more than 5 years, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 47,000,000 x 80% = VND 37,600,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs and whose accumulated consecutive period of health insurance participation is more than 5 years:

+ If this patient has not yet made any co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as (47,000,000 x 80%) + (47,000,000 x 20% - 6 x 1,210,000) = VND 39,740,000;

+ If this patient has already made co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services of which the amount has reached 6 months base pay amount, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be equal to VND 47,000,000.

c) If more drug-eluting stents are used in thecoronarystenting technique, the amount of payment of total cost of medical supplies in a single use of medical services by an insured patient shall be subject to the payment guide specified in Point b Clause 2 of this Article, in addition to which the health insurance fund shall agree to provide a cover for another half (1/2) of cost of the second stent at the purchase price defined by the healthcare service establishment which does not exceed VND 18,000,000;

Example: Drug-eluting stent A is purchased by a healthcare service establishment at the price of VND 40,000,000; the amount of payment of cost of a drug-eluting stent that is specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereof is VND 36,000,000. An insured patient is hospitalized at a healthcare service establishment to be provided with the stenting service that requires placement of 03 items of drug-eluting stent A. Total cost of other medical supplies which have not yet been included in the price of medical service, medical examination service, treatment bed day or the lump-sum price of all costs incurred by each patient (hereinafter referred to as other medical supplies) is VND 15,000,000; the amount of payment for these medical supplies at the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached is unidentified.

- If this patient is the participant in the health insurance program who is entitled to a cover for 100% of medical examination and treatment costs, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall equal VND 54,450,000 the same as that calculated in the example 1 (illustration of Point b Clause 2 Article 3). Total cost of 01 item of drug-eluting stent A which is calculated based on the amount of payment specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached and other medical supplies is calculated as 36,000,000 + 15,000,000 = 51,000,000; this cost is less than VND 54,450,000. The health insurance fund shall pay the patient (i) cost of the first stent and other medical supplies which equals VND 51,000,000; (ii) cost of the second stent which equals ½ x 36,000,000 = VND 18,000,000; (iii) shall not pay the patient cost of the third stent. In aggregate, the health insurance fund shall pay the patient total cost of medical supplies for his/her single use of medical services which equals:

51,000,000 + ½ x 36,000,000 = VND 69,000,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs, but whose accumulated consecutive period of health insurance participation is not more than 5 years, the amount of payment of total cost of medical supplies for his/her single use of medical services shall equal 43,560,000 the same as that in the example 1 (illustration of Point b Clause 2 Article 3). Total cost of 01 item of drug-eluting stent A which is calculated based on the amount of payment specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached and other medical supplies is calculated as 36,000,000 + 15,000,000 = 51,000,000; this cost is greater than VND 43,560,000. In aggregate, the health insurance fund shall pay the patient total cost which is calculated as:

43,560,000 + ½ x 36,000,000 = VND 61,560,000.

d) Participants in the health insurance program that are provided in Point b Clause 1 Article 4 of the Government’s Decree No. 105/2014/ND-CP dated November 15, 2014 and Article 2 of the Government’s Decree No. 70/2015/ND-CP shall not be required to comply with Point b Clause 2 Article 3 of this Circular and the limit on rate of payment for medical supplies that is prescribed in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached.

3. If medical items which are classified into a medical specialty are used in medical services classified into another medical specialty, the health insurance fund shall agree to make payment for them under the provisions of this Circular.

Example: Costs of guide wires of all kinds and sizes classified into the interventional cardiology and radiology (Group 7.1) which are used in medical services of either the interventional cardiology or the gastroenterology (Group 7.4) shall be covered by the health insurance fund.

4. Costs of medical supplies included in the Schedule of medical supplies given in the Appendix 01 hereto attached that are manufactured by healthcare service establishments on their own shall be covered by the health insurance fund when they are used by these establishments. Directors of healthcare service establishments shall be responsible for approving manufacturing processes, quality standards and prices of products manufactured on their own and sending social security authorities written notifications used as payment bases.

5. The health insurance fund shall not make its payments if:

a) Costs of medical supplies have been covered by the state budget or other funds;

b) Medical supplies intended for medical services have not yet approved for use by competent authorities or fall outside of the scope of entitlements in accordance with laws on health insurance.

6. Where non-public healthcare service establishments choose to buy medical supplies in accordance with Article 52 of the Law on Procurement, the health insurance fund shall make its payments for these medical supplies at their purchase prices which do not exceed the winning prices of medical supplies of same categories (same commercial names, types, technical criteria, quality standards, manufacturers and countries of origin) and according to the contract execution period prescribed in the decision on approval of contractor selection results of healthcare service establishments in the following order of priority:

a) Public healthcare service establishments at the provincial level that have the largest proposed number of beds within their provinces;

b) Other healthcare service establishments at the provincial level or those at the central level that are located within these provinces, if medical supplies are not mentioned in the contractor award results at healthcare service establishments at the provincial level that have the largest proposed number of beds;

c) Healthcare service establishments at the provincial level or those at the central level that are located within adjacent provinces, if medical supplies are not mentioned in the contractor award results at public healthcare service establishments at the provincial level or those at the central level located within these provinces;

d) Other healthcare service establishments at the central level, if medical supplies are not mentioned in the contractor award results at public healthcare service establishments at the provincial level or those at the central level located within adjacent provinces.

Article 4. Guide to payment for certain types of medical supplies

1. The health insurance fund shall make its payments for medical supplies of various types and price levels at the purchase prices of healthcare service establishment in accordance with laws on procurement on condition that these payments shall not exceed amounts of payment specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached, and according to the payment guide specified in Article 3 hereof. Where the patient chooses to use medical supplies of which prices are greater than stated amounts of payment, (s)he shall, on his/her own, be liable for the difference between the purchase price and amount of payment made by the health insurance fund.

2. The health insurance fund shall make its payments for medical supplies for which amounts of payment are specified in the 5^thcolumn of the Appendix 01 hereto attached according to the general payment guide referred to in Article 3 hereof (regulations on amounts of payment of total cost of medical supplies are not applied) and rates of payment specified in the 5^thcolumn of the Schedule of medical supplies given in the Appendix 01 hereto attached.

Example: The winning price for supply of the set of resin microspheres filled with Y-90 radioactive isotope to a healthcare service establishment is VND 380,000,000.

Resin microspheres filled with Y-90 radioactive isotope are specified in the Schedule of medical supplies given in the Appendix 01 hereto attached and are relative to the stipulated rate of payment which equals 40%.

If the patient is the participant in the health insurance program who is entitled to 100% of cover of costs of medical examination, treatment and liver cancer treatment services that require use of sets of resin microspheres filled with Y-90, including microspheres, lead pots, vials, tubes containing standard doses, cannula, needles and syringes particularly intended for administering radioactive granules, the health insurance fund shall pay an amount calculated as 380,000,000 x 40% x 100% = VND 152,000,000.

3. In respect of medical supplies of which determination of the quantity is difficult:

a) Based on medical conditions and frequency of rendering of medical services, healthcare service establishments shall set the limit on use of these supplies and notify this in writing to social security authorities.

b) The health insurance fund shall make its payment for costs of medical supplies for each use of medical service which is determined as the purchase price multiplied by (x) the designated limit;

c) If, according to the medical indication, the patient is prescribed only a part of medical supplies purchased by a healthcare service establishment and the rest of medical supplies is not used for certain reasons (e.g. no user, insufficient quantity or expiration), the health insurance fund shall pay all costs incurred from use of these medical supplies at their purchase price.

4. In respect of medical supplies of which the measurement unit is “set”, the health insurance fund shall make its payment as follows:

a) If all components of the “set” are entirely used, full payment for the whole set shall be made;

b) If one or several components of the “set” are used,

- the full payment for the whole set shall be made in the event that the rest of components of the "set” is unusable. Healthcare service establishments shall take an inventory of unusable components and notify this in writing to health insurance authorities;

- The payment for each used component at its predetermined price shall be made in the event that separate prices of specific components of the “set” are available;

- If there is none of separate prices of specific components used, based on the purchase price of the “set” and particular characteristics of specific medical supplies, healthcare service establishments shall take an inventory of components already used, not yet used and notify this in writing to health insurance authorities for payment purposes.

Article 5. Provisions on payment for reused medical supplies.

1. The health insurance fund’s payment for reusable medical supplies according to the Ministry of Health’s instructions on the reuse process and times shall conform to instructions provided by the Ministry of Health.

2. In respect of reusable medical supplies of which instructions for the process and times of reuse have not yet been provided by the Ministry of Health or manufacturers, Directors of healthcare service establishments shall, depending on medical requirements, reality and upon the request of the Scientific Advisory Board or Medicine and Therapy Board (if mandated by Directors of healthcare service establishments), set up and approve the reuse process and times, and notify social security authorities in writing for payment purposes. Sum of payment for medical supplies for a single use shall be identical and determined according to the following formula:

Where:

a) G_vtytmeans the price of a medical item that is calculated according to the price at which it is purchased in accordance with laws on procurement;

b) n_tbmeans within-year average times of use which are calculated according to the formula n_tb= n_{sdtt(previous year)}x k. If it is the first year that a healthcare service establishment reuses medical supplies, n_tbis calculated after Director of this establishment consults it from other establishment; additionally, based on capacity and frequency of performing medical services in which reused medical supplies are used within a specified year, and opinions of the Scientific Advisory Board or the Medicine and Therapy Board (if mandated by the Director of the healthcare service establishment) in that establishment, the Director shall make his/her decision and notify this in writing to social security authorities;

c) n_{sdtt(previous year)}means average times of actual use within the preceding year which are calculated as total number of uses of medical supplies by a patient within the preceding year divided by total quantity of medical supplies already used within that preceding year;

d) k means the risk adjustment coefficient value of0.8;

dd) C_hskkmeans cost of sterilization, drying and disinfection allocated for a single use of medical supplies which is calculated according to the following formula:

Where: C_hskkttmeans total actual cost of sterilization, drying or disinfection (inclusive of cost of electricity, water, disinfectant, gloves, packaging, damage to sterilization and drying equipment and wage) incurred in each time of sterilization, drying or disinfection of a unit of medical supplies.

3. In the beginning of a specified year or prior to commencement of reuse of medical supplies, based on medical requirements, reality and technical conditions of a healthcare service establishment, the Director of that establishment shall notify social security authorities of:

a) Maximum times of use (n_td) of each item of medical supplies. Each item of medical supplies shall not be used in excess of the maximum times of use;

b) Sum of payment for medical supplies in each use, subject to provisions laid down in Clause 1 and 2 Article 5 hereof.

4. At the end of a specified year, healthcare service establishment and social security authority shall define average times of actual use of medical supplies within that year (n_{sdtt(within year)}) as the basis for calculation of actual times of use (n_tb)for the next year and adjust payment of total cost of insured medical examination and treatment services incurred at this establishment within that year under the following circumstances:

a) If average times of actual use within a specified year (n_{sdtt(within year)}) are greater than times of restricted use (n_gh) qualifying for health insurance coverage (n_gh= 1.3 x n_tb), an adjustment in which total cost of insured medical examination and treatment service is reduced shall be calculated based on average times of actual use that exceed times of restricted use as follows:

b) If average times of actual use within a specified year (n_{sdtt(within year)}) are less than average times of use (n_tb), an adjustment in which total cost of insured medical examination and treatment service is increased shall be calculated based on the difference portion between average times of use and average times of actual use within year as follows:

Example: A healthcare service establishment conducts reuse of medical item A.

In 2015, there are 10 times of use of item A; the quantity of item A used is 02 units; price of each unit is VND 10,000,000; actual cost of each time of sterilization, drying and disinfection for a unit of item A is VND 200,000.

In the beginning of 2016, healthcare service establishment determines and notifies social security authority in writing of:

- Maximum times of use of item A is 07. This means that in 2016 each unit of item A is not used in more than 07 times;

- Sum of payment for medical supplies for a single use is determined as follows:

Average times of actual use (n_sdtt) of medical supplies of 2015:

n_{sdtt(year 2015)}= 10/2 = 5 times

Average times of use of 2016:

n_tb= n_{sdtt(year 2015)}x k = 5 x 0.8= 4.0

Cost of sterilization, drying and disinfection allocated for a single use of item A:

Sum of payment for item A for a single use of 2016 is determined as follows:

At the end of 2016, healthcare service establishment and social security authority define average times of actual use of item A of 2016 ((n_{sdtt(year 2016)}):

Times of restricted use qualifying for health insurance coverage:

n_gh= 1.3 x_­n_tb= 1.3 x 4 = 5.2

If n_{sdtt(year 2016)}= 4.5, compare n_tb= 4.0 ≤ n_{sdtt(year 2016)}≤ n_gh= 5.2. In this case, adjustment to total cost of insured medical examination and treatment services within year at the healthcare service establishment is not required. Sum of payment for item A for a single use of 2016 is VND 2,650,000.

If n_{sdtt(year 2016)}= 6.5 > n_gh=5.2, decreasing adjustment to total cost of insured medical examination and treatment services within year at the healthcare service establishment is made as follows:

If n_sdtt= 3 < 4.0, increasing adjustment to total cost of insured medical examination and treatment services within year at the healthcare service establishment is made as follows:

Article 6. Implementationorganization

1. The Ministry of Health shall assume the following responsibilities:

a) Implement, check and inspect compliance with this Circular throughout the nation;

b) Undertake and cooperate with related authorities in resolution of difficulties that may arise during implementation of this Circular; update and revise the Schedule of medical supplies given in Appendix 01 hereto attached.

2. The Social Security of Vietnam shall assume the following responsibilities:

a) Conduct implementation of and make payment for medical supplies in compliance with this Circular and other relevant legislative documents;

b) Cooperate with the Ministry of Health and relevant entities in handling any difficulty that may arise in the course of implementation.

3. The Departments of Health of centrally-affiliated cities and provinces shall assume the following responsibilities:

a) Implement, check and inspect compliance with this Circular throughout their jurisdictions;

b) Undertake and cooperate with relevant entities in handling any difficulty that may arise in the course of implementation.

4. Health administrations of Ministries or sectoral departments shall be responsible for implementing and auditing compliance with this Circular within their jurisdiction.

5. Healthcare service establishments shall assume responsibilities:

a) Provide medical supplies on time, in full and in compliance with regulations according to the Schedule of medical supplies which have been established, and in conformity with medical demands of health insurance participants;

b) Manage and use medical supplies in accordance with regulations, ensure safety, relevance, cost efficiency and conformity with quality standards; make payments according to the rules of timeliness, correct category, correct quantity, correct price and correct cost;

c) Build the Schedule of medical supplies to be purchased or used at each establishment in accordance with Clause 1 Article 2 hereof;

d) Send social security authorities documents specified in Clause 2 and 3 Article 2 hereof as the basis for payment of costs of medical supplies;

dd) Issue the process for sterilization, drying and disinfection of reused medical supplies at healthcare service establishments; bear responsibility and ensure quality of reused medical supplies;

e) Provide invoices or documents evidencing purchases of medical supplies in respect of those of which costs have not yet been included in prices of medical services, medical bed days or lump-sum prices for specific visits of patients in each session of inspection and audit of costs of insured medical examination and treatment services;

g) Send a written proposal for revision or supplementation of the Schedule of medical supplies specified in Appendix 01 hereof where appropriate to the reality and in conformity with medical requirements of patients to the Ministry of Health (Department of Health Insurance) or the Departments of Health of centrally-affiliated cities and provinces that proceed with preparing a consolidated report for submission to the Ministry of Health (Department of Health Insurance), or to other competent authorities for submission of a consolidated report to the Ministry of Health.

Article 7. Transitional provisions

1. If health insurance participants are hospitalized prior to the date of entry into force of this Circular and discharged from hospital within or after the date of entry into force of this Circular, provisions laid down herein shall prevail.

2. In respect of medical supplies present in the Schedule annexed to the Circular No. 27/2013/TT-BYT dated September 18, 2013 of the Minister of Health that introduces the Schedule of medical supplies of which costs are covered by the health insurance fund (hereinafter referred to as Circular No. 27/2013/TT-BYT) and documents guiding the Circular No. 27/2013/TT-BYT, but not listed in the Schedule of medical supplies given in Appendix 01 hereof, the health insurance fund shall continue to make its payments until the number of medical supplies of which contracts for provision are awarded according to the results of selection of contractors supplying medical supplies, and contracts with suppliers for supply have been signed prior to this Circular’s entry into force, is used up.

3. In respect of medical supplies which are listed in the Schedule annexed to the Circular No. 27/2013/TT-BYT and documents guiding the Circular No. 27/2013/TT-BYT, but for which conditions, rates and amounts of payment are prescribed in this Circular, the health insurance fund shall make its payments in conformity with conditions, rates and amounts of payment specified herein from the date of entry into force of this Circular.

Article 8. Referenceprovisions

In case reference documents used in this Circular are replaced, amended or supplemented, the newest versions of these documents created after being so replaced or amended shall become effective.

Article 9.Effect

1. This Circular takes effect on June 01, 2017.

2. The Circular No. 27/2013/TT-BYT and documents guiding the Circular No. 27/2013/TT-BYT shall become invalid from the date of entry into force of this Circular.

In the course of implementation of this Circular, if there is any difficulty or proposal for revision or supplementation of this Circular, entities, organizations and individuals shall consult with the Ministry of Health (Department of Health Insurance) about any possible solution./.

For the Minister

The Deputy Minister

Phan Le Tuan

APPENDIX 01

SCHEDULE OF MEDICAL SUPPLIES QUALIFYING FOR HEALTH INSURANCE COVERAGE
(Issued with the Circular No. 04/2017/TT-BYT of the Minister of Health dated April 14, 2017)