Circular No. 09/2019/TT-BYT dated June 10, 2019 of the Ministry of Health on providing instructions for assessment of requirements for signing contracts for insured primary healthcare services, referral of subclinical services and certain cases of direct payment of insured healthcare service costs

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ATTRIBUTE

Circular No. 09/2019/TT-BYT dated June 10, 2019 of the Ministry of Health on providing instructions for assessment of requirements for signing contracts for insured primary healthcare services, referral of subclinical services and certain cases of direct payment of insured healthcare service costs
Issuing body: Ministry of HealthEffective date:
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Official number:09/2019/TT-BYTSigner:Nguyen Truong Son
Type:CircularExpiry date:Updating
Issuing date:10/06/2019Effect status:
Known

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Fields:Insurance , Medical - Health

SUMMARY

Directly pay the healthcare service costs for 05 consecutive years health insurance cardholders

On June 10, 2019 the Ministry of Health issues the Circular No. 09/2019/TT-BYT on providing instructions for assessment of requirements for signing contracts for insured primary healthcare services, referral of subclinical services and certain cases of direct payment of insured healthcare service costs.

Accordingly, health insurance cardholders shall be directly paid medical and healthcare costs in the following cases:

- A patient has participated in the health insurance plan for at least 5 consecutive years and has incurred total out-of-pocket medical cost within a year greater than total base pay amount received during 6 months;

- Health insurance card data are not provided or are provided inaccurately;

- If the patient does not present his/her health insurance card prior to medical discharge, refer to another healthcare establishment within a day due to medical emergency, loss of consciousness, death or loss of the health insurance card without being not issued with another one yet;

- Cases specified in point a, b Clause 2 Article 31 of the Law on Health Insurance.

This Circular takes effect on August 01, 2019.

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Effect status: Known

THE MINISTRY OF HEALTH

Circular No. 09/2019/TT-BYT dated  June 10, 2019 of the Ministry of Health on providing instructions for assessment of requirements for signing contracts for insured primary healthcare services, referral of subclinical services and certain cases of direct payment of insured healthcare service costs

Pursuant to the Law on Health Insurance dated November 14, 2008 amended and supplemented by the Law on Health Insurance dated June 13, 2014;

Pursuant to the Government's Decree No. 146/2018/ND-CP dated October 17, 2018, detailing and guiding the implementation of a number of articles of the Law on Health Insurance;

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

The Minister of Health hereby promulgates the Circular on providing instructions for assessment of requirements for signing contracts for insured primary healthcare services, referral of subclinical services and certain cases of direct payment of insured healthcare service costs.

Article 1. Scope of regulation

This Circular shall provide instructions on insured healthcare services with regard to:

1. Assessment of conformance of healthcare establishments to eligibility requirements for signing insured primary healthcare service contracts.

2. Referral of subclinical diagnostic tests, medical imaging and functional assessment services (hereinafter referred to as subclinical services).

3. Direct payment of insured healthcare service costs made in other special cases defined in point c Clause 1 Article 31 of the Law on Health Insurance amended and supplemented by the Law No. 46/2014/QH13.

Article 2. Assessment of conformance of healthcare establishments to eligibility requirements for signing insured primary healthcare service contracts

1. Assessment of conformance of healthcare establishments to eligibility requirements for signing insured primary healthcare service contracts which is made with respect to healthcare establishments in the lists of healthcare establishments issued by the Departments of Health in Article 13 of the Circular No. 40/2015/TT-BYT dated November 16, 2015 of the Minister of Health on registration for insured primary healthcare services and referral of insured healthcare services shall only be required in the following cases:

a) Initial request for signing of insured primary healthcare service contract;

b) After termination of insured primary healthcare service contract. 

2. Assessment contents:

a) Comparison of application package for signing of insured primary healthcare service contract with regulations in Clause 1 of Article 16 in the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018 on detailing and guiding the implementation a number of articles on the Law on Health Insurance (hereinafter referred to as Decree No. 146/2018/ND-CP);

b) Comparison of information about the lists of licensed practitioners working for healthcare establishments with the lists of licensed practitioners published on the Web Portal of the Ministry of Health or the Web Portals of Departments of Health.  

3. Social Security services at provinces and centrally-affiliated cities shall be responsible for making assessments in accordance with clause 2 of this Article within the time limits specified in point b Clause 1, Article 18 in the Decree No. 146/2018/ND-CP.

Article 3. Referral of subclinical services

1. Referral of subclinical services shall adhere to the principles of conformity with healthcare-related technical requirements, assurance of legitimate rights and interests of health insurance policyholders and consistency with the following lists:

a) Subclinical services in the list of healthcare-related technical services that are approved by state competent authorities for use and currently in use at healthcare establishments but are beyond their capacity at the time when patients are prescribed these services;

b) Subclinical services not in the list of healthcare-related technical services that are approved by competent state authorities for use at healthcare establishments but, in reality, are necessary for other medical services under the regulations of the Minister of Health on medical management, diagnosis and treatment.

2. Healthcare establishments shall only be allowed to refer patients or pathology specimens to receiving healthcare establishes accredited by competent entities 
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