CIRCULAR

 PRESCRIBING TUBERCULOSIS DIAGNOSIS AND TREATMENT, AND PAYMENT FOR COVERED HEALTHCARE SERVICES PROVIDED TO PEOPLE WITH TUBERCULOSIS

Pursuant to the Law on Health Insurance;

Pursuant to the Law on Medical Examination and Treatment;

Pursuant to the Government's Decree No. 63/2012/ND-CP dated August 31, 2012 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 14, 2014 on guidelines for the Law on Health insurance;

At the proposal of the Director of the Health Insurance Department affiliated to the Ministry of Health,

The Minister of Health promulgates the Circular prescribing tuberculosis diagnosis and treatment, and payment for costs of covered healthcare services provided to people with tuberculosis.

Article 1. Scope and regulated entities

1. Scope

a) This Circular provides for diagnosis and treatment, payment of covered healthcare services and referral services provided to people who have unexpired health insurance cards and are suffering from tuberculosis, drug-resistant tuberculosis, suspected tuberculosis, or latent tuberculosis or use other tuberculosis-related healthcare services

b) This Circular provides guidelines for conclusion of contracts for supply of covered healthcare services with hospitals and health facilities that are members of the tuberculosis prevention and control network.

2. Subjects of application

a/ State-run and private hospitals that have valid contracts for supply of covered healthcare services.

b) Health facilities that are members of the tuberculosis prevention and control network as prescribed by the Minister of Health.

c) Persons who have health insurance cards and suffer from tuberculosis, drug-resistant tuberculosis, suspected tuberculosis, or latent tuberculosis or use other tuberculosis-related healthcare services.

Article 2. Interpretation of terms

1. TB Patients are those who are diagnosed with tuberculosis according to the guidance on tuberculosis diagnosis, treatment and prevention adopted by the Ministry of Health.

2. DR-TB patients are persons suffering from TB infection caused by TB bacteria that are resistant to anti-TB drug and detected by tests performed according to the guidance o tuberculosis diagnosis, treatment and prevention adopted by the Ministry of Health.

3. Patients with suspected TB are persons who have symptoms of TB and are diagnosed with suspected TB according to the tuberculosis diagnosis, treatment and prevention adopted by the Ministry of Health.

4. Persons with latent TB infection are persons who are at high risk for developing TB disease and must be treated by using by anti-TB drugs according to the guidance on tuberculosis diagnosis, treatment and prevention adopted by the Ministry of Health.

5. TB-related healthcare service users are those who receive healthcare services at non-TB specialized hospitals and must undergo tests, diagnostic imaging, functional examination and use of drugs for diagnosis of TB or TB elimination according to medical examination and treatment requirements or need to receive TB diagnosis and treatment combined with the diagnosis and treatment of other diseases at such hospitals.

Article 3. General principles

1. TB patients, DR-TB patients, patients with suspected TB, persons with latent TB infection and TB-related healthcare service users shall be entitled to TB diagnosis and treatment and reimbursement of costs of covered healthcare services in accordance with the provisions of the Law on Health Insurance and the provisions in this Circular.

2. TB patients, DR-TB patients, patients with suspected TB, persons with latent TB infection and TB-related healthcare service users shall be transferred to other hospitals providing covered healthcare services in accordance with the provisions on hospital transfer and the provisions in this Circular.

Article 4. Health facilities providing tuberculosis diagnosis and treatment

1. Communal- and equivalent-level hospitals prescribed in Article 3 of Circular No. 40/2015/TT-BYT dated November 16, 2015 of the Minister of Health on registration of health facility providing initial covered healthcare services and referral between health facilities providing covered healthcare services (hereinafter referred to as "Circular No. 40/2015/TT-BYT").

2. District- and equivalent-level hospitals include:

a) District- and equivalent-level hospitals as regulated in Article 4 of the Circular No. 40/2015/TT-BYT;

b) Medical centers of districts, district-level towns, cities affiliated to central-affiliated cities and provinces that perform preventive healthcare functions and are capable of providing TB diagnosis and treatment as prescribed in the Circular No. 02/2013/TT-BYT dated January 15, 2013 of the Minister of Health regulating the coordination between health facilities in the management of tuberculosis;

c) Grade III or grade IV-equivalent and ungraded private tuberculosis hospitals; grade III or grade IV-equivalent and ungraded private general hospitals with TB specialty.

3. Provincial- and equivalent-level hospitals include:

a) Provincial- and equivalent-level hospitals specified in Article 5 of Circular No. 40/2015/TT-BYT;

b/ Tuberculosis and lung diseases hospitals, lung hospitals, and hospitals with tuberculosis and lung diseases specialty of provinces or central-affiliated cities;

c. Tuberculosis and lung diseases hospitals, lung hospitals, and hospitals with tuberculosis and lung diseases specialty of provinces or central-affiliated cities which are assigned to provide treatment of drug-resistant tuberculosis;

d) Grade I or grade II-equivalent private tuberculosis hospitals; grade I or grade II-equivalent private general hospitals with TB specialty;

dd) Preventive healthcare centers of provinces and central-affiliated cities that have TB specialty; social disease prevention and control centers of provinces and central-affiliated cities that have TB specialty; TB prevention and control centers and TB control stations of provinces and central-affiliated cities; provincial centers for disease prevention and control.

4. Central- and equivalent-level hospitals include:

a) Hospitals prescribed in Article 6 of the Circular No. 40/2015/TT-BYT;

b/ Hospitals and specialized institutions equipped with hospital beds under the Ministry of Health.

Article 5. Contracts for supply of covered healthcare services

1. Hospitals that provide covered healthcare services and are eligible to provide TB diagnosis and treatment shall annually add the contents about TB diagnosis and treatment as stipulated in this Circular to their contracts for supply of covered healthcare services.

2. Hospitals specified in Point c Clause 3 Article 4 hereof shall add contents about hospitalization and receipt of DR-TB patients from other hospitals to contracts for supply of covered healthcare services.

3. District-level general hospitals, district-level medical centers or other agencies signing contracts for supply of covered healthcare services with communal-level hospitals shall add the contents about TB diagnosis and treatment provided by communal-level hospitals to the signed contracts.

4. Hospitals prescribed in Point b, Clause 2, Article 4 hereof that are eligible to provide TB diagnosis and treatment shall be responsible for signing contracts with social insurance agencies for providing TB diagnosis and treatment.

5. Health facilities specified in Point dd Clause 3 Article 4 hereof that have been licensed to provide healthcare services shall sign contracts for supply of covered healthcare services with social insurance agencies for provision of TB diagnosis and treatment.

Article 6. Referral between health facilities providing tuberculosis diagnosis and treatment

1. The referral between hospitals providing covered healthcare services shall comply with regulations in Circular No. 40/2015/TT-BYT, except for some other cases specified in Clause 2 of this Article.

2. Cases in which covered healthcare services are provided by hospitals of appropriate level:

a) TB patients, DR-TB patients, patients with suspected TB and persons with latent TB infection that have valid health insurance cards and have registered initial covered healthcare services at hospitals specified in Clause 1, Article 4 hereof are transferred to hospitals specified in Clause 3, Article 4 hereof;

b) DR-TB patients that have valid health insurance cards and have registered initial covered healthcare services at hospitals specified in Clause 2 Article 4 hereof are transferred to the hospitals specified in Point c Clause 3 and Clause 4 Article 4 hereof;

c) Hospitals specified in Point b, Clause 2 Article 4 hereof transfer TB patients, DR-TB patients, patients with suspected TB and persons with latent TB infection to hospitals specified in Clause 2 and Clause 3 Article 4 hereof.

Article 7. Health insurance coverage and payout

1. When receiving TB diagnosis and treatment, health insurance card holders are entitled to the benefits within the health insurance coverage and payout prescribed in the Law on Health Insurance and the provisions in this Circular.

2. Health insurance fund shall pay for the costs of healthcare services given to persons with latent TB infection who have health insurance cards.

3. If a hospital is not eligible to provide technical services, pathological specimens (e.g. blood, urine, body fluid, effusions, sputum, tissue, etc.) or the patient shall be sent to a hospital that provides covered healthcare services and is eligible to perform tests and diagnostic imaging for TB diagnosis. The health insurance fund shall pay costs of technical services to the hospital where specimens or the patient is sent or where technical services are provided according to the prices announced by the hospital providing such technical services under approval by a competent authority.

4. If a hospital does not have anti-TB drugs to treat patient who is diagnosed with TB or drug-resistant TB when receiving treatment for other diseases but cannot transfer that patient to another hospital:

a) THE patient shall use anti-TB drugs provided by a TB hospital after a medical consultation is carried out between two hospitals;

b) Health insurance fund shall pay costs of anti-TB drugs to the hospital receiving such drugs.

5. If a hospital is professionally capable of using drugs to treat TB and/or drug-resistant TB (anti-TB drugs and other drugs) which are on the list of drugs covered by health insurance but are not used by the class of hospital, the hospital shall request the Ministry of Health (if the hospital is affiliated to the Ministry of Health) or the Provincial Department of Health (if the hospital is affiliated to the provincial Department of Health or a Ministry) to add such drugs to the list of drugs to be used by that hospital after reaching an agreement with Vietnam Social Security or the relevant provincial social insurance agency.

Article 8. Implementation

1. Provincial-level Health Departments shall:

a) Instruct affiliated health facilities to implement this Circular;

b) Take charge and cooperate with provincial-level social insurance agencies in determining technical and professional conditions for modifying the list of drugs given by hospitals as prescribed in Clause 5 Article 7 of this Circular;

c/ Coordinate with provincial-level social insurance agencies in guiding the performance of contracts for supply of covered healthcare services signed with hospitals eligible to provide TB diagnosis and treatment as prescribed;

d/ Coordinate with concerned agencies and organizations in disseminating and guiding TB patients, DR-TB patients, patients with suspected TB and persons with latent TB infection who have health insurance cards in implementing regulations on health insurance and TB prevention and control, and this Circular;

dd) Formulate and request competent authorities to consider approving the mechanism for provision of financial support to TB patients with health insurance cards by using healthcare fund for the poor and other lawful funding sources.

2. Vietnam Social Security shall instruct provincial social insurance agencies to:

a) Perform contracts for supply of covered healthcare services and pay costs of covered healthcare services provided to by TB patients, DR-TB patients, patients with suspected TB, persons with latent TB infection and TB-related healthcare service users in accordance with this Circular and regulations on health insurance, TB diagnosis and treatment and other relevant regulations;

b) Reach agreement with hospitals on the method of payment for healthcare services in the cases specified in Clause 3 and Clause 4 Article 7 of this Circular to ensure the benefits health insurance card holders as prescribed.

3. Hospitals specified in Article 4 of this Circular shall:

a) Provide healthcare services and make payment of costs of covered healthcare services in accordance with regulations on health insurance and the provisions in this Circular;

b) Provide treatment to TB patients, DR-TB patients, patients with suspected TB, persons with latent TB infection and TB-related healthcare service users to ensure the benefits of health insurance card holders as prescribed;

c) The hospital receiving drugs shall cooperate with the hospital providing drugs and relevant social insurance agency to pay costs of drugs according to Clause 4 Article 7 of this Circular;

d) Provide diagnosis and treatment to TB patients, DR-TB patients, patients with suspected TB, persons with latent TB infection and TB-related healthcare service users the guidance on tuberculosis diagnosis, treatment and prevention adopted by the Ministry of Health.

Article 9. Effect

This Circular comes into force from May 01, 2016.

Article 10. Reference provisions

In the cases where any legislative documents referred to in this Circular are amended or replaced, the new ones shall apply.

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

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