MINISTRY OF HEALTH | SOCIALIST REPUBLIC OF VIETNAM |
No. 36/2021/TT-BYT | Hanoi, December 31, 2021 |
Pursuant to Law on Health Insurance dated November 14, 2008; Law on amendments to Law on Health Insurance dated June 13, 2014;
Pursuant to Decree No. 146/2018/ND-CP dated October 10, 2018 of the Government on elaborating to Law on Health Insurance;
Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of Government on functions, tasks, powers, and organizational structure of Ministry of Health;
At the request of Director General of the Department of Health Insurance,
The Minister of Health promulgates Circular on examination and treatment, and payment for medical examination and treatment costs covered by health insurance relating to tuberculosis examination and treatment.
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This Circular prescribes:
1. Medical examination and treatment, and payment for medical examination and treatment covered by health insurance relating to tuberculosis (hereinafter referred to as “TB”) examination and treatment
2. National centralized procurement of TB preventive medicine using funding sources in accordance with Point a Clause 1 Article 35 of the Law on Health Insurance (hereinafter referred to as “TB medicine procured via Health Insurance Fund”).
1. Health insurance beneficiaries suspected of contracting TB, contracting TB, contracting drug-resistant TB, or contracting latent TB and individuals using medical services relating to TB examination and treatment:
a) have their medical examination and treatment costs covered by the Health Insurance Fund (hereinafter referred to as “HIF”) in accordance with regulations and law on health insurance and this Circular;
b) have medical examination and treatment costs covered by the HIF in accordance with the Guidelines on diagnosing, treating, and preventing TB of Ministry of Health when using medical services relating to TB diagnosis and treatment;
c) benefit from referral for medical examination and treatment under health insurance in accordance with regulations on referral and this Circular.
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1. Medical examination and treatment establishments (hereinafter referred to as “medical establishments”) in commune levels and equivalents (hereinafter referred to as “commune levels”) that provide TB examination and treatment for health insurance beneficiaries are those mentioned under Article 3 of Circular No. 40/2015/TT-BYT dated November 16, 2015 of Minister of Health (hereinafter referred to as “Circular No. 40/2015/TT-BYT”).
2. Medical establishments in district levels and equivalents (hereinafter referred to as “district levels”) that provide TB examination and treatment for health insurance beneficiaries include:
a) District-level medical establishments mentioned under Article 4 of Circular No. 40/2015/TT-BYT;
b) Medical centers of districts, district-level towns, district-level cities of provinces, and district-level cities of central-affiliated cities licensed for medical examination and treatment and eligible for providing TB examination and treatment services as per the law;
c) Private hospitals that have been placed in rank III equivalents, rank IV equivalents, or have not been placed in any equivalent rank.
3. Medical establishments in province levels and equivalents (hereinafter referred to as “province levels”) that provide TB examination and treatment for health insurance beneficiaries include:
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
b) TB and pulmonary disease hospitals; pulmonary hospitals; hospitals having pulmonary and pulmonary disease wards in provinces and central-affiliated cities;
c) Private hospitals placed in rank I equivalents or rank II equivalents having TB and pulmonary wards;
d) Other medical establishments assigned by government authorities to coordinate TB prevention and control in province levels.
4. Medical establishments in central levels and equivalents (hereinafter referred to as “central levels”) that provide TB examination and treatment for health insurance beneficiaries include:
a) Medical establishments mentioned under Article 6 of Circular No. 40/2015/TT-BYT;
b) Hospitals and institutions having hospital beds and affiliated to Ministry of Health.
Article 4. Referral in TB examination and treatment of health insurance beneficiaries
1. The referral for TB examination and treatment of health insurance beneficiaries shall conform to Circular No. 40/2015/TT-BYT and specific cases under Clauses 2, 3, 4, and 5 of this Article.
2. A health insurance beneficiary who is identified to have been suspected to contract TB, contracted TB, contracted drug-resistant TB, or latent TB shall be considered to be at the appropriate referral for medical examination and treatment under health insurance when he/she falls under any of the cases specified in Article 6 of Circular No. 30/2020/TT-BYT dated December 31, 2020 of Minister of Health elaborating to Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government on elaborating to the Law on Health Insurance.
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a) Regulations under Clause 1 and Clause 2 of this Article are fully complied with;
b) He/she registers for initial medical examination and treatment at commune level and is referred to province level or vice versa.
4. An individual having latent TB shall be considered to be at the appropriate referral for medical examination and treatment under health insurance when:
a) Regulations under Clause 1 and Clause 2 of this Article are fully complied with;
b) He/she registers for initial medical examination and treatment at commune level and is referred to province level or vice versa;
c) He/she registers for initial medical examination and treatment at district level and is referred to central level and vice versa.
5. In case a health insurance beneficiary is not aware that they have contracted TB which he/she has been diagnosed with after visiting a medical establishment, the patient shall be eligible for referral in accordance with Clauses 1, 2, 3, and 4 of this Article.
1. The payment of medical examination and treatment costs under health insurance of individuals suspected with TB, having TB, having drug-resistant TB, having latent TB, and individuals using medical services relating to TB medical examination and treatment shall conform to regulations and law on medical examination and treatment and health insurance. HIF shall incur medical examination and treatment costs of the patients mentioned above when the recommendation is made by:
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
b) An individual having license for medical examination and treatment, other than those mentioned under Point a of this Clause, having undergone TB treatment training as per Guidelines on diagnosing, treating, and preventing TB of Ministry of Health;
c) An individual writing a prescription for cases under Article 6 hereof.
2. If individuals suspected of TB, having TB, having drug-resistant TB, or having TB are referred to the lowest level for further monitoring by higher level, the lowest medical establishments are responsible for producing dossiers on monitoring, managing, and providing treatment as per the law. HIF shall incur the costs for TB medicine and medical supplies necessary for the administration of said medicine as per the law; HIF shall not incur medical examination costs whenever TB medicine is issued to the patient.
If a patient who is receiving outpatient treatment via TB preventive medicine must be admitted to inpatient treatment for diseases that may or may not be related to TB and the TB preventive medicine is depleted or unavailable, HIF shall incur in the following cases:
1. If the inpatient ward is located in the same medical establishment as the outpatient ward where the patient is currently receiving outpatient treatment for TB:
a) The patient can continue to receive medicine at the outpatient ward or at the inpatient ward if doctors of the inpatient ward are eligible for writing a prescription for TB preventive medicine in accordance with Points a and b Clause 1 Article 5 hereof;
b) If a general practitioner in the inpatient ward is ineligible for writing a prescription for TB preventive medicine, he/she must consult and discuss with a doctor of the outpatient ward in order to write a prescription for TB preventive medicine.
TB preventive medicine prescribed for the patient mentioned under Points a and b of this Clause must be recorded in his/her medical record, medical examination record, and distributed together with inpatient treatment medicine.
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
a) If the medical examination and treatment where the patient is receiving inpatient treatment is a TB treatment facility utilizing TB preventive medicine, the patient shall be distributed with TB preventive medicine at the establishment. The patient must present medical examination record where treatment regimen and quantity of distributed TB preventive medicine are specified to serve as the basis for subsequent medicine distribution. Doctors in the inpatient ward shall write a prescription for TB preventive medicine if they are eligible for writing a prescription for TB in accordance with Points a and b Clause 1 Article 5 hereof.
If doctors in the inpatient ward are ineligible for writing a prescription for TB preventive medicine in accordance with Point a and b Clause 1 Article 5 hereof, the doctors shall write a prescription for TB preventive medicine by using the treatment regimen which the patient is currently following and is recorded in the medical examination record. TB preventive medicine shall be recorded in medical record, medical examination record, and distributed together with inpatient treatment medicine.
b) If the medical establishment where the patient is receiving inpatient treatment is not a TB treatment facility utilizing TB preventive medicine, a representative of the patient shall receive TB preventive medicine from the medical establishment which is currently distributing TB preventive medicine to the patient to ensure adequate, continuous, and prompt treatment. The patient’s representative must present valid identification documents (ID Card or Citizen Identity Card or passport), confirmation of inpatient treatment prepared using form under the Appendix attached hereto in order to receive medicine.
NATIONAL CENTRALIZED PROCUREMENT OF TUBERCULOSIS PREVENTIVE MEDICINE VIA HEALTH INSURANCE FUND
Article 7. Responsibility for developing plans and organizing bidder selection
1. Entities assigned by Ministry of Health to organize national centralized procurement of TB preventive medicine using HIF are responsible for developing plans and organizing selection of contractors for TB preventive medicine using HIF in accordance with Circular No. 15/2019/TT-BYT and this Circular.
2. Entities assigned by Minister of Health to act as contact point for directing TB and pulmonary disease prevention, control on a national level (hereinafter referred to as “national contact points”) are responsible for issuing documents guiding preparation of TB preventive medicine demand procured via HIF and sending to entities assigned by Chairpersons of People’s Committees of provinces or Directors of Departments of Health to act as contact point for directing TB and pulmonary disease prevention, control in provinces (hereinafter referred to as “provincial contact points”) in order to guide medical establishments in provinces to implement.
3. Provincial contact points are responsible for reviewing and consolidating the demand for TB preventive medicine procured via HIF of all medical establishments in the provinces and submitting to Departments of Health for appraisal before sending the demand to the national contact points.
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
The plans for TB preventive medicine demand procured via HIF at medical establishments shall be produced based on any of the following information:
1. Estimated number of people suspected with TB, having TB, having drug-resistant TB, having latent TB and receiving treatment by December 31 inclusive of the year preceding the planning year and estimated number of people having TB in the planning year.
2. Estimated quantity of TB preventive medicine in store for each treatment regimen at the medical establishments by December 31 inclusive of the year preceding the planning year. Quantity of TB preventive medicine in store at medical establishments at the end of the year, transferred to the following year, and deducted from procurement plan of the following year. Procurement, use, and storage of TB preventive medicine procured using other funding sources in the year preceding the planning year.
3. TB treatment regimen built based on applicable TB diagnosis, treatment, and prevention guidelines.
4. List of TB preventive medicine under Appendix 1 attached to Circular No. 30/2018/TT-BYT dated October 30, 2018 of Minister of Health and List of medicine used in Projects for prevention of some diseases dangerous to public health (Tuberculosis) under Section III Part C of Appendix II attached to Circular No. 15/2020/TT-BYT dated August 10, 2020 of Minister of Health.
5. Guidelines on producing plans for TB preventive medicine demand procured via HIF, orientation for converting treatment regimen of national contact points.
Article 9. Development and consolidation of demand for TB preventive medicine procured via HIF
1. Prior to the planning period, the national contact points shall send guidelines on producing plans for TB preventive medicine demand procured via HIF to Departments of Health and provincial contact points.
2. Based on the aforementioned guidelines produced by national contact points, provincial contact points shall send the guidelines on producing plans for TB preventive medicine demand procured via HIF to provincial medical establishments.
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
4. The national contact points are responsible for reviewing and consolidating demands for TB preventive medicine procured via HIF nationally.
Article 10. Implementation of selection results of bidders providing TB preventive medicine via HIF
1. Preparation of backup estimates of TB preventive medicine:
a) Based on signed contracts, medicine use plans, and treatment demands in the quarter, medical establishments shall prepare backup estimates of TB preventive medicine necessary which must not exceed 20% of the medicine distributed under signed framework agreement and send to the contractors awarded with contracts and provincial contact points for monitor before the 15th of the month preceding the quarter in which the backup estimates is prepared or on an irregular basis;
b) In case a medical establishment wishes to use more than 20% of the medicine distributed under signed framework agreement or contract, the medical establishment shall conform Article 11 hereof.
2. Supply of TB preventive medicine:
a) Within 10 days from the date on which backup estimates sent by medical establishments are received, the contractors awarded with contracts are responsible for transporting the backup amount or revised amount (if any) of TB preventive medicine to the medical establishments on the basis of information and details under Clause 1 of this Article;
b) If awarded contractors fail to supply adequate medicine in a timely manner as per signed contracts, local medical establishments shall report to provincial contact points for presentation to Departments of Health and national contact points.
3. Reporting on the use of TB preventive medicine:
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
b) Provincial contact points shall produce reports on the use of TB preventive drugs of the previous quarter, including the reallocation between provincial medical establishments before the 15th of the first month of each quarter. In case excess or shortage of medicine requires reallocation from central levels, provincial contact points must submit written presentation to Departments of Health and national contact points;
c) The awarded contractors shall submit medicine supply plans to medical establishments on the basis of proposal of national contact points in adequate quantity, quality, and progress as per signed contracts.
1. Medicine reallocation in provinces:
a) Provincial contact points shall reallocate additional amount of medicine within 20% of the total medicine distributed in framework agreement to provincial medical establishments;
b) In case a medical establishment wishes to use more medicine than 20% of the amount distributed under framework agreement, the reallocation of medicine in the province shall be implemented as follows:
- The medical establishment shall send the request for medicine reallocation to the provincial contact point which specifies the amount of medicine to be reallocated and reason for the reallocation;
- Within 10 working days from the date on which written request of the medical establishment is received, provincial contact point is responsible for reviewing amount of medicine used, amount of medicine in inventory, amount of remaining medicine in framework agreement of local medical establishments in order to decide on the reallocation. The provincial contact point shall send documents on the reallocation to the relevant medical establishments (including those that receive additional medicine and those that transfer excess medicine), awarded contractors for implementing the reallocation, and provincial social insurance authority for cooperate in implementation;
- Within 10 working days from the date on which documents of provincial contact points are received, awarded contractors shall reallocate medicine in accordance with request of provincial contact points and are responsible for signing contract appendices with medical establishments that receive additional medicine and medical establishments that transfer excess medicine.
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a) National contact points shall reallocate additional medicine within 30% of total medicine quantity approved in the contractor selection plans;
b) In case quantity of additional medicine exceeds 30% of total medicine approved in contractor selection plans, entities assigned by Ministry of Health to perform national centralized procurement of TB preventive medicine using HIF shall adopt procedures for conducting additional procurement as per bidding laws and this Circular.
c) Procedures for reallocating medicine on a nationwide scale:
- When the medicine reallocation scope under Clause 1 of this Article is exceeded, provincial contact points shall send documents requesting medicine reallocation to national contact points;
- Within 7 days from the date on which written request of provincial contact points are received, national contact points are responsible for reviewing amount of medicine used, amount of medicine in inventory, and amount of medicine remaining in the framework agreement of nationwide medical establishments in order to decide on reallocation. National contact points shall send documents on reallocation to provincial contact points, awarded contractors for reallocation, and provincial social security authorities;
- Within 10 working days from the date on which documents of the national contact points are received, the awarded contractors are responsible for reallocating medicine at request of the national contact points.
3. If a medical establishment which wishes to utilize TB preventive medicine purchased via HIF but their demands have not been consolidated when plans for selecting contractors purchasing medicine were produced, the procedures for reallocation are as follows:
a) The medical establishment shall send the request for medicine reallocation to provincial contact points and send report to the national contact point. Within 10 working days from the date on which written request of the medical establishment is received, the provincial contact points must send demand of the medical establishment to the national contact points;
b) Within 10 working days from the date on which documents of the provincial contact points are received, the national contact points shall consolidate, review use demand, amount of medicine purchased, amount of medicine remaining in framework agreement of the nationwide medical establishments to decide on reallocation;
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
d) Awarded contractors are responsible for sending contracts signed additionally with each medical establishment and attaching list of medical establishments with which the contractors have signed additional contracts for distributing TB preventive medicine to national contact points, provincial contact points, and provincial social insurance authorities. The list must contain: Code of medical establishments; name and address of medical establishments signing the contracts; number and date of signing additional contracts; effective period of the contracts; contract value. Within 7 working days from the date on which the contracts are signed, awarded contractors are responsible for distributing TB preventive medicine to added medical establishments;
e) In case of rejecting reallocation, the national contact points shall inform Departments of Health and provincial contact points in writing in order to notify the medical establishments. The written response must include the reason for rejection.
1. This Circular comes into force from February 15, 2022.
2. This Circular replaces Circular No. 04/2016/TT-BYT dated February 26, 2016 of Minister of Health on medical examination, treatment, and payment of medical examination and treatment costs covered by health insurance relating to TB examination and treatment.
Article 13. Terms of reference
In case documents referred to in this Circular are replaced or amended, the new versions shall prevail.
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
1. National contact points are responsible for:
a) reviewing and consolidating the demand for TB preventive medicine purchased via HIF;
b) allocating TB preventive medicine purchased via HIF on a nationwide scale;
c) inspecting and supervising warehouse system of awarded contractors on a periodic or irregular basis to guarantee quality and availability of TB preventive medicine as per signed contracts;
d) directing and coordinating training, repeated training, of medical establishments affiliated to TB prevention system to provide TB examination and treatment in accordance with regulations of Minister of Health and this Circular.
2. Departments of Health are responsible for:
a) selecting, assigning or requesting competent authorities to issue decisions on assigning provincial contact points to implement tasks in accordance with this Circular;
b) appraising plans for demand for TB preventive medicine purchased via HIF of local medical establishments;
c) directing provincial contact points of provinces to provide training and repeated training for local medical establishments under their management to provide TB examination and treatment of Minister of Health and this Circular.
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
a) adhering to guidelines of national contact points:
- Guidelines on producing plans for demand for TB preventive medicine purchased via HIF (for medical establishments);
- Reviewing and consolidating demand for TB preventive medicine purchased via HIF of local medical establishments;
- Requesting Departments of Health to appraise plans for demand for TB preventive medicine purchased via HIF of local medical establishments;
b) allocating TB preventive medicine purchased via HIF in the provinces in accordance with Clause 1 Article 11 hereof;
c) organizing training, repeated training for officials of local medical establishments in order to meet TB examination and treatment demands;
d) inspecting and supervising implementation of regulations under this Circular and other regulations relating to management and use of TB preventive medicine at local (provincial-level, district-level, commune-level) medical establishments on a periodic or irregular basis.
4. Vietnam Social Security is responsible for:
a) guiding Social Security authorities of provinces and central-affiliated cities to implement regulations in this Circular;
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
c) receiving, managing, and return electronic data in a timely and adequate manner to medical establishments as per the law;
d) sharing relevant information regarding:
- Data on usage and settlement, finalization of costs for TB preventive medicine purchased via HIF in the provinces to provincial contact points for management, monitor, consolidation of demand, and allocation of medicine within their competence;
- Data on usage and settlement, finalization of TB preventive medicine purchased via HIF in the country to national contact points for management, monitor, consolidation of demand, and allocation of medicine within their tasks.
5. Medical establishments are responsible for:
a) researching and organizing examination, treatment, and TB prevention in accordance with regulations and law on medical examination, treatment, health insurance, and regulations under this Circular;
b) producing dossiers on monitor, management, and joint treatment of persons suspected with TB, having TB, having drug-resistant TB, and latent TB referred from higher referral medical establishments;
c) producing plans for demand for TB preventive medicine purchased from HIF in the establishments and submitting to provincial contact points;
d) on a monthly and quarterly basis, consolidating and reporting on costs for TB preventive medicine purchased via HIF to provincial contact points;
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
6. Awarded contractors are responsible for:
a) ensuring adequate, timely, and promptly distribution of TB preventive medicine as per framework agreement and contracts signed with medical establishments;
b) allocating TB preventive medicine in a timely manner in accordance with this Circular;
c) submitting reports on results of distributing TB preventive medicine of the preceding quarter and plans for distributing medicine of the subsequent quarter, and reports on implementation of contracts signed with medical establishments to national contact points on a quarterly basis.
Difficulties that arise during implementation should be reported to Ministry of Health (Department of Health Insurance) for consideration./.
PP. MINISTER
DEPUTY MINISTER
Tran Van Thuan
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CONFIRMATION OF INPATIENT TREATMENT
(Attached to Circular No. …………… /2021/TT-BYT dated …………… of Minister of Health)
…………………………
(PRESIDING ENTITY)
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(TREATMENT FACILITY)
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SOCIALIST REPUBLIC OF VIETNAM
Independence – Freedom – Happiness
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CONFIRMATION OF INPATIENT TREATMENT
Full name of patient: …………………………………………………………
Gender: ……………………………………………………………………
Date of birth: ……………………………………………………………………………
Health insurance card number: …………………………………………………………
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Mọi chi tiết xin liên hệ: ĐT: (028) 3930 3279 DĐ: 0906 22 99 66
The patient is receiving inpatient treatment at: ……………………………………. Ward
……(Location and date)
Confirmation of treatment facility
(Signature and seal)
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Thông tư 36/2021/TT-BYT quy định về khám bệnh, chữa bệnh và thanh toán chi phí khám bệnh, chữa bệnh bảo hiểm y tế liên quan đến khám bệnh, chữa bệnh lao do Bộ trưởng Bộ Y tế ban hành
Tóm tắt
Cơ quan ban hành | Bộ Y tế |
Số hiệu | 36/2021/TT-BYT |
Loại văn bản | Thông tư |
Người ký | Trần Văn Thuấn |
Ngày ban hành | 2021-12-31 |
Ngày hiệu lực | 2022-02-15 |
Lĩnh vực | Bảo hiểm |
Tình trạng | Còn hiệu lực |