Circular No. 04/2016/TT-BYT stipulates on medical examination, treatment, and health insurance payment related to tuberculosis medical examination and treatment.

CIRCULAR

Provisions on medical examination, treatment, and payment of medical examination costs,

treatment of health insurance related to tuberculosis diagnosis and treatment

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Based on the Health Insurance Law;

Based on the Medical Examination and Treatment Law;

Pursuant to DecreeNo. 1. The List of Biddable Medicines at Appendix I.

Based on Decree No. 105/2014/ND-CP dated November 14, 2014 of the Government detailing and guiding implementation of certain provisions;Resolution number 11 năm 2014 of the Government detailing and guiding the implementation of ai number of matters;No. Article of the Health Insurance Law;

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

The Minister of Health issues this Circular to regulate medical examination, treatment, and payment of medical examination costs related to tuberculosis medical examination and treatment.to examination costs,examination treatment, health insurance-related tuberculosis medical examination and treatment.

Article 1. Scope of regulation and subjectsQuantity in accordance with

Thông tư này quy định chi tiết khoản 4 Điều 38 Luật Thủy sản số 18/2017/QH14 đã được sửa đổi, bổ sung tại điểm c khoản 21 Điều 14 Luật số 146/2025/QH15.

a) This Circular regulates medical examination and treatment (hereinafter referred to as ME&T), payment of ME&T costs, and referral ME&T health insurance (hereinafter referred to as HI) for people with tuberculosis, drug-resistant tuberculosis, suspected tuberculosis, latent tuberculosis, and those using healthcare services related to tuberculosis ME&T.

b) This Circular guides the ME&T HI contracts between healthcare facilities and healthcare facilities within the tuberculosis prevention network as specified by the Minister of Health.

Thông tư này áp dụng đối với tổ chức, cá nhân có liên quan đến hoạt động kinh doanh đối tượng thủy sản nuôi chủ lực trên lãnh thổ Việt Nam.

a) State-owned and private healthcare facilities that have ME&T HI contracts.

b) Healthcare facilities within the tuberculosis prevention network as specified by the Minister of Health.

c) People participating in HI who suffer from tuberculosis, drug-resistant tuberculosis, suspected tuberculosis, latent tuberculosis, and those using healthcare services related to tuberculosis ME&T.

Article 2. Interpretation of Terms

1. A person diagnosed with tuberculosis according to the Ministry of Health's guidelines on tuberculosis diagnosis, treatment, and prevention.

2. A person with drug-resistant tuberculosis is someone with tuberculosis whose Mycobacterium tuberculosis has been determined to be resistant to anti-tuberculosis drugs through tests as specified by the Ministry of Health's guidelines on tuberculosis diagnosis, treatment, and prevention.

3. A person suspected of having tuberculosis is someone with symptoms of tuberculosis diagnosed as suspected tuberculosis according to the Ministry of Health's guidelines on tuberculosis diagnosis, treatment, and prevention.

4. A person with latent tuberculosis is someone at risk of developing tuberculosis who needs to be treated with anti-tuberculosis drugs according to the Ministry of Health's guidelines on tuberculosis diagnosis, treatment, and prevention.

5. A person using healthcare services related to tuberculosis ME&T is someone currently receiving ME&T at non-specialized tuberculosis facilities but has been prescribed tests, imaging diagnostics, functional examinations, and medication for tuberculosis diagnosis, excluding tuberculosis diagnosis, or requires tuberculosis ME&T in conjunction with other diseases when receiving ME&T at such facilities.

Article 3. General Principles

1. People with tuberculosis, drug-resistant tuberculosis, suspected tuberculosis, latent tuberculosis, and those using healthcare services related to tuberculosis ME&T shall be provided ME&T and payment of ME&T costs according to the laws on HI and the provisions of this Circular.

2. People with tuberculosis, drug-resistant tuberculosis, suspected tuberculosis, latent tuberculosis, and those using healthcare services related to tuberculosis ME&T shall be referred for ME&T HI according to the regulations on referral and the provisions of this Circular.

Article 4. Healthcare facilities conducting tuberculosis ME&T

1. Healthcare facilities at the commune level and equivalent as stipulated in Article 3 of Circular No. 40/2015/TT-BYT dated November 16, 2015 of the Minister of Health on initial registration for ME&T HI and referral ME&T HI (hereinafter referred to as Circular No. 40/2015/TT-BYT).

2. Healthcare facilities at the district level and equivalent include:

a) Healthcare facilities at the district level and equivalent as stipulated in Article 4 of Circular No. 40/2015/TT-BYT;

b) District hospitals, urban districts, provincial cities, and centrally-administered municipalities' health centers performing preventive functions and meeting the conditions to provide tuberculosis ME&T services as stipulated in Circular No. 02/2013/TT-BYT dated January 15, 2013 of the Minister of Health on cooperation among healthcare facilities in managing tuberculosis;

c) Private pulmonary hospitals ranked equivalent to Class III, equivalent to Class IV, and not yet ranked; private general hospitals ranked equivalent to Class III, equivalent to Class IV, and not yet ranked with a pulmonary department.

3. Healthcare facilities at the provincial level and equivalent include:

a) Healthcare facilities at the provincial level and equivalent as stipulated in Article 5 of Circular No. 40/2015/TT-BYT;

b) Provincial Tuberculosis and Pneumonia Hospitals, Pneumonia Hospitals, Hospitals with pulmonary departments in centrally-administered municipalities;

c) Provincial Tuberculosis and Pneumonia Hospitals, Pneumonia Hospitals, Hospitals with pulmonary departments in centrally-administered municipalities assigned the task of treating drug-resistant tuberculosis;

d) Private pulmonary hospitals ranked equivalent to Class I, equivalent to Class II; private general hospitals ranked equivalent to Class I, equivalent to Class II with a pulmonary department;

đ) Provincial Centers for Preventive Medicine with a Tuberculosis Department; Provincial Centers for Social Diseases Control with a Tuberculosis Department; Provincial Centers for Tuberculosis Control, Tuberculosis Stations; Provincial Centers for Disease Control.

4. Healthcare facilities at the central level and equivalent include:

a) Facilities as stipulated in Article 6 of Circular No. 40/2015/TT-BYT;

b) Hospitals and specialized institutes with beds under the Ministry of Health.

Article 5. Health insurance medical examination and treatment contractsu report. The methods for collecting data and establishing indices in the report must be implemented to ensure consistency with accounting work. 1. Medical establishments that meet the conditions for tuberculosis (TB) care annually supplement the contents related to TB care as prescribed in this Circular into health insurance medical examination and treatment contracts.

2. The medical establishments specified in Point c, Clause 3, Article 4 of this Circular are responsible for supplementing the contents regarding the reception and acceptance of drug-resistant TB patients from other medical establishments into health insurance medical examination and treatment contracts.

3. District general hospitals, district health centers, or other entities with health insurance medical examination and treatment contracts at commune-level medical establishments are responsible for supplementing the contents of TB care at commune-level medical establishments into health insurance medical examination and treatment contracts.

4. Medical establishments specified in Point b, Clause 2, Article 4 of this Circular, which have the necessary conditions for TB care, are responsible for organizing contracts with social insurance agencies to organize TB care.

5. Healthcare facilities specified in Point đ, Clause 3, Article 4 of this Circular, which have been granted permission to operate medical services, are responsible for signing health insurance medical examination and treatment contracts with social insurance agencies to organize TB care.

Article 6. Specialized technical transfer in medical examination and treatment for tuberculosis

1. Specialized technical transfer in TB medical examination and treatment shall be carried out according to the provisions of Circular No. 40/2015/TT-BYT, except for certain specific cases as stipulated in Clause 2 of this Article.

2. Cases determined to be within the correct medical examination and treatment line under health insurance:

a) People participating in health insurance who are diagnosed with TB, drug-resistant TB, suspected TB, latent TB, and initially registered for health insurance medical examination and treatment at medical establishments specified in Clause 1, Article 4 of this Circular may transfer to medical establishments specified in Clause 3, Article 4 of this Circular;

b) People participating in health insurance who are diagnosed with drug-resistant TB and initially registered for medical examination and treatment at medical establishments specified in Clause 2, Article 4 of this Circular may transfer to medical establishments specified in Point c, Clause 3 and Clause 4, Article 4 of this Circular;

c) Medical establishments specified in Point b, Clause 2, Article 4 of this Circular may transfer TB patients, drug-resistant TB patients, suspected TB patients, and latent TB patients to medical establishments specified in Clause 2 and Clause 3, Article 4 of this Circular.

Article 7. Scope of benefits and level of health insurance coverage

1. Participants in health insurance when receiving TB medical examination and treatment shall enjoy benefits within the scope and level of coverage as prescribed by laws on health insurance and the provisions of this Circular.accounting vouchers that have been erased, altered are invalid for payment and journal entries. When making a mistake on a pre-printed voucher, it must be invalidated 2. The health insurance fund will cover the costs of health insurance medical examination and treatment for people with latent TB who hold health insurance cards.

3. In cases where medical establishments do not have the conditions to perform technical services, they must transfer biological samples (such as blood, urine, body fluids, secretions, sputum, tissue...) or patients to health insurance medical establishments that have the conditions to perform diagnostic tests and imaging examinations to diagnose TB. The health insurance fund will cover the costs of performing these technical services for the medical establishment transferring the samples or the patient, or it will pay the costs to the medical establishment performing the technical service according to the approved price by the competent authority at the place where the service is performed.

4. In cases where medical establishments do not have anti-TB drugs to treat patients who are being treated for other diseases but are also diagnosed with TB or drug-resistant TB and cannot transfer the patients to other TB medical establishments, the following actions should be taken:

a) Patients can use anti-TB drugs provided by specialized TB medical establishments after consultation between the two medical establishments;

b) The health insurance fund will cover the cost of the drugs for the medical establishment receiving the drugs.

5. In cases where medical establishments have the ability to use types of drugs required for TB and drug-resistant TB treatment (anti-TB drugs and other drugs) included in the list of drugs covered by the health insurance fund but outside the scope of use according to the classification of the medical establishment, the medical establishment must report to the Ministry of Health (for establishments under the Ministry of Health) or the Department of Health (for establishments under the Department of Health and other ministries and sectors in the province or city) to coordinate with the Vietnam Social Security or the provincial or municipal social security agency to supplement the list of drugs for use at that medical establishment.

1. Departments of Health of provinces and centrally-administered cities:

a) Direct subordinate healthcare establishments to implement the contents prescribed in this Circular;

Article 8. Implementation organization

b) Take the lead and coordinate with the provincial or municipal social security agency to determine the professional technical conditions for supplementing the drug list at medical establishments as stipulated in Clause 5, Article 7 of this Circular;

c) Coordinate with the provincial or municipal social security agency to guide the implementation of health insurance medical examination and treatment contracts at medical establishments that meet the conditions for TB care as prescribed;

d) Coordinate with relevant agencies and organizations to disseminate and guide participants in health insurance who are diagnosed with TB, drug-resistant TB, suspected TB, and latent TB to comply with laws on health insurance, laws on TB prevention and control, and the provisions of this Circular;

đ) Develop and submit to the competent authority for decision-making mechanisms and levels of support for TB patients with health insurance cards beyond the portion covered by the health insurance fund from the medical care fund for the poor and other legitimate sources of funding as prescribed.

2. The Vietnam Social Security directs provincial and municipal social security agencies:

a) To implement health insurance medical examination and treatment contracts and settle the costs of health insurance medical examination and treatment for TB patients, drug-resistant TB patients, suspected TB patients, latent TB patients, and users of related healthcare services according to the guidance in this Circular and laws on health insurance, regulations on TB medical examination and treatment, and other relevant laws;

b) To coordinate with medical establishments on the method of settling the costs of medical examination and treatment for cases as stipulated in Clause 3 and Clause 4, Article 7 of this Circular to ensure the rights of health insurance participants as prescribed.

3. Medical establishments as prescribed in Article 4 of this Circular are responsible for:

a) Implementing medical examination and treatment and settling the costs of health insurance medical examination and treatment according to laws on health insurance and the provisions of this Circular;

b) Providing medical examination and treatment for TB patients, drug-resistant TB patients, suspected TB patients, latent TB patients, and users of related healthcare services to ensure the rights of health insurance participants as prescribed;

c) The medical establishment receiving the drugs must cooperate with the medical establishment providing the drugs and the social insurance agency to settle the costs of drugs as stipulated in Clause 4, Article 7 of this Circular.

b) Implementing medical care for individuals with tuberculosis, drug-resistant tuberculosis, suspected tuberculosis, latent tuberculosis, and those using healthcare services related to tuberculosis treatment to ensure the rights of health insurance beneficiaries as prescribed;

Medical facilities receiving medication shall coordinate with medical facilities issuing the medication and social insurance agencies to implement the reimbursement of costs for medications as stipulated in Clause 4, Article 7 of this Circular;

d) Organize tuberculosis care for individuals with tuberculosis, drug-resistant tuberculosis, suspected tuberculosis, latent tuberculosis, and those using healthcare services related to tuberculosis care in accordance with the Ministry of Health’s guidelines on tuberculosis diagnosis, treatment, and prevention.

Article 9. Effective Date

This Circular takes effect from May 1, 2016.

Article 10. Reference Provisions

In cases where referenced documents in this Circular are replaced or amended, they shall be applied according to the replaced or amended documents.

During the implementation process, if there are difficulties or obstacles, it is recommended that agencies, organizations, and individuals report them to the Ministry of Health for consideration and resolution./.