Circular No. 11/2009/TT-BYT Issuing the List of Rehabilitation Technical Services and Average Number of Treatment Days for Certain Diseases and Disease Groups Covered by the Health Insurance Fund

CIRCULAR

Issuing the List of rehabilitation technical services and average number of days for a treatment course of certain diseases and disease groups covered by the Health Insurance Fund

of certain diseases and disease groups covered by the Health Insurance Fund

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Pursuant to the Health Insurance Law dated November 14, 2008;

Pursuant to Decree No. 188/2007/NĐ-CP dated December 27, 2007 of the Government on the functions, tasks, powers, and organizational structure of the Ministry of Health;

Pursuant to Circular No. 09/2009/TTLT-BYT-BTC dated August 14, 2009 of the Ministry of Health and the Ministry of Finance guiding the implementation of health insurance;

The Ministry of Health hereby issues the List of rehabilitation technical services and average number of days for a treatment course of certain diseases and disease groups treated at medical facilities providing rehabilitation services covered by the Health Insurance Fund and provides guidance on its implementation as follows:

Article 1. Attached to this Circular is the "List of rehabilitation technical services and average number of days for a treatment course of certain diseases and disease groups covered by the Health Insurance Fund" (hereinafter referred to as the "List").

Article 2. Scope, subjects, and principles of application

1. The scope and subjects of application of the List issued herein shall apply to patients with health insurance cards undergoing treatment and rehabilitation at general and specialized hospitals with departments or units for physiotherapy-rehabilitation or rehabilitation; at convalescent hospitals and other rehabilitation medical facilities (hereinafter collectively referred to as rehabilitation medical facilities) that have signed contracts for health insurance medical services.

2. Principles of payment

The application of the List for payment between rehabilitation medical facilities and the Social Insurance Fund shall be carried out as follows:

a) There must be doctors, medical technicians, or nursing staff with certificates or certifications confirming they have been trained in physiotherapy-rehabilitation to prescribe and perform technical services.

b) There must be a list of medical service prices approved by the competent authority in accordance with regulations on hospital fees, consistent with the scope of technical expertise according to the approved technical tiering.

c) When prescribing, the specific and accurate name of the technical service must be recorded. The prescription of specific technical services for each patient during each treatment course must be consistent with the diagnosis, correct dosage, correct location, and correct duration according to the treatment guidelines and must be fully documented in the medical record.

d) Payment shall be made for the services actually performed (if applying the fee-for-service payment method); it is not allowed to divide one service into multiple services for payment purposes; the examination fee shall only be paid once for the entire outpatient treatment course at the approved price. For medical facilities using the capitation or case-based payment methods, the Social Insurance Fund shall base its review and ensure the quality of treatment and the rights of insured patients according to this List.

đ) For diseases and disease groups specified in Part II of the List, the Health Insurance Fund shall pay according to the scope of insurance benefits and the actual number of treatment days for each case but shall not exceed the average number of treatment days specified for each disease or disease group in the List.

Article 3. Payment for the cost of treating accompanying diseases for patients at rehabilitation medical facilities

Based on the scope of technical expertise according to the approved treatment tiering, rehabilitation medical facilities shall provide health insurance medical services according to the contracts signed with the Social Insurance Fund. During the treatment and rehabilitation process, if patients require emergency care or treatment for accompanying diseases, they may use medicines and medical supplies covered by the Health Insurance Fund and other necessary interventions to treat the patients, consistent with the scope of technical expertise of each facility. Based on the scope of benefits for insured individuals, the Social Insurance Fund shall make payments for these cases as stipulated for those treated at other medical facilities.

Article 4. Effectiveness

This Circular shall take effect from October 1, 2009.

2. Abolish Decision No. 102/2002/QĐ-BYT dated January 14, 2002 of the Minister of Health on issuing the List of rehabilitation technical services and diseases and disease groups treated at medical facilities and convalescent hospitals covered by health insurance.

In the process of implementing this Circular, if there are difficulties or obstacles, please report them to the Ministry of Health for consideration and resolution./.