Circular No. 15/2015/TT-BYT guiding the implementation of medical examination and treatment under health insurance for people infected with HIV and those using healthcare services related to HIV/AIDS.

CIRCULAR

Guidelines for conducting medical examinations and treatments under health insurance for people infected with HIV and those using healthcare services related to HIV/AIDS.

Guidelines for conducting medical examinations and treatments under health insurance for people infected with HIV and those using healthcare services related to HIV/AIDS.

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Based on the Health Insurance Law;

Based on the Medical Examination and Treatment Law;

Pursuant to the Law on Prevention and Control of Infection with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS);

This Circular prescribes procedures for receiving, providing health care for domestic violence victims and statistical reports on domestic violence victims at medical facilities.

Pursuant to Decree No. 105/2014/ND-CP dated November 15, 2014 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law;

The Minister of Health issues this Circular guiding the implementation of medical examinations and treatments under health insurance for people infected with HIV and those using healthcare services related to HIV/AIDS as follows:

Article 1. Scope of Regulation and Applicability

1. Medical examination and treatment facilities under health insurance (BHYT).

2. Medical examination and treatment facilities under BHYT providing antiretroviral therapy (ARV) drugs for people infected with HIV (hereinafter referred to as ARV drugs).

3. Healthcare facilities providing ARV treatment according to Circular No. 09/2011/TT-BYT dated January 26, 2011 of the Minister of Health guiding the conditions and scope of expertise of healthcare facilities providing ARV treatment that have signed contracts for medical examinations and treatments under BHYT.

4. People participating in BHYT who are infected with HIV, and people participating in BHYT using healthcare services related to HIV/AIDS.

5. This Circular does not apply to people participating in BHYT who are infected with HIV and are being managed in prisons, temporary detention centers, holding facilities, compulsory educational institutions, juvenile rehabilitation centers, and compulsory drug rehabilitation centers.

Article 2. General Principles

1. People participating in BHYT who are infected with HIV when undergoing medical examinations and treatments for HIV/AIDS and people participating in BHYT when using healthcare services related to HIV/AIDS shall enjoy benefits of medical examinations and treatments under BHYT within the scope of rights and levels of benefit as prescribed by laws on BHYT.

2. People participating in BHYT who are infected with HIV and are undergoing medical examinations and treatments at healthcare facilities providing ARV treatment may continue to undergo medical examinations and treatments for HIV/AIDS at such facilities according to Circular No. 32/2013/TT-BYT dated October 17, 2013 of the Minister of Health guiding management, monitoring, and treatment of people infected with HIV and those exposed to HIV to ensure convenience in accessing treatment, maintaining stability and effectiveness in managing care, treatment, and prevention of HIV/AIDS.

Payment for costs of medical examinations and treatments for HIV/AIDS between medical examination and treatment facilities and social insurance organizations shall be carried out in accordance with the provisions of laws on BHYT. The BHYT Fund will not pay for costs of medical examinations and treatments in cases where patients have BHYT cards but such costs have already been paid from state budget (national target programs in health, ODA projects, etc.) or other legitimate sources.

Article 3. Contracts for medical examinations and treatments under health insurance

1. Medical examination and treatment facilities under BHYT shall supplement contents regarding medical examinations and treatments for HIV/AIDS as prescribed in this Circular into annual contracts for medical examinations and treatments under BHYT with social insurance organizations.

2. Healthcare facilities providing ARV treatment belonging to district health centers, urban districts, provincial preventive healthcare centers, and other medical examination and treatment facilities meeting the legal requirements for medical examinations and treatments shall be responsible for signing contracts with social insurance organizations to organize medical examinations and treatments and settle costs of medical examinations and treatments under BHYT for HIV/AIDS patients.

3. General hospitals or district health centers, urban districts, provincial preventive healthcare centers, and agencies or units currently contracting with social insurance organizations for medical examinations and treatments under BHYT at commune health stations and equivalent facilities shall be responsible for supplementing contents regarding medical examinations and treatments for HIV/AIDS into contracts for medical examinations and treatments under BHYT at commune health stations and equivalent facilities.

Article 4. Registration for initial health examination and treatment under health insurance

1. Persons participating in health insurance who are infected with HIV shall register for initial health examination and treatment under health insurance at healthcare facilities in accordance with Circular No. 37/2014/TT-BYT dated November 17, 2014 issued by the Minister of Health on registration for initial health examination and treatment and referral for health examination and treatment under health insurance.

2. In case of need, persons participating in health insurance who are infected with HIV may register for initial health examination and treatment under health insurance at one of the initial healthcare facilities providing HIV/AIDS health examination and treatment within the district or provincial administrative area.

3. Persons participating in health insurance who are infected with HIV may change their initial registration for health examination and treatment under health insurance at the beginning of each quarter in accordance with the provisions of the law on health insurance, as guided by the social insurance organization issuing the health insurance card.

Article 5. Referral for health examination and treatment

1. Referral for health examination and treatment under health insurance shall be carried out in accordance with the provisions of Articles 8 and 9 of Circular No. 37/2014/TT-BYT dated November 17, 2014 issued by the Minister of Health on registration for initial health examination and treatment and referral for health examination and treatment under health insurance.

2. Referral for health examination and treatment between healthcare facilities treating HIV/AIDS with antiretroviral therapy (ARV) at commune, district, provincial, and central levels according to the professional management classification specified in Circular No. 09/2011/TT-BYT dated January 26, 2011 issued by the Minister of Health on conditions and scope of professional activities of healthcare facilities treating HIV/AIDS with antiretroviral therapy and Circular No. 32/2013/TT-BYT dated October 17, 2013 issued by the Minister of Health on management and follow-up of treatment for HIV-infected individuals and individuals exposed to HIV.

Article 6. Scope of benefits and level of health insurance coverage

1. Persons participating in health insurance who are infected with HIV and persons participating in health insurance when using medical services related to HIV/AIDS shall enjoy benefits in accordance with the scope of benefits and level of coverage as prescribed by the law on health insurance.

2. Persons participating in health insurance who are infected with HIV and persons participating in health insurance when using medical services related to HIV/AIDS shall have the health insurance fund pay for:

a) Medicines (including ARV medicines), chemicals, medical supplies, technical services within the scope of payment by the health insurance fund;

b) HIV testing for pregnant women and during childbirth according to professional requirements in health examination and treatment if not covered by other sources of funding;

HIV感染者进行医疗保险登记 - 完成。

d) Health examination, HIV testing, ARV medicines, and other health examination and treatment services for children born from HIV-infected mothers;

đ) HIV testing according to professional requirements in health examination and treatment (excluding costs for HIV testing for organ donors, sperm donors, and egg donors);

省级卫生部门的责任 - 完成。

社会保险越南国家局的责任 - 完成。

Article 7. 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;

a) Direct subordinate healthcare facilities to implement the contents stipulated in this circular;

b) Take the lead and coordinate with the Social Insurance of provinces and centrally-administered cities to provide specific guidance on the registration for initial health examination and treatment under health insurance for persons participating in health insurance who are infected with HIV/AIDS;

c) Take the lead and coordinate with the Social Insurance of provinces and centrally-administered cities to guide the implementation of health examination and treatment contracts under health insurance at healthcare facilities that meet the conditions and scope of professional activities for treating HIV/AIDS with antiretroviral therapy as prescribed;

d) Coordinate with relevant agencies and organizations to disseminate and guide persons participating in health insurance who are infected with HIV to comply with the provisions of the law on health insurance, the law on HIV/AIDS prevention and control, and the provisions of this circular.

2. The Social Insurance of provinces and centrally-administered cities shall be responsible for signing health examination and treatment contracts under health insurance and settling the costs of health examination and treatment under health insurance for HIV-infected individuals and persons participating in health insurance when using medical services related to HIV/AIDS in accordance with the guidance provided in this circular and the provisions of the law on health insurance, regulations on health examination and treatment for HIV/AIDS, and other relevant laws.

3. Healthcare facilities as stipulated in Clauses 1, 2, and 3 of Article 3 of this circular shall be responsible for:

a) Providing health examination and treatment under health insurance for HIV-infected individuals and persons participating in health insurance when using medical services related to HIV/AIDS, ensuring the rights of persons participating in health insurance as prescribed;

b) Providing HIV/AIDS health examination and treatment in accordance with the guidelines for diagnosis and treatment of HIV/AIDS and guidelines for management and follow-up of treatment for HIV-infected individuals and individuals exposed to HIV issued by the Ministry of Health;

c) Cooperating with the social insurance organization to implement the settlement of costs for health examination and treatment under health insurance in accordance with the law on health insurance and the provisions of this circular.

Article 8. Cross-reference provisions

1. Circular No. 09/2011/TT-BYT dated January 26, 2011, issued by the Minister of Health, guiding the conditions and scope of expertise for healthcare facilities treating with antiretroviral drugs.

2. Circular No. 32/2013/TT-BYT dated October 17, 2013, issued by the Minister of Health, guiding the management and monitoring of HIV-infected individuals and those exposed to HIV.

3. Circular No. 37/2014/TT-BYT dated November 17, 2014, issued by the Minister of Health, guiding the registration for initial medical examination and treatment and the referral process for health insurance medical examination and treatment.

In case these referenced documents are replaced or amended by other documents, they shall be implemented according to the replacing or amending documents.

Article 9. Effective Date

1. This circular takes effect from August 15, 2015;

2. During implementation, if there are difficulties or obstacles, units and localities are requested to report to the Ministry of Health for timely review and resolution.