Circular No. 18/2016/TT-BYT stipulates the list of technical procedures, medical supplies used for rehabilitation, and the payment of daytime rehabilitation costs within the scope of payment by the Health Insurance Fund.

CIRCULAR

Prescribes the Technical List, medical supplies list for use

 in rehabilitation and payment of daytime rehabilitation costs

within the scope of payment of the Health Insurance Fund

On the basis of pursuant to the Health Insurance Law dated November 14, 2008 and the Law Amending and Supplementing Certain Provisions of the Health Insurance Law dated June 13, 2014;

Decree No. 63/2012/NĐ-CP dated August 31, 2012 of the Government stipulating functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Medical Examination and Treatment;

The Minister of Health issues this Circular prescribing the Technical List, medical supplies list for use in rehabilitation and payment of daytime rehabilitation costs within the scope of payment of the Health Insurance Fund.

Article 1. Scope of Regulation

This Circular stipulates the Technical List for rehabilitation, medical supplies list for use in rehabilitation and payment of daytime rehabilitation costs within the scope of payment of the Health Insurance Fund.

Article 2. Applicability

1. Persons holding health insurance cards when seeking medical examination and treatment (hereinafter referred to as KBCB), rehabilitation (hereinafter referred to as PHCN).

2. Medical facilities conducting PHCN according to the organizational form prescribed in Circular No. 46/2013/TT-BYT dated December 31, 2013 of the Minister of Health stipulating functions, tasks, and organizational structure of rehabilitation facilities.

Article 3. Technical List, medical supplies list and principles of payment

1. Technical List for rehabilitation

The Technical List for PHCN shall be implemented in accordance with Circular No. 43/2013/TT-BYT dated December 11, 2013 of the Minister of Health detailing the classification of technical specialties for the healthcare system and Circular No. 50/2014/TT-BYT dated December 26, 2014 of the Minister of Health stipulating the classification of surgeries and procedures and staffing levels for each surgery and procedure.

2. Medical supplies list for use in PHCN and principles of payment

a) The medical supplies list for use in PHCN includes:

- The medical supplies list issued together with Circular No. 27/2013/TT-BYT dated September 18, 2013 of the Minister of Health promulgating the medical supplies list within the scope of payment of the Health Insurance Fund;

- The supplementary medical supplies list for use in PHCN issued together with this Circular.

b) Principles of payment for medical supplies costs used in PHCN shall be implemented in accordance with Circular No. 27/2013/TT-BYT dated September 18, 2013 of the Minister of Health promulgating the medical supplies list within the scope of payment of the Health Insurance Fund and other regulations of the law on health insurance (hereinafter referred to as BHYT).

Article 4. Payment of service costs for rehabilitation techniques and medical examination and treatment

1. Principles of payment for service costs for rehabilitation techniques

a) There must be a Technical List for PHCN approved by the competent authority. When ordering services, the specific name of the technique and body part must be recorded in the medical record. The ordering of techniques for patients must be appropriate to the diagnosis.

b) Services performed are paid for accordingly. For medical facilities applying fee-for-service or case-based payment methods, the Social Insurance will base its assessment and payment on the Technical List.

c) Health insurance payment for cases determined to be within the correct medical examination and treatment facility (KBCB) level as follows:

- Transfer between facilities as prescribed in Circular No. 14/2014/TT-BYT dated April 14, 2014 of the Minister of Health regarding transfer between medical examination and treatment facilities and Circular No. 40/2015/TT-BYT dated November 16, 2015 of the Minister of Health regarding registration for initial medical examination and treatment under health insurance and transfer for medical examination and treatment under health insurance.

- Based on the approved Technical List for PHCN, if the district-level KBCB does not have suitable techniques for the patient's rehabilitation needs, the commune-level KBCB may refer the patient to a provincial-level PHCN facility.

2. Payment of costs for medical examination and treatment of other diseases at rehabilitation facilities

a) Based on the approved Technical List for KBCB, rehabilitation facilities providing medical examination and treatment services will be reimbursed according to contracts signed with the Social Insurance.

b) During medical examination and treatment and rehabilitation, if patients require emergency care or treatment for accompanying diseases, medical facilities can use necessary medications, medical supplies, and treatments within their approved scope of practice. The Social Insurance will reimburse these cases as it would for treatment at other medical facilities.

3. Payment of rehabilitation costs at other medical examination and treatment facilities

Based on the approved Technical List, other medical facilities providing rehabilitation techniques will be reimbursed by the Social Insurance as stipulated for rehabilitation at rehabilitation facilities.

Clause 1. The payment for drug costs, medical supplies, and technical services for daytime rehabilitation shall be implemented as for inpatient treatment.

Clause 2. The level of payment for bed day costs for daytime rehabilitation shall be carried out according to the provisions of Circular Joint Circular No. 37/2015/TTLT-BYT-BTC dated October 29, 2015, issued by the Minister of Health and the Minister of Finance on unified prices for medical examination and treatment services under health insurance nationwide and other related regulations.

Article 6. Responsibilities for Implementation

Clause 1. The Ministry of Health assigns the Department of Medical Examination and Treatment to take the lead, coordinate with the Social Insurance Department and relevant Departments, Bureaus, and units to direct, guide, and inspect the implementation of this Circular throughout the country.

Clause 2. The Vietnam Social Security directs, guides, and inspects provincial social security offices under central cities to implement the provisions of this Circular.

Clause 3. Provincial Health Departments under central cities and state management agencies for health under ministries and sectors take the lead, coordinate with relevant units to direct, guide, and inspect the implementation of this Circular at medical examination and treatment facilities within their jurisdiction.

Clause 4. Medical examination and treatment facilities and rehabilitation facilities have the responsibility to implement the provisions of this Circular.

Article 7. Effective Date

Clause 1. This Circular takes effect from August 19, 2016.

Clause 2. Circular No. 11/2009/TT-BYT dated August 14, 2009, issued by the Minister of Health on the list of technical services for rehabilitation and average number of days for a treatment course of certain diseases and disease groups covered by the health insurance fund ceases to be effective from the date this Circular takes effect.

Article 8. Reference Provisions

Where referenced documents in this Circular are replaced or amended, implementation shall be in accordance with the replacing or amending documents.

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