Circular No. 24/2021/TT-BYT amends and supplements certain Articles of Circular No. 46/2013/TT-BYT dated December 31, 2013, issued by the Minister of Health, concerning the functions, tasks, and organizational structure of rehabilitation facilities.

CIRCULAR

AMENDMENTS AND SUPPLEMENTS TO CERTAIN ARTICLES OF CIRCULAR NO. 46/2013/TT-BYT

DATED DECEMBER 31, 2013 ISSUED BY THE MINISTER OF HEALTH ON FUNCTIONS,

TASKS AND ORGANIZATIONAL STRUCTURE OF REHABILITATION FACILITIES

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Pursuant to the Law on Medical Examination and Treatment dated November 23, 2009;

Pursuant to the Health Insurance Law dated November 14, 2008 and the Law Amending and Supplementing Certain Articles of the Health Insurance Law dated June 13, 2014;

Pursuant to the Government's Decree No. 75/2017/NĐ-CP dated June 20, 2017 stipulating the 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 amending and supplementing certain articles of Circular No. 46/2013/TT-BYT dated December 31, 2013 issued by the Minister of Health on functions, tasks and organizational structure of rehabilitation facilities.

Article 1. Amendments and supplements to certain articles of Circular No. 46/2013/TT-BYT dated December 31, 2013 issued by the Minister of Health on functions, tasks and organizational structure of rehabilitation facilities

1. To add Clause 4 to Article 2 as follows:

"4. Medical establishments that do not fall under the cases stipulated in Clauses 1, 2 and 3 of this Article but have been approved by competent authorities to provide a list of rehabilitation techniques within their scope of professional activities according to the Law on Medical Examination and Treatment."

2. To amend Clause 1 of Article 3 as follows:

"1. Rehabilitation is a set of interventions including medical methods, rehabilitation techniques, assistive technologies, educational measures, vocational guidance, social support, and environmental improvements aimed at enabling patients and persons with disabilities (hereinafter referred to collectively as patients) to develop, achieve, maintain maximum functional capacity, prevent and reduce disability in accordance with their living environment."

3. To amend Clause 3 of Article 3 as follows:

"3. Day Inpatient Rehabilitation is a form of inpatient treatment at a rehabilitation facility based on professional requirements during daytime working hours, including holidays and public holidays. Daytime working hours are defined as working hours outside nighttime working hours as specified in Article 106 of the Labor Code (nighttime working hours are from 10 PM the previous day to 6 AM the following day)."

4. To add Clause 5 to Article 3 as follows:

"5. Rehabilitation Techniques include: physiotherapy, occupational therapy, activity therapy, speech therapy, psychological therapy, and intervention using rehabilitation equipment and other techniques.
a) Physiotherapy is a technique using physical agents to enhance health; treat, intervene, and restore functional capacity for pathological conditions, post-injury, or adjust and adapt to bodily deficiencies of patients; prevent risk factors related to movement leading to disability;
b) Activity Therapy involves using training skills techniques, changing ways of performing functional activities, adjusting living environments, and providing adaptive tools to enhance each patient's ability to participate in daily life activities, in line with their needs and preferences;
c) Speech Therapy is a technique using communication and interaction forms to assess, diagnose, prevent, and treat, intervene, and research communication, language, speech, voice, fluency disorders (stuttering), hearing, cognition, and swallowing problems of patients;
d) Psychological Therapy is a technique using communication and interaction forms to assess, diagnose, treat, and intervene in functional disorders regarding emotional responses, thinking patterns, and behavioral models of patients;

đ) Intervention Using Rehabilitation Equipment involves using one or more products, devices, or software to intervene in movement or mobility (including orthotic devices, prostheses), hearing, vision, communication, cognition, environmental modification, and daily living activities to enable patients to develop, maintain, improve function, prevent, reduce the consequences of disability, and maximize adaptation to their living environment."

5. To add Article 4a after Article 4 as follows:

"Article 4a. Day Inpatient Rehabilitation
1. Indication for Day Inpatient Rehabilitation: The indication for day inpatient rehabilitation for patients is within the authority and responsibility of doctors holding a medical practice certificate as prescribed by the Law on Medical Examination and Treatment and must meet the following criteria:
a) The patient's health condition and disease require inpatient treatment but do not need continuous 24-hour monitoring and treatment at a rehabilitation facility, while still ensuring the quality, purpose, and requirements of rehabilitation treatment;
b) The total time spent on monitoring, caring for, and implementing medical methods and rehabilitation techniques for patients at a rehabilitation facility according to professional requirements is not less than four hours in a day.
2. Patients undergoing day inpatient rehabilitation may be transferred to inpatient treatment or vice versa according to the doctor's prescription.
3. Patients meeting the criteria in Clause 1 of this Article but residing outside the district, city, town, or provincial city where the rehabilitation facility is located may undergo day inpatient rehabilitation or 24-hour inpatient treatment.
4. Patients undergoing day inpatient rehabilitation will be clinically examined and tested daily or according to the schedule set by the treating doctor and will enjoy inpatient treatment, monitoring, and care during day inpatient rehabilitation. Daily visits during day inpatient rehabilitation will not be charged as outpatient visits.
5. Procedures, processes for medical examination and treatment, medical records, and information technology applications for day inpatient rehabilitation shall be carried out in accordance with the regulations of the Minister of Health.
6. Beds for day inpatient rehabilitation:
a) For state medical establishments: Beds for day inpatient rehabilitation are included in the total number of planned beds approved by the competent authority.
b) For private medical examination and treatment facilities: Day hospital beds for functional recovery rehabilitation shall be included within the total number of beds registered and approved by the competent state authority.
c) The maximum number of patients requiring functional recovery rehabilitation day hospital treatment shall not exceed three (3) patients per bed in one day.
7. Costs for medical examination and treatment, and day hospital bed fees for functional recovery rehabilitation:
a) For insured patients: Implemented according to Circular No. 39/2018/TT-BYT dated November 30, 2018, issued by the Minister of Health, and Circular No. 13/2019/TT-BYT dated July 5, 2019, amending and supplementing Circular No. 39/2018/TT-BYT on unified service fee levels for medical examination and treatment under health insurance between hospitals of the same level nationwide and guidelines for applying and settling costs for medical examination and treatment under health insurance in certain cases.

b) For uninsured patients: Implemented according to Circular No. 37/2018/TT-BYT dated November 30, 2018, issued by the Minister of Health, and Circular No. 14/2019/TT-BYT dated July 5, 2019, amending and supplementing certain articles of Circular No. 37/2018/TT-BYT on the maximum price range for services for medical examination and treatment not covered by the Health Insurance Fund in state medical examination and treatment facilities and guidelines for applying and settling costs for medical examination and treatment in certain cases and healthcare service prices approved by the competent authority.

6. Amend Clause 3 of Article 21 as follows:

"3. The Director of the hospital shall be responsible for:
a) Specifying the cooperation between the functional recovery department or center with other departments, rooms, and related units within the hospital;

b) Specifying the cooperation among members of the functional recovery team to examine, diagnose, assess, determine goals, develop plans, treat, and intervene in functional recovery effectively. The functional recovery team includes: A functional recovery physician as the head of the team, members being treating physicians from various departments, rooms, or related units within the hospital, rehabilitation technicians, nurses, and social workers."

7. Amend and supplement Clause 1 of Article 24 as follows:

"1. Responsibilities of units under the Ministry of Health:
a) The Department of Medical Examination and Treatment shall take the lead and coordinate with relevant units to direct, organize, and inspect the implementation of this Circular for medical examination and treatment facilities nationwide;
b) The Department of Health Insurance shall be responsible for taking the lead and coordinating with the Department of Information Technology, the Department of Medical Examination and Treatment, the Department of Planning and Finance, and related units to build and guide the coding of day hospital bed fees for functional recovery rehabilitation to serve management and adjudication, settlement of costs for medical examination and treatment under health insurance;

c) The Department of Information Technology shall be responsible for taking the lead and coordinating with the Department of Medical Examination and Treatment to guide the implementation of electronic medical records for functional recovery facilities."

8. Amend Clause 3 of Article 24 as follows:

"3. Medical examination and treatment facilities shall be responsible for:
a) Recruiting and arranging sufficient human resources as prescribed to effectively implement functional recovery activities;
b) Specifying and assigning a unit to be the main contact point for managing functional recovery activities;
c) Investing in upgrading infrastructure, medical equipment, organizing production, supply, and guiding the use of functional recovery devices in compliance with the provisions of this Circular;
d) Notifying the Social Insurance Office of the province where the medical examination and treatment facility operates about the implementation of day hospital treatment for functional recovery and signing a contract or adding a supplementary agreement for payment of costs for medical examination and treatment for day hospital treatment for functional recovery for insured patients when the medical examination and treatment facility first implements day hospital treatment for functional recovery;

đ) Publicly announcing the implementation of day hospital treatment for functional recovery at the facility in accordance with regulations."

9. Amend Clause 4 of Article 24 as follows:

"4. The responsibility of commune health stations, township health stations, and town health stations is:
a) To carry out tasks related to functional recovery as stipulated in Circular No. 33/2015/TT-BYT dated October 27, 2015, issued by the Minister of Health, guiding the functions and responsibilities of commune health stations, township health stations, and town health stations;
b) Organizing propaganda, education, dissemination of knowledge, and guidance for persons with disabilities on self-care, health protection, functional recovery, prevention, and reduction of disabilities;

c) Developing and implementing community-based functional recovery plans in accordance with the guidelines of the Minister of Health; early detection and intervention for children with disabilities; establishing and maintaining health records for persons with disabilities."

Article 2. Repeal certain clauses and articles of Circular No. 46/2013/TT-BYT dated December 31, 2013 of the Minister of Health on the functions, tasks, and organizational structure of rehabilitation facilities.

1. Abolish Article 5.

2. Repeal Clause 3 of Article 11.

3. Repeal Article 26.

Article 3. Effectiveness

1. This Circular takes effect from February 1, 2022.

2. Article 5 of Circular No. 18/2016/TT-BYT dated June 30, 2016 of the Minister of Health on the list of techniques, medical supplies used in rehabilitation and the payment for daytime rehabilitation costs within the scope of health insurance fund reimbursement shall cease to be effective from the date this Circular takes effect.

During implementation, if there are difficulties or obstacles, agencies, organizations, and individuals should report them to the Ministry of Health (Department of Medical Examination and Treatment) for consideration and resolution./.