Circular No. 27/2018/TT-BYT guiding the implementation of health insurance and medical examination and treatment related to HIV/AIDS

CIRCULAR

Guidelines for Implementing Health Insurance

and Health Insurance-Related Medical Examination and Treatment Related to HIV/AIDS

PURSUANTPursuant to the Health Insurance Law number 25/2008/QH12 dated November 14 2008 which has been amended and supplemented with some articles according to the Health Insurance Law on June 13, 2014dated June 13, 2014;

Pursuant to the Law on Prevention and Control of Infection Caused by Viruses Leading to Acquired Immune Deficiency Syndrome (AIDS) number1 dated June 29, 2006;46/2018/NĐ-CP dated October 17, 2018 of the Government detailing and guiding measures to implement certain provisions of the Health Insurance Law; 64/2006/QH1hereby promulgating the Circular guiding the implementation of health insurance and medical examination and treatment related to HIV/AIDS.

Based on Decree No. 1a) The establishment of lists and payment of health insurance premiums;

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;

THE MINISTER OF HEALTH b) Scope of health insurance benefits; c) Medical examination and treatment, payment of costs for health insurance-related medical examination and treatment, and utilization of healthcare services related to HIV/AIDS.2. This Circular applies to agencies, organizations, and individuals related to the implementation of health insurance and health insurance-related medical examination and treatment for people infected with HIV.

Article 1. Scope of Regulation and Applicability

1. This Circular stipulates on:

Article 2. Establishment of Lists and Payment of Health Insurance Premiums

People infected with HIV participate in health insurance in accordance with current laws on health insurance, including the establishment of lists, payment of health insurance premiums, and issuance of health insurance cards for subjects under Clause 4 and Clause 5, Article 12 of the Health Insurance Law number 25/2008/QH12 dated November 14, 2008, which has been amended and supplemented with some articles according to the Health Insurance Law dated June 13, 2014, as follows:

1. For cases where people infected with HIV visit an HIV/AIDS treatment facility (hereinafter referred to as HIV/AIDS treatment facility) for the first time to treat HIV/AIDS or are detected as being infected with HIV at an HIV/AIDS treatment facility:

a) In the case where patients do not have a health insurance card and are eligible for support in paying health insurance premiums: The HIV/AIDS treatment facility guides patients to complete procedures for requesting a health insurance card and submits a list of such patients to the provincial AIDS prevention and control unit (hereinafter referred to as the provincial AIDS prevention and control unit) within five working days before the last day of the month to establish a list for supporting the payment of health insurance premiums. If patients come for examination or are detected as being infected with HIV within less than five days from the end of the month, the list will be transferred to the following month;

b) In the case where patients already have a health insurance card, are currently receiving medical examination and treatment within their designated network, and are eligible for support in paying health insurance premiums: After the health insurance card expires, the HIV/AIDS treatment facility compiles a list of patients participating in health insurance and sends it to the provincial AIDS prevention and control unit within thirty days before the expiration date of the health insurance card;

c) In the case where patients already have a health insurance card, are currently receiving medical examination and treatment outside their designated network, and are eligible for support in paying health insurance premiums: After the health insurance card expires, the HIV/AIDS treatment facility refers patients to an appropriate HIV/AIDS treatment facility within their designated network for medical examination and treatment to compile a list for supporting the payment of health insurance premiums as stipulated in point a of this clause;

d) Before the 15th of each month, the provincial AIDS prevention and control unit compiles a list of requests for support in paying health insurance premiums from all HIV/AIDS treatment facilities in its jurisdiction (including those of the Ministry of Health and other ministries and sectors) and sends it to the Social Security Department of the province;

đ) Within ten working days from the date of receipt of the list of requests for health insurance cards sent by the provincial AIDS prevention and control unit, the Social Security Department of the province is responsible for reviewing to avoid issuing duplicate health insurance cards and providing information about the current participation status of each patient in the list;

e) Based on the information provided by the social security agency of the province and the level of support for paying health insurance premiums approved annually by the provincial People's Committee for each group of subjects, the provincial AIDS prevention and control unit is responsible for:

- Compiling a list of patients supported in paying health insurance premiums from the funds managed by the provincial AIDS prevention and control unit (if applicable) and a list of patients requesting local support in paying health insurance premiums to send to the Department of Health, specifying clearly the cases fully supported in paying health insurance premiums and the cases partially supported in paying health insurance premiums;

- Compiling a list of patients not fully supported in paying health insurance premiums (if applicable) and the specific amount that patients must pay to send to the HIV/AIDS treatment facility where they registered for treatment;

g) After receiving information from the provincial AIDS prevention and control unit, the Department of Health is responsible for transferring the approved support funding for health insurance premiums to the Social Security Department before the 10th of the first month of each quarter to issue health insurance cards;

h) HIV/AIDS treatment facilities are responsible for:

- Notifying patients of the amount they need to pay (if applicable) and collecting it to transfer to the Social Security Department for issuance of health insurance cards;

- Notifying the provincial AIDS prevention and control unit in writing of the list of patients who have participated in health insurance and the amount of support for paying health insurance premiums;

- Accepting photographs provided by patients in cases where patients do not have identification documents or personal confirmation documents to transfer to the Social Security Department for issuance of health insurance cards with photographs.

2. For people infected with HIV participating in health insurance not falling under the circumstances specified in Clause 1 of this Article, they shall self-pay health insurance premiums according to the household form as stipulated in Clause 7, Article 9 of the Government Decree number 146/2018/NĐ-CP dated October 17, 2018 detailing and guiding measures to implement certain provisions of the Health Insurance Law. The reduction in the amount paid shall be implemented in accordance with current health insurance laws.

||| - Notify the patient and collect the portion of fees that the patient must pay (if any) to transfer to the Social Insurance for issuance of the health insurance card;

||| - Provide in writing to the provincial HIV/AIDS prevention and control units the list of individuals who have joined health insurance and the portion of funding support for health insurance contributions;

||| - Accept photographs provided by the patient in cases where the patient does not have personal identification documents or identity confirmation documents to transfer to the Social Insurance for issuance of the health insurance card with photograph.

2. For HIV-infected individuals participating in health insurance not falling under the provisions of Clause 1 of this Article, they shall self-contribute to health insurance according to the family household form as stipulated in Clause 7 of Article 9 of Decree No. 146/2018/NĐ-CP dated October 17, 2018 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law. The reduction in contribution levels shall be carried out in accordance with current health insurance laws.

医疗保险的范围和利益 - 完成。

感染HIV的参保人员和使用与艾滋病相关服务的参保人员的利益 - 完成。

使用与艾滋病相关医疗服务的感染HIV的参保人员的报销项目 - 完成。

预防机会性感染 - 完成。

医疗检查、治疗及医疗保险费用报销 - 完成。

HIV感染者进行医疗保险登记 - 完成。

跨地区就医 - 完成。

医疗机构无法完成检测或医疗服务时的处理方式 - 完成。

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 4. Medical Examination and Treatment and Reimbursement of Costs for Health Insurance

1. HIV-infected persons with health insurance cards shall register for initial health insurance medical examination and treatment according to Circular No. 40/2015/TT-BYT dated November 16, 2015, issued by the Ministry of Health, which stipulates the registration process for initial health insurance medical examination and treatment and referral procedures for health insurance medical examination and treatment.

In cases where patients with health insurance cards are undergoing antiretroviral therapy at provincial-level medical facilities and require initial health insurance medical examination and treatment, they may register for such services at the same facility if necessary.

2. If patients undergoing HIV/AIDS treatment develop other diseases that their current medical facilities cannot treat, they shall be referred to specialized technical levels according to the law.

3. In cases where individuals undergoing antiretroviral therapy travel for work, temporary employment, or study in other locations for longer periods than the outpatient antiretroviral drug supply period or temporarily reside in other locations, they may seek medical examination and treatment at equivalent medical facilities listed on their health insurance cards that provide HIV/AIDS services. If the equivalent medical facility does not provide HIV/AIDS services, patients may seek medical examination and treatment at county-level medical facilities providing such services or be referred according to regulations.

Example: If a person's health insurance card lists the initial health insurance medical examination and treatment registration at Hospital A in County X, they can receive health insurance medical examination and treatment or HIV/AIDS treatment at Hospital B in County X (same or different province) or if the initial health insurance medical examination and treatment registration is at Hospital C in Province Y, they can receive health insurance medical examination and treatment or HIV/AIDS treatment at Hospital D in Province Y.

4. In cases where healthcare facilities cannot perform certain tests or medical services and must send patients or samples to approved facilities capable of performing these tests and services, the Health Insurance Fund will reimburse the sending facility according to the service fee and health insurance coverage for individuals with health insurance cards as prescribed; the transferring healthcare facility is responsible for paying the costs for the testing and technical services performed by the receiving unit, then consolidating these costs into the patient's medical examination and treatment expenses to settle with the social insurance agency.

State-owned enterprises that have been assigned by the Ministry of Agriculture and Rural Development to conduct offshore wind power project surveys before the effective date of this Circular shall continue to implement according to the assigned documents; any new matters arising after the effective date of this Circular shall be implemented in accordance with the provisions of this Circular.

1. Provincial Departments of Health shall be responsible for:

a) Directing subordinate healthcare facilities to implement the contents prescribed in this Circular; assigning tasks to commune health stations and healthcare facilities to compile lists and collect health insurance contributions (if applicable) according to Clause 1, Article 2 of this Circular to transfer to the provincial AIDS prevention and control units for consolidation and submission to the Department of Health for issuance of health insurance cards;

b) Taking the lead and coordinating with Social Insurance agencies in provinces and centrally-administered cities to review and verify the list of HIV-infected individuals eligible for health insurance cards as prescribed in Clause 1, Article 2 of this Circular, and determine the funding support for issuing health insurance cards;

c) Taking the lead and coordinating with Social Insurance agencies in provinces and centrally-administered cities to provide specific guidance on the registration process for initial health insurance medical examination and treatment for HIV-infected individuals participating in health insurance;

d) Advising People's Councils and People's Committees of provinces and centrally-administered cities on supporting health insurance contributions for HIV-infected individuals without health insurance cards in their jurisdictions;

đ) Coordinating with relevant agencies and organizations to prepare annual budgets for supporting HIV-infected individuals, submitting them for approval by competent authorities according to the分级任务如下：

2. The Vietnam Social Security is responsible for organizing the implementation and directing the Social Security of provinces and centrally-administered cities to perform the following tasks:

a) Enter into insurance medical examination and treatment contracts with healthcare facilities having the function of treating HIV/AIDS and meeting the conditions for insurance medical examination and treatment as stipulated by the Health Insurance Law to examine diseases, treat HIV/AIDS, and settle costs for HIV/AIDS medical examinations and treatments for HIV-infected individuals and those holding health insurance cards when using services related to HIV/AIDS medical examinations and treatments according to Article 3 of this Circular and relevant laws on health insurance;

b) Guide healthcare facilities to update the costs for medical examinations and treatments that the Social Insurance Agency will settle in cases where medical examinations and drug issuance require waiting for HIV viral load and CD4 test results by posting such information on the health insurance claim adjudication information portal to ensure accurate information and continuous medication supply for patients;

c) Take the lead and coordinate with the Department of Health to review and cross-check the list of HIV-infected individuals eligible for health insurance cards as stipulated in Clause 1, Article 2 of this Circular;

d) Guide HIV/AIDS treatment facilities to collect the portion of health insurance card purchase costs that HIV-infected individuals must pay themselves.

3. Healthcare facilities providing HIV/AIDS treatment as specified in Clause 1, Article 2 of this Circular shall be responsible for:

a) Implementing insurance medical examinations and treatments for HIV-infected individuals and those holding health insurance cards when using technical services related to HIV/AIDS medical examinations and treatments, ensuring the rights of health insurance participants as prescribed;

b) HIV/AIDS treatment facilities shall advise and guide HIV-infected individuals participating in health insurance to choose initial health insurance examination and treatment registration sites at hospitals or district health centers within the province capable of treating HIV/AIDS according to the guidance provided in Article 8 of Circular No. 40/2015/TT-BYT dated November 16, 2015 on initial health insurance examination and treatment registration and referral for health insurance examination and treatment;

Example: If an individual is diagnosed with HIV at Facility A but does not have a health insurance card, Facility A shall prepare a list requesting issuance of a health insurance card and advise the patient to register for initial health insurance examination and treatment at Facility A. In case the patient wishes to register for initial health insurance examination and treatment at a hospital or district health center in County B within the province, Facility A shall prepare a list for health insurance participation but must clearly indicate in the list that the patient's initial health insurance examination and treatment registration site is Facility B. If the hospital or district health center in County B does not have the function of treating HIV/AIDS, the HIV-infected individual can still receive HIV/AIDS medical examinations and treatments at Facility A.

c) Coordinate with the Social Insurance Agency to implement settlement of costs for insurance medical examinations and treatments according to laws on health insurance and provisions in this Circular;

4. HIV/AIDS treatment facilities meeting the conditions stipulated by laws on medical examinations and treatments shall be responsible for requesting the Social Insurance Agency to enter into contracts to organize medical examinations and treatments and settle costs for insurance medical examinations and treatments for HIV/AIDS patients;

Article 6. Transitional Provisions

Individuals holding health insurance cards undergoing antiretroviral therapy at provincial or central-level healthcare facilities prior to the effective date of this Circular may continue their HIV/AIDS treatment at these facilities until December 31, 2019. Healthcare facilities shall continue managing and treating the disease, and patients do not need to go through transfer procedures for annual HIV/AIDS medical examinations and treatments.

Article 7. Effective Date

1. This Circular takes effect from January 1, 2019.

2. Repeal Circular No. 15/2015/TT-BYT dated June 26, 2015 of the Ministry of Health guiding insurance medical examinations and treatments for HIV-infected individuals and the use of services related to HIV/AIDS upon the effective date of this Circular;

During implementation, if there are difficulties or obstacles, please report to the Ministry of Health for timely consideration and resolution./.