Công văn 3100/BYT-BH thanh toán chi phí khám chữa bệnh BHYT liên quan đến COVID-19

Pursuant to the Law on Health Insurance and its guiding documents;

Pursuant to Point a, Clause 7, Article 1 of the Government’s Resolution No. 16/NQ-CP dated February 08, 2021 prescribing the expenses for quarantine, medical examination and treatment and some specific regulations in COVID-19 pandemic prevention and control;

The Ministry of Health provides the temporary guidance on the payment of health insurance-covered medical care costs for health insurance card holders during the concentrated quarantine period and for a number of other cases during the COVID-19 pandemic as follows:

1. Payment of medical care costs for health insurance card holders who are in the period of concentrated quarantine and have to seek medical care services at health insurance-covered medical care providers:

1.1. The state budget shall cover the medical care costs incurred by COVID-19, including: costs for medical examination, patient bed, technical services, drugs, blood, intravenous fluids, etc. according to the Ministry of Health’s guidance;

1.2. The health insurance fund shall cover the medical care costs for other diseases within the same scope of benefits and with the same levels of health insurance benefits as the cases of seeking medical care services at the right treatment line, except the costs specified at Point 1.1 of this Clause;

1.3. Health insurance card holders shall pay their own costs and the ones outside the scope of health insurance benefits (if any) in accordance with the law on health insurance.

2. In case a health insurance-covered medical care provider has to organize the concentrated quarantine under a decision of a competent authority or is assigned by a competent authority the task of medical service provision for persons with suspected or confirmed COVID-19, the Department of Health shall coordinate with the Social Security of the province or centrally run city in:

2.1. Guiding the applicant for health insurance-covered primary care services at such medical care provider to receive primary care services at another health insurance-covered medical care provider in the province or city;

2.2. Guiding the medical care provider to transfer medical service line in conformity with the pandemic situation.

The cases mentioned in this Clause shall be defined as health insurance-covered medical care at the right line.

3. For a patient who has been prescribed, dispensed drugs, provided with medical supplies and treated by a medical care provider, and given a paper of appointment for re-examination or medical examination number, medical report book for the appointment for re-examination (hereinafter collectively referred to as the paper of appointment for re-examination), but due to the pandemic, the patient cannot go to such establishment for re-examination:

3.1. The medical care provider that has prescribed, dispensed drugs and provided with medical supplies, treatment and issued the paper of appointment for re-examination shall be responsible for:

a) Informing and guiding the patient to choose an appropriate medical care provider for re-examination, provision of drugs, medical supplies and treatment.

b) Guiding the medical care provider where the patient is being in the quarantine or another medical care provider to re-examine, provide drugs, medical supplies and treatment for the patient; transfer drugs or coordinate with pharmaceutical companies in transferring transfer drugs and medical supplies to another medical care provider for re-examination, provision of drugs, medical supplies and treatment to the patient in case such medical care provider does not have drugs and medical supplies for medical examination and treatment of diseases requiring re-examination according to the paper of appointment.

3.2. The patient may use the paper of appointment for re-examination to go to another health insurance-covered medical care provider under instructions of the medical care provider issuing such paper of appointment for re-examination and guidance of the Department of Health, the Social Security Agency in the area of residence or where the patient is being in quarantine for medical examination and treatment.

In case the pandemic comes to an end, the patient may use the paper of appointment for re-examination issued by the medical care provider where the drugs and medical supplies have been provided to seek medical services at the medical care provider that has transferred drugs and medical supplies.

These cases are defined as health insurance-covered medical care at the right treatment line.

3.3. The health insurance-covered medical care provider that provides medical examination for, dispense drugs, medical supplies to, and treat the patient shall be responsible for:

a) Making and archiving dossiers of medical examination and treatment, provision of drugs and medical supplies according to regulations, aggregate them and send them to the social security agency (who has signed the contract on health insurance-covered medical care with such medical care provider);

b) Transferring electronic data to the health insurance information inspection system according to the Decision No. 4210/QD-BYT dated September 20, 2017 of the Ministry of Health on standard and format of output data used in the management, assessment and payment of health insurance-covered medical care costs, in which:

- In XML Table 1: at the field 17 “MA_NOI_CHUYEN”, to insert the code of the medical care provider granting the paper of appointment for re-examination; at the field No. 13 “TEN_BENH”, to insert the content: "Medical examination and treatment and drug supply in accordance with the paper of appointment for re-examination and treatment instructions of the medical care provider (insert name of the medical care provider granting the paper of appointment for re-examination)".

For example: In case Bach Mai Hospital with the health insurance-covered medical care provider code being 01929 is the medical care provider having issued the paper of appointment for re-examination but the patient goes to A Provincial General Hospital for medical services due to the pandemic, at the field 17 “MA_NOI_CHUYEN”, to insert: 01929; at the field No. 13 “TEN_BENH”, A Provincial General Hospital shall insert: "Medical examination and treatment, and drug supply according to the paper of appointment for re-examination and treatment instructions of Bach Mai Hospital".

- In case a medical service provider receives drugs and medical supplies from the medical service provider issuing the paper of appointment, in XML Table 2: at the field No. 3 “MA_THUOC”, to insert the code of the medical service provider that has issued the paper of appointment for re-examination; drug codes as issued together with the Decision No. 7603/QD-BYT dated December 25, 2018 of the Minister of Health on promulgating the common lists of codes applied in medical examination and treatment management and health insurance payment (version 6). These codes are separated by an underscore (_).

For example: In case Bach Mai Hospital with the health insurance-covered medical care provider code being 01929 is the medical care provider that has issued a paper of appointment for re-examination and has transferred Cyclosporine - an anti-rejection medication (with the code: 40.405) to A Provincial General Hospital, at the field No. 3 “MA_THUOC” A Provincial General Hospital shall insert as below: “01929_40.405”.

The medical service provider shall agree with the social security agency who has signed the contract on health insurance-covered medical care with such medical care provider before the performance to ensure the electronic data extraction, transfer and payment of health insurance-covered medical care costs.

c) Collecting the jointly paid amount of costs of drugs that are received from the medical care provider transferring the drugs and medical supplies, based on the amount used for the patient (if any);

d) Paying the medical care provider that have transferred drugs and medical supplies the drug costs, including the patient's jointly paid amount (if any).

dd) In case the pandemic or the quarantine comes to an end, the medical care provider where the drugs and medical supplies have been provided shall issue a paper of appointment for re-examination or treatment-line transfer paper and guide the patient to continue seeking medical services at the medical care provider that has transferred drugs. This case is defined as health insurance-covered medical care at the right treatment line.

3.4. The commune-level health station that receive and supply drugs and medical supplies to the patient shall be responsible for making and storing the dossier of provision of drug and medical supplies according to regulations, aggregate the costs and send them to the medical care provider (who has signed the contract with the social security agency for health insurance-covered medical care in such commune-level health station).

3.5. The medical care provider (who has signed the contract with the social security agency for health insurance-covered medical care in the commune-level health station) shall aggregate the costs and send them to the social security agency.

3.6. The social security agency (who has signed the health insurance-covered medical care contract with the health insurance-covered medical care provider receiving and using drugs and medical supplies for the patient) shall:

a) Pay medical care costs to the health insurance-covered medical care provider according to current regulations;

b) Pay the costs of drugs and medical supplies to the medical care provider that has been received drugs and medical supplies from the transferring medical care provider and use them for the patient, these cost shall be the incurring costs of the medical care provider (if any).

4. Use of the paper of appointment for re-examination during the duration of pandemic announcement by the competent authority or the quarantine period of a health establishment or a patient: A health insurance card holder with a paper of appointment for re-examination may take re-examination regardless of the time of re-examination appointment stated in the paper of appointment for re-examination. In this case, the health insurance inspection information system of the social security agency shall not detect the error at the field of the date of re-examination appointment.

5. The planning and prescription of drugs during the period of COVID-19 prevention and control.

5.1. Prescribing doctors and assistant doctors shall, based on the patients’ condition, prescribe elderly patients, patients with diseases requiring long-term treatment the number of drugs to be used for 90 (ninety) days in maximum.

5.2. The medical care providers must provide their patients with their telephone numbers for contact when necessary.

5.3. Medical care providers shall, based on the quantity of patients who seek medical services, purchase and stockpile drugs (particularly drugs for cardiology, diabetes, blood pressure treatment, etc.).

6. In case health insurance card holders themselves seek medical care services, and the health establishments conclude that they are not subject to the concentrated quarantine, the health insurance fund shall pay the medical care costs in accordance with the law on health insurance.

7. The synthesis of forms of request for payment of health insurance-covered medical care costs shall comply with the Decision No. 6556/QD-BYT dated October 30, 2018 of the Minister of Health promulgating the form of the Statement of medical care costs used in medical care providers and the Appendix providing instructions on recording a Statement of medical care costs. Health establishments are not allowed to separate the costs of a patient with a health insurance card into many different cost statements.

8. The Departments of Health shall coordinate with the social security agencies of provinces and centrally run cities in guiding patients to seek medical care services at health insurance-covered medical care providers in their provinces and centrally run cities in accordance with the pandemic situation.

The payment of health insurance-covered medical care costs for health insurance card holders during the concentrated quarantine period and for a number of other cases during the COVID-19 pandemic according to this Official Dispatch shall be applied from February 08, 2021.

This Official Dispatch replaces the Official Dispatch No. 2146/BYT-BH dated April 17, 2020 of the Minister of Health providing the temporary guidance on the payment of health insurance-covered medical care costs for health insurance card holders during the concentrated quarantine period and for a number of other cases during the COVID-19 pandemic and the Official Dispatch No. 2276/BYT-BH dated April 24, 2020 of the Minister of Health amending Clause 3 of the Official Dispatch No. 2146/BYT-BH on guiding the payment of health insurance-covered medical care costs related to the COVID-19 pandemic.

Any difficulty and problem arising in the course of implementation should be promptly reported to the Ministry of Health for guidance./.