Instructions for signing a health insurance medical examination and treatment contract

The document clearly states that, in order to implement the Law on Health Insurance (HI), Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding measures to implement a number of articles of the Law on Health Insurance and Decree No. 75/2023/ND-CP dated October 19, 2023 of the Government amending and supplementing a number of articles of Decree 146/2028/ND-CP, Vietnam Social Security guides provincial Social Security agencies to implement the signing of contracts for medical examination and treatment (KCB) under health insurance as follows:

Firstly, continue to sign health insurance contracts according to the instructions of Vietnam Social Security in Official Dispatch No. 4076/BHXH-CSYT dated December 13, 2021, Official Dispatch No. 3794/BHXH-CSYT dated December 12, 2022 and the Health Insurance Appraisal Process issued with Decision No. 3618/QD-BHXH dated December 12, 2022.

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Second, request the Director of the Provincial Social Insurance to evaluate and decentralize the signing of health insurance treatment contracts to district-level Social Insurance in accordance with the provisions of Point h, Clause 4, Article 6 of Decision No. 2355/QD-BHXH dated September 16, 2022 of the General Director of Vietnam Social Insurance stipulating the functions, tasks, powers and organizational structure of local Social Insurance. Develop a plan to guide and support the appraisal and payment and settlement of health insurance treatment costs for district-level Social Insurance.

Third, the content of the health insurance contract is according to Form No. 7 of the Appendix issued with Decree 75/2023/ND-CP. The provincial Social Insurance agrees with the health insurance facility to supplement some contents in the Contract according to the provisions of law.

Fourth, assess the necessity of signing a health insurance contract with a new health facility based on the general health insurance situation in the area (number of health facilities that have signed health insurance contracts, health insurance overload, ability to meet health insurance cardholders' health insurance needs, increased number of health insurance cards, etc.), and the use of the assigned health insurance budget. The Director of the Provincial Social Insurance is responsible for signing health insurance contracts with new health facilities.

Fifth, organization of implementation of health insurance contract:

a) Actively coordinate with the Department of Health in: Determining medical examination and treatment facilities registering for initial health insurance treatment at all levels in the province; Regulating subjects, structure of groups of subjects, number of health insurance participants registering for initial health insurance treatment at medical examination and treatment facilities in accordance with the actual conditions of the locality and the response capacity of the medical examination and treatment facility; Guiding the transfer of health insurance treatment between medical examination and treatment facilities; Guiding the registration or change of the place of initial health insurance treatment registration... according to the provisions of Articles 13 and 14 of Circular No. 40/2015/TT-BYT dated November 16, 2015 of the Ministry of Health regulating initial health insurance treatment registration and transfer of health insurance treatment and Official Dispatch No. 3637/BHXH-CSYT dated November 29, 2022 of Vietnam Social Security.

b) Closely review contract documents to ensure they are complete and in accordance with regulations: Operating license, person in charge of professional expertise of the medical facility, hospital classification decision, operating location of the medical facility, person registered to practice medical care, etc. In case of changes or expiration, the medical facility must fully supplement them according to regulations.

c) Work with medical examination and treatment facilities and have a record of determining the number of hospital beds and medical examination and treatment staff as required at medical examination and treatment facilities, ensuring compliance with the provisions at Points c and d, Clause 1, Article 8 of Circular No. 13/2023/TT-BYT dated June 29, 2023 of the Ministry of Health regulating the price framework and method of determining the price of medical examination and treatment services as required by state medical examination and treatment facilities.

d) Strengthen the inspection of patient service quality at medical examination and treatment facilities according to the provisions of Point a, Clause 4, Article 9 of Circular No. 22/2023/TT-BHYT dated November 17, 2023 of the Ministry of Health. Note that clinics and patient rooms must use air conditioning to serve patients if it has been included in the medical service price structure. Medical examination and treatment facilities are requested to ensure the number of employees in accordance with the provisions of Article 3 of Circular No. 03/2023/TT-BYT dated February 17, 2023 of the Ministry of Health guiding job positions, number of employees, and staff structure according to professional titles in public health service units.

Source: https://www.congluan.vn/huong-dan-ky-hop-dong-kham-chua-benh-bao-hiem-y-te-post277279.html