Circular 04/2016/tt-Byt: Regulations On Examinations, Treatment And Pay The Doctor, Cure Health Insurance Related To Examinations, Cure Tuberculosis

Original Language Title: Thông tư 04/2016/TT-BYT: Quy định về khám bệnh, chữa bệnh và thanh toán chi phí khám bệnh, chữa bệnh bảo hiểm y tế liên quan đến khám bệnh, chữa bệnh lao

Read the untranslated law here: https://www.global-regulation.com/law/vietnam/2952775/thng-t-04-2016-tt-byt%253a-quy-nh-v-khm-bnh%252c-cha-bnh-v-thanh-ton-chi-ph-khm-bnh%252c-cha-bnh-bo-him-y-t-lin-quan-n-khm-bnh%252c-cha-bnh-lao.html

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CIRCULAR regulations on examinations, treatment and pay the doctor, cure health insurance related to examinations, cure tuberculosis _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ pursuant to the law of health insurance;
Consultation pursuant to the law;
Pursuant to Decree No. 63/2012/ND-CP on August 31, 2012 of the Government functions, tasks, powers and organizational structure of the Ministry of health;
Pursuant to Decree No. 105/2014/ND-CP on November 14, 2014 Government of detailed rules and instructions for making a number of articles of the law on health insurance;
At the suggestion of the Director of medical insurance, the Ministry of health, the Minister of Health issued a circular prescribed examinations, treatment and pay the doctor, cure health insurance related to examinations, cure tuberculosis.
Article 1. Scope and objects 1. Adjustment range a) this circular regulations on examinations, cure (hereafter abbreviated as KCB), payment of MEDICAL expenses and medical insurance MEDICAL transit (hereinafter abbreviated as HEALTH INSURANCE) for people with drug-resistant tuberculosis, tuberculosis, incidence of tuberculosis, latent TB facilities and medical services related to MEDICAL workers.
b) this circular guides on a contract basis for KCB KCB and medical facility in TB prevention network.
2. apply object a) MEDICAL institutions of State and privately contracted KCB.
b) medical institutions in TB prevention network as defined by the Minister of health.
c) participants HEALTH TB, TB drug resistance, tuberculosis, tuberculosis incidence underlying facilities and medical services related to MEDICAL workers.
Article 2. Explanation of terms 1. People with tuberculosis who are diagnosed with tuberculosis according to guide diagnosis, treatment and prevention of tuberculosis of the Ministry of health.
2. People with drug resistant TB is tuberculosis patients have drug-resistant tuberculosis status against employees identified by the tests under the guidance of diagnosis, treatment and prevention of tuberculosis of the Ministry of health.
3. The incidence of tuberculosis facilities has symptoms of TB disease was diagnosed as infected with tuberculosis facilities under the guidance of diagnosis, treatment and prevention of tuberculosis of the Ministry of health.
4. People with latent TB is the danger of TB identified should be treated with anti-tuberculosis drugs under the guidance of diagnosis, treatment and prevention of tuberculosis of the Ministry of health.
5. The use of medical services related to MEDICAL workers who are being LET in to the base does not belong to a specialist tuberculosis but was appointed laboratory, diagnostic imaging, probe the function and use of medication for the diagnosis of tuberculosis, diagnosed Tuberculosis Elimination required expertise in ETHICS or in need of MEDICAL workers in coordination with other diseases as KCB at the base it.
Article 3. General principles 1. Sufferers of tuberculosis, tuberculosis drug resistance, tuberculosis, latent tuberculosis incidence of facilities and users of medical services related to MEDICAL workers to be LET, the payment of the EXAMINATION under the provisions of the law on HEALTH INSURANCE and the provisions of this circular.
2. People with drug-resistant tuberculosis, tuberculosis, incidence of tuberculosis, latent TB facilities and medical services related to the MEDICAL workers be KCB transit according to the rules on transit and as prescribed in this circular.
Article 4. The medical establishment has made examinations, cure tuberculosis 1. The basis for EXAMINATION online and equivalent as defined in article 3 to circular 40/2015/TT-BYT on November 16 in 2015 of the Minister of health regulations to register early and transit KCB KCB (hereafter abbreviated to circular 40/2015/TT-BYT).
2. The basis for EXAMINATION online and equivalent including: a) The basis for EXAMINATION online and equivalent as defined in article 4 to circular 40/2015/TT-BYT;
b) District Health Centre, district, town, city in the province, the city of centrally implemented backup functions are qualified to provide MEDICAL services to employees in accordance with circular No. 02/2013/TT-BYT on 15 January 2013 of the Minister of health regulations on coordination between medical institutions in the management of tuberculosis;
c) specialty hospital workers the equivalent rank to private, class III, class IV equivalent and not yet rated equivalent; the private hospital is rated class III, equivalent, equivalent to class IV and has not been rated equivalent of having TB specialist.
3. The basis for EXAMINATION online the equivalent and include: a) The MEDICAL facility and equivalent provincial provisions in article 5 to circular 40/2015/TT-BYT;
b) Tuberculosis Hospital and lung diseases, Lung hospitals, specialty hospital of tuberculosis and lung disease the province, central cities;
c) hospital TB and lung diseases, Lung hospitals, specialty hospital of tuberculosis and lung disease the province, central cities are given the task of treating drug-resistant TB;
d) specialty hospital employees are rated class I equivalent, class II equivalent; the private hospital is rated class I equivalent, class II equivalent has tuberculosis specialist;
DD) Health Center province, central cities have the Faculty of Tuberculosis; Social disease prevention Center of the province, central cities have the Faculty of Tuberculosis; The Center for the prevention of tuberculosis, the TB prevention Station, central cities; The Center for disease control of the route.
4. The basis for EXAMINATION of the central line and equivalent including: a) the basis for EXAMINATION under the provisions of article 6 to circular 40/2015/TT-BYT;
b) hospitals, specialty hospital has beds in the Health Ministry.
Article 5. Contract doctor, cure health insurance 1. The KCB basis are eligible for EXAMINATION and additional annual TB of content about MEDICAL workers under the provisions of this circular in KCB contract.
2. MEDICAL establishments are specified in point c of paragraph 3 article 4 this circular has the additional responsibility of collecting, receiving the TB drug resistance from other MEDICAL facilities in the KCB contract.
3. online District Hospital, health center or other agency district online contract KCB at the MEDICAL facility of responsible Township online additional content KCB lao at the base MEDICAL online the KCB contract.
4. MEDICAL facility prescribed in point b, item 2 article 4 this circular are qualified MEDICAL workers are responsible for organizing signed with the social insurance agency to organize MEDICAL workers.
5. medical facility in VND, paragraph 3 article 4 this circular has been licensed MEDICAL activity are responsible for signing the contract with KCB social insurance agency to organize MEDICAL workers.
Article 6. Transit technical expertise in examinations, cure tuberculosis 1. The transit technical expertise in tuberculosis EXAMINATION was performed in accordance with circular 40/2015/TT-BYT, except for some other specific cases prescribed in paragraph 2 of this Article.
2. The case is determined to be true online examinations, cure health insurance: a) participants HEALTH INSURANCE drug-resistant tuberculosis, TB, tuberculosis, incidence of latent TB facilities registered the initial basis of KCB KCB prescribed in clause 1 article 4 this circular route to transfer MEDICAL facility prescribed in paragraph 3 article 4 this circular;
b) HEALTH INSURANCE participants registered drug resistant TB initial MEDICAL facility for EXAMINATION prescribed in clause 2 4 of this circular to the transit base for EXAMINATION specified in point c of paragraph 3 and paragraph 4 Article 4 this circular;
c) MEDICAL facility prescribed in point b, item 2 article 4 this circular transit KCB sufferers of tuberculosis, tuberculosis drug resistance, tuberculosis, tuberculosis incidence of potential facilities to the MEDICAL facility prescribed in clause 2 and Clause 3 in article 4 of this circular.
Article 7. The scope and level of enjoying medical insurance 1. STUDENT HEALTH PLAN participants when KCB rights workers in the scope and level of influence enjoyed by HEALTH INSURANCE legislation regulation and the provisions of this circular.
2. SOCIAL INSURANCE Fund to pay the cost for the KCB people with latent TB is the card of HEALTH INSURANCE.
3. The base case for EXAMINATION are not eligible to make the technical service shall transfer the swabs samples (e.g., urine, blood, body fluids, exudates, sputum, tissue, ...) or the sick person to base KCB is eligible to perform technical tests, diagnostic imaging for the diagnosis of tuberculosis. HEALTH INSURANCE Fund pays the cost of performing the engineering services for the MEDICAL facility where the sample swabs, transfer the patient away or pay costs for MEDICAL facility where perform technical services according to the price of the competent bodies for approval at the facility where the implementation of technical services.
4. The base case for EXAMINATION no drugs against tuberculosis to treatment for patients being treated for other illnesses are detected TB, TB drug resistance attached but can not transfer the patient to the MEDICAL facility of the other employees, then do the following: a) patients used the drug against tuberculosis because tuberculosis specialist MEDICAL campuses provide after consultations between the two MEDICAL facility;
b payment of HEALTH INSURANCE Funds) for MEDICAL facility where get smoking.
5. where the MEDICAL facility has the ability to use the drugs as required expertise in tuberculosis drug resistance tuberculosis, KCB (and other drugs) drug list in the scope of SOCIAL INSURANCE Fund payments but outside the range used by class of MEDICAL facility, the MEDICAL facility Health Ministry reports (for the base directly to health) or the Department of health (for the base directly under the Department of health and the Ministry of industry, province, City) to United with social insurance or social insurance Vietnam province, central cities supplement the list of drugs used in MEDICAL establishments.
Article 8. Implementation 1. The Health Department of the province, central cities: a) directed the medical facility directly implemented the contents specified in this circular;
b) presiding, in coordination with the social insurance of the province, the city of centrally determined conditions of technical expertise in the addition of a category of drugs in the MEDICAL facility as defined in clause 5 article 7 of this circular;
c) in collaboration with the social insurance Department, central cities Guide made KCB at the contract facility for EXAMINATION and are eligible for EXAMINATION prescribed for tuberculosis;
d) collaboration with agencies, related organizations, popular HEALTH INSURANCE participants guide TB, TB drug resistance, tuberculosis and tuberculosis incidence of facilities underlying the implementation of the provisions of the law on HEALTH INSURANCE, the law on the prevention of tuberculosis and the provisions of this circular;

DD) building, the authority to decide the mechanism, the level of support for the HEALTH INSURANCE card TB out of HEALTH INSURANCE Fund instalments from the Fund for the poor and LET the funds of other legal regulations.
2. social insurance social insurance steering Vietnam's provinces and cities under central: a) made KCB contract and payment of costs for the KCB sufferers of tuberculosis, tuberculosis drug resistance, tuberculosis, latent tuberculosis incidence of facilities and users of medical services related to MEDICAL workers under the guidance of this circular and the regulation of HEALTH INSURANCE legislation , rules of ETHICS, and the provisions of other relevant laws;
b) consistent with the basis of payment for EXAMINATION and medical treatment costs for the case prescribed in clause 3 and clause 4 Article 7 of this circular guaranteed rights of participants under the rules of HEALTH INSURANCE.
3. The basis of the EXAMINATION under the provisions of article 4 of this circular has the responsibility: a) made KCB and KCB payments pursuant to the HEALTH INSURANCE legislation and regulations this circular;
b) made KCB for sufferers of tuberculosis, tuberculosis drug resistance, tuberculosis, latent tuberculosis incidence of facilities and users of medical services related to MEDICAL workers to ensure benefits for the participants under the rules of HEALTH INSURANCE;
c) basis for EXAMINATION where collaboration with the receiving facility where drug supply and MEDICAL social insurance agency to make the payment of the cost of drugs prescribed in clause 4 Article 7 of this circular;
d) Organization for the EXAMINATION and TB, TB drug resistance, tuberculosis, tuberculosis incidence underlying facilities and medical services related to TB diagnosis according to the instructions for EXAMINATION, treatment and prevention of tuberculosis of the Ministry of health.
Article 9. Effective enforcement of this circular effect since May 1, 2016.
Article 10. Terms of reference case reference texts in this circular are replaced or modified, the supplement shall apply according to the text have been replaced or the text has been modified and supplemented.
In the process of implementation, if there are difficulties, obstacles and suggest the Agency, organization, personal reflections on the Health Ministry to consider, resolve./.