Circular 27/2013/tt-Byt: Issued Directory Of Medical Supplies In The Scope Of Payment Of Medical Insurance Fund

Original Language Title: Thông tư 27/2013/TT-BYT: Ban hành danh mục vật tư y tế thuộc phạm vi thanh toán của Quỹ bảo hiểm y tế

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The CIRCULAR issued directory of medical supplies in the scope of payment of Health Insurance Fund _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ the base item 2 article 21 the law on medical insurance on November 14, 2008;
Pursuant to Decree No. 62/2009/ND-CP on July 27, 2009 by the Government detailing and guiding the implementation of some articles of the law on health insurance;
Pursuant to Decree No. 63/2012/ND-CP on August 31, 2012 of the Government functions, duties, and powers of the Ministry of Health Organization crane;
Base Item 3 article 7 circular No. 03/2009/TTLT-BYT-BTC on August 14, 2009 by the Union Health Ministry-the Ministry of Finance shall guide the implementation of health insurance;
The Minister of Health issued a circular issued directory of medical supplies in the scope of payment of medical insurance Fund, article 1. Directory of medical supplies 1. Attached to this circular listing medical supplies in the scope of payment of health insurance Funds, including the ordinary medical alternative medical supplies, equipment, professional instrument (hereinafter referred to as the medical supplies) are used in diagnosis , treatment and rehabilitation, in order to meet the requirements of professional and quality services, healing.
2. list of medical supplies attached to this circular is the basis of the health insurance Fund to pay the cost of medical supplies used for sick people have medical insurance card at the base hospital, cure health insurance.
Article 2. List building medical supplies in the scope of payment of medical insurance Fund for each medical facility, bệnht investment alternative medical cures used in some devices to diagnose, treatment 1. A base to build medical supplies in the scope of payment of medical insurance Fund for each medical facility, healing: a) directory of medical supplies specified in clause 1 1 of this circular;
b) Online and scope technical expertise of medical facility, healing is the approval authority according to the rules of divide technical expertise of the Ministry of health.
2. The selection of medical supplies to build medical supplies used in the base doctor, healing is done according to the principle of ensuring the required technical expertise and quality consultation services; There are costs, reasonable price.
3. types of base materials and specific medical has been shopping, medical establishments, General healing category medical supplies used at the facility (according to the model in the annex attached to this circular) submitted to social security as the basis of payment.
4. During the period of 15 working days from the date of receiving the list of medical supplies because of the base doctor, healing, social insurance is responsible for inspection and reply in writing; the absence of consent must clearly state the reason.
5. in case of need to change or supplement type of medical supplies to medical supplies have United with social insurance, medical facility, healing and social insurance is responsible for the uniform implementation of category supplies health supplements prescribed in paragraph 3 , Paragraph 4 of this Article.
Article 3. The principle applies and payment 1. General principles: a) the cost of medical supplies are medical insurance Fund payments according to the actual number used for sick people, the number of medical supplies used for human disease is calculated according to the unit of each type of medical materials stipulated in the category medical supplies attached herewith;
b) prices to social security applies the payment of medical supplies used for the patient's health insurance:-patient establishments, healing State: is calculated according to the purchase price of the unit under the provisions of the law on medical supplies procurement;
-Patient establishments, private healing: is calculated according to the purchase price of the unit but not be higher than the purchase price on the basis of examinations, cure the top state in the province, central cities (hereinafter referred to as the Department) under the provisions of the law on medical supplies shopping. The base case the doctor, cure the province's State does not use the type of medical supplies which the social insurance applies the lowest price at which the health insurance fund to pay for the medical facility, healing the State to pay for the kind of medical supplies;
c) kinds of medical supplies has been texture and calculated in the price of the technical service, on the treatment of bed price or cost currency packages under conditions as specified on the service price examinations, cure, the health insurance Fund is not confirmed;
d) for those types of medical supplies have not been calculated into the price and structure of the technical service, on the treatment of bed price or the price currency package according to the illness, the health insurance Fund paid separately according to the principles defined in art. 1 of this article; the amount of the payment of the cost of medical supplies for each sick person does not exceed the level entitled under the provisions of the health insurance Law and the writing guide on benefits and medical insurance rates for each group of objects;
DD) the types of medical supplies was ranked by a specialist if used in other specialty was medical insurance Fund payments;
e health insurance Funds) non-payment for other types of medical supplies are in the category of medical supplies in the event of: other financial resources have been paid; be used in the technical services in the scope of health insurance benefits under the provisions of the law on health insurance and the writing guide make health insurance Law.
2. application and payment in some specific case: a) for other types of medical supplies hard to quantify when used, yet the quota regulations minimum use: the base doctor, healing and building unity with the social insurance of the minimum level of use for the service technician has used this type of medical supplies under the principle of ensuring sufficient quantity to perform technical services, in accordance with the retention, preservation mode and convenient in payment;
b) for medical supplies unit is "Ministry" that had many items or parts, medical supplies are accompanying the payment of medical insurance. If the price of the kinds of medical supplies comes computer then the payment according to the price of each category; stated prices are calculated according to the unit package is "the" does not segregate each kind to pay more.
The case just use a part or a part of the "sets" the payment according to the price of parts used for the patient if there are separate price of each Department; If there is no separate prices for each Department are used shall be based on the price of shopping and particularities of each Department, the base doctor, healing and social insurance exchanges, uniform level of the payout for that Department;
c) payment for other types of medical supplies used in the high-tech services, major costs in high-tech services, major costs due to health regulations: – where the cost of the kind of medical supplies has already included in the price of services technically not separate for payment according to the principle specified in point c of Paragraph 1 of this article;
-The case is not included in the price of technical services, the health insurance Fund paid separately according to the principle specified in point d of Paragraph 1 of this article, but not exceed the level entitled regulations for the case of using high technology services, major cost;
d) for other types of medical supplies used repeatedly:-for the medical supplies can reuse that have instructions on the process for reuse, reuse of the Ministry of health shall follow the instructions of the Ministry of health;
-For the medical supplies can be reused without there guidance on the process for reuse, reuse of the Health Ministry or of the producer, the Director of the hospital based on the required expertise, practical use, according to the recommendations of the Board of medicine and treatment and consistency with the social insurance to decide on the number of times reused. The price paid per use is the same and is determined by the total value of medical supplies plus the cost of cleaning, drying, sterilizing of reusable time divided by the total number of times used;
DD) for those medical supplies has many types, many different prices, wide price range such as the articulation, artificial joints, disc drives, the artificial vertebra, bone, rhythm machine, the machine created with and without breaking the rhythm rocked implanted in the body, can artificial glass: the Director of the hospital based on the required expertise , practical use, according to the recommendations of the Board of medicine and treatment and consistency with the social insurance to choose, decide the appropriate medical, meets the required expertise and affordability of the health insurance Fund;
e) for Toric artificial crystal glass: use only in glass replacement surgery may be accompanied by corneal astigmatism.
Article 4. Implementation 1. The base doctor, cure has the responsibility: a) building and United with the social insurance medical supplies list for use at the facility. No case was then reported to superior agency directly to solve;
b) provides full, timely, properly regulated, to meet the needs of the treatment of the sick medical insurance under the category of medical supplies has built, not to sick people to buy;
c) When the construction cost consultation service, healing must list the full range of medical supplies needed to perform technical services and specify the type of medical supplies would not included in the price of technical services to the private payments as prescribed in this circular;
d) manage the indicated use of the medical supplies, save; timely payment, the right type, in the right amount and the right price;
DD) General, full stats, exactly the kind of medical supplies used for the sick person to the payment of social insurance according to the form because the Ministry of Health issued.
2. the Department of health, the central cities are responsible for: a) the direction, instruction, inspection, inspection of the implementation of the provisions of this circular and the other legal documents related to construction activity listing medical supplies, stores, supplying medical supplies payment of expenses, use of medical supplies the base doctor, healing in the management authority;
b) issued the list of medical supplies used in clinics communes, wards and towns in the area are the management interface.
3. social insurance is responsible for:

a) check and a full reply in writing, promptly about listing medical supplies are medical insurance Fund payments at the base hospital, healing;
b) make the payment in accordance with the provisions of this circular and the other legal texts concerned;
c) collaboration to solve problems arising in the process of implementation.
4. The purchase of medical supplies made under the provisions of circular No. 68/2012/TT-BTC dated 26/4/2012 of the Ministry of Finance regulates the tender to shopping the property to maintain normal operations of State agencies, political organizations, social-political organizations, social-political organizations of career , social organization, social-professional organization, the people's armed units.
Article 5. Transitional provisions and terms of reference 1. Cases of sick people have medical insurance card to the institution before the date this circular effect but is still being treated at the base hospital, cure shall follow the list of medical supplies and other provisions of this circular.
2. For other types of medical supplies available in the catalogue of medical supplies attached to decision No. 6383/2003/QD-BYT on 08/12/2003 by the Minister of health on issuing medical supplies list attrition are social insurance (health insurance) payments and decision No. 21/2008/QD-BYT on 9/6/2008 by the Minister of health on the issued listing medical supplies, medical supplies in alternative treatment was the basis of the doctor, cure, medical insurance Fund continued payment until used up the amount of medical supplies had been shopping according to the bidding result, supply and contracts signed with the contractor before the date of this circular are enforceable.
3. the case law referenced in this circular are replaced or modified, it shall apply in addition to the replacement text or modify, Supplement.
Article 6. Effect 1. This circular effect since July 15, 2013.
2. Annuls the decision of 6334/2003/QD-BYT on 08/12/2003 by the Minister of health on issuing medical supplies list attrition are social insurance (health insurance) payments and decision No. 21/2008/QD-BYT on 9/6/2008 by the Minister of health on issuing list medical supplies alternative health supplies in examinations, cure since the day this circular effect.
In the process of implementation, if there are difficulties, obstacles and suggest the Agency, organization, personal reflections on the Ministry of health (health insurance) to consider and resolve.