Công văn 4082/BYT-BH của Bộ Y tế về việc áp dụng mức lương cơ sở theo quy định tại Nghị định 24/2023/NĐ-CP của Chính phủ trong thanh toán chi phí khám chữa bệnh bảo hiểm y tế

To: Vietnam Social Security

Replying to Official Dispatch No. 1914/BHXH-CSYT dated June 23, 2023 of the Vietnam Social Security on requesting guidance on application of statutory pay rate in payment for covered health care services in accordance with Decree No. 24/2023/ND-CP of the Government, the Ministry of Health provides guidance on implementation thereof during the period from July 01, 2023 to December 31, 2023 as follows:

1. Regarding health insurance payouts in accordance with regulations in Point d Clause 1 Article 14 of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government providing detailed regulations and guidance on implementation of the Law on Health Insurance applicable from July 01, 2023 or cases where patients have been admitted to hospitals or have started treatment duration from July 01, 2023 but have been discharged from hospitals or have completed their treatment duration from July 01, 2023:

- Expense for a time of medical examination and treatment shall not be less than 15% of the statutory pay rate: equivalent to less than 270.000 VND.

2. Regarding direct payments in accordance with regulations in Article 30 of Decree No. 146/2018/ND-CP or cases where patients have been admitted to hospitals or have started treatment duration from July 01, 2023 but have been discharged from hospitals or have completed their treatment duration from July 01, 2023:

- At Point a Clause 1, the maximum amount shall not exceed 15% of the statutory pay rate: equivalent to 270.000 VND at the maximum.

- At Point b Clause 1, the maximum amount shall not exceed 50% of the statutory pay rate: equivalent to 900.000 VND at the maximum.

- At Clause 2, the maximum amount shall not exceed 100% of the statutory pay rate: equivalent to 1.800.000 VND at the maximum.

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3. The payment for total medical supply costs for each time of use of technical services shall not exceed the total statutory payments received during 45 months according to regulations in Point b Clause 2 Article 3 of Circular No. 04/2017/TT-BYT dated April 14, 2017 of the Ministry of Health on promulgation of the schedule, rates and conditions of payment of costs of covered medical supplies to health insurance policyholders:

- For patients who have been admitted to hospitals from July 01, 2023, the payment shall not exceed 81.000.000 VND.

- For patients who have been admitted to hospitals or have started their treatment duration before July 01, 2023 but have been discharged from hospitals or have completed their treatment duration from July 01, 2023, the payment of the total medical supply costs for each time of use of technical services shall be determined according to the points of time when the technical service provision has been completed. To be specific:

+ Before July 01, 2023, the statutory pay rate prescribed in Decree No. 38/2019/ND-CP dated May 09, 2019 of the Government on statutory pay rate for officials and public employees and armed forces, equivalent to 67.050.000 VND at the maximum has been applied.

+ From July 01, 2023, the statutory pay rate prescribed in Decree No. 24/2023/ND-CP dated May 14, 2023 of the Government on statutory pay rate for officials and public employees and armed forces, equivalent to 81.000.000 VND at the maximum is applied.

4. From July 01, 2023, if patients have been admitted to hospitals or have started their treatment duration before July 01, 2023 but have been discharged from  hospitals or have completed their treatment duration from July 01, 2023, the co-payment for covered health care services in the year which is greater than the total statutory payments received during 06 months to determine benefits for no co-payment according to Point dd Clause 1 Article 14 of Decree No. 146/2018/ND-CP shall be greater than the amount which is calculated as following:

(6 -

Total co-payments from January 01, 2023 to before July 01, 2023

) x 1.800.000 VND

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For your information and compliance.

PP. MINISTER
DEPUTY MINISTER




Tran Van Thuan