Thông tư 18/2022/TT-BYT của Bộ Y tế về việc sửa đổi, bổ sung một số điều của Thông tư 56/2017/TT-BYT ngày 29/12/2017 của Bộ trưởng Bộ Y tế quy định chi tiết thi hành Luật Bảo hiểm xã hội và Luật An toàn vệ sinh lao động thuộc lĩnh vực y tế

CIRCULAR

ON AMENDMENTS TO CIRCULAR NO. 56/2017/TT-BYT OF DECEMBER 29, 2017 OF THE MINISTER OF HEALTH ON ELABORATION OF THE LAW ON SOCIAL INSURANCE AND THE LAW ON SOCIAL SAFETY IN THE HEALTH SECTOR

Pursuant to the Law on Social Insurance dated November 20, 2014;

Pursuant to the Law on occupational safety and sanitation dated June 25, 2015;

Pursuant to Decree No. 95/2022/ND-CP dated November 15, 2022 of the Government defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the request of the Director of the Department of Medical Examination and Treatment, the Director of the Department of Pediatric and Maternal Health,

The Minister of Health promulgates a Circular on amendments to the Circular No. 56/2017/TT-BYT dated December 29, 2017 of the Minister of Health on elaboration of the Law on Social Insurance and the Law on Occupational Safety and Health in the health sector.

Article 1. Amendments to circular No. 56/2017/TT-BYT dated December 29, 2017 of the Minister of Health on elaboration of the Law on Social Insurance and the Law on Occupational Safety and Health in the health sector (hereinafter referred to as Circular No. 56/2017/TT-BYT)

...

...

...

“Article 4. Diseases eligible for lump-sum social insurance payout

Except for cases of being suffering from one of the life-threatening diseases such as cancer, polio, dropsy cirrhosis, leprosy, severe tuberculosis, HIV infection progressing into AIDS specified in point c clause 1 Article 60 of the Law on Social Insurance, a person suffering from diseases or illnesses that results in at least 81% of work capacity reduction or impairment level and total loss of the worker’s functions, self-control or he/she is unable to keep personal hygiene and complete other everyday tasks without other people watching, helping and taking care of him/her is fully eligible for lump-sum social insurance payout.”.

2. Point d Clause 1 Article 5 is amended as follows:

“d) The original or valid copy of the hospital discharge note or the medical record summary as specified in Appendix 3 and Appendix 4 to this Circular. In case the worker does not receive in-patient or out-patient treatment, he/she must have documents on injury examination and treatment suitable to the time of the occupational accident and injury to request assessment.

In case the assessed person is an entity described at Point c, Clause 1, Article 47 of the Law on Occupational Safety and Hygiene: The medical record summary must clearly state that the injury caused by the occupational accident cannot be entirely treated.”.

3. Clause 3 Article 5 is amended as follows:

“3. Documents of medical assessment as the basis for provision of pension for a worker:

a) Letter of introduction for assessment of the employer according to Annex 1 enclosed herewith in case the worker is paying compulsory social insurance or the application for medical assessment according to Annex 2 enclosed herewith in case of workers whose social insurance participation period is reserved and retired workers pending pension or monthly benefits, in which the worker self-declares in the application form the injury or illness requested for assessment;

b) Original copy or valid copy of at least one of the following medical documents:

...

...

...

- Certificate of disability;

- Discharge note;

- Health record booklet;

- Health record paper;

- Subclinical results paper;

- Prescriptions of the health facility;

- Records of occupational diseases;

- Minutes of the most recent medical assessment of the person who has been assessed;

c) One of the documents specified at Point dd, Clause 1 of this Article.”.

...

...

...

“b) Original copy or valid copy of at least one of the following medical documents:

- Medical record summary;

- Certificate of disability;

- Discharge note;

- Health record booklet;

- Health record paper;

- Subclinical results paper;

- Prescriptions of the health facility;

- Records of occupational diseases;

...

...

...

5. Point d Clause 5 Article 5 is amended as follows:

“b) Original copy or valid copy of at least one of the following medical documents:

- Medical record summary;

- Certificate of disability;

- Discharge note;

- Health record booklet;

- Health record paper;

- Subclinical results paper;

- Prescriptions of the health facility;

...

...

...

- Minutes of the most recent medical assessment of the person who has been assessed.”.

6. Point d Clause 6 Article 5 is amended as follows:

“b) Original copy or valid copy of at least one of the following medical documents:

- Medical record summary;

- Certificate of disability;

- Discharge note;

- Health record booklet;

- Health record paper;

- Subclinical results paper;

...

...

...

- Records of occupational diseases;

- Minutes of the most recent medical assessment of the person who has been assessed.”.

7. Point c Clause 2 Article 6 is amended as follows:

“c) The original or valid copy of the hospital discharge paper or summary of the medical record as prescribed in this Circular or the occupational disease recorded with more serious occupational disease injuries.

In case the assessed person is an entity described at Point c, Clause 1, Article 47 of the Law on Occupational Safety and Hygiene: The medical record summary must clearly state that the occupational disease cannot be entirely treated.”.

8. Clause 1 Article 12 is amended as follows:

“1. As for cases of re-assessment of occupational accidents and occupational diseases, workers are entitled to take the initiative to take an assessment of the level of working capacity reduction and is paid a fee for assessment in case the assessment results are satisfactory to raise the allowance for occupational accidents and diseases”.

9. Clause 4 Article 13 is amended as follows:

“4. The checklist of assessment to qualify for retirement benefits, survivorship benefits and leave due to inability to take care of children after giving birth or taking maternity leave, receiving children through surrogacy, assessment to qualify for lump-sum social insurance payout according to the documents specified in Clause 3 or 4, Article 5 and Clause 2, Article 12 of this Circular, as the case maybe.

...

...

...

If the worker is suffering from one of the life-threatening diseases such as cancer, polio, dropsy cirrhosis, leprosy, severe tuberculosis, HIV infection that has progressed to AIDS, the original or a valid copy of the hospital discharge note or the medical record summary shall prevail for claims of benefits.

If a worker suffers from other diseases or illnesses that eligible for lump-sum social insurance payout, the medical assessment record must clearly state in details the diseases or illnesses that result in at least 81% of work capacity reduction or impairment level and total loss of the worker’s functions, self-control or he/she is unable to keep personal hygiene and complete other everyday tasks without other people watching, helping and taking care of him/her.”.

10. Point d Clause 5 Article 13 is amended as follows:

“d) In case a person has been assessed due to an occupational accident or occupational disease for 02 or more times, but the impairment rating has not been summed up:

- In case the medical assessment record acknowledges duplicate injuries in one or more organs or body parts, the Medical Assessment Council shall re-examine all the injuries acknowledged in the record. This medical assessment record (including both duplicate and non-duplicate injuries) and combined with the whole person impairment rating stated in the medical assessment record does not have duplicate injuries as prescribed, and then issue a new medical assessment record;

- In case a person has been assessed due to an occupational accident or occupational disease for 02 or more times but has a summary of the medical record or hospital discharge note or an occupational disease record that states the injuries that are more serious or minor than those stated in the medical assessment record of these assessment visits, the Medical Assessment Council shall perform an assessment for all injuries stated in the medical assessment record that there is a change in the state of injuries and combining with the whole person impairment rating with the whole person impairment rating stated in the remaining medical assessment record according to regulations, and then issue a new medical assessment record;

- In addition to the above cases, the Medical Assessment Council shall combine the whole person impairment ratings of those assessment records according to the method specified in Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH dated September 27, 2013 of the Minister of Health, the Minister of Labor, War Invalids and Social Affairs on the whole person impairment ratings due to injuries, illnesses, diseases and occupational disease and issuance of new medical assessment records.”.

11. Clause 3 Article 15 is amended as follows:

“3. In case patients are allowed to stay at commune health stations for medical stations that are decided by the Department of Health to have beds according to the provisions of Point b, Clause 5, Article 4 of Circular No. 39/2018/TT-BYT dated 30 November 2018 of the Ministry of Health uniformly stipulating the price of medical examination and treatment services covered by health insurance among hospitals of the same class nationwide and guiding the application of prices and payment of medical examination and treatment expenses covered by insurance. In some cases, they will be granted a certificate of leave for enjoying social insurance according to the form specified in Appendix 7 issued with this Circular, clearly stating the number of days of stay at the commune health station. and the number of days off to enjoy social insurance but not exceeding 30 days”.
If the patient stays at a commune-level health station with hospital beds as specified in point b clause 5 Article 4 of Circular No. 39/2018/TT-BYT dated November 30, 2018 unifying prices of medical examination and treatment services covered by medical insurance among hospitals of the same class across the country and guidelines for applying prices and payment for medical services in certain cases, the health station may issue a discharge note in accordance with the template specified in Annex 7 enclosed herewith when the patient is discharged from the health station, clearly stating the number of days of stay at the commune health station and the number of days off qualified for social insurance payout but not exceeding 30 days”.

...

...

...

"2. Only one certificate of leave qualified for social insurance payout will be issued for each examination. In case the patient needs to take a leave of longer than 30 days, when the leave period stated on the certificate of leave qualified for social insurance payout expires or is about to expire, the patient must conduct a follow-up examination for the health practitioner to consider and decide.

In case an employee is examined by two or more specialties of different health facilities at the same time and is granted multiple certificates of leave qualified for social insurance, that employee will only be entitled to one of the certificates with the longest leave period.

In case an employee undergoes medical examination and treatment with many specialties on the same day at the same health facility with many different diseases, only one certificate of leave qualified for social insurance payout shall be issued and he/she is only eligible for the disease with the highest insurance payout.

In case a patient is treated for tuberculosis under the National Tuberculosis Program, the maximum leave time shall not exceed 180 days for a certificate of leave qualified for social insurance payout.

In case an employee has a miscarriage, abortion, or stillbirth with a gestational age of 13 weeks or more, the maximum leave period prescribed by the Law on Social Insurance shall not exceed 50 days for one certificate of leave eligible for social insurance payout.”.

13. Article 20a shall be added to Article 20 as follows:

“Article 20a. Issuance of hospital discharge notes and certificates of leave qualified for social insurance payout to COVID-19 infected patients treated at health facilities as follows:

1. Eligible entities:

People infected with COVID-19 receiving inpatient or outpatient treatment at the following health facilities:

...

...

...

b) COVID-19 admission and treatment facilities established under Point a, Clause 1, Article 1 of Resolution No. 168/NQ-CP dated December 31, 2021 of the Government on mechanisms and policies on COVID-19 prevention and control as follows:

- COVID-19 field hospitals;

- COVID-19 hospitals;

- COVID-19 intensive care hospitals;

- Centers for the intensive care of COVID-19 patients.

2. Issuing persons:

The heads of the facilities specified in Clause 1 of this Article or their authorized people in accordance with law.

3. Regulations on the issuance of hospital discharge notes and certificates of leave qualified for social insurance payout:

a) After finishing treatment at health facilities, patients are granted hospital discharge notes and certificates of leave qualified for social insurance payout according to this Circular. In case the certificate issued before the effective date of this Circular does not conform to the form prescribed in Circular No. 56/2017/TT-BYT, the health facility shall have to re-issue it according to the provisions of this Circular.  The date of admission, the date of discharge in hospital discharge note shall conform to the inpatient medical record; and the date on the signature of the health practitioner shall conform to the date of issue;

...

...

...

c) In case the patient is discharged from hospital and the hospital discharge note contains information about the period of continued outpatient treatment or the period of isolation, the leave period shall be determined according to the time stated in the discharge note;

d) In case the patient is discharged from hospital and the hospital discharge note does not include information on the period of continued outpatient treatment but the patient must be isolated according to regulations, the leave period shall be determined according to the isolation period specified in Appendix 9 to this Circular;

dd) In case the COVID-19 admission and treatment facility has been dissolved, the health facility which is assigned to manage and operate the COVID-19 admission and treatment facility as prescribed in Clause c, Section V of Decision No. 4111/QD-BYT dated August 26, 2021 of the Minister of Health on the promulgation of documents guiding the establishment of COVID-19 admission and treatment facilities under the 3-tier pyramid model is responsible for granting or re-issuing or renewing hospital discharge notes and certificates of leave qualified for social insurance payout to patients;

e) The issuance and use of the hospital discharge note form and the certificate of leave qualified for social insurance payout shall comply with Appendix 3 and Appendix 7 issued together with this Circular.”.

14. Article 21 shall be amended as follows:

“Article 21. Forms of issuance of certificates of leave qualified for social insurance payout and guidance for the contents of certificates of leave qualified for social insurance payout

1. As for workers or children aged under 7 of workers receiving impatient treatment: The hospital discharge note with the form specified in Annex 3 enclosed herewith shall be used.

If the person is referred to another health facility during the treatment, a valid copy of the outward referral form shall be provided.

If the victim passed away at a health facility, such health facility is not required to issue a discharge note. The social insurance payout during the treatment period of the patient at the health facility before his/her death shall be based on the date recorded in the death certificate prepared in accordance with Circular No. 24/2020 /TT-BYT dated December 28, 2020 of the Ministry of Health stipulating the form of diagnosis of causes of death, issuance of death certificates and death statistics at health facilities.

...

...

...

If a patient needs to take a leave for outpatient treatment after discharged from the hospital, the social insurance authority shall provide social insurance payout according to the leave period (days) written on the discharge note.

3. The form and content of a certificate of leave qualified for social insurance payout shall comply with Appendix 7 issued with this Circular.

a) The first day off is the date on which the patient comes for medical examination and treatment;

b) The date on the signature of the health practitioner in the certificate of leave qualified for social insurance payout shall be written as follows:

- According to the date on which the patient finishes medical examination and treatment;

- According to the date on which the health facility issues the certificate of leave qualified for social insurance payout in a case where the worker requests for re-issuance according to this Circular;

c) In case of re-issuance, the word "RE-ISSUANCE" must be shown on the certificate of leave qualified for social insurance payout.

4. The recording of the code and the name of the long-term disease on the certificate of leave qualified for social insurance payout, the hospital discharge note must comply with the Circular No. 46/2016/TT-BYT dated December 30, 2016 of the Government on promulgation of the list of diseases requiring long-term treatment.

In case the disease code stated in the certificate of leave qualified for social insurance payout, the hospital discharge note matches the disease code specified in Circular No. 46/2016/TT-BYT, but the name of the disease does not match the name of the disease specified in the Circular No. 46/2016/TT-BYT, the disease code specified in Circular No. 46/2016/TT-BYT shall prevail".

...

...

...

“1. Update the conclusion of the medical assessment record into the national medical examination and treatment database to communicate with the data system of the social insurance agency.”.

16. Clause 6 Article 26 is added as follows:

“6. In case the employee has received medical examination and treatment but has not been issued with a hospital discharge note, certificate of live birth, certificate of maternity leave, certificate of insufficient health to take care of the child after birth, certificate of leave qualified for social insurance payout, the health facility where the employee has received medical examination and treatment shall, based on this Circular and the employee’s written request, issue a hospital discharge note, certificate of live birth, certificate of maternity leave, certificate of insufficient health to take care of the child after birth, certificate of leave qualified for social insurance payout, in which the date on the signature of the health practitioner shall be written according to the date of issue.”

17. Amendments to Appendices 1, 2, 3,4 and 7 issued together with this Circular.

18. Appendix 9 shall be added together with this Circular.

Artice 2. Entry into force

1. This Circular comes into force as of February 15, 2023

2. Appendix 4 and Appendix 5 issued together with Joint Circular No. 20/2016/TTLT-BYT-BLDTBXH dated June 30, 2016 of the Minister of Health and the Minister of Labor, War Invalids and Social Affairs on guidance for medical examination and assessment of diseases, illnesses, deformities and abnormalities related to exposure to toxic chemicals for partisans and their biological children cease to be effective from the effective date of this Circular.

Article 3. Implementation

...

...

...

PP. MINISTER
DEPUTY MINISTER




Tran Van Thuan