-
• ^ cotIWTH if k ca,r ^bf^-4tjr;^riv> BQYTS ™ ^ 6 ) N G H6A
XA HOI CHU NGHI A VI£T NAM
Bpc lap - Tu do - Hanh phiic
S6:50 /2017/TT-BYT Ha Npi, ngay23 thang 12 nc
TH6NG TIT Sura doi, bo sung cac quy djnh lien quan den thanh
chi phi kham bp nh, chua benh ___________
Can cu Ludt bdo hiem y te so 25/2008/QH12 ngay 14 thang 11 nam
2008 da dupe sua doi, bo sung mpt so dieu theo Lupt so 46/2014/QH13
ngay 13 thang 6 nam 2014;
Can cu Ludt khdm bpnh, chua b$nh so 40/2009/QH12 ngay 23 thang
11 nam 2009;
Can cu Luqt thong he sd 85/2015/QH13 ngay 23 thang 11 nam 2015;
Can cu Nghi d\nh sd 75/2017/ND-CP ngay 20 thang 6 nam 2017 cua
Chinh phu quy dfnh chuc nang, nhipm vy, quyen han va co cdu to
chuc cua Bp Yti;
Theo de nghi cua Vu truong cac Vp: Phdp che, Bdo hiem y te, Ke
hoach - Tdi chinh va Cue truong ede Cue: Quan ly Khdm, chua bpnh,
Cue Quan ly y dupe co truyen;
Bo truong Bo Y te ban hanh Thong tu sua doi, bo sung cac quy dmh
lien r
quan den thanh toan chi phi khdm bpnh, chua bpnh.
Dieu 1. Sua doi, bo sung Quyet djnh so 1895/1997/QD-BYT ngay 19
thang 9 nam 1997 cua Bp truong Bp Y te ve vifc ban hanh Quy che
bpnh vien
1. Sua d6i, bd sung diem i myc 2 cua Quy chi cong tac Khoa chan
doan hinh anh ve nhipm vy cua Bac sy, ky thuyt vien chan doan hinh
anh nhu sau:
"Cac co so kham bfnh, ch&a bfnh t6 chuc luu phim chan doan
hinh anh bang ban dipn ttir ho$c phim chyp, tru truong hpp kham,
diiu tri ngoai tru.
- Thong tin chyp phim chan do£n hinh anh cua ngudi bpnh npi tru
phai dupe the hipn trong H6 so bpnh an va S6 Chin doan hinh anh cua
co so kham bpnh, chfta bfnh.
- Trong truong hpp chuyin tuyen, cin chuyen cac phim chan doan
hinh anh kem theo cac giay, phiiu chuyin vipn: bac sy noi chuyin
ngubi benh di co
im-^iuu BENH VIEN OK TINH PHU THO
C O N G V A N D E N So:...333
,Ngay.d¥...th3nc PjLnam2oYJ. ten —
-
trach nhipm ky vao tb photocopy cua ban tra lbi ki t qui gbi di
ding thai ghi thdng tin ve vipc da chuyen phim vao trong cdc phieu
y£u cau thyc hipn chan doan hinh anh (bao gom: Phieu chieu/chyp
X-quang; Phieu chyp cSt lop vi tinh; Phiiu chyp cpng hircmg tu; Ban
t r i lbi ki t qua chieu/chyp X-quang; B£n tra lbi kit qua chyp cAt
lop vi tinh; Ban tra lbi kit qua chyp cpng hubng tu) tuong ung voi
phim dupe chuyen va luu cung ho so bpnh an.
- Truong hpp ngubi dupe chyp phim thupc doi tupng kham ngoyi
tru: tra phim d§ chyp kem theo ban tra lbi ket qua tuong ung voi
phim da chyp cho ngudi do. Ngudi bpnh ho£c ngudi dyi dipn ciia
ngudi bpnh phai ky xac nhyn da lay phim chan doan hinh anh tyi:
+ So Kham benh ciia co so kham bpnh, chua bpnh (ghi rS so lupng
phim da lay) doi voi truong hpp ngubi bf nh khong thupc doi tupng
bao hiim y t i ;
+ Chiing ttr thanh toan chi phi kham bpnh, chfta bpnh (ghi r6 so
lupng phim da lay) doi voi trubng hpp ngubi benh thupc dbi tupng
bao hiim y t i " .
2. Bo sung them diem d trong khoan 3 PhAn II thupc Myc lyc cua
Mau H6 so bpnh an nhu sau:
"- D: Mau "Phiiu cong khai djch vy kham bpnh, chba benh npi tru:
1 loai"
Dieu 2. Sua doi, bo sung Quyit djnh so 4069/2001 /QD-BYT ngay 28
thang 10 nam 2001 cua Bo trubng Bp Y te ve viec ban hanh mau ho so
bpnh an
Sua doi, bo sung hubng dan sir dung Phiiu phau thuyt/thu thuyt
nhu sau: Doi voi cac phau thuyt phai su dyng phiiu va ve lupc
d6;
- Doi voi thu thuyt co su dyng phuong phap vo cam toan than ho$c
phai thyc hipn trong phbng mo ho£c thu thuyt can thipp dubng mach
mau (khong bao gom tiem, truyen), dubng thb: Su dyng phieu thu
thuyt va vS lupc d6 thu thuyt (niu can thiet).
- Doi voi cac thu thuyt khac: Khong phai lap phiiu phau
thuyt/thu thuyt nhung phai ghi chi djnh va npi dung thyc hifn djch
vy vao ho so bpnh an va co chb ky xac nhyn ciia ngubi benh hoac
ngubi dyi dipn ciia ngubi bpnh sau moi dpt dieu trj."
Dieu 3. Sin doi, bo sung Thong tur so 28/2014/TT-BYT ngay 14
thang 8 nam 2014 cua Bp trutVng Bp Y te quy djnh npi dung hp thong
chi tieu thong ke nganh Y te
Sua doi phan khai nipm, djnh nghia ciia chi tieu so 20 v i s6
ngay diiu trj trung binh ciia 1 dpt dieu trj npi tru nhu sau:
-
3
"Ng&y diiu trj npi tru: La m$t ngiy trong do, ngubi bfnh
dupe lam bpnh an npi tru, dupe hubng it nhAt mpt trong cac chi dp:
theo ddi, chan doan, dieu trj hoac chfim sbc."
Dieu 4. Sura doi, bo sung Thong tu so 40/2014/TT-BYT ngay 17
thang 11 nam 2014 ciia Bp trubng Bp Y te ban hanh Danh myc thuoc
tan dupe thupc pham vi thanh toan cua Quy Bao hiim y te
Sua doi, bo sung Danh myc thuoc tan dupe tyi Thong tu so
40/2014/TT-BYT nhu sau:
1. Sua doi ten thuoc "Ester etylic cua acid beo iod hoa" so thu
ty 636 cpt so 2 th&nh "Ethyl ester cua acid beo iod hoa trong
dAu hyt thuoc phipn"
2. Sua doi ten thuoc "Calci-3-methyl-2-oxovalerat +
calci-4-methyl-2-oxovalerat + calci-2-methyl-3-phenylpropionat +
calci-3-methyl-2-oxobutyrat +
calci-DL-methyl-2-hydroxy-4-methylthiobutyrat + L-lysin acetat+
L-threonin + L-tryptophan+ L-histidin + L-tyrosin+ Nito + calci" so
thu ty 1039 cpt so 2 thanh "Calci-3-methyl-2-oxovalerat +
calci-4-methyl-2-oxovalerat + calci-2-oxo-3-phenylpropionat +
calci-3-methyl-2-oxobutyrat + calci-2-hydroxy-4-methylthiobutyrat +
L-lysin acetat + L-threonin + L-tryptophan + L-histidin + L-tyrosin
+ Nito + calci".
Diiu 5. Sua dii, bo sung Thdng tu so 05/2015/TT-BYT ngay 17
thang 3 n*m 2015 cua Bp trubng Bp Y te ban hanh Danh myc thuoc dong
y, thuoc tu dupe lipu va vi thuoc y hpc co truyen thupc pham vi
thanh toan cua Quy Bao hiim y ti
Sua doi, bo sung Danh myc thuoc dong y, thuoc dupe lipu nhu
sau:
1. Sua doi, bo sung thuoc "Dipp hy chfiu, Nhan tran, Co nhp noi,
Rau ngo/Riu bftp, (Kim ngan hoa), (Nghp)" so thu ty 26 cpt s6 1
thanh "Dipp ha chau, Nhan tran, Co nhp noi, (Rau ngo/Rau bap), (Kim
ngan hoa), (Nghp)".
2. Sua doi, bo sung thuic "Dipp hy chau, Xuyen tarn lien, Bo
cong anh, Co myc" so thu ty 28 cpt s6 1 th^nh "Dipp hy chau/Dipp hy
chau dAng, Xuyen tarn lien, Bo cong anh, Co myc".
3. Sua d i i , bo sung thuoc "Kim ngan hoa, Nhan tran, Thuong
nhl tu, Nghp, Sinh dja, Bo cdng anh, Cam thao" so thu ty 34 cpt s6
1 th^nh "Kim ngan hoa, Nhan tran/Nhan tran tia, Thuong nhT tu,
Nghp, Sinh dja, B6 cong anh, Cam thao".
4. Sua doi, bo sung thuoc "D$c hoyt, Que chi/Que nhyc, Phong
phong, Duong quy, T i tfin (Day dau xuong), Xuyen khung, Tin giao,
Bach thupc, Tang ky sinh, Sinh dja/Thyc dja/Dja hoang, Do trpng,
Nguu tat, Phyc linh/Bach linh,
-
Cam thao, (B£ng sam/Nhan sam)" so thu ty 58 cpt so 1 thdnh "Bpc
hoyt, Que chi/Que nhyc, Phdng phong, Duong quy, Te tin/Day dau
xucmg, Xuy6n khung, Tan giao, Bych thupc, Tang ky sinh, Sinh
dja/Thyc dja/Bja hoang, Bo trpng, Nguu tit , Phyc linh/Bych linh,
Cam thao, (Ding sam/Nhan s£m)".
5. Sua d6i, b6 sung thuoc "Chi thyc, Nhan sam/Dang sam, Bach
truyt, Bach linh/Phyc linh, Ban hy, Mych nha, H$u phac, Cam thao,
Can khuong, Hoang lien, (Ngo thu du)" so thu ty 88 eft sd 1 thinh
"Chi thyc, Nhan sam/Ding sam, Bych truyt, Bach linh/Phyc linh, Ban
hy, Mych nha, Hyu phac, Cam thao, Can khuong, Hoang lien/Ngo thu
du".
6. Sua doi, bo sung thuoc "Toan tao nhan, Duong quy, Hoai son,
Nhyc thung dung, Ky tu, Ngu vj tu, Ich tri nh&n, H6 phach,
Thien true hoing, Long cot, Xucmg bo, Thien ma, Dan sam, Nhan sam,
Trie bich dipp" so thu ty 141 cpt so 1 thanh "Toan tao nhan, Duong
quy, Hoai son, Nhyc thung dung, Ky tu, Ngu vj tu, Ich tri nhan, Ho
phich, Thien true hoang, Long cdt, Tiet xuong bo, Thien ma, Dan
sam, Nhan sam, Trie bach dipp".
7. Sua d6i, bo sung thudc "Xuyen khung, Tan giao, Bych chi,
Duong quy, Mych mon, HAng sam, Ngo thu du, Ngii vj tir, Bfing
phiAn" s6 thur ty 143 cpt s6 1 thanh "Xuyen khung, Tan giao, Bych
chi, Duong quy, Mych mon, H6ng sam, Ngo thu du, Ngu vj tu, Bang
phiin/Borneol".
8. Sua doi, bo sung thuoc "Ty ba dipp, Cat canh, Bich bp, Tien
h6, Tang bach bi, Thien mon, Bych linh/Phyc linh, Cam thao, Hoang
cam, (Cineol/Menthol)" so thu ty 158 (eft 1) thinh "T^ b i difp,
Cit cinh, Bach bp, Tien h6, Tang bych bi, Thien mon, Bych linh/Phyc
linh, Cam thao, Hoang cam, Cineol, (Menthol)".
9. Sua doi, bo sung thuoc "Dang sam, Bych linh, Bych truyt, Cam
thao, Thyc dja, Bych thupc, Duong quy, Xuyen khung, Ich mau" s6 thu
ty 196 cpt so 1 thanh "Dang sam, Bach linh/Phyc linh, Bych truyt,
Cam thao, Thyc dja, Bych thupc, Duong quy, Xuyen khung, Ich
mau".
10. Sura doi, bo sung thuoc "M§ ti6n, Huyet giac, O dau, Dai
hoi, Long niio, Mpt dupe, Dja liAn, NhQ huong, Binh huong, QuA,
Gung, Methyl salicylat, Gelatin, Ethanol" so thu ty 223 cpt so 1
th£nh "M3 tiAn, Huyet giac, 6 dAu, Dyi hoi, Long nSo, Mpt dupe, Dja
liAn, Nhu huong, Binh huong, Que, Gung, Methyl salicylat, Glycerin,
Ethanol".
11. Sua doi, b6 sung ten vj thuoc "Duong quy (To&n quy)" s6
thu ty 296 cpt so 1 thanh "Duong quy (To&n quy, Quy dAu, Quy
v^/quy rau)".
-
12. Sua ddi nguon goc vj thuoc "Thyc dja" so thu ty 301 cpt sd 1
"N" thinh "N-B".
Dieu 6. Sua doi, bd sung Thong tu so 41/2015/TT-BYT ngay 16
thang 11 nam 2015 sua doi, bo sung mpt so dieu cua Thong tu so
41/2011/TT-BYT ngay 14 thing 11 nam 2011 cua Bp trubng Bp Y te
hubng dan cap chung chi hinh nghe doi voi ngubi hinh nghe vi cap
giay phep hoat dpng doi vbi car sb kham bpnh, chua bpnh
1. Sua doi, bo sung Dieu 7a nhu sau: "Dieu 7a. Pham vi hoat dpng
chuyen mon ghi tren chiing chi
hinh nghe 1. Pham vi hoyt dpng chuyen mon ghi tren chiing chi
hanh nghe theo cac
nh6m chuyen khoa quy djnh tyi Phy lyc 4b ban hinh kern theo
Thong tu nay.
2. Ngubi hinh nghe d i dupe cap chung chi hinh nghe co phym vi
hoat dpng chuyen mon thupc chuydn khoa nio thi dupe phep thyc hipn
cac djch vy chuyen mon ky thuyt cua chuyin khoa d6, tru trubng hpp
thyc hipn mpt so phau thuyt, thu thuyt loyi d$c bipt quy djnh tyi
Thong tu s6 50/2014/TT-BYT ngiy 26 thing 12 nim 2014 cua B$ trubng
Bp Y te quy djnh ve vipc phan loyi phau thuyt, thu thuyt v i djnh
muc nhan lyc trong timg ca phau thuyt, thu thuyt thi can cb them
chung chi, chung nhyn dio tyo phu hpp.
Ngubi chju trach nhipm chuyen mon ky thuyt ciia co sb kham bpnh,
chua bpnh cin cu vio pham vi hoyt dpng chuyen mon ghi tren chung
chi hinh nghe, vfin hing, chiing chi ho$c chiing nhyn v i ning lyc
ciia ngubi hinh nghe de cho phep b§ng van bin ngubi hinh nghe dupe
thyc hipn cic chuyen mon ky thuyt cu the tyi co sb kham bpnh, chua
bpnh do minh phy trach.
2. Sua doi, bo sung Phy lyc 4b ban hinh kirn theo Thong tu so
41/2015ATT-BYT nhu sau:
" 1. Bic sy chuyen khoa npi tong hpp: Kham bpnh, chQra bpnh npi
khoa.
lb. Bic chuydn khoa phyc h6i chiic ning." Dieu 7. Sua d6i, bb
sung Thdng tu sb 35/2016/TT-BYT
ngiy 28 thing 9 nam 2016 cua Bp trubng Bp Y te ban hinh Danh myc
v i ty If, dieu kipn thanh toin doi vbi djch vy ky thuat y te thuoc
phym vi dupe hubng cua ngubi tham gia bio hiem y te
1. Sua doi, bo sung diAm b khoan 1 DiAu 3 nhu sau:
-
X * X
"b) Dupe thyc hipn theo quy trinh chuyen mon do cap co tham
quyen phe duypt, cy the:
- Cac ca so kham bpnh, ch&a bpnh phii ap dyng thyc hipn cac
tai lipu chuyen mon huong din ve chin dodn, dieu trj va quy trinh
ky thuyt do Bp Y te ban hanh hoic do ngubi dung dau co sb kham
bpnh, ch&a benh ban hanh ap dung tyi co sb (tren co sb cin cu
vio cac t i i lipu chuyen mon hubng dan va quy trinh ky thuyt do Bp
Y te ban hinh v i dieu kipn thyc te cua co so).
- Ddi voi cac djch vy khim bpnh, ch&a bpnh chua dupe Bp Y te
ban hanh cac hubng din chuyen mon ho$c quy trinh ky thuyt, ngubi
dung dau co sb kham bpnh, chua bpnh xay dyng v i ban hinh cac hubng
dan chuyen mon ho$c quy trinh ky thuyt dA thyc hipn tyi co sb tren
co sb tham khio cac nguAn tai lipu chinh thong, co bAng chung khoa
hpc v i phu hpp voi dieu kipn cua co sb.
- Khi ban hinh cac hubng dan chuyen mon ho$c quy trinh ky thuyt
de thyc hipn tyi co sb, ngubi dung dau co sb kham bpnh, chua bpnh
co trach nhipm gui hubng din ho$c quy trinh d i ban hinh din co
quan bio hiem xa hpi tinh noi co sb kham bpnh, chua bpnh dat try
so."
2. Sua doi vi dy tyi diAm b Khoan 3 DiAu 4 nhu sau: "Vi du:
Ngubi bpnh thupc doi tupng co muc hubng 95% chi phi kham
bpnh, chua bpnh, dupe chi djnh thyc hipn djch vy ky thuyt "Chup
cAt lop vi tinh toin than" (khong cb thuoc cin quang), thyc hipn
nhu sau:
Trubng hpp chi djnh "Chyp danh gia cic giai doyn cua u ho$c da
chan thuong", thanh toin theo gia ciia djch vy k£ thuyt "Chyp cAt
lop vi tinh toin than", co gia 6.606.000 dAng (khong co thuoc cin
quang), nhu sau:
- Quy bio hiAm y te thanh toan: 6.606.000 dAng x 95% = 6.275.700
dAng.
- Ngubi bpnh thanh toan phin cung chi tra: 6.606.000 dong x 5% =
330.300 dong.
Trubng hpp khac, thanh toan theo gia djch vy ky thuyt "Chyp cAt
lop vi tinh 1 - 32 diy", cb gia 536.000 dAng (khong co thuoc cin
quang), nhu sau:
- Quy bio hiAm y te thanh toin: 536.000 dAng x 95% = 509.200
dAng.
- Ngubi bpnh thanh toan phan cung chi tri: 536.000 dAng x 5% =
26.800 dAng.
- Chi phi chinh lech l i = 6.606.000 dAng - 536.000 dAng =
6.070.000 dong, ngubi bpnh khong phii chi t r i ."
-
7
3. Sura doi, bo sung Khoan 2 Diiu 5 nhu sau:
"2. Doi voi djch vy ky thuyt y te ma dieu kipn thanh toin co quy
djnh ngubi thyc hipn phii co Chiing chi dio tyo nhung d i dupe cap
Giiy chiing nhyn dio tyo thay cho Chiing chi dio tyo thi Giay
chiing nhyn dio tyo dupe tiep tyc sii dyng theo quy djnh ciia Nghj
djnh so 109/2016/ND-CP ngiy 01 thing 7 nim 2016 cua Chinh phu quy
djnh cap chiing chi hinh nghi doi voi nguoi hinh nghe v i cap gily
phip hoyt dpng doi vbi co sb kham bpnh, chua bpnh."
4. Siia doi myc 1, 10 v i 14 ciia Danh myc 1 - Djch vu ky thuyt
co quy djnh cy thi diiu kipn, ty lp v i miic gia thanh toan nhu
sau:
STT DVKT/Nh6m DVKT
Diiu kipn thanh toin Ty lp, mire gia thanh toin
1. Lpc miu cap ciiu
Thyc hipn doi vbi mpt trong cac trubng hpp sau:
a) Qua t i i the tich khong dap ung vbi diAu trj ho$c cb vo
nipu, thiAu nipu;
b) Ting kali co roi loyn tren dipn tarn do hoac kali miu tren
6,5 meq/L;
c) HOi chiimg ure mau cao: tran djch ming tim, cic bieu hipn roi
loyn tarn than khong ly gii i dupe b ngubi bpnh suy thyn;
d) Toan chuyen hoa n$ng (pH miu dubi 7,1);
r
d) Ngp dpc rupu, ngp dpc thuoc ho$c ngp dpc glycol. e) Cic
trubng hpp ngp d$c khic c6 chi djnh lpc miu cap cuu sau khi hpi
chan.
- Trubng hpp phai d$t catheter, thanh toan bing g i i cua djch
vy k^ thuyt "Than nhan tyo cap cuu".
- Trubng hpp khong phii dat catheter (do su dyng dupe AVF co
sin), thanh toan bing gia ciia djch vy ky thuyt "Thyn nhan tyo cap
cuu" tru (-) di 130.000 dbng (tuong duong V* (mpt phan tu) gia ciia
catheter).
-
8
STT DVKT/Nhbm DVKT
Dieu 1 den thanh toin Ty If, mvc gi i thanh toin
10 Cac xet nghipm chi diem khoi u bing ky thuyt mien djch phbng
xa ho$c hoa sinh.
Chan doin va theo d6i dieu trj bpnh ung thu doi voi mpt trong
cic xet nghipm sau:
- Djnh lupng CA125: Buong trung;
-Djnh lupng CA 15-3: Vu;
- Djnh lupng CA 19 - 9: Tyy, dubng mat;
- Djnh lupng CA 72 - 4: Dy diy;
- Djnh lupng CEA: Ung thu bieu mo.
- Thanh toin theo gia DVKT "Xi t nghipm chi diem khoi u bing ky
thuyt hoa sinh"; - Khbng thanh toan dbi vbi trubng hpp cac ket qui
xbt nghipm, chan doan hinh anh khac da chan doan xac djnh hoac d i
danh gia dupe ket qui dieu trj bpnh ung thu. Trubng hpp thyc hipn
cac xet nghipm de theo doi ket qui diAu trj, danh gia tai phai. di
cin thi van dupe thanh toin.
11 Djnh lupng CRP/CRPhs
Chan doin, theo dbi mft trong cic trubng hpp sau day: a) Nghi
ngb co 6 nhiem trung, co it nhat 02 trong 04 tieu chuan sau: -
Nhipt dp co thA < 36°C ho$c > 38,3°C; - Nhjp tim nhanh 90
lan/phut; - Nhjp thb > 22 lln/phut ho$c PaC02 12G/L, ho$c <
4G/L ho£c > 10% bych cau non. Doi vbi tre em: Khi nghi ngb cb A
nhiem trung, cb nhipt d$ co the < 36°C ho$c > 38,3°C v i cb
nhjp tim hoic nhjp thb thay doi qua gibi han sinh ly theo tuoi. b)
Nhiem trung so sinh; c) Bpnh mych vinh, nhAi mau co tim; d) Viem da
nhiem d$c, cac bpnh ty mien.
Thanh toin bing gia DVKT
-
STT DVKT/Nhom DVKT
Dieu kipn thanh toin Ty lp, mbe gii thanh toin
12. Djnh lupng Pro-calcitonin [Mia]
1. Chan doin va theo doi tinh trang nhiem trung n$ng khi co mpt
trong nhflmg dau hipu sau day:
- DiAm suy da tyng (SOFA) > 2; - Nghi ngb co 6 nhiem trung va
co 2 trong 3 tieu chuan: Nhjp thb> 22 lan/phut; Huyet ip tarn
thu < 100 mmHg; Glassgow < 13 diem.
2. BAi voi tre em:
- Chin doin va theo doi cac trubng hpp nhiem trung huyet;
- Theo dbi va tien lupng suy da tang khi cb roi loyn chuc ning
tu 2 co quan trb len.
Thanh toan bing gia DVKT.
Khi su dyng xet nghipm Procalcitonin dA theo dbi tinh trang
nhiem trung nyng va dap ung dieu tri theo quy djnh tyi khoan 1 Myc
nay:
+ Thanh toan tbi da 01 lan/moi 24 gib dbi vbi ngubi bpnh soc
nhiem trung; + Thanh toan tbi da 01 lan/moi 48 gib dbi voi ngubi
bpnh nhilm trung nftig;
+ Khong thanh toan dbi vbi cic trubng hpp da co bing chung
chiing minh: hAt dau hipu chi djnh va Procalcitonin < 02 lan gia
in iriam emeu.
12. Djnh lupng Pro-calcitonin [Mia]
Cic trubng hpp nhiem khuin khic.
Thanh toan theo gia DVKT Djnh lupng CRP/CRP hs.
12. Djnh lupng Pro-calcitonin [Mia]
Trubng hpp chi djnh DVKT D;nh lupng CRP/CRP hs cung thbi diAm
hoac da cb ket qua Procalcitonin dA chan doan, theo dbi tinh tryng
nhiem trbng nftig.
Thanh toan DVKT Procalcitonin va khong thanh toan DVKT Djnh
lupng CRP/CRP hs
-
10
STT DVKT/Nh6m DVKT
Dieu kipn thanh toin Ty If, mire gii thanh toin
14. Phau thuft thb thuy tinh bing phaco v i femtosecond co hoyc
khong d$t IOL/Phau thuyt the thuy tinh bing phaco
a) Doi voi ngubi bpnh dye the thuy tinh cb thj lyc <
3/10:
- Co sb kham bpnh, ch&a bpnh co khim bpnh, chua bpnh chuyen
khoa mit; Trubng hpp ngubi bpnh con mit dpc nhat thi chi dupe thyc
hipn tyi co sb khim bpnh, ch&a bpnh tuyen tinh, tuyen trung
uong ho$c co sb khim bpnh, chua bpnh hang 11 trb len.
- Ngubi thyc hipn djch vy ky thuyt l i bic sy dupe dio tyo djnh
hubng chuyen khoa mit trb len va co chung chi dio tyo phau thuyt
vien phaco; b) Doi vbi ngubi bpnh dye the thuy tinh co thj lyc >
3/10: - Co sb khim bpnh, ch&a bpnh co khim bfnh, ch&a bfnh
chuySn khoa mit tu tuyen tinh, tuyen trung uong hoyc co sb khim
bpnh, ch&a bpnh hyng I I trb len; - Ngubi thyc hipn djch vy ky
thuyt la bic sy chuyen khoa cap 1 chuyen nganh mit ho$c tuong duong
trb len co chung chi dio tao phau thuyt vien phaco; Luu y: thj lyc
3/10 (cich ghi thyp phan) tuong duong vbi thj lyc 20/80 (cich ghi
Snellen).
Thanh toin bing g i i cua DVKT "Phau thuyt dye thuy tinh the
bing phuong phip Phaco".
-
11
4. Sua doi myc 12, 13, 39 va 65 cua Danh myc 2 - Djch vy ky
thuyt y te co quy djnh cy the dieu kipn thanh toan nhu sau:
STT DVKT/Nh6m DVKT
Diiu kipn thanh toan
12 Npi soi khbp Thyc hipn tyi bpnh vipn ho£c trung tarn y te co
chuc ning kham bpnh, chua bpnh npi tru d i dupe co quan co tham
quyen cho phep dieu trj bpnh co xuong khop v i nft soi khop co
trong danh myc ky thuyt cua co so khim bpnh, chua bpnh da dupe
co
X X quan co tham quyen phe duypt; co bic sy co chung chi hinh
nghe vbi pham vi hoyt dpng chuyen mon thupc mpt trong cic chuyen
khoa: npi tong hpp, chuyen khoa thupc hp npi, chan doin hinh inh,
ngoyi, thupc hp ngoyi, chuyen khoa nhi,
• *
bic sy y hpc co truyen v i co chung chi, chung nhyn dio tyo npi
soi khop do co sb dio tyo/bpnh vipn (dupe Bp Y te phe duypt) dio
tyo va cap. 13 Tiem khbp (khdp/gan
/diem bam gin/ can/canh cpt song /ngoaimangcung)
MAi dpt dieu trj tiem khong qui 3 vj tri, moi vj tri khong qua 1
mfli tiem v i khong qui 3 dpt dieu trj trong 12 thing.
18 Cac DVKT phyc hoi chuc ning.
1. Cic DVKT phyc hAi chuc ning phai do ngubi hinh nghe co phym
vi hoyt dpng chuyen mon ghi tren chung chi hinh nghe hoyc quyet
djnh bo sung phym vi hoyt dpng chuyen mon ve phyc hoi chuc ning
thyc hipn. 2. TAng sA DVKT phyc hAi chuc ning thanh toin toi da
khong qui 06 DVKT/ngay, trong do: a) Cic ky thuyt vyn dpng trj lipu
thanh toin toi da 03 ky thuyt/ngiy, bong do cic ky thuyt tuong
duong vbi k^ thuyt van dpng toan than thanh toan toi da 02 ky
thuyt/ngay; b) Cic ky thuyt hoyt dpng trj lipu thanh toan tbi da 02
ky thuyt/ngay; c) Cic ky thuyt ngon ngb trj lieu thanh toin 02 ky
thuyt/ngay; d) Cic ky thuyt vyt ly trj lieu thanh toin tAi da 04 ky
thuyt/ngiy.
-
12
STT DVKT/Nhom DVKT
Dieu kipn thanh toan
39 Tap nuAt X X
Do ngubi hanh nghe d i dupe dio tyo, boi duong kiln thuc ve vyt
ly tri lipu, phyc hoi chuc ning it nhat 3 thing tyi cic co sb dio
tyo do B$ Y te quy djnh chi djnh, thyc hif n. Thanh toin toi da
khong
X X X
qua 03 lan cho mpt dpt dieu tri doi vbi ngubi bpnh: a) Sau phau
thuyt hoac xy trj vung mipng, hau, thyc quin; b) Bpnh ly sp nio co
gay roi loan nuAt do: Tai biAn mych miu nio ho$c Chin thuong sp
nio; c) Bpnh ly day thin kinh vfn dQng do: Byi lipt hojic Viem da
day da re; d) Parkinson; d) Xo cpt ben teo co.
65 Chyp cpng huong tu khic
Giim doc co sb khim bpnh, chua benh quy djnh cic trubng hpp dupe
chi djnh chyp va gui co quan bao hiem xa hoi. Trubng hpp Giim doc
co sb khim bpnh, chua bpnh khong quy djnh dupe cic trubng hpp chi
djnh chyp thi phii phe duypt hoic uy quyAn phe duypt doi vbi tirng
trubng hpp cy the. Trubng hpp cin thiet phai to chuc hpi chan trubc
khi phe duypt.
Dieu 8. Sua doi, bo sung Thong tu so 04/2017/TT-BYT ngay 14
thing 4 nam 2017 cua Bp trubng Bo Y te ban hinh Danh myc vi ty lp,
dieu kipn thanh toin doi vbi vyt tu y te thupc phym vi dupe hubng
cua ngubi tham gia bio hiem y te
1. Sura doi, bA sung diAm c Khoin 2 DiAu 3 nhu sau: "c) Doi vbi
djch vy k$ thuyt d$t stent dpng mych vanh phai su dyng nhieu
hon mpt stent phu thuAc, muc thanh toin cho tong chi phi vyt tu
y te bao gAm X X X • X
stent thu nhat va tong vft tu y te khic ngoai stent trong mpt
lan su dyng djch vy k$r thuyt thyc hipn theo hubng dan thanh toin
tyi diem b Khoin 2 Dieu nay,
-
13
ngoai ra Quy bao hiAm y tA thanh toan them mpt phan hai (1/2)
chi phi dbi voi stent thu hai theo gia mua vao ciia ca sb kham
bpnh, chua bpnh nhung khong cao hon 18.000.000 dong;
Vi dy: Stent phii thuoc A co gia mua vao tyi mpt ca sb kham
bpnh, chua bpnh la 40.000.000 dAng; muc thanh toan doi vbi stent
phu thuoc theo quy djnh tyi cpt 5 Danh myc vyt tu y tA tyi Phy lyc
01 Thong tu nay la 36.000.000 dong. Ngubi bpnh nhyp vipn tyi co sb
kham bpnh, ch&a bpnh nay dA thyc hipn djch vu ky thuyt dft
stent vbi chi djnh dft 03 stent phu thuAc A. Chi phi cac vyt tu y
tA khac ngoai stent ma chua dupe tinh vao gia cua djch vy ky thuyt,
kham bpnh, ngay giubng dieu trj hoyc thu trpn goi theo trubng hpp
bpnh (sau day gpi tit la vyt y tu y te khac) ciia ngubi bpnh la
15.000.000 dAng; cac vyt tu y tA nay khong co muc thanh toan quy
djnh tyi cpt 5 Danh myc vyt tu y te tyi Phu lyc 01 ban hanh kem
theo Thong tu nay.
- Trubng hpp ngubi bpnh la doi tupng tham gia bao hiem y tA co
muc hubng 100% chi phi kham bpnh, chua bpnh di kham bpnh, chua benh
dung tuyen, muc thanh toan tong chi phi vyt tu y te trong mpt lan
su dung djch vu ky thuyt cua ngubi bpnh theo Vi dy 1 minh hpa diem
b Khoan 2 Dieu 3 la 54.450.000 dAng. T6ng chi phi 01 stent phu
thuoc A tinh theo mure thanh toan tyi cpt so 5 Danh myc vyt tu y tA
tyi Phy lyc 01 ban hanh kem theo Thong tu nay va cac vyt tu y tA
khac la 36.000.000 + 15.000.000 = 51.000.000 dAng; chi phi nay nhb
hem 54.450.000 dAng. Quy bao hiAm y te thanh toan cho ngubi
bpnh:
+ Stent thu nhlt va chi phi vyt tu y tA khac Ik 51.000.000 dong;
+ Stent thu hai: Do % x 40.000.000 m 20.000.000 dAng lbn hon
18.000.000
dAng. Quy bao hiem y te thanh toan 18.000.000 dAng cho stent thu
hai. + Stent thur ba khong thanh toan. Vi vyy, Quy bao hiAm y tA
thanh toan tAng chi phi vyt tu y te trong mpt
lln su dyng djch vy ky thuyt cho ngubi bpnh la: 51.000.000 +
18.000.000 = 69.000.000 dAng;
Trubng hpp ngubi bpnh ty di kham bpnh, chOa benh khong dung
tuyAn tyi bpnh vipn tuyAn trung uong, Quy bao hiem y te thanh toan
tong chi phi vyt tu y te trong mpt lan su dyng djch vy ky thuyt cho
ngubi bpnh la: (51.000.000 + 18.000.000) x 40% = 27.600.000
dAng;
Trubng hpp ngubi bpnh ty di kham bpnh, chua bpnh khong dung
tuyen tai bpnh vipn tuyAn tinh, Quy bao hiAm y te thanh toan tAng
chi phi vyt tu y te Pong mft lan su dyng djch vy ky thuyt cho ngubi
bpnh la: (51.000.000 + 18.000.000) x
-
14
60% = 41.400.000 dAng; - Truong hpp ngubi bpnh la doi tupng tham
gia bao hiem y te co muc
hubng 80% chi phi khdm bpnh, ch&a bpnh di khdm bpnh, chua
bpnh dung tuyen nhung chua du tlibi gian tham gia bao hiem y tA
lien tyc tren 5 ndm, tong chi phi 01 stent phu thuoc A tinh theo
muc thanh todn tyi cpt so 5 Danh myc vyt tu y tA tai Phu luc 01 ban
hanh kem theo Thong tu ndy va cac vat tu y te khac la 36.000.000 +
15.000.000 = 51.000.000 dong; chi phi nay nho hon 54.450.000 dong.
Quy bao hiem y tA thanh todn cho ngubi bpnh Id:
+ Stent thu nhat vd chi phi vdt tu y tA khdc la: 51.000.000 x
80% = 40.800.000 dong;
+ Stent thu hai la: 18.000.000 dong; + Stent thu ba khdng thanh
todn. Vi vyy, Qu^ bao hiAm y tA thanh toan tAng chi phi vft tu y tA
trong mpt
ldn su dpng djch vy k? thuyt cho ngubi bpnh Id: 51.000.000 x 80%
+ 18.000.000 - 58.800.000 dAng".
Trubng hpp ngubi bpnh ty di khdm bpnh, chflra bpnh khong dung
tuyen tyi bpnh vipn tuyen trung uong, Quy bao hiAm y tA thanh toan
tong chi phi vyt tu y te trong mpt lan su dyng djch vy ky thuyt cho
ngubi bfnh Id: (51.000.000 x 80% + 18.000.000) x 40% = 23.520.000
dAng.
Trubng hpp ngubi bpnh ty di kham bpnh, chflra bpnh khong dung
tuyAn tyi bpnh vipn tuyen tinh, Qu£ bdo hiAm y tA thanh todn tAng
chi phi vat tu y tA trong mpt ldn su dung djch vy ky thuyt cho
ngubi bpnh la: (51.000.000 x 80% + 18.000.000) x 60% = 35.280.000
dAng."
2. Sua dAi, bA sung Phu iuc 01 Danh myc vyt tu y te thupc phym
vi dupe hubng ciia ngubi tham gia bdo hiem y te nhu sau:
a) Sua dAi, bA sung "Bom tiem truyen dp lyc cac loyi, cac cb" so
thu ty 35, ma so N03.01.030 - "Bom tiem, bom tiem truyen dp lyc cac
loyi, ede cb";
b) Sua doi "Dyng cy, may cdt, khau noi ty dpng su dyng trong k$
thuyt Doppler cac loyi, cac cd (bao gom ca bp dau do Doppler dpng
mych bui tri)" tyi
X ' X i i * X
so thu ty so 262, md so N07.04.050 thanh "Dyng cy, mdy cdt, khau
noi ty dpng cac loyi, cac co (bao gAm ca ghim khau mdy)".
Dieu 9. Sua doi Thong tu so 23/2011/TT-BYT ngay 10 thang 6 ndm
2011 cua Bo trubng Bp Y te hubng dan sir dyng thuAc trong cac co sb
y te co giubng bpnh
Sua doi diem a khodn 1 Dieu 6 nhu sau:
-
15
"a) Cong khai thuAc dung hang ngay cho tirng ngubi bpnh bing
each thong bao cho ngubi bpnh trade khi dung thuoc, dAng thbi yeu
cau ngubi benh hoft ngubi nha ky nhyn vao PhiAu cong khai djch vy
khdm, ch&a bpnh npi tru hang ngay (theo mau dupe ban hanh tyi
Phy lyc sA 01 ban hanh kem theo Thong tu sua doi, bo sung mpt so
quy djnh ve chi phi khdm bpnh, chua bpnh bao hiem y te). PhiAu cong
khai djch vy khdm, ch&a bpnh npi tra hang ngay dA b kpp dau
giubng bpnh ho$c cuoi giubng bpnh."
Dieu 10. Hipu lyre thi hanh. 1. Thong tu nay co hipu lyc thi
hanh ke tu ngay 01 thang 3 ndm 2018.
2. Bdi bb cac quy djnh sau trong Quy che bpnh vipn ban hanh kem
theo Quyet djnh so 1895/1997/QD- BYT ngay 19 ngay 9 ndm 1997 cua Bp
trubng Bp Y te:
a) Diem i myc 2 ciia Quy che cong tdc Khoa chan doan hinh
anh;
b) "Da hpi chan toan bpnh vipn, doi vbi bpnh vipn hyng II I ;
hpi chan toan khoa ho$c lien khoa, doi vbi bpnh vipn hyng I vd I I
; sau khi hpi chan co chi djnh cho ngubi bpnh chuyAn vipn" Uong
diem a myc 3 Phdn II ciia Quy che chuyen vipn.
3. Bdi bb phan khai nipm, djnh nghla cua chi tieu so 20 vA so
ngay dieu trj trung binh cua 1 dpt dieu trj npi tru quy djnh tyi
Thong tu so 28/2014/TT-BYT ngay 14 thang 8 ndm 2014 ciia Bp trubng
Bp Y te quy djnh npi dung he thbng chi tieu thbng ke nganh Y
te.
4. Bdi bb ten cac thuAc quy djnh tyi sb thu ty 636, 1039 ciia
cpt so 2 thupc Danh myc thuoc tan dupe thupc phym vi thanh toan cua
Quy Bao hiAm y tA ban hanh kem theo Thbng tu sA 40/2014/TT-BYT ngay
17 thang 11 nam 2014 ciia Bp trubng Bp Y te.
5. Bdi bb cac quy djnh sau trong Thbng tu so 05/2015/TT-BYT ngay
17 thang 3 ndm 2015 cua Bp trubng Bp Y tA ban hanh Danh myc thuAc
dong y, thuAc tu dupe lipu:
a) Ten cac thuoc quy djnh tyi so thu ty 26, 28, 34, 58, 88, 141,
143, 158, 196, 233 cua cpt so 1 thupc Danh myc thuoc dong y, thuoc
dupe lipu;
b) Ten vj thuAc tyi so thu ty 296 cpt so 1 thupc Danh myc thuoc
dong y, thuAc dupe lipu;
c) NguAn goc vj thuAc tyi so thu ty 301 cpt sb 1 thupc Danh myc
thuoc
dong y, thuAc dupe lipu;
-
16
6. Bdi bo cac quy djnh sau trong Thong tu so 41/2015/TT-BYT ngay
16 thang 11 ndm 2015 sua doi, bo sung mpt so diAu ciia Thdng tu so
41/2011/TT-BYT ngay 14 thdng 11 ndm 2011 ciia Bp trubng Bp Y tA
hubng dan cap chung chi hanh nghA doi vbi ngubi hanh nghe va cap
giay phep hoyt dpng doi vbi co sb kham bpnh, ch&a bpnh:
a) DiAu 7a; b) Khodn 1 Phy lyc 4b. 7. Bai bb cac quy djnh sau
trong Thbng tu so 35/2016/TT-BYT
ngay 28 thang 9 ndm 2016 ciia Bp trubng Bp Y tA ban hdnh Danh
myc va ty lp, diAu kipn thanh toan doi vbi djch vy ky thuft y tA
thupc phym vi dupe hubng cua ngubi tham gia bao hiAm y tA:
a) Diem b khoan 1 DiAu 3;
b) Khodn 2 DiAu 5; c) Myc 1, 10 va 14 cua Danh myc 1 - Djch vy
ky thuft cb quy djnh cy the
diAu kipn, ty lp va muc gia thanh todn; d) Myc 12, 13, 39 va 65
ciia Danh myc 2 - Djch vy ky thuyt y te cb quy
djnh cy the diAu kipn thanh toan. 8. Bdi bb cac quy djnh sau
trong Thbng tu so 04/2017/TT-BYT ngay 14
thang 4 ndm 2017 cua Bp trubng Bp Y te ban hdnh Danh myc va ty
lp, diAu kipn thanh toan doi vbi vyt tu y te thupc phym vi dupe
hubng cua ngubi tham gia bao
X X
hiem y te: a) DiAm c Khodn 2 Dieu 3; b) So thu ty 35, md sb
N03.01.030; c) So thu ty so 262, md so N07.04.050. 9. Bdi bb diAm a
khoan 1 DiAu 6 Thbng tu so 23/2011/TT-BYT ngay 10
thang 6 ndm 2011 ciia B$ trubng Bp Y te hubng dan su dyng thubc
trong cac ca sb y tA cb giubng bpnh
Dieu 11. DiAu khodn chuyen tiep 1. Viec thanh todn chi phi kham
bpnh, chua bpnh bao hiem y tA dbi vbi
cac trubng hpp dd kham bpnh, chtta bpnh trudc ngdy Thong tu ndy
cb hipu lyc thi hanh va trubng hpp ngubi bpnh vdo vipn trubc ngdy
Thbng tu ndy cb hipu lyc thi hanh nhung ra vipn sau ngdy Thbng tu
ndy cb hipu lyc thi hdnh ap dyng theo quy djnh cua cac vdn ban quy
pham phap luyt dd dupe ban hdnh trubc ngay Thbng tu nay cb hipu lyc
thi hanh.
-
2. Doi vbi cic bpnh vipn chua co bac sy ho£c cu nhan, ky thuyt
vien tbt nghipp trinh do dyi hoc ve chuyen khoa chan doan hinh anh,
chuyen khoa X-quang, chuyen khoa xet nghipm thi phii cu cin bp di
dio tyo cac chuyen khoa nay ho$c tuyen dyng ngubi hinh nghA co phym
vi hoyt dpng chuyen mon cac chuyen khoa niy de dap ung cac dieu
kipn chuyen mon theo quy dinh v i hoan thanh trubc ngay 01 thing 01
nim 2021.
Dieu 12. Dieu khoin tham chieu Trubng hpp cic vin bin dupe dan
chieu trong Thong tu nay bj thay thA
hofcc sua doi, bA sung thi thyc hipn theo vin bin thay the ho$c
vin ban di dupe sua doi, bo sung do.
DiAu 13. To chuc thyc hipn Chanh Vin phong Bp, Vy trubng, Cyc
trubng, TAng eye trubng cac Vy,
Cyc, Tong cyc thupc Bp Y te, Giam doc Sb Y te cac tinh, thinh
pho tryc thufc trung uong, Thu trubng y te nganh va cac dem vj lien
quan chju trach nhipm thi hanh cac quy dinh tyi Thbng tu niy.
Trong qui trinh thyc hipn neu cb khb khin, vubng mic dA nghj cac
ca quan, to chuc, c i nhan phin anh bing vin ban vA Bp Y te de xem
xet, giai quyet./.
far J&tr N(ti nhfn: KT. BO TRUING ^ - Uy ban v6 c4c vin d£
xa hpi cua Qu6c hpi (dS b/c); - Van phdng Chinh phu (Vy KGVX, COng
bao,
C6ng TTDT Chinh phu); - BO truong (d0 b/c); - Cac Thir truong
(d« phOi hpp chi dgo); - BO Tu phap (Cyc K i t e tra VBQPPL); - Cac
BO, co quan ngang BO,
cic co quan tryc thupc Chinh phii - UBND cac tinh, thanh ph6
tryc thuOc TW; - SO Y tO cac tinh, thanh ph6 tryc thuOc TW; - Y tS
cac BO, nganh; - Bao hiOm xa hpi cac tinh, thanh phO tryc thuOc TW;
- COng Thdng tin di$n tu BO Y tO; - Luu: VT, KCB, BHYT, KHTC, YDCT,
PQ 0 2 b ) .
