Management and operating regime of the Center for Health Insurance Assessment and Multi-Line Payment in Vietnam

Management and operating regime of the Center for Health Insurance Assessment and Multi-Line Payment in Vietnam (Internet image)

Regarding this issue, LawNet would like to answer as follows:

1. Management and operation regime of the Center for Health Insurance Assessment and Multi-Line Payment in Vietnam

- The Center for Health Insurance Assessment and Multi-Line Payment is managed and operated by the Center Director according to the head-man regime. The Center Director is responsible before the General Director and the law for all activities of the Center. Assisting the Center Director are no more than 03 Deputy Center Directors. The Director and Deputy Directors of the Center are appointed, dismissed, transferred, rewarded, and disciplined by the General Director according to regulations.

- The Center Director promulgates regulations on the assignment of tasks, working relationships, working practices, and working regulations of the Center and urges and inspects the implementation of those regulations.

- The Center Director assigns or authorizes the Center Deputy Director to handle tasks under the Center Director's authority.

The Deputy Director of the Center is responsible before the Director of the Center and before the law for assigned tasks. The Center Director must be responsible for the decisions of the assigned or authorized Center Deputy Director.

(Article 3 of Decision 1219/QD-BHXH 2020)

2. Duties and powers of the Center for Health Insurance Assessment and Multi-Line Payment in Vietnam

Duties and powers of the Center for Medical Insurance Assessment and Multi-Payment include:

- Manage and operate the health insurance appraisal information system, coordinate with the Information Technology Center and Health Insurance Policy Implementation Board and related units to develop and adjust the functions of the health insurance assessment information system, update and link medical examination and treatment data from medical examination and treatment facilities, promote professional communication between software in management, pay and settlement of medical examination and treatment costs, health insurance and other professional software according to assigned functions and tasks.

- Lead and coordinate with the Health Insurance Policy Implementation Board and relevant units to develop a health insurance appraisal process and transfer it to the Health Insurance Policy Implementation Board for appraisal, submit it to the General Director for promulgation, and organize implementation after approval.

- Organize the implementation and implementation of medical insurance assessment rules; supervise, analyze, synthesize, direct, and guide the Social Insurance of the provinces and centrally run cities (hereinafter referred to as the Provincial Social Insurance), carrying out the contents that need to be focused on inspection and assessment at the Social Insurance agency and health insurance medical examination and treatment establishments.

- Implement and coordinate with the Health Insurance Policy Implementation Board to guide Provincial Social Insurance, Social Insurance of the Ministry of National Defense, and Social Insurance People's Public Security in implementing measures to control medical examination and treatment costs, protect the rights of health insurance participants, and prevent and combat abuse and exploitation of health insurance regimes.

-Guide the Social Insurance of Provinces and related units to update, exploit, and use professional assessment software, other related professional software, and health insurance medical examination and treatment data. . Periodically inform and warn about doubts about the payment of medical examination and treatment expenses by local health insurance so that the provincial Social Security can determine its key tasks in managing medical examination and treatment funds under health insurance.

- Assume the prime responsibility for, and coordinate with relevant units in, building and updating the shared lists; formulating, amending, and supplementing assessment rules; Coordinate with the Information Technology Center, Health Insurance Policy Implementation Board and related units to develop software for managing supply, use, analysis, and evaluation of drug use (ABC - VEN ); Medical technology assessment software (HTA), submitted to the General Director for promulgation and implementation, guiding the Provincial Social Insurance and implementation units.

- Appraise and notify medical examination and treatment expenses covered by health insurance, multi-line payment according to regulations.

- Implement the signing of contracts to supply anti-HIV drugs, make advances, and settle costs for purchasing anti-HIV drugs with the winning contractor according to regulations. Summarize and finalize the cost of anti-HIV drugs of the Provincial Social Insurance to transfer to the Health Insurance Policy Implementation Board and the Department of Finance and Accounting.

- Coordinate with the Health Insurance Policy Implementation Board to advise and assist the General Director: participate with ministries and branches in building, amending, and supplementing policies and laws on health insurance; develop a method to pay medical examination and treatment expenses covered by health insurance.

- Coordinate with relevant units to check the assessment and payment of medical examination and treatment costs covered by health insurance at the Provincial Social Insurance and medical examination and treatment facilities; build a national database on insurance in the field of health insurance.

- Assume the prime responsibility for coordinating with relevant units in determining medical service prices and the list of drugs, medical supplies, and technical services within the scope of coverage of the health insurance participants.

- Take responsibility for managing data from business software within the unit's functions and tasks.

- Resolve recommendations and problems of organizations and individuals related to the implementation of appraisal operations (electronic appraisal or direct appraisal) at the Social Insurance Agency and health insurance medical examination and treatment facilities within the scope of functions, tasks, and powers of the Center.

- Coordinate with relevant units to participate in: Scientific research; administrative reform; IT applications; emulation and reward; applying the Quality Management System according to TCVN national standards; propagating and disseminating health insurance policies; international cooperation; and training and professional development according to the functions and tasks of the unit.

- Manage civil servants, public employees, and assets according to regulations.

- Implement information, statistics, reporting, clerical, and archival regimes according to regulations.

- Perform other tasks assigned by the General Director.

(Article 2 of Decision 1219/QD-BHXH 2020)

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