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Chapter 2 Applications and Reviews of Contracted Service Institutions
Article 3
Medical care institutions with licenses and meet the criteria set out in the Attachment may apply to become a contracted service institution to the Insurer by submitting relevant documents as required by the Attachment.
The Insurer shall complete the review of the submitted application within thirty days. The reviewing period may extend by another thirty days if necessary by informing the applicant.
Physicians managing elementary medical units other than joint clinics, who is qualified for multiple practices, such as physicians, Chinese medicine doctors, and dentists, can only apply to become a contractor for the categories that they are licensed for.
Article 4
The medical care institution or the responsible medical personnel applying to be a contractor will be disqualified should any of the following circumstances occur:
1. Violation of medical care laws, currently under disciplinary suspension, or having unpaid fines;
2. Violations of the laws and regulations governing National Health Insurance (hereinafter referred to as the “Insurance”) and as a result, contract suspended or terminated, or fines not paid up in full;
3. Pending issues with the Insurer and refusal to cooperate to seek resolutions;
4. Outstanding debts to the Insurer and refusal to allow the Insurer to deduct such outstanding payments from payable medical costs and expenses;
5. Medical personnel unable to practice due to illness as diagnosed by professional physician(s) and deemed by the Insurer’s on the basis of on-site investigations;
6. Failure to renew expired licenses held by medical personnel;
7. Retention of responsible medical personnel(s) or medical personnel still subject to a disciplinary sanction.
Article 5
The medical care institution or the responsible medical personnel applying to be a contractor will be disqualified in five years should any of the following circumstances occur:
1. The institution at the same address sees their franchise contract suspended or terminated twice or more within the last five years;
2. The franchise contract is suspended or terminated again within five years after the completion of the previous franchise contract termination;
3. The franchise contract is terminated or will be terminated for the second time within five years after the completion of the previous contract termination.
No contract shall be granted to any applicant should any of the above situations repeats within five years after given the contract.
It is possible to suspend the contract to specific service items or categories of a medical care institution if such service items or categories are deemed by the Insurer to be in violation of these Regulations based on on-site investigations, or if there are factual violations of the Act, and the situation of violation or related facts sustain.
No contract shall be granted within five years after the five suspensions or terminations of specific service items or categories or three suspensions or terminations of the same service item or category within five years in pursuant to the situations described in each Subparagraph of Paragraph 1.
Article 6
The Insurer shall not pay for any expenses associated with the insurance medical care institution services rendered to the insurance beneficiaries by any medical personnel liable for the actions described in Subparagraphs 2 to 3 of Paragraph 1 of the preceding article.
Article 7
The Insurer shall conclude franchise contracts with insurance medical care institutions which have passed the review of their application for contracting according to the principles set out in Article 2.
The abovementioned contracts shall be in standard form, whose contents shall be reviewed once every year. Any amendment shall be applicable to the following contractual renewals.
Where the circumstances set forth in Articles 38, 39, 40 or 47 are not applicable to medical personnel or practicing physicians, pharmacists (assistant pharmacists), physical therapists (physical therapy technicians), occupational therapists (assistant occupational therapists), medical technologists (medical technicians) and medical radiation technologists (medical radiological technicians) of a medical care institution within five years from the application date for contracting, the effective date of contracting may be fixed retrospectively to the date of the practicing license issued for the medical care institution if the application date is within fifteen working days from the issuance of the said practicing license.
Article 8
The abovementioned contract is valid for three years. Upon expiry of the franchise contract and in the absence of writing notices from the insurance medical care institution to the Insurer to request the termination of its contracted status, the Insurer may renew the contract in pursuant to the Regulations if the insurance medical care institution meets any of the following criteria:
1. Not in the circumstances described by the Regulations where no contract shall be granted;
2. No received any disciplinary sanctions (contract-violation point) or improvements already made if having been subject to any contract-violation point;
3. Contract suspended but improvements already made after suspension;
4. Fines imposed in accordance to the Act are paid up in full;
5. Not in the circumstances described by Articles 4, 5 and 45.
Article 9
Hospitals applying for the contracting for hospital stays shall be reviewed by hospitals. Mental state restoration medical care institutions applying for the contracting of community rehabilitation services for the mentally ill shall be evaluated and approved by medical care institutions.
The Insurer shall refer to the changed results of assessments on hospitals after the expiry of the previous assessed results, in the review of the insurance payment levels. For any hospitals not accepting further assessments or fail to pass assessments, the contract shall be changed to the elementary medical care units.
The Insurer may refer to the Hospital Accreditation Standards to determine the contract categories for new hospitals not yet evaluated by the central competent authority of health, on the basis of special case, pursuant to relevant laws and regulations.
Insurance medical care institutions other than hospitals shall participate in assessments or investigations organized by the central competent authority of health pursuant to relevant laws and regulations. The contract shall be terminated if the assessment results fail to or the insurance medical care institution refuses to participate in the assessment.