10 التزامات على المؤسسات الصحية للانضمام إلى شبكة مركز التأمين الوطني

The National Health Insurance Center has mandated health institutions to meet 10 criteria to join its network. According to a project proposed by the center, the commitments include providing healthcare to beneficiaries with the necessary quality and care in accordance with professional and ethical standards that align with best practices and medical methods, without discrimination among patients, and adhering to all requirements and conditions stated in the proposed regulation. Institutions must also inform the center of any changes to the information and documents attached to the accreditation request, and they must provide the center with all information and documents related to the healthcare being purchased, in accordance with the conditions and terms specified by the center in the regulation and healthcare purchase contracts.

The center purchases healthcare services for beneficiaries from accredited institutions, in accordance with the provisions of the regulation, the healthcare coverage list, and the healthcare purchase guidelines issued by the center, as well as the conditions and terms specified in the healthcare purchase contract. The center concludes healthcare purchase contracts with health institutions according to the approved healthcare purchase contract templates from the center.

The project introduced 5 types of accreditations: "Basic Accreditation," "Conditional Accreditation," "Emergency Accreditation," "International Health Facility Accreditation," and any other accreditation that may be needed, which is issued by an independent and justified decision from the center's CEO.

The center maintains a list titled "Network of Health Institutions Accredited by the Center," which includes institutions and health clusters that have obtained any of these accreditations.

Health institutions of all types, licensed to provide emergency healthcare services, automatically receive "Emergency Accreditation" as soon as the regulation comes into effect, without the need to apply for accreditation.

The regulation allows the center to revoke "Basic Accreditation" or "Conditional Accreditation" obtained by an accredited health institution in 5 cases: if the accredited health institution fails to implement any of the measures mentioned in the notification, and if any of the licenses and accreditations issued by the ministry or the Saudi Center for Health Facility Accreditation are revoked or canceled.

Among the cases for revoking accreditation is also if the center finds that the accredited health institution has forged any of the documents submitted, whether regarding the accreditation request or after obtaining accreditation or conditional accreditation, and if the center finds that the accredited health institution has provided misleading information or documents, or committed fraud, whether regarding the accreditation request or after obtaining accreditation or conditional accreditation, and if the accredited health institution submits a request to the center for its revocation.

The center may revoke the accreditation of one of the health institutions belonging to an accredited health cluster without affecting the health cluster or the health institutions affiliated with it. The center must ensure, in the revocation decision, the necessary measures to be taken by the cluster and the affiliated health institution regarding the transfer of beneficiaries from the revoked health institution and all measures deemed necessary by the center to address any issues that may arise from the revocation of accreditation.