국민건강보험법
Article 47-4 (Assessment of Appropriateness of Medical Care Benefits)
제47조의4 요양급여의 적정성 평가
- Ministry
- 보건복지부
- In force
- 2026-01-02
- Articles
- 147
심사평가원은 요양급여에 대한 의료의 질을 향상시키기 위하여 요양급여의 적정성 평가(이하 이 조에서 "평가"라 한다)를 실시할 수 있다.
The Health Insurance Review and Assessment Service may conduct an assessment of the appropriateness of medical care benefits (hereinafter referred to as "assessment" in this Article) to improve the quality of medical care for medical care benefits.
심사평가원은 요양기관의 인력ㆍ시설ㆍ장비, 환자안전 등 요양급여와 관련된 사항을 포함하여 평가할 수 있다.
The Health Insurance Review and Assessment Service may conduct assessments including matters related to medical care benefits, such as the staffing, facilities, and equipment of medical institutions, and patient safety.
심사평가원은 평가 결과를 평가대상 요양기관에 통보하여야 하며, 평가 결과에 따라 요양급여비용을 가산 또는 감산할 경우에는 그 결정사항이 포함된 평가 결과를 가감대상 요양기관 및 공단에 통보하여야 한다.
The Health Insurance Review and Assessment Service shall notify the medical institutions subject to the assessment of the assessment results, and if the medical care benefit costs are to be added or deducted according to the assessment results, it shall notify the medical institutions subject to addition or deduction and the National Health Insurance Service of the assessment results including the determined matters.
제1항부터 제3항까지에 따른 평가의 기준ㆍ범위ㆍ절차ㆍ방법 등에 필요한 사항은 보건복지부령으로 정한다.
Matters necessary for the standards, scope, procedures, and methods of the assessment under paragraphs ① through ③ shall be determined by a Ordinance of the Ministry of Health and Welfare.
Translation
Machine translation. The Korean text is authoritative.
Statute text is reproduced from 법제처 국가법령정보센터. This is information, not legal advice.