First, the background of the document.
In order to implement the decision-making arrangements of the CPC Central Committee and the State Council and the work requirements of the municipal party committee and municipal government, according to the requirements of the overall plan of "Class B management", the National Medical Insurance Bureau, the Ministry of Finance, the National Health and Wellness Commission and the National Bureau of Disease Control jointly issued the Notice on Optimizing the Relevant Policies of Medical Insurance for the Treatment Expenses of Infected Patients in novel coronavirus after the Implementation of "Class B Management". According to the spirit of national documents, the city has issued the relevant policies for the implementation of medical insurance in this city.
Second, the file execution time
This document shall come into effect as of the implementation date of "B and B Management" of novel coronavirus infection, and shall be implemented first until March 3, 20231day.
Three, about COVID-19 patients hospitalization expenses.
In order to ensure that infected patients in novel coronavirus will not be affected by hospitalization expenses, the document stipulates that the hospitalization expenses of patients in COVID-19 will be fully guaranteed for patients in COVID-19.
Hospitalization expenses incurred by COVID-19 patients in all medical institutions that meet the novel coronavirus infection diagnosis and treatment plan formulated by the health department,
It consists of basic medical insurance, serious illness insurance and medical assistance. In accordance with the provisions of the payment, the personal burden is partially subsidized by the financial sector.
Subsidy funds are paid in advance by local finance, and the central finance subsidizes 60% of the actual expenditure. This policy is based on the admission time of COVID-19 patients and will be implemented until March 3, 20231.
Four, about the outpatient and emergency expenses in COVID-19.
In order to ensure that patients in COVID-19 can get medical services in time at the initial stage of infection, the document clearly implements special guarantee to improve the reimbursement level of outpatient and emergency departments in designated medical institutions of basic medical insurance for COVID-19. We will increase the tilt support of medical insurance to rural and urban communities and other primary medical institutions, give special support to the outpatient and emergency expenses of patients with novel coronavirus infection and suspected symptoms in designated medical institutions of primary medical insurance, encourage primary medical institutions to supplement enough drugs for treating novel coronavirus infection in the medical insurance drug list, and do not set deductible lines and capping lines for outpatient and emergency expenses related to the treatment of insured patients in COVID-19 designated medical institutions of medical insurance.
The reimbursement rate of secondary and below medical institutions is 70%, and that of tertiary medical institutions is 60%.
The implementation time of this policy is from June 8, 2023 to March 36, 2023.
Five, about the drug safety of patients treated in COVID-19.
The therapeutic drugs listed in the national medical insurance catalogue, which belong to the novel coronavirus infection diagnosis and treatment scheme, are included in the scope of patient expenses protection in COVID-19. The therapeutic drugs in the novel coronavirus infection diagnosis and treatment plan outside the national medical insurance catalogue are temporarily included in the national medical insurance drug catalogue. The drugs for the treatment of novel coronavirus infection determined by the leading group for joint prevention and control in COVID-19 of our city will be temporarily included in the medical insurance drug list of our city, and will be implemented until March 3, 20231day.
Six, about COVID-19 patients need drugs online procurement and price monitoring.
Open online channels for therapeutic drugs in COVID-19, and establish a "priority" green channel for therapeutic drugs online in COVID-19. For those who have not yet hung up the network, medical institutions can also negotiate for the record and purchase according to regulations. Strengthen the price monitoring of therapeutic drugs in COVID-19, and promptly deal with the unreasonable price increase, inadequate distribution and "price increase by hitchhiking" of non-COVID-19 therapeutic drugs and medical consumables.
Seven, about COVID-19 patients "internet plus" medical insurance service.
COVID-19 patients can provide medical insurance mobile payment and settlement services for patients who have symptoms related to novel coronavirus infection and meet the "Guidelines for Family Treatment of novel coronavirus Infected Persons" in medical institutions that provide "internet plus" medical services recognized by the Municipal Health and Health Commission. The price of the first Internet service is implemented with reference to the follow-up services, and the reimbursement standard is consistent with offline. Internet follow-up service for patients in COVID-19 is still implemented according to the current reimbursement policy for Internet follow-up items.
8. For the first consultation service on the Internet, refer to the consultation fee price of the follow-up projects on the Internet.
For the first consultation service on Internet infection in novel coronavirus allowed by the health department, refer to the price of Internet follow-up project. Specifically, the charge for the first Internet consultation allowed by the infection health department in novel coronavirus is implemented with reference to the price of Internet follow-up items, that is, the code and name of the specific implementation item are "1101001001.10 Internet follow-up fee". "11101.20 internet follow-up fee", "11065438"
Nine, about the medical insurance convenience service
Continue to implement the long-term prescription medical insurance payment policy for outpatient chronic diseases. Vigorously promote the "online" and "handheld" service channels such as the National Medical Insurance Service Platform APP, Chongqing Medical Insurance APP, Chongqing Medical Insurance Bureau WeChat official account, and Chongqing Express APP, and realize 64 online high-frequency services. In accordance with the principle of convenience nearby, we will continue to provide green channels to ensure the handling of special diseases for the masses. Patients with chronic diseases and special diseases are not restricted by the original designated hospitals, and temporarily continue to buy medicines nearby. Simplify the handling of cross-provincial hospitalization in different places, and realize self-service registration and online settlement of cross-provincial hospitalization in different places through the above-mentioned online channels; Further unblock the record-free channels in Sichuan and Chongqing, and the insured persons in our city are hospitalized in designated medical institutions in Sichuan Province, and can directly settle accounts in designated medical institutions in the medical network without filing procedures.
Ten, about the coordination department to ensure the effectiveness of the policy.
Implementing "Class B management" for novel coronavirus infection is an important decision made by the CPC Central Committee and the State Council on the basis of comprehensive evaluation of virus variation, epidemic situation and prevention and control work in China. All relevant departments earnestly perform their duties and strengthen coordination. Specifically, the medical insurance department should focus on the audit and settlement of related expenses and strengthen fund supervision; The financial department should concentrate on timely disbursement of financial subsidies; Health departments should focus on guiding medical institutions to do a good job in the identification, information registration and uploading of novel coronavirus infected patients; The CDC should focus on uploading the information and data of infected people in novel coronavirus. Through coordination and linkage, we will ensure that the decision-making arrangements of the CPC Central Committee and the State Council and the work requirements of the municipal party committee and municipal government are fully implemented.