It means from 1.8.
In the national novel coronavirus infection diagnosis and treatment plan
Used for treating novel coronavirus infection.
Pfizer oral liquid Nai Mathevet tablets
Ritonavir tablets combined packaging, etc.
Drugs outside the medical insurance catalogue in 53 countries
Temporarily included in the scope of medical insurance payment
ut infra
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State (city) medical insurance bureau, finance bureau, health and wellness committee:
In order to implement the decision-making arrangements of the CPC Central Committee and the State Council, and smoothly and orderly implement 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 and Prevention issued the Notice on Optimizing the Relevant Policies of Medical Insurance for Infected Patients in novel coronavirus after the Implementation of Class B Management (1), which is hereby forwarded to you and put forward the following requirements in combination with the actual situation in our province. Please implement it carefully together.
I. Implementing safeguard policies
(a) continue to implement the policy of reimbursement of hospitalization expenses in advance. Novel coronavirus infected patients in all medical institutions, in line with the health department to develop novel coronavirus infection diagnosis and treatment program of hospitalization medical expenses, to play the role of basic medical insurance, serious illness insurance and medical assistance as a whole, medical insurance reimbursement of 90%, personal burden by financial subsidies. Based on the patient's admission time, it will be implemented until March 3, 20231day.
(two) the implementation of outpatient and emergency expenses special protection. For patients with infection and suspected symptoms in novel coronavirus, the outpatient and emergency expenses (within the scope of medical insurance catalogue) related to the treatment of novel coronavirus infection in designated medical institutions with first-class medical insurance (designated medical institutions with second-class and below) are not set with deductible line and capping line, and the proportion of medical expenses reimbursement within the scope of medical insurance policy is 70%. It will be implemented until March 3, 20231.
Second, expand the scope of medication.
In the "National novel coronavirus Infection Diagnosis and Treatment Plan", the combination package of nematevir tablets/ritonavir tablets for treating novel coronavirus infection, the monoclonal antibody of Ambavir for injection/Romizumab, Azivudine tablets, Danlawei capsules, Qingfei Jiedu granules, Sanhan Huashi granules and Sangju Yinqiao powder in the drug list of infected people in COVID-19, Yunnan Province are temporarily included in the scope of medical insurance payment, and are managed according to Class A drugs, and will be implemented until 20.
Third, do a good job in medical insurance settlement.
The outpatient and emergency medical expenses of the insured patients diagnosed as novel coronavirus infection and suspected symptoms by the designated medical institutions of primary medical insurance (designated medical institutions of secondary and below) are directly settled through the medical category of "COVID-19 Outpatient". The hospitalization expenses incurred by infected patients in novel coronavirus in medical institutions shall continue to be settled according to the ICD codes related to novel coronavirus infection published in the Notice on Printing and Distributing ICD Codes Related to novel coronavirus Infection (Guo Wei Han Yi [2020] No.58).
Fourth, the new internet is the first medical service.
Timely increase the price of online first-visit medical services. For public medical institutions that have been announced by the health department to allow online first-visit medical services, with reference to offline outpatient fees, according to the principle of online and offline consistency, temporary maximum price standards are formulated.
Verb (abbreviation of verb) strengthens fund supervision
Focus on monitoring and verifying the number of people infected with COVID-19 in designated medical institutions, the number of people, the proportion of funds used, the abnormal increase in expenses and other indicators, and carry out multi-sectoral joint punishment for those who use medical insurance funds in violation of regulations to ensure the safety of medical insurance funds and ensure that the treatment expenses are spent on the cutting edge.
Work requirements related to intransitive verbs
Local medical insurance, finance, health and health departments should deeply understand the significance of doing a good job in the medical insurance for the treatment expenses of infected patients in novel coronavirus during the period of "B and B management", earnestly improve their political stance, strictly implement national requirements, fulfill departmental responsibilities, and compact their work responsibilities, so as to promote the implementation of the medical insurance policy for the treatment expenses of infected patients in novel coronavirus, so that insured patients can truly enjoy the policy dividend and ensure that the province can smoothly spend the peak period of infection.
Major problems and situations encountered in local work, please report to the Provincial Medical Insurance Bureau, the Provincial Department of Finance and the Provincial Health and Wellness Committee in a timely manner.
This notice shall be implemented as of October 8, 2023/kloc-0. In case of national policy adjustment during the implementation period, it shall be strictly implemented in accordance with national regulations.
Attachment: Notice of the National Health Insurance Bureau, the Ministry of Finance, the National Health and Wellness Commission and the National Bureau of Disease Control on Optimizing the Medical Insurance Policy for the Treatment Expenses of Infected Patients in novel coronavirus after the Implementation of Class B Management.
Yunnan province medical security bureau
Yunnan Provincial Department of Finance
Yunnan Provincial Health and Wellness Committee
65438+202317 October
The same day
Yunnan Provincial Medical and Social Security Bureau also released
Interpretation of relevant policies
↓↓↓
(Screenshot of "Yunnan Medical Security" WeChat)
In order to adapt to the current situation of epidemic prevention and control and implement the overall plan of "Class B management" smoothly and orderly, on June 7, 2023, the Provincial Medical Insurance Bureau, together with the Provincial Department of Finance and the Provincial Health and Health Commission, issued the Notice of Yunnan Medical Insurance Bureau and other three departments forwarding to the National Medical Insurance Bureau and other four departments on optimizing the relevant policies of novel coronavirus infected patients' medical insurance after the implementation of "Class B management" (Yun Medical Insurance [2023] No.2). Timely adjust and optimize the medical insurance policy for the treatment expenses of infected patients in novel coronavirus, and implement it from 0: 00 on June 8, 2023, first to 438+0 on March 365, 2023.
First, continue to implement the policy of full reimbursement of hospitalization expenses.
Novel coronavirus infected patients in all medical institutions, in line with the health sector to develop novel coronavirus infection diagnosis and treatment program, hospitalization medical expenses are fully guaranteed. Give full play to the role of basic medical insurance, serious illness insurance and medical assistance, with medical insurance reimbursement of 90% and financial burden of 10%.
The second is to implement a special guarantee for outpatient and emergency expenses.
In order to ensure that infected patients in novel coronavirus can get medical services in time at the initial stage of infection, and to increase the support of medical insurance to rural and urban communities and other primary medical institutions, there is no deductible line and capping line for outpatient and emergency expenses related to novel coronavirus infection treatment for infected patients in primary (secondary and below) designated medical institutions in novel coronavirus, and the reimbursement rate within the scope of medical insurance policy is 70%, which is uniformly implemented by the whole province.
The third is to temporarily expand the scope of medical insurance payment.
On the basis of the national medical insurance drug list, 53 kinds of drugs out of the national medical insurance list, such as the combination package of nemativir tablets and ritonavir tablets used to treat novel coronavirus infection in the national novel coronavirus infection diagnosis and treatment plan, Ambavirumab/Romizumab for injection, Azvudine tablets, Monola Wei capsules, Qingfei Detoxification Granules, Sanhu Yinqiao Powder, etc. in the drug list of infected people in COVID-19, Yunnan Province, were temporarily included in the medical insurance.
The fourth is to increase online first-time medical services.
Timely increase the price of online first-aid services, and public medical institutions that are allowed to carry out online first-aid services announced by the health department shall follow the principle of online and offline consistency and refer to offline outpatient treatment fees.
Source: Yiliang Circle is comprehensively organized by National Medical Insurance Bureau and Yunnan Medical Security.
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