Recently, the city has further accelerated the full implementation of the responsibility system for diabetes health supervisors, mobilized designated medical institutions with health management capabilities, and initiated peer-to-peer invitations to diabetic patients by telephone and SMS. Then, after the full implementation of the responsibility system for diabetes health supervisors, what changes will be made in relevant policies? Yesterday, the relevant person in charge of the Municipal Medical Insurance Bureau made an interpretation.
Tianjin North Network News: Recently, the city has further accelerated the full implementation of the responsibility system for diabetes health supervisors, mobilized designated medical institutions with health management capabilities, and initiated peer-to-peer invitations to diabetic patients by telephone and SMS. Then, after the full implementation of the responsibility system for diabetes health supervisors, what changes will be made in relevant policies? Yesterday, the relevant person in charge of the Municipal Medical Insurance Bureau made an interpretation.
According to reports, after diabetic patients accept the offer, the designated medical institutions for medical insurance will be upgraded from the designated treatment institutions selected by diabetic patients to the health authorities for patients. After the upgrade, the Health Administration will be responsible for providing health management services related to diabetes, such as health education, disease monitoring, complication screening, diagnosis and treatment drugs and referral. Patients go to the health authorities to receive special treatment for diabetes, and the medical insurance reimbursement is not affected by the adjustment of the Catalogue of Drugs for Special Diseases in Diabetes Outpatients (Revised Edition) in 2022 after 65438+February/kloc-0.
According to the relevant regulations on the implementation of the health responsibility system for diabetic patients in this city, after the designated medical institutions for diabetic patients are upgraded to the competent health department, the medical insurance will relax the management restrictions on the payment scope and hospitalization times of diabetic patients, and the medical security benefits related to diabetic patients will not be affected.
Scope of medical insurance reimbursement: diabetic patients go to the health authorities for special treatment of diabetes. According to the actual situation of patients, the health authorities choose appropriate medical services from the scope of payment of basic medical insurance in this city and formulate standardized medical treatment plans for diabetes and complications. The medical expenses incurred shall be reimbursed by the medical insurance fund according to the special treatment standards for diabetes stipulated in the Catalogue of Drugs for Special Diseases in Diabetes Outpatients in 2022 (Revised Edition).
Number of hospitals: After having the competent health department, diabetic patients who need to go to other medical institutions for special treatment of diabetes due to their illness can agree with the competent health department to turn the originally selected designated medical institutions into referral cooperative medical institutions of the competent health department, or choose other designated medical institutions as referral cooperative medical institutions under the guidance of the competent health department. The number of referral cooperative medical institutions can be determined according to actual needs, and it is no longer limited by the number of tertiary medical institutions in policy. Patients go to referral cooperative medical institutions for special diagnosis and treatment of diabetes, and medical insurance reimbursement is not restricted by the Catalogue of Drugs for Special Diseases in Diabetes Outpatients (Revised Edition) in 2022.
In addition, if the health authorities or their referral cooperative medical institutions have issued outsourcing prescriptions, all designated retail pharmacies in the city that have opened Internet settlement can sell corresponding drugs to diabetic patients according to their posts, and the medical insurance reimbursement treatment is the same as that of the medical institutions that have issued prescriptions. If the insured patient chooses the contract medical association as the health authority, and all members of the contract medical association are the health authorities of the patient, the patient can go to each member of the contract medical association for diabetes treatment and credit card reimbursement.
Medical insurance treatment standard: diabetic patients go to the health authorities and their referral cooperative medical institutions for medical treatment, and the medical expenses incurred by diabetic patients can be directly reimbursed by credit card according to regulations. The medical insurance treatment standards for diabetic patients, including the minimum payment standard, the proportion of medical insurance reimbursement and the maximum payment limit, are implemented according to the existing regulations and are not affected by any factors.