COVID-19 infection officially implemented the "B and B tube"
In recent days
Jiangxi Provincial Medical Security Bureau, Jiangxi Provincial Department of Finance,
Issued by Jiangxi Provincial Health and Wellness Committee
"After the implementation of novel coronavirus's infection,' Class B B B tube'.
Notice of medical security optimization measures "
Let's study together.
↓↓↓
Jiangxi Provincial Medical Security Bureau Jiangxi Provincial Department of Finance Jiangxi Provincial Health and Wellness Committee
After the implementation of "Class B and B Tube" in novel coronavirus,
Notice of medical safety optimization measures
Jiangxi Medical Insurance Fa [2023] 1
Medical Insurance Bureaus, Finance Bureaus and Health and Wellness Committees of all districts and cities:
In order to implement the decision-making arrangements of the CPC Central Committee, the State Council, the provincial party committee and the provincial government, and in accordance with the requirements of "protecting health and preventing serious diseases" in the overall plan of "Class B management", we will ensure that the people can spend the peak period of infection smoothly. According to the spirit of the Notice of the National Health Insurance Bureau, the Ministry of Finance, the National Health and Wellness Committee and the National Bureau of Disease Control on Optimizing the Relevant Policies of Medical Insurance for Infected Patients in novel coronavirus after the Implementation of Class B Management (Medical Insurance Office [2023]1No.), the expenses burden of infected patients in novel coronavirus is effectively reduced. The relevant matters concerning further optimizing the medical insurance measures for infected patients in novel coronavirus, our province are hereby notified as follows:
First, the implementation of COVID-19 infected patients hospitalized medical expenses for continuous protection.
Hospitalization expenses incurred by novel coronavirus infected patients in the designated medical institutions (including those temporarily included in the medical insurance agreement management) that meet the "novel coronavirus Infection Diagnosis and Treatment Plan" formulated by the Health Department, Continue to implement the "two guarantees" cost guarantee policy in accordance with the Notice of Jiangxi Provincial Department of Finance of Jiangxi Provincial Medical Insurance Bureau on Doing a Good Job in Medical Security for Pneumonia Infected in novel coronavirus (Jiangxi Medical Insurance Bureau Office [2020] No.2) and the Supplementary Notice of Jiangxi Provincial Health Committee Office on Further Doing a Good Job in Medical Security for Pneumonia Infected in novel coronavirus (Jiangxi Medical Insurance Office [2020] No.3). The personal burden of hospitalization medical expenses after the insured patients' basic medical insurance, serious illness insurance and medical assistance are paid according to the regulations shall be borne by the financial department, of which: the central financial subsidy is 60%, and the financial burden of the insured places is 40% (the financial burden of the uninsured places is 40%). The above-mentioned hospitalization medical expenses shall be paid in advance by the designated medical institution in the patient's place of treatment, and then applied to the financial department for settlement. Specific settlement matters will be notified separately.
Two, the implementation of COVID-19 infected insured patients emergency medical expenses temporary special protection.
Cooperate with the implementation of graded diagnosis and treatment, guide patients to seek medical treatment at the grassroots level, and ensure stable and orderly medical services. Increase medical insurance to rural and urban communities and other primary medical institutions (secondary and below medical institutions) tilt support, for novel coronavirus infected and suspected symptoms of insured patients in primary medical insurance designated medical institutions for outpatient and emergency expenses, the implementation of special protection, to encourage primary medical institutions equipped with enough medical insurance directory (including temporary supplements) novel coronavirus infection treatment drugs. Insured patients in the designated medical institutions of primary medical care, in line with the novel coronavirus infection diagnosis and treatment program (Trial Tenth Edition) "and within the scope of the medical insurance catalogue, outpatient and emergency medical expenses related to infection treatment in novel coronavirus are temporarily included in the payment scope of our province's basic medical insurance pooling fund, with no deductible line and capping line, and the unified reimbursement ratio is 70%. After the reimbursement of special outpatient support, other medical insurance reimbursement (including outpatient co-ordination) policies will not be superimposed. The province unified the medical category of "COVID-19 outpatient service", and settled the related outpatient and emergency expenses through the unified medical security information system in the province, realizing online instant settlement and reimbursement; Can not be settled immediately, can hold the relevant outpatient bills to the insured medical insurance agencies to apply for manual reimbursement.
The outpatient and emergency expenses of the insured patients for novel coronavirus infection treatment in other medical institutions shall be implemented in accordance with the medical insurance policies for other Class B infectious diseases.
Three, the implementation of temporary medical insurance drug list, to meet the needs of patients.
If the infected patients in COVID-19 need temporary medical insurance payment, they will be temporarily included in the scope of medical insurance payment in our province on the basis of COVID-19 treatment drugs within the scope of the National Medical Insurance Drug List and the novel coronavirus Infection Diagnosis and Treatment Plan (Trial Tenth Edition), but outside the scope of the National Medical Insurance Drug List, and will be paid as "one time". Due to the shortage of drugs, you can refer to the list of drugs for the treatment of novel coronavirus infection identified by the provincial joint prevention and control institutions. Combined with the operation of the medical insurance fund, the Provincial Medical Insurance Bureau puts forward the varieties, time limits and reimbursement categories temporarily included in the medical insurance drug list of our province, and reports them to the National Medical Insurance Bureau for the record before implementation.
Fourth, do a good job in the "internet plus" medical insurance service to help patients make online diagnosis and treatment.
For the first consultation service of novel coronavirus infected with the Internet allowed by the health department, the medical insurance departments in all co-ordination areas have newly set up the "COVID-19 Internet (Remote) First Consultation" medical service price item, which distinguishes the grades of medical personnel, sets the price online and offline according to the same standard, and includes it in our province's medical insurance and pays according to "Class A". According to the regulations, medical insurance mobile payment and settlement services are provided for patients who have symptoms related to novel coronavirus infection and meet the Guidelines for Family Treatment of Infected Persons in novel coronavirus, and the reimbursement standards are consistent online and offline. Follow-up services for infection-related symptoms in novel coronavirus are still implemented according to the current Internet follow-up payment policy.
Five, continue to do a good job in COVID-19 related medical equipment emergency online procurement and price monitoring.
In accordance with the Notice of Jiangxi Medical and Social Security Bureau on Doing a Good Job in Emergency Online Procurement and Price Monitoring of Medical Devices Related to COVID-19 Epidemic (No.43 [2022] issued by Jiangxi Medical and Social Security Bureau) and the Notice of Jiangxi Medical and Social Security Bureau on Further Strengthening the Supply of Drugs Related to COVID-19 Epidemic (No.20231issued by Jiangxi Medical and Social Security Bureau), we will continue to do a good job in centralized procurement and treatment of drugs needed for novel coronavirus infected people. Including the follow-up implementation of the negotiated price of medical devices and the purchase price of vaccines.
Six, continue to optimize the medical insurance management services.
As a whole, regional medical insurance agencies should, according to needs, sign a temporary novel coronavirus infection treatment medical insurance service agreement with non-medical insurance designated medical institutions with novel coronavirus infection treatment ability in time, and guide all kinds of medical institutions to do a good job in the collection and uploading of information related to novel coronavirus infection diagnosis and treatment settlement and the settlement of medical insurance expenses. It is necessary to optimize the medical insurance handling process and provide convenient medical insurance services. It is necessary to continue to provide convenient medical insurance services, implement the long-term prescription medical insurance payment policy, implement routine medical insurance handling on the Internet, timely deal with emergency matters, private special matters, delay non-emergency matters, and eliminate hidden dangers. It is necessary to give full play to the handling power, promote the sinking of services, cooperate with relevant departments to do a good job in promoting health in rural and urban communities, popularize knowledge of epidemic prevention and control, raise people's awareness of self-protection, and effectively ensure that medical insurance management is not relaxed and medical insurance handling services are not interrupted.
Seven, continue to do a good job in other novel coronavirus infection medical security work.
(1) COVID-19's vaccine and vaccination expenses continue to be in accordance with the Notice of Jiangxi Provincial Health and Wellness Committee, Jiangxi Provincial Department of Finance and Jiangxi Provincial Medical Insurance Bureau on Doing a Good Job in Safeguarding COVID-19's Vaccine and Vaccination Expenses (Jiangxi Provincial Medical Insurance Bureau [2021] No.2) and the Notice of Jiangxi Provincial Health and Wellness Committee, Jiangxi Provincial Department of Finance, Jiangxi COVID-19 Medical Insurance Payment Standard for Vaccination Expenses (Jiangxi Provincial Medical Insurance Bureau [202/]
(II) The cost of nucleic acid testing in COVID-19 is strictly in accordance with the requirements of the Notice of the Office of Jiangxi Provincial Medical Insurance Bureau on Forwarding the Office of the State Medical Insurance Bureau on Issues Related to Standardizing the Payment of Nucleic Acid Testing Costs by Medical Insurance Fund and the Notice of Jiangxi Provincial Health and Health Committee of Jiangxi Provincial Department of Finance on Issues Related to Standardizing the Payment of Nucleic Acid Testing Costs by COVID-19 Medical Insurance Fund (No.32 [2022]). Strict implementation of the relevant provisions of the medical insurance fund payment, shall not be allowed to expand the scope of payment, and effectively protect the insured person to see a doctor when COVID-19 nucleic acid testing costs, according to the provisions of payment. The expenses of nucleic acid testing for non-medical purposes such as "close contacts", "overseas entry personnel" and "caregivers of newly hospitalized patients" are not included in the scope of medical insurance fund payment.
Eight. safeguard measure
(1) The implementation of "B and 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 in all localities should improve their political positions, strengthen departmental coordination and linkage, earnestly perform their duties, and ensure that policies are effective. The medical insurance department is responsible for the audit and settlement of related expenses and strengthening fund supervision; The financial department is responsible for timely disbursement of financial subsidies; The health department is responsible for guiding medical institutions to do a good job in COVID-19 patients' identification, information registration and uploading in time, publishing the list of medical institutions providing "internet plus" medical services in time, and uploading COVID-19 patients' information and data in time.
(II) Medical insurance pays novel coronavirus infection expenses to implement special guarantee, which is not included in the overall budget of the annual basic medical insurance, and is charged from the surplus funds of the medical insurance fund over the years, and is subject to separate statistics and separate settlement. The medical insurance fund is indeed a co-ordination area where the income exceeds the expenditure, and the local finance can give appropriate subsidies. Promote the adjustment of funds in the province in a timely manner.
(3) The above-mentioned temporary measures shall be implemented from the date of implementation of "B and B management" of novel coronavirus infection, and shall be implemented first until March 3, 20231day (hospitalization expenses shall be guaranteed according to admission time). Whether to continue should be determined according to the relevant national policy requirements and the situation of infection prevention and control in novel coronavirus. For the temporary payment measures of medical insurance fund, medical security departments at all levels should strengthen supervision to ensure the safe and stable operation of the fund.
Jiangxi province medical security bureau
jiangxi provincial department of finance
Jiangxi Provincial Health and Wellness Committee
65438+202317 October
(This film is voluntary)