Article 1 In order to further improve the management of severe chronic disease medical care, to reduce the economic burden of insured persons suffering from severe chronic disease, according to "Pingdingshan City, urban workers basic medical insurance interim measures (Ping [1999] No. 86) to develop this approach.
Second, severe chronic disease refers to the insured persons suffering from hospitalization conditions of severe diseases requiring long-term treatment or drug support, approved by the use of outpatient treatment and the integrated fund to pay for the costs of the prescribed medical insurance (see table).
Article 3 insured persons suffering from one of the diseases listed in this method and meet the basic conditions of diagnosis, can apply for outpatient treatment
Applicants for outpatient treatment need to fill out the "Pingdingshan City, identification of severe chronic diseases application form, and provide "two A" or more or specialist designated medical institutions diagnostic certificates and related materials (recent hospitalization medical records, laboratory tests, examination reports, etc.), to be submitted by the employer to the medical insurance agency.
Article 4: The medical insurance agency organizes experts to appraise the severe chronic diseases, and if the appraisal meets the conditions for outpatient treatment of severe chronic diseases, it will issue the "Handbook for Outpatient Treatment of Severe Chronic Diseases"
The appraisal work is organized once every half a year (the appraisal procedure of severe chronic diseases is shown in Appendix 2).
Article 5: Critical chronic diseases are managed under the "five fixed" management: i.e. fixed medical units, fixed treatment time, fixed scope of medication, fixed scope of treatment items, fixed cost limit, and if a participant suffers from more than one type of qualifying critical chronic diseases at the same time, the fixed amount of medical fee will be implemented according to the highest type of disease.
Article 6: The person who suffers from severe chronic diseases shall choose the qualified designated medical institution for treatment, and the designated medical institution shall not be changed within the approved treatment period, and may be re-selected at the expiration of the period,
Community medical service institutions that are qualified to be designated may apply for undertaking the work of providing medical services for the severe chronic diseases,
Article 7: Each approved treatment period for chronic diseases shall be up to 6 months. The maximum duration of treatment is six months, and those who need to extend the treatment due to their condition are required to re-apply for the treatment.
Article 8: The outpatient treatment of severe chronic diseases is subject to accounting and settlement management (except for anti-rejection treatment after organ transplantation). Patients with severe chronic diseases go to the designated medical institutions for medical treatment, and with the Manual of Outpatient Treatment of Severe Chronic Diseases, go through the bookkeeping procedures according to the procedures of inpatient medical treatment. To the end of the medical treatment, in line with the provisions of the integrated fund to pay the cost of the medical insurance agency directly to the hospital settlement, the individual part of the burden, by the individual to the hospital settlement,
Article 9 of the fixed-point medical institutions to set up a special department for the management of severe chronic disease patients to set up a medical file, a complete record of the changes in their condition and diagnosis and treatment of the situation, the management of the severe chronic disease department and the receiving doctor according to the disease The management department of the severe chronic disease and the receiving doctor should provide reasonable treatment and examination according to the condition. The drug list and diagnostic and treatment programs are implemented in accordance with the provisions of basic medical insurance. The restricted use of medicines in the drug list is also applicable to patients with severe chronic diseases, and the medicines that are "restricted to outpatient use" belong to the medicines that are not paid for by the integrated fund, and do not belong to the scope of medicines used for chronic disease treatment.
If a chronic patient needs consultation from other departments due to his/her condition, the treatment and medication costs required after the consultation can be included in the scope of payment.
Article 11 Medical expenses incurred by a chronic patient at a non-selected fixed-point medical institution or at a non-fixed-point medical institution shall not be paid by the co-ordination fund.
Article 11: The medical fees for chronic renal failure, malignant tumors, and anti-rejection treatment after organ transplantation shall be paid according to the hospitalization standard; the outpatient medical fees for other severe chronic diseases shall not be subject to a starting line, and shall not be counted as the number of hospitalizations, and shall not be computed in segments, and reasonable medical fees incurred shall be paid by the coordinated fund for 70% of the total medical expenses incurred by the active employees, and by the coordinated fund for 75% of the total medical expenses incurred by the retired persons.
Article 12: The medical expenses for chronic diseases paid by the integrated fund shall be counted as the maximum payment limit of the annual integrated fund or major disease assistance.
Article 13 These measures shall be implemented as of the date of issuance