Notice on the launch of the new disposable materials database
The designated medical institutions:
According to the Shandong Provincial Department of Labor and Social Security "on the issuance of" Shandong Province urban workers' basic medical insurance diagnostic and treatment items catalog "and" Shandong Provincial Urban Workers' Basic Medical Insurance Medical Service Facilities Item Scope "of the notice" (LuLuShe [2001] No. 2) spirit. In accordance with the national basic medical insurance system must adhere to the "basic protection, extensive coverage" principle, in accordance with the Shandong Provincial Price Bureau, Shandong Provincial Department of Health "on the issuance of" Shandong Province, the Ministry, the provincial medical institutions prices (clinical diagnosis and treatment) "Notice" (Lu price FeiFa [2008] No. 193) in the" Shandong Province, the Ministry, the provincial medical institutions may be Another charge for disposable materials catalog" the scope of the provisions of the provincial and municipal sentinel medical institutions to convene the relevant experts on the use of basic medical insurance disposable materials for demonstration and discussion. Now the relevant matters are notified as follows:
A, the use of regulations
1, the provincial price departments are not allowed to charge separately, shall not be entered into the disposable materials database settlement of the use of;
2, the provincial price departments can be charged separately, the basic medical insurance does not pay for, can be entered into the database of disposable materials, settlement of the cost of the entire individual to pay.
3. Provincial price departments stipulate that separate charges can be made and basic medical insurance is allowed to pay for disposable medical materials exceeding 100 yuan, with 15% personal responsibility for domestically produced ones, 40% for imported ones, and zero for those below 100 yuan; the costs are borne by individuals proportionately after they enter into the co-ordination.
Two, management mode
Refine the structure of the database categories. From the past general, vague categories into a clear and specific material common name, to facilitate the fixed-point medical institutions to correspond to the report, to facilitate the review and supervision of the management department.
Three, reporting requirements
The database required to fill out the project, the entry fields must be complete and standardized. General name must be in accordance with the standardized name of the complete expression, specifications and models to fill in accurately, shall not be abbreviated or replaced by letters; the time of entry in accordance with the actual time of entry; the manufacturer must fill in the complete, imported and domestic corresponds to the accuracy of the material categories must be in accordance with the scope of the provisions of the corresponding fill in. Does not meet the reporting requirements, the city health insurance office does not add the deductible percentage, will not be used as a basis for settlement.
Four, the old and new database alternation time limit
Municipal Health Insurance Office will be established before August 30, 2009, a new one-time material database, September 1, 2009 onwards, the units began to enter, the old and new databases in parallel to October 31, November 1 from the abolition of the old database, the implementation of the new database. All units should seize the time and do a good job of entering the new database within the stipulated time, so as to ensure the normal settlement of the insured. Each designated medical institution shall disseminate the scope of use of disposable materials and policy regulations to each clinical department, so that each scheduled physician can grasp the relevant policies in time to ensure the normal operation of the new disposable materials database.
Attachment:
Scope of disposable materials allowed to be charged separately by Jinan Basic Medical Insurance
I. Disposable materials allowed to be charged separately
3. Surgical treatments
Stent, balloon, artificial implant; titanium clips, titanium nails, titanium plates; special guide wires, catheters, floating catheters, catheters to remove embolisms, anastomoses, sutures, anastomoses (suture) nail compartment, all kinds of drains. Nail bin, a variety of drainage tubes, drainage bottles, drainage bags, negative pressure suction device, ventricular shunt, disposable connecting tubes, disposable irrigation and flushing lines, indwelling catheters, tee, connecting tubes, tracheal catheters, central venous kits, nasogastric tubes, gastric tubes, pigtail tubes, anal tubes, special infected surgical kits, urinary catheters, disposable catheterization kits, colostomy devices, autologous blood transfusion device, endoscopic retrieval bags, stone removal Mesh baskets, disposable wire saws, saw blades; titanium connectors, hemostatic clips, ligature clips for positioning, arterial clips, silver clips, scalp clips, etc.; bone wax, indwelling needles, special puncture needles, special suture needles (threads), absorbable hemostatic materials (bio-protein sponges, gelatine sponges), anti-adhesion; plaster bandages, elastic bandages, polyester bandages, self-adhesive bandages, polymer bandages, elastic liners, chest straps, abdominal belt dressings, adhesive tapes, Skin protection film, brain tampons, sterile adhesive no-sew strips, disposable mesh headgear, disposable pressurized pads; silicone oil.
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