Jiangxi Province, the new crown medical insurance reimbursement policy

Today (January 8) onwards

new coronavirus infection formally implemented "Class B B tube"

Recently

Jiangxi Provincial Bureau of Medical Security, Jiangxi Provincial Department of Finance,

Jiangxi Provincial Health Commission issued

"on the implementation of the new coronavirus infection" Class B B tube "after

medical security optimization measures notice"

to understand

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Jiangxi Provincial Bureau of Medical Security, Jiangxi Provincial Department of Finance,

Jiangxibe B tube" after

medical insurance optimization measures notice

a to understand

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Jiangxi Provincial Bureau of Medical Protection Jiangxi Provincial Department of Finance Jiangxi Provincial Health Commission

on the implementation of the new coronavirus infection "Class B B tube" after

The notice of medical insurance optimization measures

Gan medical insurance hair [2023] No. 1

Each district city medical insurance bureau, Finance Bureau, Health Health Commission:

In order to implement the CPC Central Committee, the State Council and the provincial party committee, the provincial government's decision-making and deployment, according to the "B B tube" overall program "to protect the health, Prevention of serious illness" requirements, to ensure that the people smoothly through the peak of infection, according to the "National Health Insurance Bureau Ministry of Finance National Health and Health Commission National Disease Control Bureau on the implementation of the "Class B B tube" after the implementation of the optimization of new coronavirus infected patients with treatment costs of medical insurance related policies" (medical insurance hair [2023] No. 1) spirit, "the new coronavirus infection", the new coronavirus infected patients with the new coronavirus infected patients with the new coronavirus infection. The spirit of [2023] No. 1, and effectively reduce the cost burden of patients with new coronavirus infection, is now to further optimize the province's new coronavirus infection patients medical security measures related matters are notified as follows:

First, the implementation of the new coronavirus infection patients diagnosed with inpatient hospitalization medical cost continuation of the protection

The new coronavirus infection patients in the province within the scope of the fixed-point health care institutions (including temporary inclusion of medical insurance agreement management of medical institutions) occurred, the new coronavirus infection patients, the new coronavirus infection patients, the new coronavirus infection patients in the province (including temporary inclusion of medical insurance agreement management). Medical institutions), in line with the health sector to develop the "new coronavirus infection diagnosis and treatment program" of the hospitalization medical costs, continue to be in accordance with the "Jiangxi Provincial Bureau of Health Insurance Jiangxi Provincial Department of Finance on the new coronavirus infection of the pneumonia epidemic of medical protection work notice" (Gan Medical Insurance Electric [2020] No. 2) and "Jiangxi Provincial Bureau of Health Insurance Office Jiangxi Provincial Department of Finance Office Jiangxi Provincial Health Commission Office of the Jiangxi Provincial Health Insurance Bureau Office of the Jiangxi Provincial Department of Finance Office of the Jiangxi Provincial Health and Health Commission Office of the new coronavirus infected pneumonia epidemic on further improving the work of medical protection (Gan medical insurance office word [2020] No. 3) "two ensure" cost protection policy implementation. The individual part of the hospitalization medical expenses of insured patients after the payment of basic medical insurance, major disease insurance and medical aid according to the regulations shall be borne by the financial sector, of which 60% shall be subsidized by the central government and 40% shall be borne by the financial sector of the insured place (40% shall be borne by the financial sector of the place of residence of those who are not insured). The above hospitalization medical expenses will be advanced by the designated medical institutions in the place of medical treatment before applying to the financial department for settlement. Specific settlement matters to be announced.

Second, the implementation of the new coronavirus infection insured patients outpatient emergency medical expenses temporary special protection

Co-operation with the implementation of hierarchical diagnosis and treatment, guiding patients to the grass-roots level of medical care, to ensure that the medical services are smooth and orderly. Increase the health insurance to rural areas, urban communities and other primary health care institutions (second level and the following medical institutions) inclined to support the primary health insurance designated medical institutions, the new coronavirus infection and suspected symptoms of the insured patients outpatient emergency expenses, the implementation of a special protection, to encourage the primary health care institutions with the full health insurance directory (including the temporary supplement) of the new coronavirus infection treatment drugs. The outpatient and emergency medical expenses incurred by insured patients in primary health insurance designated medical institutions, in line with the "new coronavirus infection diagnosis and treatment plan (tentative 10th edition)" and within the scope of the health insurance directory, related to the treatment of the new coronavirus infection, are temporarily included in the scope of payment of the province's basic health insurance fund, with no starting line or ceiling, and a uniform reimbursement rate of 70%. After the reimbursement of the special outpatient protection, the reimbursement will no longer be superimposed on other health insurance reimbursement (including outpatient co-ordination) policies. The province's unified use of "new crown outpatient" medical category, through the province's unified health insurance information system to settle the relevant outpatient emergency expenses, the realization of the network instant settlement of reimbursement; can not be instantly settled, can be related to outpatient expenses to the participating health insurance agencies to apply for manual reimbursement.

The insured patients in other medical institutions in the new coronavirus infection treatment outpatient emergency costs, in accordance with other Class B infectious diseases health insurance policy.

Third, the implementation of the temporary health insurance drug catalog to meet the needs of patients with medication

Implementation of the new coronavirus infection patient needs medication health insurance payment temporary protection, in the implementation of the national health insurance drug catalog on the basis of the "new coronavirus infections diagnostic and treatment program (Trial 10th Edition)" within the scope of the new coronavirus infections, but belongs to the scope of the national health insurance drug catalog outside the scope of the new coronavirus treatment medicines, the temporary inclusion of the province's health insurance payment, according to the "Class A". Payment will be made in accordance with "Category A". Due to insufficient supply of drugs, can refer to the provincial joint prevention and control mechanism identified new coronavirus infection treatment drug catalog, by the Provincial Health Insurance Bureau combined with the operation of the health insurance fund, put forward the temporary inclusion of the province's health insurance drug catalog of varieties, duration and reimbursement categories, reported to the National Health Insurance Bureau for the record after the implementation.

Fourth, do a good job "Internet +" health insurance services, help patients online diagnosis and treatment

For the health sector permitted for the new coronavirus infection open Internet first diagnosis service, the co-ordination of the district health insurance department unified new set up "Internet (remote) new coronary first diagnosis The medical insurance department of each coordinating area has unified the establishment of "Internet (remote) new coronary first consultation" medical service price item, differentiated the grade of medical personnel, set the price according to the same standard as online and offline, and included in the province's medical insurance according to the payment of "Category A", and according to the regulations, provide patients with symptoms related to new coronary virus infection in line with the "Guidelines for Home Treatment of New Coronary Virus Infected Patients" with the medical insurance mobile payment settlement service and reimbursement. The reimbursement standard is the same both online and offline. The reimbursement standard is the same online and offline. For the follow-up service of the symptoms related to the new coronavirus infection, it is still implemented according to the current payment policy of the follow-up service on the Internet.

V. Continuing to do a good job of the new coronavirus-related drugs and equipment emergency network procurement and price monitoring

In accordance with the "Jiangxi Provincial Bureau of Medical Protection on doing a good job of the new coronavirus outbreak-related drugs and equipment emergency network procurement and price monitoring work of the notice" (Gan medical insurance word 〔2022〕 No. 43) and the "Jiangxi Provincial Bureau of Medical Protection on the further enhancement of the new coronavirus outbreak-related drugs platform supply work of the notice" (Gan medical insurance word 〔2023〕 No. 1), "the new coronavirus outbreak-related drug platform supply work" (Gan medical insurance word 〔2023〕 No. 1). 2023] No. 1), continue to do a good job of centralized procurement, listed procurement, record procurement, price monitoring and other work of medicines required for the treatment of patients with new coronavirus infections, and effectively strengthen the security of supply of medicines in rural areas and grassroots level. This includes following up on the implementation of negotiated prices for medicines and equipment, as well as the purchase price of vaccines.

Sixth, continue to optimize the management of health insurance management services

The coordinating area health insurance agency should be timely according to the needs of the non-medical insurance designated medical institutions with new coronary virus infection treatment capacity to sign a temporary new coronary virus infection treatment health insurance service agreement, to guide various types of medical institutions to do a good job in the new coronary virus infection related to the diagnosis, settlement of the collection and uploading of information and settlement of health insurance costs. The medical insurance service agreement should be optimized, and the process of medical insurance administration should be optimized. To optimize the process of medical insurance administration and provide convenient medical insurance services. We will continue to provide convenient medical insurance services, implement the long-term prescription medical insurance payment policy, and carry out online handling of routine matters, timely handling of urgent matters, convenient handling of special matters, delayed handling of non-urgent matters, and elimination of hidden dangers with peace of mind. To give full play to the power of the office, to promote the sinking of services, to do a good job of participating in the mobilization of publicity and other services at the same time, with the relevant departments to do a good job in rural areas, urban communities, health promotion, popularization of knowledge of the epidemic prevention and control, and improve the masses of self-protection awareness, and effectively achieve the management of the health care management is not relaxed, health care management services uninterrupted.

VII, continue to do a good job of other new coronavirus infection health care

(a) new coronavirus vaccine and vaccination costs continue to be in accordance with the "Jiangxi Provincial Bureau of Health Protection Jiangxi Provincial Department of Finance Jiangxi Provincial Health Commission on the new coronavirus vaccine and vaccination costs to do a good job to protect the work of the notice" (Gan medical insurance hair 〔2021〕 No. 2) and the "Jiangxi Provincial Bureau of Health Protection Jiangxi Provincial Department of Finance Jiangxi Provincial Health Commission on the new coronavirus vaccine and vaccination costs protection work" (Gan medical insurance hair [2021] No. 2) and the "Jiangxi Provincial Bureau of Health Protection Jiangsu Province Health and Health Commission on the new coronavirus vaccination costs of health insurance payment standards notice "(Gan Medical Insurance Development [2021] No. 9) document requirements, as well as the national dynamic adjustment of the spirit of the relevant documents.

(ii) new coronavirus nucleic acid testing costs in strict accordance with the "Jiangxi Provincial Bureau of Medical Security Office forwarded to the Office of the State Medical Security Bureau on the standardization of health insurance fund to pay nucleic acid testing costs of the notice on the relevant issues" and "Jiangxi Provincial Bureau of Medical Security Jiangxi Provincial Department of Finance Jiangxi Provincial Health Health Commission on the standardization of health insurance fund to pay for the cost of the new coronavirus nucleic acid testing costs of the notice on the relevant issues" (Gan medical insurance word [ 2022] No. 32) document requirements, as well as the spirit of the national dynamic adjustment of the relevant documents. 2022] No. 32) document requirements for the implementation of the strict implementation of the health insurance fund to pay the relevant provisions, shall not be unauthorized expansion of the scope of payment, and effectively protect the insured people to see a doctor when the new coronavirus nucleic acid test costs, according to the provisions of the payment. "Close contacts" "foreign entrants" "new hospitalized patients accompanying personnel" and other non-diagnostic nucleic acid testing costs, not included in the scope of payment of the health insurance fund.

Eight, safeguard measures

(a) new coronavirus infection implementation of the "B B tube", is the Party Central Committee, the State Council in a comprehensive assessment of the virus mutation, the epidemic situation and our prevention and control work on the basis of a major decision, the relevant departments around the world to raise the political position, strengthen the coordination of departments, and effectively fulfill their responsibilities, to ensure that the policy is effective. Ensure that the policy is effective. The medical insurance department is responsible for the relevant cost audit, settlement work, and strengthen the supervision of the fund; the financial sector is responsible for the timely disbursement of financial subsidies; the health sector is responsible for guiding medical institutions to do a good job in a timely manner in the identification of new crown patients, information registration and uploading work, and timely publication of the list of medical institutions that provide "Internet +" medical services, and at the same time responsible for the New crown patients' information and data upload work in a timely manner.

(ii) health insurance to pay for the new coronavirus infection costs to implement special protection, not included in the annual basic health insurance integrated total budget scope, from the health insurance fund balance fund in previous years, the implementation of separate statistics, separate settlement. In integrated areas where the health insurance fund does not cover expenses, appropriate subsidies may be provided by local finances. In due course to promote intra-provincial fund transfer.

(c) the above temporary measures since the implementation of the new coronavirus infection "B B tube" date of implementation, the first implementation to March 31, 2023 (hospitalization cost protection to the time of admission shall prevail), whether the continuation of the relevant national policy requirements and new coronavirus infection prevention and control of the situation to be determined by a separate study. Temporary measures to pay for the health insurance fund, medical insurance departments at all levels to strengthen supervision to ensure the safe and smooth operation of the fund.

Jiangxi Provincial Bureau of Medical Protection

Jiangxi Provincial Department of Finance

Jiangxi Provincial Health Commission

January 7, 2023

(This is an active public)