On the afternoon of January 8, the reporter learned from the Shaanxi Provincial Bureau of Medical Protection, the Bureau, together with the financial, health departments, the first time to implement the requirements, optimization, refinement and improvement of the eight policy initiatives, and make every effort to protect the people's lives and health security. The relevant initiatives since the implementation of the new coronavirus infection "B B tube" date of implementation.
On the new coronary patients hospitalization cost protection
Hospitalization medical costs of the individual part of the financial subsidies at all levels
The new coronary virus infected patients in all the admitted medical institutions, in line with the new coronary virus infections formulated by the health department of the diagnosis and treatment of medical costs of hospitalization, the implementation of the cost of upfront protection policy, by the basic medical insurance, insurance, medical assistance, etc., according to the provisions of payment. After the basic medical insurance, major disease insurance, medical assistance and other required payment, the individual part of the burden by the financial subsidies at all levels, of which:
The central government will bear 60%, the provincial government will bear 20%, the city and county will bear 20%. The required funds, according to the principle of territoriality, by the health insurance department after review, by the city (district), county (district) financial first payment, the central and provincial financial according to the actual costs incurred in the actual settlement.
The policy is calculated on the basis of the patient's admission time, the first implementation until March 31, 2023.
The medical costs of patients with new coronavirus infection are budgeted separately, not included in the total budget target of the designated medical institutions, not included in the scope of DRG/DIP payments, and paid on a per-project basis.
On the new crown patients outpatient emergency treatment cost protection
Second-level and the following designated medical institutions outpatient emergency reimbursement ratio of 70%
Increase the medical insurance to rural areas, urban communities and other primary health care institutions tilted to support the coordinated promotion of the implementation of hierarchical diagnosis and treatment, to guide the patient grass-roots level of medical care. Unify the outpatient protection treatment for new coronavirus infections, implement special protection for outpatient and emergency expenses of insured patients with new coronavirus infections and suspected symptoms occurring in second-level and lower-level health insurance designated medical institutions, and primary medical institutions should be fully equipped with new coronavirus infections therapeutic medicines in the medical insurance drug list (including temporary additions by the province),
Insured patients' expenses for treatment of new coronavirus infections occurring in primary health insurance designated medical institutions should be fully allocated to primary health care institutions. The outpatient and emergency expenses related to the treatment of coronavirus infection in the primary health insurance designated medical institutions, there is no starting line and ceiling line, the reimbursement rate of 70%, the first implementation until March 31, 2023.
Participants in the insurance policy, the outpatient and emergency expenses related to the treatment of coronavirus infection.
The outpatient and emergency expenses incurred by insured patients for the treatment of new coronavirus infections in other medical institutions shall be implemented in accordance with the current reimbursement policy of the medical insurance.
On the new coronary patients medication security
Expand the scope of health insurance drugs to implement the temporary catalog
In order to adapt to the current situation of the epidemic, to meet the needs of new coronary patients with medication, new coronary virus infections in the new coronary virus diagnosis and treatment program of new coronary virus treatment drugs to extend the temporary payment policy of health insurance, the first to implement until March 31, 2023. The drugs outside the catalog in the "Diagnostic and Treatment Program for Novel Coronavirus Infections (Trial Implementation of the 10th Edition)" will be temporarily included in the scope of payment of the medical insurance fund, and will be managed in accordance with Category A. The province will temporarily include the drugs in Category B. The drugs temporarily included in our province are managed according to Category B.
Municipalities (districts) health insurance department in a timely manner according to the National Health and Health Commission's new coronavirus infection diagnosis and treatment program, in conjunction with the same level of health departments to do a good job in comparison with the screening of drugs outside the directory, do a good job of their own policy marking and maintenance work. In accordance with the requirements of the "Guiding Opinions on Actively Promoting the Work of Medical Insurance Access for Therapeutic Medical Institutions' Preparations", we should speed up the work of medical insurance access for therapeutic in-hospital preparations, and include the eligible in-hospital preparations for the prevention and treatment of the new coronavirus outbreak into the scope of payment of medical insurance according to the procedures. Effectively play a good Shaanxi national health insurance convergence and complementary role, and effectively protect the public medical needs.
On the new crown patients online clinic
Promote mobile payment settlement
Health departments around the world to timely publish the list of medical institutions to provide "Internet +" medical services, for the permission of the new coronary virus infection for the opening of the Internet first diagnosis service, in accordance with the provisions of the new coronary virus infection patients with symptoms. For patients with symptoms related to new coronavirus infections and those who meet the "Guidelines for Home Treatment of People with New Coronavirus Infections", the medical institutions should provide online diagnosis and treatment services, accelerate the promotion of mobile payment, and give full play to the advantages of the "Internet+" health insurance service for their medical institutions providing "Internet+" healthcare services. "Medical services of medical institutions to provide health insurance mobile payment settlement services.
The new Internet first consultation fee medical service price items, follow the principle of online and offline consistency, according to the province's current outpatient consultation fee standard charges, reimbursement standards and offline to maintain consistency. Follow-up services for symptoms related to the new coronavirus infection are still implemented in accordance with the current Internet follow-up reimbursement policy. Strengthen the information support, in accordance with the "new coronary infection outpatient reimbursement policy configuration operation manual" policy adjustments, in the health insurance information platform to do a good job of testing and verification, strengthen the training and guidance to improve the quality of service.
Regarding the standardization of health insurance code
Temporarily no national standard code to use the temporary code given by the province
All levels of health insurance departments to strengthen the docking with the same level of the health sector, timely upgrade of HIS system of the basic health to ensure that the community health institutions and village clinics are equipped with new medicines, consumables, and new diagnostic and therapeutic items for the treatment of new crowns in a timely manner to obtain the national health insurance code. For designated medical institutions that are temporarily included in the medical insurance, guidance should be provided to do a good job of standardization in a timely manner to ensure real-time and accurate settlement. Temporarily no national standard code of drugs, consumables, diagnostic items continue to use the province to give the temporary code.
On reducing the cost of new coronary treatment to enhance the ability of health insurance protection
Medical institutions can search offline clinically necessary drugs
The cities (districts) health insurance department to continue to do a good job of the new coronary virus infected patients with the treatment of the drugs required for the negotiation or negotiation of the price of centralized purchasing, purchases, listed purchases, record purchases, price monitoring and other work. Medical institutions can search offline procurement difficulties, clinical necessity and new coronary patients urgently needed drugs, medical supplies manufacturers for the record procurement, the relevant procurement information should be uploaded to the procurement platform in a timely manner.
The amount of drugs and medical consumables purchased for the record is not included in the proportion of offline purchases by medical institutions that do not exceed 5% of the total purchase amount.
Medical insurance departments at all levels should do a good job of monitoring the medical insurance fund, make full use of the information system, strengthen the treatment of new crowns of medical costs to monitor and analyze, such as the discovery of data anomalies, we must promptly organize on-site verification, to ensure that the safety of the medical insurance fund can be sustained. If the medical insurance fund is unable to cover its expenses, appropriate subsidies can be provided by the same level of finance. In due course to promote the provincial fund transfer, and further improve the health insurance fund **** relief capacity and the use of efficiency.
On the management of health insurance services
Multi-measures to optimize the handling of services
Municipalities (districts) health insurance department to actively expand the scope of the agreement with the new crown receiving medical institutions, with the new coronary virus infection treatment capacity of non-medicare fixed-point medical institutions to sign a new coronary virus infected patients receiving medical institutions health insurance cost settlement temporary special agreement to carry out the health insurance settlement. (c) Actively implementing long-term prescription medical insurance payment. We are actively implementing the long-term prescription health insurance payment policy, and implementing the online office, emergency matters in a timely manner, special matters for the convenience of the people, non-urgent matters postponed office, eliminating hidden dangers at ease office.
The guidance of various types of medical institutions to do a good job of new coronavirus infection-related diagnosis, settlement and other information collection and uploading, health insurance cost settlement work. All levels of the agency should do a good job of mobilization, health promotion, popularization of knowledge of the epidemic prevention and control, to improve the public self-protection awareness. To strengthen the five-tier network construction, give full play to the grass-roots management force, and promote the health insurance services to rural areas (community) sinking.
On the responsibilities of the relevant departments
Improve the coordinated mechanism to ensure the implementation of the policy
All departments should raise the political position, effectively fulfill their responsibilities, and work closely together, the health insurance department is responsible for the audit of the relevant costs, settlement of the work, and to strengthen the supervision of the fund; the financial sector is responsible for the timely disbursement of the financial subsidies; the health sector is responsible for guiding the medical institutions to do a good job in the identification of patients with the new type of coronavirus infection, the identification of patients with the new type of coronavirus infection, and to strengthen the supervision of the fund. The health department is responsible for guiding medical institutions to do a good job of identifying, registering and uploading information on patients infected with the new coronavirus, uploading information and data on patients infected with the new coronavirus, and upgrading the HIS system of basic health care. All departments should strengthen the coordination and linkage, timely communication and consultation, to ensure that the province's epidemic prevention work effectively promote the implementation of various policies.
Two new crown drugs into the health insurance
Pfizer Paxlovid failed to enter
2022 national health insurance drug catalog negotiation work on January 8 officially ended. The person in charge of the Department of Pharmaceutical Management of the National Health Security Bureau introduced the new crown treatment drugs to participate in the negotiation of the health insurance drug catalog.
This year,
*** there are azivudine tablets, nematodevir tablets / ritonavir tablets combination package (hereinafter referred to as "Paxlovid"), clear lung detoxification particles, three kinds of new crown therapeutic drugs through the independent declaration of the enterprise, the form of review, expert evaluation and other procedures, to participate in the negotiation. Among them,
Azulfidine tablets, lung detoxification particles negotiation success, Paxlovid due to the manufacturer of Pfizer Investment Limited offer high unsuccessful.
The person in charge said, although Paxlovid failed to negotiate the inclusion of health insurance directory, but according to the recent National Health Insurance Bureau in conjunction with the relevant departments jointly issued the "on the implementation of the" Class B B tube "after the implementation of the optimization of new coronavirus infections in patients with treatment costs of health care insurance policy notice" (hereinafter referred to as "notice") requirements, the new coronavirus infections in patients with the new coronavirus infection. ("Circular"), all therapeutic drugs in the "Diagnostic and Treatment Plan for New Coronavirus Infections (Trial Implementation of the 10th Edition)", including Paxlovid, Azulfidine Tablets, Monoravir Capsules, and Dispersing Cold and Resolving Dampness Granules, etc., will be paid for by the medical insurance on a temporary basis until March 31, 2023
. During this period, insured patients with new coronavirus infections will be eligible for reimbursement for these drugs.
In addition, Azulfidine tablets and lung detoxification granules have been included in the national health insurance drug list after the negotiation,
more than 600 medicines for treating fever, cough, and other symptoms of the new coronary symptoms have been included in the national health insurance drug list. At the same time, in order to meet the needs of patients with new coronary virus infection, the recent local health insurance departments combined with the operation of the local health insurance fund, and a number of new coronary symptomatic treatment of drugs temporarily included in the scope of payment of the region's health insurance. Overall, the medical insurance reimbursement of the new coronary virus infection treatment medication varieties.
The person in charge also said that the recent Office of the National Health Insurance Bureau issued the "new crown therapy drug price formation guidelines (for trial implementation)", the prevention and treatment of new coronavirus infection required by the new listed antiviral therapy drugs, to take a full cycle of multi-level measures to guide enterprises to open and transparent and reasonable pricing.