Shandong new crown reimbursement latest policy

Recently, Shandong Provincial Medical Protection Bureau, Shandong Provincial Department of Finance, Shandong Provincial Health and Health Commission jointly issued the "Notice on conscientiously implementing the medical insurance hair [2023] No. 1 document to optimize the province's new coronavirus infection patients treatment costs medical insurance related policies" (hereinafter referred to as "Notice"), clear in the primary health insurance designated medical institutions incurred in relation to the new coronavirus infection treatment Policy scope of outpatient emergency expenses, no starting line and ceiling line, the reimbursement rate of the province unified for 75%, the first implementation until March 31, 2023.

Optimization of health insurance inpatient payment policy to improve the level of grassroots outpatient protection

The "Notice" pointed out that the new coronavirus infection patients in all the receiving medical institutions, in line with the health sector to develop a new coronavirus infection diagnosis and treatment program of inpatient medical costs, continue to implement the previous cost protection policy, by the basic health insurance, major disease insurance, medical assistance, etc. After the payment in accordance with the regulations, the individual After the basic medical insurance, major disease insurance and medical aid are paid according to regulations, the individual part of the burden is subsidized by the finance, and the required funds are paid by the municipal finance first, and the provincial finance combines with the central subsidy to subsidize the municipalities in the districts (excluding the counties directly managed by the provincial finance) according to 80% of the actual incurred costs, and the counties directly managed by the provincial finance are subsidized according to 90% of the actual incurred costs. The policy is calculated on the basis of the patient's admission time and implemented until March 31, 2023 first.

Collaborate to promote the implementation of hierarchical diagnosis and treatment, guide patients to primary care, and ensure smooth and orderly medical services. 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, encourage primary health care institutions with full medical insurance drug catalog (including the province temporary additions) of the new coronavirus infection treatment drugs. The primary health insurance designated medical institutions in the new coronavirus infection and suspected symptoms of the insured patients outpatient emergency expenses to implement special protection, the insured patients in the primary health insurance designated medical institutions with the new coronavirus infection related to the treatment of outpatient emergency expenses within the scope of the policy, do not set up a starting line and ceiling line, reimbursement ratio of the province as a unified 75%, the implementation of the first until March 31, 2023,.

Participating patients in other medical institutions in the new coronavirus infection treatment outpatient emergency costs, in accordance with the coordinating area of the current basic health insurance outpatient protection policy.

Effective protection of medical institutions medical treatment costs Temporary expansion of the scope of medical insurance drug directory coverage

"Notice" clearly, the medical insurance departments at all levels to further improve the medical insurance fund advance payment work, to ensure that the new coronavirus infected patients admitted to the medical institutions of the medical insurance costs in place in a timely manner, the admitted to the medical institutions of the medical insurance fund in advance of the payment of not less than 1-2 months, and according to the needs of the timely addition to ensure that the medical insurance fund is sufficient. The medical insurance fund will be allocated at least 1-2 months in advance to the receiving medical institutions, and additional funds will be allocated as needed. The new coronavirus infection and suspected symptoms of insured patients treatment costs are not included in the total control indicators of medical institutions to ensure that patients receive timely treatment, to ensure that the receiving medical institutions do not affect the treatment of the total budget management provisions of medical insurance.

The national "new coronavirus infection diagnosis and treatment program" (hereinafter referred to as "diagnosis and treatment program") in the new coronavirus treatment drugs are not in the basic health insurance directory, temporarily included in the scope of payment of the health insurance fund, with reference to the management of Class A drugs, the first to implement until March 31, 2023; for the "diagnosis and treatment program" out of the basic health insurance directory of the drugs, according to the requirements of the timely suspension of the health insurance payment. The Provincial Health Insurance Bureau will work with relevant departments to determine the province's temporary inclusion in the health insurance payment of new coronavirus infection treatment drug list, reported to the National Health Insurance Bureau for the record after the implementation of the first implementation to March 31, 2023.

Doing a good job "Internet +" medical services and health insurance payment Further improve the price formation mechanism

"Notice" requires that the local health department to provide "Internet +" medical services in a timely manner to publish the list of medical institutions. For the industry sector permitted online for the emergence of new coronavirus infection related symptoms, in line with the "new coronavirus infected patients home treatment guidelines" to provide the first Internet services, to give the price and health insurance policy support, continue to be in accordance with the Provincial Bureau of Health Insurance, the Provincial Health Commission, "on the new coronavirus infections on the Internet medical insurance service work notice" (Lu medical insurance hair [2022] No. 44) implementation. To carry out health insurance mobile payment services should strictly implement the relevant technical standards of the National Health Insurance Bureau, relying on the national unified health insurance information platform, to realize the flow of health insurance electronic prescriptions, health insurance mobile payment and health insurance electronic vouchers landing application, to ensure that the "Internet +" health insurance services are safe and convenient.

Continuing to do a good job of new coronavirus infection patients treatment required drugs and other centralized band purchasing selected results landing, green channel listing and offline procurement, medical institutions should be offline procurement products in a timely manner in the procurement platform for the record. With the medical insurance designated medical institutions, large retail pharmacy chains as the focus, focusing on key drugs to do a good job of price monitoring, and constantly improve the price monitoring mechanism, expand the scope of monitoring, the abnormal price situation with the relevant departments to do a good job of policy guidance and guidance.

Improvement of health insurance protection capacity optimization of medical security services

"Notice" puts forward, the local health insurance department to combine the actual operation of the health insurance fund, to promote the implementation of the policy in a coordinated manner, and reasonably reduce the burden on the masses, to ensure that the security of the health insurance fund can be sustained. On this basis, the health insurance fund does appear to be unable to cover the expenses of the integrated area, can be given appropriate subsidies by the local financial. The first thing you need to do is to get your hands on a new car, and you'll be able to get your hands on a new car.

Each region should strictly implement the new coronavirus infection "B class B management" service management, in a timely manner, the new coronavirus infection with the ability to save non-specialized medical institutions into the temporary special agreement management, guidance to the designated medical institutions and temporary special agreement medical institutions to do a good job of the new coronavirus infection of the local medical treatment, off-site Guiding fixed-point medical institutions and medical institutions under temporary special agreements to do a good job of diagnosis and settlement of local and cross-location medical treatment for new coronavirus infection. Strengthening the analysis of the fund's operation, grasping the impact of the treatment costs of the new coronavirus infection on the fund, and formulating a plan for the fund's adjustment. Further broadening business processing channels, continuously sorting out and simplifying service processes, and actively guiding "online and palmtop processing" through the "LU Medical Insurance" applet, "Love Shandong" APP, and Shandong Province's one-network processing platform for government affairs services. "The company has also implemented online handling of routine matters and online handling of urgent matters. The implementation of routine matters online, urgent matters in a timely manner, special matters to facilitate the people, non-urgent matters to extend the office, the elimination of hidden dangers assured to do, and effectively achieve the management of health insurance management without relaxation, health insurance management services uninterrupted. To strengthen information technology protection, timely and good information system policy configuration and adjustment work, urge the designated medical institutions to complete the interface modification, system docking and testing work on time, to ensure that patients normal medical settlement.