Beijing Municipal Bureau of Health and Beijing Municipal Bureau of Finance Interim Provisions on the Scope of Reimbursement of Publicly-funded Medical Treatment for Large-Scale Medical Equipment and Valuable Medical Materials
Beijing Municipal Bureau of Health Beijing Municipal Bureau of Finance
Beijing Municipal Bureau of Health and Beijing Municipal Bureau of Finance
The district and county bureaus of health and finance, public-funded medical care offices, the tertiary institutions, the Relevant medical units:
In order to further adapt to the requirements of the reform of the city's employee medical insurance system, strengthen the management of publicly-funded medical care, overcome waste, and rationalize the use of health resources, in accordance with the spirit of the Ministry of Health and the Ministry of Finance Health and Finance (97) No. 9, "Notice on the Scope of Reimbursement for the Use of Large-Scale Medical Devices in Publicly-Funded Medical Care" and the relevant management requirements, and in conjunction with the city's Relevant management requirements, combined with the city's actual situation, the following temporary provisions:
A public medical reimbursement of large medical equipment (hereinafter referred to as "large medical equipment reimbursement"), refers to the application of high-tech, large, sophisticated, expensive equipment for diagnosis, treatment, in line with the management of the public healthcare The inspection and treatment programs are in line with the regulations of public medical care management.
The equipment included in the "large-scale medical equipment reimbursement scope":
X-ray computed tomography (CT)
Cardiac and angiography X-ray machine (including digital subtraction equipment)
Magnetic resonance imaging (MRI)
Magnetic field imaging (MRI)
Magnetic field imaging (MRI)
Magnetic field imaging (MRI)
Single Photon Emission Computerized Scanning Device (SPECT)
Ultrasonic Diagnostic Equipment (Color Doppler)
Medical Linear Accelerators
The costs of using the above listed large-scale medical equipments for examination and treatment due to the needs of medical conditions (including the costs of more than 200 yuan for a single examination and treatment item that have been approved and included for reimbursement), shall be subject to the approval by the Ministry of Health and Finance. In accordance with the spirit of the Ministry of Health and Ministry of Finance's Wei Zheng Fa (97) No. 9, "the proportion of personal burden should be appropriately higher than the proportion of general examination and treatment costs", the individual needs to bear 20% of the required costs, halved for retirement, and not for retired cadres, the Old Red Army, and the disabled soldiers of the revolution in the countryside of the second class B and above, who do not bear the burden.
Retired cadres, veteran Red Army soldiers, and disabled soldiers of the revolution in the countryside with grade B or above, individuals will not bear the burden.
Three, included in the "large medical equipment part of the reimbursement scope" of the equipment:
Stereotactic radiation therapy device [refers to: gamma knife (r-knife)]
[Stereostatic Radio Therapeutic (r-Knife)]
Considering the actual situation of the city, limited to the use of the Tiantan Hospital for the treatment of intracranial deep, small substantial lesions (limited to less than 3cm), including intracranial arteriovenous malformations of the gamma knife treatment costs, the public medical funds reimbursement of 60% of the required costs, where the indications for the scope of the patient for the gamma knife treatment by the treating doctor. All patients within the scope of indications for gamma knife treatment, by the treating doctor to fill out the "valuable medical equipment and materials for examination, treatment approval form", the family members to sign
After the public medical management authority for approval, after the approval of the gamma knife costs incurred can be reimbursed in accordance with the prescribed ratio.
Four, temporarily excluded from the "large-scale medical equipment reimbursement scope" of the equipment:
Stereotactic radiation therapy device [refers to: Aix knife (X-knife)]
[Stereostatic Radio Therapeutic (X-Knife)]
Positron Emission Tomography (PET)
Electron Beam CT (Electron Beam CT)
[also known as: Ultrafast UFCT]
Ophthalmic Excimer Laser Therapeutic instrument
Microelectrode-guided stereotactic equipment
Fifth, in the examination, treatment items in a single cost of more than 500 yuan (including 500 yuan) of medical materials are valuable medical materials, the use of valuable medical materials (including disposable medical devices, disposable imported medical materials, etc.), the public medical funds for reimbursement of 50% of the costs incurred (anastomosis is limited to esophageal, rectal anastomosis). (anastomosis is limited to esophagus and rectum anastomosis). The use of valuable medical materials need to be treated by the doctor to fill out the "valuable medical
Equipment and materials for examination, treatment approval form", signed by the family, the hospital's public medical office for approval for the record, before reimbursement in accordance with the provisions of the public medical management.
Sixth, in order to strengthen the management of large-scale medical equipment, the city's various types of medical institutions at all levels for public medical examination, treatment of large-scale medical equipment, should be in accordance with the Ministry of Health, "Interim Measures for the Management of the Configuration and Application of Large-Scale Medical Equipment," the requirements of the "large-scale medical equipment configuration license, "Large medical equipment application license" and "large medical equipment on duty personnel technical qualification certificate
".
Seven, undertake the task of public medical care at all levels and types of medical institutions have carried out reimbursement and partial reimbursement of the scope of the existing large-scale medical equipment for examination, treatment projects, in March 31, 99 years ago to register and declare to fill out the "public medical use of large-scale medical equipment declaration form" in triplicate, with the "three certificates". The "three certificates" copy, by the district and county public medical office recognized by the public medical office reported to the municipal public medical office for the record
case, overdue without the validation of the above large-scale medical equipment will not be included in the scope of reimbursement of public medical care.
Eight, where the use of public medical reimbursement outside the scope of diagnostic and treatment equipment for examination, treatment programs, in addition to the provisions of the "three certificates", but also must fill out the "new use of large-scale medical equipment at public expense of the medical declaration form" in triplicate, reported to the municipal public medical office. Publicly-funded medical office, the public medical expert committee agreed only after the demonstration of public medical reimbursement, otherwise the public medical reimbursement will not be reimbursed.
9, the medical unit to strengthen the management of large medical equipment, develop appropriate approval methods for the use of large medical equipment, strictly grasp the clinical indications for examination and treatment, the rational use of large medical equipment, to strengthen the regular training of personnel, accept the health administration at all levels, the management of publicly-funded medical supervision and inspection.
Ten, the districts and counties of public medical office to develop large medical equipment management implementation rules, establish and improve the use of large medical equipment at public expense of supervision, inspection system, and strengthen the management.
Where the violation of the provisions of public medical care and quality requirements do not meet the inspection and treatment costs incurred, the public medical care management should refuse to pay, the cost of the use of the unit to bear. Serious cases, the use of large-scale medical equipment to cancel its public medical reimbursement scope of eligibility.
Eleven, the provisional provisions since the date of publication of the implementation of the municipal public health care office is responsible for the interpretation.