(January 8)
new coronavirus infection officially implemented "B B tube"
Recently
Jiangxi Provincial Bureau of Medical Protection, Jiangxi Provincial Department of Finance,
Jiangxi Provincial Health Commission issued
"on the implementation of the new coronavirus infection" B B tube
"On the implementation of the new coronary virus infection" after
medical insurance optimization measures notice
a to understand
↓↓↓↓
Jiangxi Provincial Bureau of Medical Protection Jiangxi Provincial Department of Finance Jiangxi Provincial Health Commission
On the implementation of the new coronary virus infection "Class B B tube" after
medical protection Optimization measures of the notice
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 of the prevention of serious diseases "Requirements, to ensure that 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 "B B tube" after the implementation of the optimization of new coronavirus infected patients treatment costs of medical insurance related policies "(medical insurance hair [2023] 1 ) spirit, effectively reduce the cost burden of patients with new coronavirus infection, now will 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
New coronavirus infection patients in the province within the scope of the fixed-point medical institutions (including temporary inclusion of medical insurance agreement management of medical institutions) Hospitalization medical expenses incurred by patients with new coronavirus infection in the designated medical institutions within the province (including medical institutions temporarily included in the management of the medical insurance agreement), which are in line with the Diagnostic and Treatment Plan for New Coronavirus Infections formulated by the health sector, will continue to be covered in accordance with the "Jiangxi Provincial Bureau of Medical Insurance Jiangxi Provincial Department of Finance Notice on the Work of Doing a Good Job of Medical Protection for Pneumonia Epidemic Infected by New Coronavirus Infections" (Gan Medical Insurance Electricity 〔2020〕 No. 2) and the "Office of the Jiangxi Provincial Bureau of Medical Insurance Office of the Jiangxi Provincial Department of Finance Office of the Jiangxi Provincial Healthcare Commission Office on Supplementary Notice on Further Improving the Medical Protection Work of the Pneumonia Epidemic Infected by New Coronavirus" (Gan Medical Insurance Office [2020] No. 3), "two ensure" cost protection policy is implemented. The individual part of the hospitalized medical expenses of the insured patients after the basic medical insurance, major disease insurance and medical aid are paid in accordance with the regulations shall be borne by the financial departments, of which 60% shall be subsidized by the central government and 40% shall be borne by the financial departments of the insured places (40% shall be borne by the financial departments of the places 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 patients insured outpatient emergency medical expenses temporary special protection
Coordination of the implementation of hierarchical diagnosis and treatment, guiding patients to the grass-roots level of medical care, to ensure smooth and orderly medical services. Increase the health insurance to rural areas, urban communities and other primary health care institutions (second level and below) inclined to support the primary health insurance designated health care institutions, new coronavirus infections and suspected symptoms of the insured patients outpatient emergency expenses, the implementation of a special protection, to encourage primary health care institutions with a full range of health insurance directory (including the temporary supplement) new coronavirus infections treatment of drugs. Outpatient and emergency medical expenses incurred by insured patients at designated primary health insurance medical institutions, which are in line with the "Diagnostic and Treatment Plan for Novel Coronavirus Infections (Trial Implementation of the 10th Edition)" and within the scope of the health insurance catalog and related to the treatment of Novel Coronavirus Infections, will be temporarily included in the scope of payment of the province's basic health insurance fund, with no threshold 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) policy. 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 of instant settlement reimbursement; can not be instantly settled, can be related to outpatient expenses to the participating health insurance agencies to apply for manual reimbursement.
Participating patients in other medical institutions in the new coronavirus infection treatment of outpatient emergency costs, in accordance with other Class B infectious diseases health insurance policy.
Third, the implementation of 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 Infection Diagnostic and Treatment Program (Trial 10th Edition)" within the scope of the new coronavirus infections, but belonging to the scope of the national health insurance drug catalog outside the scope of the new coronavirus treatment medicines, temporarily included in the scope 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, the provincial health insurance bureau combined with the operation of the health insurance fund, the temporary inclusion of the province's health insurance drug catalog 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 diagnostic services, the co-ordination of the district health insurance department unified new set up "Internet (remote) new coronary first diagnostic The medical insurance department of each co-ordinating area will set up a new "Internet (remote) new coronary first consultation" medical service price item, differentiate the grade of medical personnel, set the price according to the same standard as the online and offline, and include it in the province's medical insurance according to the payment of "Category A", so as to provide the required medical insurance mobile payment settlement service for the patients who are suffering from the symptoms related to the new coronary virus infection, and in accordance with the "Guidelines for Home Treatment of Newly Coronary Virus Infected Patients". The reimbursement standard is the same both online and offline. The reimbursement standard is the same between online and offline. For the follow-up service of new coronavirus infection related symptoms, it is still implemented in accordance with the current payment policy of Internet follow-up service.
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 strengthening of the new coronavirus outbreak-related drugs platform supply work of the notice" (Gan Medical Insurance word 〔2023〕 No. 1), and "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 in the new coronavirus infection patients treatment of drugs and other centralized purchasing, procurement, record procurement, price monitoring and other work, and effectively strengthen the rural and grass-roots level of drug supply security. Including the follow-up implementation of the negotiated price of drugs and equipment, vaccine procurement prices.
Sixth, continue to optimize the management of health insurance management services
The coordinating area health insurance agency should be timely according to the need to have a new coronary virus infection treatment capacity of non-medicare designated medical institutions 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 of the new coronary virus infection related to the diagnosis of the settlement of the collection and uploading of information and the settlement of health insurance costs. The medical insurance service agreement should be optimized. To optimize the process of medical insurance administration and provide convenient medical insurance services. To continue to do a good job of health insurance services, the implementation of long-term prescription health insurance payment policy, the implementation of health insurance work online routine matters, emergency matters in a timely manner, special matters, convenience, non-urgent matters delayed, eliminating hidden dangers to do at ease. 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 are uninterrupted.
VII, continue to do a good job of other new coronavirus infection medical insurance
(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 a good job of the new coronavirus vaccine and vaccination costs of the protection of 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 of the protection of work" (Gan medical insurance hair [2021] No. 2) and the "Jiangxi Provincial Bureau of Health Protection Jiangsu Provincial Department of Finance Jiangsu Province Health and Health Commission on the new coronavirus vaccination costs of health insurance payment standards notice "(Gan medical insurance hair [2021] No. 9) document requirements, as well as the national dynamic adjustment of the spirit of the relevant documents.
(b) the new coronavirus nucleic acid testing costs in strict accordance with the "Jiangxi Provincial Medical Protection Bureau Office forwarded the Office of the State Medical Protection Bureau on the standardization of health insurance fund to pay the nucleic acid testing costs of the relevant issues of the notice" and "Jiangxi Provincial Medical Protection Bureau of Jiangxi Provincial Department of Finance Jiangxi Provincial Health and Health Commission on the standardization of health insurance fund to pay for the cost of the new coronavirus nucleic acid testing costs of the relevant issues of the notice" (Gan medical insurance word [ 2022] No. 32) document requirements, as well as the national dynamic adjustment of the spirit 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 seek medical treatment required for the new coronavirus nucleic acid test costs, in accordance with the provisions of the payment. "Close contacts", "foreign entrants", "new hospitalized patients accompanying personnel" and other non-diagnostic nucleic acid test costs, not included in the medical insurance fund.
Eight, safeguards
(a) the implementation of new coronavirus infection "B B tube", is the CPC Central Committee, the State Council in a comprehensive assessment of the virus mutation, the epidemic situation and the prevention and control of China's work on the basis of the major decisions made by the relevant departments around the political position, strengthen departmental coordination and linkage, 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 the medical institutions to do a good job in a timely manner in the identification of new crown patients, information registration and uploading of the work, and the timely publication of the list of medical institutions to provide "Internet +" health care, and is responsible for the information and data of new crown patients in a timely manner. The new crown patient information, data upload work in a timely manner.
(2) 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 medical insurance fund is indeed unable to cover its 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 the prevention and control of the new coronavirus infection situation to be determined by a separate study. Temporary measures to pay 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 piece of active public)