The medical insurance agency pre-allocates the overall cost of hospitalization and outpatient treatment for special diseases every month; insured persons who are identified as suffering from special diseases should go to a designated medical institution designated by the labor and social security department for medical treatment and drug purchase. Medical expenses are directly billed and settled immediately.
2. Extended information:
On February 17, 2020, the National Medical Insurance Administration issued the "Opinions on Supporting Measures for the National Organization of Centralized Mass Procurement and Use of Coronary Stents" (hereinafter referred to as the "Opinions"), from network connection and distribution to medical insurance fund prepayment Relevant supporting measures have been clarified in four aspects, including medical insurance payment and incentives and constraints of medical institutions, to promote the smooth implementation of the selected results of the centralized procurement of coronary stents.
1. In terms of platform linking, it is required to link to the provincial procurement platform at the selected price. For coronary stents other than the selected varieties, relevant companies will be guided and encouraged to adjust prices to reasonable levels. In terms of distribution, the winning company is required to independently select the company that distributes the selected products.
2. Regarding the medical insurance fund prepayment policy, the medical insurance fund is required to prepay no less than 30% of the annual agreed purchase amount to medical institutions, and medical institutions and enterprises are required to settle the payment in a timely manner, and the settlement time shall not exceed the end of the next month after the delivery acceptance is passed. .
3. In terms of medical insurance payment standards, it is clarified that the winning price of the selected product will be the payment standard, and the full amount will be included in the scope of medical insurance payment, and the medical insurance fund will pay according to the prescribed proportion. If coronary stents other than the selected products fall within the payment scope of the medical insurance fund, various localities can reasonably set the upper limit of medical insurance payment standards based on the actual transaction price. At the same time, within two years, the payment standard will be gradually adjusted so that it does not exceed the highest winning price.
4. In terms of incentive and restraint mechanisms, the portion of medical insurance funds saved will be retained by medical institutions at a proportion no higher than the balance retained by the centralized procurement of drugs organized by the state after assessment.
In areas where payment by disease type (disease group) is implemented, the medical insurance payment standard for the corresponding disease type (disease group) may not be lowered in the first year, and will be adjusted regularly in accordance with the rules in the future. The implementation of this set of measures can reduce the medical costs of relevant patients and improve their quality of life.