District medical insurance bureaus, finance bureaus, health and health commission, social undertakings bureau of Beijing Economic and Technological Development Zone, audit bureau, and relevant designated medical institutions:
In order to conscientiously implement the decision-making arrangements of the CPC Central Committee, the State Council, the Municipal Party Committee and the Municipal Government, and according to the requirements of the Notice of the National Health Insurance Bureau, the Ministry of Finance, the National Health and Wellness Commission and the National Disease Control Bureau on Optimizing the Relevant Policies of Medical Insurance for Infected Patients in novel coronavirus after the Implementation of Class B Management, we decided to optimize and adjust the relevant policies of medical insurance in this city in order to ensure the people to successfully pass the peak period of infection. The relevant matters are hereby notified as follows:
The first is to optimize the medical insurance payment policy and improve the level of reimbursement for medical treatment at the grassroots level.
Novel coronavirus infected patients in all medical institutions, in line with the health department to develop the novel coronavirus infection diagnosis and treatment program of hospitalization medical expenses, the implementation of early cost protection policy, by the basic medical insurance, serious illness insurance, medical assistance and other commitments. In accordance with the provisions of payment, the personal burden is partially subsidized by the financial department, and the required funds are advanced by the financial department, and the central government subsidizes 60% of the actual expenses. This policy is based on the patient's admission time and will be implemented until March 3, 20231day.
Cooperate to promote the implementation of graded diagnosis and treatment, guide patients to seek medical treatment at the grassroots level, and ensure stable and orderly medical services. According to the actual situation of this Municipality, we will increase the support for bringing village clinics and community health service institutions in rural areas into the designated medical institutions of this Municipality, and sign an agreement on temporary designated medical institutions with interested village clinics and community health service institutions in rural areas. Encourage medical institutions to provide adequate drugs for the treatment of novel coronavirus infection in the medical insurance drug list. Special guarantee will be provided for the outpatient and emergency expenses of insured patients with novel coronavirus infection and 1 1 suspected symptoms in designated medical institutions at or below the second level in this city. There is no deductible line and no capping line, and the reimbursement ratio is 90%. It will be implemented for the first time until March 3, 2023/day.
Due to the increase of expenses paid by the medical insurance fund due to the adjustment of reimbursement ratio, the medical insurance department automatically filled the difference through the information system in April according to the medical information of the insured patients uploaded by the medical institutions, and directly transferred the cost of filling the difference to the entrusted bank account bound by the insured, and the insured did not need to declare.
The outpatient and emergency expenses of the insured patients for novel coronavirus infection treatment in other medical institutions shall be implemented in accordance with the medical insurance policies for other Class B infectious diseases.
Two, the implementation of temporary medical insurance drug list, to meet the needs of patients.
According to the "novel coronavirus Infection Diagnosis and Treatment Plan" issued by the National Health and Wellness Committee and state administration of traditional chinese medicine, the temporary payment policy for therapeutic drugs in novel coronavirus will be extended to March 3, 20231day. With the consent of the National Medical Insurance Bureau, the drugs used to treat novel coronavirus infection determined by the joint prevention and control mechanism of this Municipality will be temporarily included in the list of medical insurance drugs in this Municipality, and will be implemented first until March 3, 20231day.
Third, do a good job in the "internet plus" medical insurance service to help patients make online diagnosis and treatment.
The administrative department of health shall promptly publish the list of medical institutions providing Internet diagnosis and treatment services, and provide mobile payment and settlement services for patients who have symptoms related to novel coronavirus infection and meet the guidelines for home treatment of infected people in COVID-19. The medical insurance department shall support the price policy of first-visit medical services on the Internet in accordance with the principle of online and offline consistency, and the reimbursement standard shall be consistent with offline. Follow-up services for infection-related symptoms in novel coronavirus are still implemented according to the current Internet follow-up reimbursement policy.
Fourth, improve the price formation mechanism and enhance the ability of medical security.
We will continue to do a good job in price negotiation or consultation, centralized procurement, online procurement, filing procurement and price monitoring of drugs needed for the treatment of infected patients in novel coronavirus, so as to reduce the treatment costs of infected patients in novel coronavirus. Combined with the actual operation of the medical insurance fund, the medical insurance department promotes the implementation of the policy as a whole and scientifically determines the scope and level of protection, which not only reduces the burden on the masses reasonably, but also ensures the safety and sustainability of the medical insurance fund. On this basis, the medical insurance fund is insufficient, and the financial department gives appropriate subsidies.
Five, optimize the medical insurance handling process, to provide convenient medical insurance services.
Continue to provide convenient medical insurance services, implement the long-term prescription medical insurance payment policy, and implement online routine medical insurance handling, timely emergency treatment, private special events, and delay non-urgent matters to eliminate hidden dangers. According to the needs, and belongs to the scope of medical institutions that provide novel coronavirus infection treatment ability for infected patients in COVID-19 as determined by the municipal public health department, non-medical insurance designated medical institutions signed the Temporary Special Agreement on the Settlement of Medical Insurance Expenses for Infected Patients in novel coronavirus, guiding all kinds of medical institutions to do a good job in the collection, uploading and settlement of medical insurance expenses related to the diagnosis and treatment of novel coronavirus infection. Give full play to the handling power and promote the sinking of services. Agencies at all levels should cooperate with relevant departments to do a good job in promoting health in rural and urban communities, popularize knowledge of epidemic prevention and control, raise people's awareness of self-protection, and earnestly ensure that medical insurance management is not loose and medical insurance handling services are not interrupted. All designated medical institutions should diagnose novel coronavirus infection and 1 1 suspected symptoms, accurately express the diagnosis information and upload it in time.
Sixth, strengthen departmental coordination and linkage to ensure that policies are effective.
Implementing "Class B management" for novel coronavirus infection is an important decision made by the CPC Central Committee and the State Council on the basis of comprehensive evaluation of virus variation, epidemic situation and prevention and control work in China. All relevant departments should improve their political positions and earnestly perform their duties. The medical insurance department is responsible for the audit and settlement of related expenses and strengthening fund supervision; The financial department is responsible for timely disbursement of financial subsidies; The health department is responsible for guiding medical institutions to do a good job in the identification, information registration and uploading of infected patients in novel coronavirus; The CDC is responsible for uploading the information and data of infected people in novel coronavirus. Strengthen coordination and linkage to ensure the full implementation of the decision-making arrangements of the CPC Central Committee and the State Council.
This notice shall come into force as of the date of implementation of "Class B infection" in novel coronavirus.
Beijing Municipal Medical Security Bureau
beijing finance bureau
Beijing Municipal Health and Wellness Committee
65438+202317 October
Attachment: 1 1 suspected symptoms