654381On the afternoon of October 8, the reporter learned from Shaanxi Provincial Medical Security Bureau that the bureau, together with the finance and health departments, implemented the requirements at the first time, optimized, refined and improved eight policies and measures, and made every effort to protect people's lives, health and safety. Since the implementation of "B and B management" of novel coronavirus infection, relevant measures will be implemented.
Guarantee of hospitalization expenses for patients in COVID-19.
The hospitalization expenses borne by individuals are subsidized by governments at all levels.
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, personal burden is partially subsidized by governments at all levels, including:
The central government will bear 60%, the provincial level will bear 20%, and the cities and counties will bear 20%. The required funds, in accordance with the principle of territoriality, shall be paid in advance by the municipal (prefectural) and county (district) finance after being audited by the medical insurance department, and the central and provincial finance shall be settled according to the actual expenditure.
This policy is based on the patient's admission time and will be implemented until March 3, 20231day.
The medical expenses of infected patients in novel coronavirus are budgeted separately, which are not included in the total budget index of designated medical institutions, and are not included in the DRG/DIP payment scope, and are paid according to the project.
Study on outpatient and emergency expenses guarantee in COVID-19
The reimbursement rate for outpatient and emergency services in designated medical institutions at level 2 and below is 70%.
We will increase medical insurance's inclined support for rural and urban communities and other grassroots medical institutions, jointly promote the implementation of graded diagnosis and treatment, and guide patients to seek medical treatment at the grassroots level. Unify the outpatient treatment of infection in COVID-19, and implement special protection for outpatient and emergency expenses of insured patients with novel coronavirus infection and suspected symptoms in designated medical institutions at the secondary level and below. Grassroots medical institutions should be equipped with enough novel coronavirus infection treatment drugs in the medical insurance drug list (including provincial temporary supplements).
The outpatient and emergency expenses incurred by the insured patients in the designated medical institutions of primary medical insurance related to the treatment of novel coronavirus infection are not deductible or capped, and the reimbursement ratio is 70%, which will be implemented until March 3, 20231.
The outpatient and emergency expenses of the insured patients in other medical institutions for novel coronavirus infection treatment shall be implemented in accordance with the current medical insurance reimbursement policy.
Drug safety of patients in COVID-19.
Expand the scope of medical insurance drugs and implement a temporary catalogue.
In order to adapt to the current epidemic situation and meet the drug demand of patients in COVID-19, Novell Coronavirus extended the temporary payment policy for therapeutic drugs in Novell Coronavirus infection diagnosis and treatment plan to March 3, 20231day. "novel coronavirus infection diagnosis and treatment plan (Trial Tenth Edition)" in the directory of drugs temporarily included in the scope of medical insurance fund payment, according to class A management, our province temporarily included drugs according to class B management.
Municipalities (districts) medical insurance departments in a timely manner according to the National Health and Health Commission COVID-19 infection diagnosis and treatment plan, in conjunction with the health and health departments at the same level to do a good job of drug comparison and screening, do a good job in policy identification and maintenance. According to the requirements of "Guiding Opinions on Actively Promoting the Medical Insurance Access of Preparations in Therapeutic Medical Institutions", we will accelerate the medical insurance access of therapeutic preparations in hospitals, and include the qualified COVID-19 epidemic prevention preparations in medical institutions into the scope of medical insurance payment according to procedures. Give full play to the complementary role of universal medical insurance in Shaanxi and effectively protect the medical needs of the people.
On-line diagnosis and treatment of COVID-19's patients.
Promote mobile payment settlement
Local health departments should promptly publish the list of medical institutions that provide "internet plus" medical services, provide online diagnosis and treatment services for patients with symptoms related to novel coronavirus infection and those who meet the "Guidelines for Family Treatment of COVID-19 Infected Persons", speed up mobile payment, give full play to the advantages of "internet plus" medical insurance services, and provide medical insurance mobile payment and settlement services for medical institutions that provide medical services in "internet plus".
The new Internet first-aid medical service price item follows the principle of consistency between online and offline, and is charged according to the current outpatient service fee standard in our province, and the reimbursement standard is 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. Strengthen information support, make policy adjustment according to "COVID-19 Infectious Disease Outpatient Policy Configuration Operation Manual", do a good job in testing and verifying the medical insurance information platform, strengthen training and guidance, and improve service quality.
Thoughts on standardizing medical insurance coding
At present, there is no national standard code to use the temporary code given by our province.
Medical insurance departments at all levels should strengthen the docking with the health departments at the same level, upgrade the primary health HIS system in time, and ensure that the newly equipped drugs and consumables in community health institutions and village clinics and the newly developed treatment and diagnosis projects in COVID-19 get the national medical insurance code in time. For the designated medical institutions temporarily included in the medical insurance, it is necessary to guide them to implement the standards in time to ensure real-time and accurate settlement. For drugs, consumables and diagnosis and treatment projects that have no national standard coding for the time being, we will continue to use the temporary coding given by our province.
Thoughts on reducing medical expenses and improving medical security ability in COVID-19
Medical institutions can search for clinically necessary drugs offline.
Municipalities (districts) medical insurance departments continue to do a good job in price negotiation or negotiation, centralized procurement, online procurement, filing procurement, price monitoring and other work of drugs needed for the treatment of infected patients in novel coronavirus. Medical institutions can offline search for related drugs and medical consumables manufacturers that are difficult to purchase, clinically necessary and urgently needed for COVID-19 patients' treatment for filing and purchasing, and relevant purchasing information should be uploaded to the purchasing platform in time.
The amount of related drugs and medical consumables purchased for the record is not included in the proportion limit of 5% of the total purchase amount of offline procurement of medical institutions.
Medical insurance departments at all levels should do a good job in the supervision of medical insurance funds, make full use of information systems, strengthen the monitoring and analysis of medical expenses in COVID-19, and organize personnel to conduct on-site verification in time to ensure the safety and sustainability of medical insurance funds. The medical insurance fund is indeed insufficient to co-ordinate regional income, and the finance at the same level can give appropriate subsidies. Timely promote the adjustment of funds in the province to further improve the economic capacity and efficiency of medical insurance funds.
On the management of medical insurance handling service
Optimize loading and unloading service by taking multiple measures simultaneously.
Municipalities (districts) medical insurance departments actively expanded the scope of the agreement of medical institutions admitted to COVID-19, and signed the Temporary Special Agreement on the Settlement of Medical Insurance Expenses for Infected Patients in novel coronavirus to carry out medical insurance settlement with non-medical insurance designated medical institutions with the ability to treat novel coronavirus infection. Actively implement the long-term prescription medical insurance payment policy, and implement online office, emergency affairs in time, special affairs private affairs office, non-emergency matters extension office, and elimination of hidden dangers office.
Guide all kinds of medical institutions to collect and upload information related to novel coronavirus infection diagnosis and treatment settlement, and settle medical insurance expenses. Agencies at all levels should do a good job in insurance mobilization and health promotion, popularize knowledge of epidemic prevention and control, and raise people's awareness of self-protection. It is necessary to strengthen the construction of five-level handling network, give full play to the power of grassroots handling, and promote the sinking of medical insurance services to rural areas (communities).
About the responsibilities of relevant departments
Improve the coordination and linkage mechanism to ensure the implementation of policies
All departments should improve their political positions, earnestly perform their duties and cooperate closely. 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 identify, register and upload information of infected patients in novel coronavirus, upload information and data of infected patients in novel coronavirus, and upgrade the basic medical and health information system. All departments should strengthen coordination, timely communication and consultation to ensure the effective promotion of epidemic prevention work in our province and the implementation of various policies.
Two kinds of COVID-19 drugs are included in medical insurance.
Pfizer paciclovir failed to enter.
In 2022, the negotiation of the national medical insurance drug list officially ended on June 8, 65438. The person in charge of the Department of Drug Administration of National Medical Insurance Bureau introduced the participation of therapeutic drugs in the negotiation of medical insurance drug list in COVID-19.
This year, * * * through the procedures of independent declaration by enterprises, formal examination and expert review, three COVID-19 therapeutic drugs, namely acyclovir tablets, nimativir tablets/ritonavir tablets (hereinafter referred to as "Paciclovir") and Qingfei Jiedu Granules, participated in the negotiation. Among them,
The negotiation between afudin tablets and Qingfei Jiedu granules was successful, but the negotiation of paciclovir failed due to the high quotation of Pfizer Investment Co., Ltd.
The person in charge said that although paciclovir could not be included in the medical insurance catalogue through negotiation, according to the requirements of the Notice on Optimizing the Relevant Policies of Medical Insurance for the Treatment Expenses of Infected Patients in novel coronavirus after the Implementation of Class B Management (hereinafter referred to as the Notice),
All the therapeutic drugs in novel coronavirus's infection diagnosis and treatment plan (10th edition for trial implementation) include paciclovir, afudin tablets, Danlawei capsules, cold-dispelling and dampness-removing granules, etc. , temporarily paid by medical insurance until March 3, 20231.
. During this period, the insured infected persons in COVID-19 can enjoy the medical insurance reimbursement policy when using these drugs.
In addition, after Afuddin tablets and Qingfei Jiedu granules were included in the national medical insurance drug list through this negotiation,
In the national medical insurance drug list, there are more than 600 drugs used to treat COVID-19's symptoms such as fever and cough. At the same time, in order to meet the treatment needs of infected patients in COVID-19, recently, local medical insurance departments, combined with the operation of local medical insurance funds, temporarily included a number of symptomatic treatment drugs in COVID-19 into the scope of medical insurance payment in this region. Generally speaking, there are many kinds of drugs reimbursed by medical insurance to treat COVID-19 infection.
The person in charge also said that recently, the Office of the National Medical Insurance Bureau issued the Guidelines for the Formation of Therapeutic Drugs in COVID-19 (Trial), taking full-cycle and multi-level measures to guide enterprises to make open, transparent and reasonable pricing for newly listed antiviral drugs needed for the prevention and treatment of novel coronavirus infection.