Follow | Autonomous Region's basic medical insurance clinics at this level are adjusted by special chronic disease payment

On September 4, the reporter learned from the Autonomous Region Medical Insurance Bureau that in order to further regulate the management of special medical insurance clinics at the autonomous region at the level of the autonomous region, special chronic disease management and reduce the burden of medical expenses of insured personnel, the special chronic disease payment management of basic medical insurance clinics at the autonomous region is 10 There will be adjustments from the 1st.

A total of 10 diseases at the unique chronic diseases at the autonomous region at the level: systemic lupus erythematosus, Parkinson disease, liver cirrhosis, malignant chemotherapy, hemodialysis, peritoneal dialysis, tissue and organ transplantation Sexual hepatitis, hemophilia, pulmonary hypertension. Special chronic disease species within the above scope are all included in the general outpatient clinic coordination guarantee.

Outpatients' special chronic diseases, maximum payment limit, payment ratio, and payment quota: Insured persons at the fixed -point pharmaceutical institution of special chronic diseases in the outpatient clinic, and the medical expenses that meet the policy scope. Special chronic diseases in outpatient clinics are consolidated within the scope of the payment scope of overall funds and large insurance funds, and the maximum payment limit within a year is 305,000 yuan. The costs of more than 1,000 yuan, 35,000 yuan (including 35,000 yuan), 80%of the funds of the fund; the cost of more than 35,000 yuan, the maximum payment limit below, and 90%of the fund payment. Malignant tumor mortar chemotherapy, hemodialysis, peritoneal dialysis, tissue and organ transplantation, anti -rejecting therapy, pulmonary hypertension, hemophilia, viral hepatitis are calculated within the payment scope of overall funding funds and large insurance funds. 305,000 yuan; liver cirrhosis, Parkinson's disease payment quota is 8,000 yuan; systemic lupus erythematosus payment quota is 6,000 yuan. Participants with the above diseases can apply for special chronic disease treatment for outpatient clinics. They can be declared at the same time with more than two types of diseases. After approval, an payment standard is performed.

The outpatient special chronic disease cost settlement strictly implements the country and the Inner Mongolia Autonomous Region's basic medical insurance, work injury insurance and maternity insurance drugs, the scope and payment standards of basic medical insurance diagnosis and treatment projects and medical service facilities in Inner Mongolia Autonomous Region, which exceeded the prescribed medical insurance fund.

Source ｜ Official Website of the Health Commission of Inner Mongolia Autonomous Region

Comprehensive arrangement ｜ Tongliao release

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