How to settle in medical insurance cross -provincial medical treatment directly?The latest notice comes

In order to implement the decision -making and deployment of the Party Central Committee and the State Council, deepen the direct settlement reform of basic medical insurance across provinces and other places, and strive to solve difficult problems such as the incomparable records of medical treatment in different places. Further do a good job of doing a good job of direct settlement of basic medical insurance across provinces and other places. "

Promoting the direct settlement of basic medical insurance cosmetic medical expenses is an important reform measure to improve the medical insurance system and solve the outstanding concerns of the people. Since the establishment of the National Medical Insurance Bureau, on the basis of fully realizing the direct settlement of hospitalization expenses across provinces, it has made every effort to promote the online registration of all regions to achieve online medical online filing and ordinary outpatient expenses. Five clinics such as malignant tumor outpatient chemotherapy and chemotherapy are directly settled in provinces.

In recent years, the direct settlement policy of cross -provinces and different places from hospitalization from hospitalization to ordinary outpatient clinics, and then expanded to slow special diseases of outpatient clinics. In the early stage of the pilot, most policies were promoted in the form of "patch". A systematic combing and integration, and on this basis, strengthen the top -level design, crack the scope of the record personnel narrow and the time limit, and the long -term residents of inter -provincial residents cannot enjoy treatment in both directions and the place of insurance. Later reimbursement ratio is low. In response to some regions, it does not support the incorporation of emergency rescue expenses, trauma costs, inspection and treatment of drugs during hospitalization during hospitalization, and the problem of direct settlement after the filing of the record, and formulate a unified nationwide norm.

The "Notice" requires that the medical insurance departments in various places must adjust policies and measures that do not match this notice in time to ensure that they will be connected with national policies by the end of December 2022; combined with local conditions, further clarify and refine policy management regulations, streamline materials, simplify materials, simplify simplifying The processing process and optimizing management services; adjust the information system simultaneously according to the requirements to ensure a smooth transition of direct settlement work for cross -provinces and other places. The "Basic Medical Insurance Cross -Provincial Different Places Direct Settlement Regulations" will be officially implemented from January 1, 2023.

The main content of "Notice"

Clarify the goals and tasks at the end of the 14th and Five -Year Plan

That is, by the end of 2025, the direct settlement system system and the management service system of cross -provinces and different places are more sound. More than 70%, the number of ordinary outpatient inter -provincial networking of designated pharmaceutical institutions has doubled, and the cost -related treatment expenses of slow special diseases in clinics that are widely carried out in various places are gradually incorporated into the scope of cross -provincial direct settlement. Reimbursement online and offline can be opened across provinces.

Unified hospitalization, general outpatient and outpatient slow special disease costs cross -provincial direct settlement policy

It is clarified that the "medical land catalog and the place of insurance place" fund payment policies in principle are clarified in principle; Prepaid and post -liquidation "different places for medical treatment funds management requirements.

Efforts to solve the three problems of medical treatment, settlement and collaboration in different places

Further improving the medical treatment policy for different places. The scope of medical record personnel in different places expanded to inter -provincial emergency rescue personnel and non -emergency and non -referral personnel. The validity period of the unified filing is valid, and during the validity period, you can take the doctor several times and enjoy the direct settlement service. Support insured personnel to enjoy treatment in both directions and the insurance place. Guide localities to reasonably determine the reimbursement policy for temporary inter -provincial medical treatment.

Further clarify the scope of direct settlement services for medical institutions. The expenses of emergency rescue costs, during the hospitalization period inspection and treatment of drug purchase, and the non -third -party liability trauma costs that meet the regulations of the medical ground management are included in the direct settlement scope of cross -provincial medical treatment. Insured participants are allowed to apply for medical treatment and enjoy cross -provincial direct settlement services before discharge.

Further regulate the cross -regional collaboration process of the agency. Establish a mechanism for collaborative treatment of medical place and the place of insurance to improve the efficiency of collaborative disposal of regional problems. Promote information sharing of medical insurance policies and stop announcements. Compact large medical expenses (30,000 yuan and above) for medical treatment responsibility for medical treatment. Relying on designated pharmaceutical institutions uploading the medical expenses of the self -funded personnel, exploring the provision of provincial handmade reimbursement online processing services. Strengthen the management of funds for medical treatment across provinces

The responsibilities of the medical insurance departments and financial departments at all levels have been strengthened, and the annual prepaid amount adjustment process of cross -provincial medical funds and emergency adjustments within the year specifically specifies the fund liquidation model, implementation path and time limit requirements.

Improve the support for the standardization of medical insurance information

It is required to continue to deepen the national unified medical insurance information platform and medical insurance information business coding standard for the entire process of full -process application, promote the optimization and improvement of national inter -provincial medical management subsystems, and strengthen system operation and maintenance management and security guarantee.

Strengthen the supervision of direct settlement funds for cross -provincial medical treatment

It is required to improve the supervision mechanism of direct settlement fund for cross -province medical treatment, improve regional cooperation and joint inspection and other working systems; implement the responsibility for regulatory land and placement of insurance, and take direct settlement of cross -province medical treatment as the focus of daily supervision, special inspection, flight inspection and other key points. Content; at the same time, the medical insurance funds and deductions of medical insurance funds and deductions of cross -provincial medical supervision are clarified.

Source | CCTV News Client

Edit | Xia Hong Li Xiang

School pair | Zhao Zeqin Zhang Yongqiong

Review | Liu Ying

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