Palestinian seal "Administrative Measures for Slow Special Diseases of Medical Insurance Clinic"

In order to further regulate the treatment and management of slow special diseases of outpatient clinics, and effectively guarantee the basic medical needs of patients with slow special diseases in outpatient clinics, recently, the Municipal Medical Security Bureau issued the "Administrative Measures for the Slow Special Diseases of Palestinian Medical Insurance Outpatient Clinic" (hereinafter referred to as the "Measures" . This "Measures" will be implemented from August 1, 2022, with a validity period of 5 years.

According to the "Measures", the patient's application for outpatient clinics must be determined to go to the cities, county (district) medical insurance bureau entrusted by the cities, county (district) medical insurance bureau. After confirming the information of the medical insurance agency in the jurisdiction, the insured patients can enjoy the medical treatment of slow special diseases for outpatient clinics. Unthined designated medical institutions shall not conduct outpatient clinics.

According to the relevant person in charge of the Municipal Medical Insurance Bureau, physicians who are equipped with the corresponding disease scope of the corresponding diseases of the clinic clinic, the corresponding medical institutions such as the medicines and the facilities and equipment of the corresponding diseases and the inspection and testing of the medical insurance information system Application for the management of the medical insurance service agreement for the first -class outpatient medical insurance service; the designated medical institutions of the second and above can apply for the management of the second -class outpatient slow special disease medical insurance service agreement management. A designated retail pharmacies with high reserve rates, good pharmaceutical services, and real -time management specifications in existence and real -time management can be applied for management.

The "Measures" stipulates that insured persons who enjoy the treatment of slow and special diseases for outpatient clinics need to bring a social security card (medical insurance electronic voucher) and prescription when they purchase medicines locally. Identity, the cost of the "one -stop" settlement; insured persons cannot directly settle the outpatient expenses of the slow special disease at a designated pharmaceutical institution outside the city. The cost list is reimbursed at the medical insurance agency of the participating place.

Persons such as hyperthyroidism, hyperthyroidism, hypothyroidism, tuberculosis, and polypicidal tuberculosis diseases such as tuberculosis and polypharodia tuberculosis should choose the treatment institution to review each year. Payment in the annual payment standards; patients with slow special diseases who have not conducted reviews in accordance with regulations have suspended the medical treatment of slow special diseases for outpatient clinics.

In terms of treatment standards, the "Measures" stipulates that people who meet the management of slow special diseases in outpatient clinics will be enjoyed from the date of confirmation of the outpatient disease; The treatment is enjoyed from the date of confirmation.

In terms of reimbursement ratio, the medical expenses incurred by a class outpatient disease in the outpatient treatment of the insured employees are in line with the payment scope of the basic medical insurance fund, and the annual limit payment is implemented on an annual limit on the payment line and the total amount of the disease. After the illness of urban and rural residents, the medical expenses of special diseases that rely on outpatient drug treatment for a long time rely on outpatient drugs must be relying on the scope of the payment scope of basic medical insurance funds, and the annual limit settlement is implemented.

The medical expenses incurred in the second -class outpatient disease in the presence of the insurance employee are in line with the payment scope of the employee's basic medical insurance fund. 70%. The medical expenses that occurred the second -class outpatient disease in urban and rural residents for the treatment of urban and rural residents are in line with the payment of the basic medical insurance for urban and rural residents. The reimbursement fund reimbursement is 60%.

In terms of annual payment standards, the employees of special diseases for outpatient diseases are 1,000 yuan, 1500 yuan, and 2,000 yuan, respectively, and the insured residents are 600 yuan, 800 yuan, and 1500 yuan, respectively. Insured employees of the second -class outpatient special diseases, a cumulative inpatient medical expenses incurred in the year (including slow special diseases and maternity medical expenses), the maximum payment limit for the basic medical insurance coordinated fund is 140,000 yuan. The cumulative hospital medical expenses incurred in urban and rural residents (including special diseases and maternity medical expenses) of the cumulative annual cumulative inpatient medical expenses (including second -class outpatient diseases, maternity medical expenses) are implemented.

Source: Bazhong Daily

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