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Medical insurance adjustment in our province's provincial level

Chronic diseases, special diseases for outpatient clinics

Add 19 chronic diseases, 4 special diseases

From August 1st

Add 19 clinics chronic diseases, 4 clinic special diseases

In order to further improve the level of medical insurance benefits at the provincial -level insurance employees, effectively reduce the burden of medical expenses of the masses in the insurance, and enhance the inclusiveness and availability of the medical insurance system. Recently, the Hebei Provincial Medical Security Bureau issued the "About the increase in provincial medical insurance increases Notice of the Special Diseases of the Outpatient Clinic "(hereinafter referred to as the" Notice ").

The "Notice" requires that in accordance with the principle of "doing its best and doing force", combined with the actual situation of the provincial level, after research, it was decided to add 19 clinics to chronic diseases and special diseases at the provincial level. Special diseases for clinics have been implemented from August 1.

Why is this policy introduced?

The reporter learned from the Hebei Provincial Medical Security Bureau that the "Guiding Opinions on the Establishment and improvement of the Employment of Personal Insurance Outpatient Protection Protection Mechanisms" issued by the General Office of the State Council (Guoqi Fa [2021] No. 14) proposed that according to the affordability of the medical insurance fund, gradually gradual Expand the scope of slow special diseases paid by the overall fund, incorporate some diseases with long treatment cycles, large health damage, and heavy costs. Special treatment can be managed with reference to inpatient treatment.

It is reported that the provincial provinces are currently enjoys 38 outpatient chronic diseases and 5 special diseases for outpatient diseases. After combing the situation of the province, through in -depth research and demonstration, clinical expert demonstration, combined with the actual situation of the provincial level, in accordance with the principle of "doing our best and doing their best", our province has decided to increase the diseases of chronic and special diseases at the provincial clinic at the provincial level. , Further alleviate the burden of medical treatment for employees and improve medical security treatment.

Photo source: Photo.com

What are the increased chronic diseases including the increase?

The "Notice" clearly adds 19 types of outpatient chronic diseases based on the 38 outpatient chronic diseases of the province at the province, involving 18 new outpatient chronic diseases, and increasing the connotation of chronic diseases of outpatient clinics.

The newly added outpatient disease species of the provincial level will be chronic atrophic gastritis, ulcerative colitis, chronic pancreatitis, bronchial dilatation, gout, osteoporosis, hyperthyroidism, Alzheimer disease, vascular dementia, vascular dementia, vascular dementia , Eye epilepsy, chronic peripheral vascular disease, rheumatism heart disease, dry syndrome, ankylosing spondylitis, dermatomyitis, spinal stenosis, glaucoma, and lumbar disc herniation, etc., have been included in the provincial guarantee scope.

Increase the connotation of chronic diseases for outpatient clinics, and modify the "schizophrenia" in the original outpatient clinics of the province to "mental disorders". Its connotation is based on "schizophrenia" and increases "division emotional disorder, paranoid mental illness. Double -phase emotional disorders, mental disorders caused by epilepsy, and mental development.

Clarified the treatment standard

The newly added clinic chronic disease continues to implement the "Notice on Further improving the Provincial Medical Insurance Outpatient Chronic Disease Policy" (Hebei Medical Bao Zi [2020] No. 57), "Notice on Further Regulating the Provincial Policies of Medical Insurance" (Ji Medical Insurance Treatment [2021] No. 5) The starting standard and reimbursement ratio set.

In accordance with the principle of "linked to payment and treatment", basic medical insurance implements single disease types and total annual limit management, and the annual expenditure of a single outpatient chronic disease specification fund does not exceed the annual limit of the disease. For two or more than two or more outpatient diseases, each person per year pays the maximum annual limit of 5,000 yuan.

Other subsidies and supplementary insurance implementation of the annual limit management of single diseases, and the annual expenditure of a single outpatient chronic disease specification fund does not exceed the annual limit of the disease.

What are the special diseases including the additional clinic?

The "Notice" clearly adds 4 special diseases on the basis of the 5 outpatient diseases at the original level of the province, involving two new clinics special diseases, increasing the connotation of the disease of the special disease of the original clinic, and the 38 original 38 types A chronic disease in the outpatient chronic disease was adjusted to the special disease of the clinic.

Special diseases of the new outpatient clinic at the provincial level, two special diseases of short bowel syndrome and psoriasis are included in the scope of special disease guarantee for outpatient diseases at the provincial level.

Increase the connotation of special diseases of outpatient clinics, and incorporate "postoperative anti -rejection therapy" into the scope of the "postoperative anti -reinforcement therapy of organ transplantation" at the original level of outpatient diseases at the original provincial level.

Adjust the special diseases of outpatient clinics, and adjust the "renewable disorder anemia" in the original 38 outpatient chronic diseases into special diseases of the outpatient clinic, and no longer retain chronic diseases of "renewable disorder anemia".

The newly added and adjusted special diseases, the medical expenses of the special diseases occurred in the outpatient medical expenses, the hospitalization treatment policy, that is, a year of the year is calculated based on a resident. After exceeding the starting line, the medical insurance overall fund is paid in proportion.

These 8 medical institutions are responsible for the review and identification

The "Notice" clarifies the application process and precautions, and continues to implement the "online independent application, medical institution review and identification, and instant medical insurance treatment" model.

Insurance patients can register and log in to Hebei Smart Medical Insurance Mini Program, fill in the relevant information and upload the proof information for the declaration. You can enjoy treatment.

The "Notice" requires to strengthen the management services identified by the review. Hebei Provincial People's Hospital, the first, second, third, and fourth hospitals of Hebei Medical University, 8 medical institutions including Hebei Provincial Hospital of Traditional Chinese Medicine, Hebei Provincial Studio Hospital, Shijiazhuang People's Hospital, and other medical institutions are responsible for hosted the provincial outpatient clinic chronic diseases and special diseases. All medical institutions organize the training of physicians in a timely manner to ensure that the evaluation is objective and fair, and at the same time, we must do a good job of application guidance and policy interpretation. Severe punishment of fraud and falsification of medical records

The "Notice" requires that in order to promote the implementation of relevant policies and ensure that patients who meet the conditions of chronic diseases and special diseases in the outpatient clinic, they should do their best to enjoy medical insurance treatment in time. Each participating unit shall do a good job of policy promotion, increase policy awareness, guide participation in participation, guide participation participation Inspection personnel provide objective and authentic medical history to prove the information and declare it in accordance with the actual application.

The "Notice" also requires that the normalization of the evaluation and identification behavior is continuously promoted. The designated medical institutions shall comprehensively strengthen the organization and management of the unit's review and identification work, and take effective measures to monitor the application of chronic diseases, special diseases, data review, and qualification identification on outpatient clinics. Check it up and check and correct the issues of violations in a timely manner. The provincial -level agencies should strengthen the normalized supervision of the identification behavior, and incorporate the management of the standards for reducing standards or fraud, and forgery of medical records in medical institutions and physicians, and severely punish illegal acts.

Basic medical insurance at the provincial level newly added

The types of chronic diseases and annual limits of the adjustment of outpatient clinics

Forward reminders more people

Source: Hebei Youth Daily

Reporter: Zhang Lei

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