The latest notice of Hebei!Implementation from August 1st

Author:Shijiazhuang Daily client Time:2022.07.14

Recently, from the website of the Hebei Provincial Medical Security Bureau, it was learned that after research, it was decided to add 19 chronic diseases and 4 special diseases on the basis of the special chronic diseases at the provincial level.

Hebei Provincial Medical Security Bureau

About provincial medical insurance increases

Notice of Special Diseases of Chronic Diseases in Outpatient Clinic

Hebei Medical Insurance Regulations [2022] No. 4

The provincial medical insurance participating units and designated medical institutions:

In order to further improve the medical insurance treatment level of employees at the provincial level and enhance the inclusiveness and availability of the medical insurance system, in accordance with the principle of "doing their best, doing their best", combined with the actual situation of the provincial level, after research, it was decided to be in the province in the province in the provincial level. Based on the special diseases of the original chronic diseases at the level, 19 chronic diseases and 4 special diseases are added. The relevant matters are notified as follows.

1. About the outpatient chronic disease

(1) Chronic disease species of new outpatient clinics at the provincial level. Add 19 on the basis of 38 chronic diseases in the provincial level: 1. Chronic atrophic gastritis, 2. ulcerative colitis, 3. Chronic pancreatitis, 4. bronchial dilatation, 5. gout, 6. osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis, osteoporosis. 7. Hyperthyroidism, 8. Alzheimer's disease, 9. Vascular dementia, 10. Epilepsy, 11. Chronic peripheral vascular disease, rheumatoid heart disease, dry syndrome, 14. Ankylosing spine. Inflammation, 15. Corticitis, 16. Spotal stenosis, 17. glaucoma, 18. Lumbar disc herniation, 19. Increase the connotation of chronic diseases for outpatient clinics. Modify the "schizophrenia" in chronic diseases at the provincial clinic at the provincial level to "mental disorders". Its connotation includes "schizophrenia, schizophrenia, emotional disorder, paranoid mental illness, bipolar emotional disorders, mental disorders caused by epilepsy, mental spirituality Development of mental disorders ".

(2) Treatment standards. 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. The annual expenditure of a single chronic disease specification fund does not exceed the annual limit of the disease. Two or two chronic diseases are added, and each person's annual fund payable annual limit is 5,000 yuan. Other subsidies and insurance supplementary insurance implementation of the annual limit management of single diseases, and the annual expenditure of a single chronic disease -based overall funding fund does not exceed the annual limit of the disease.

2. Special disease about outpatient clinics

(1) Special diseases of new outpatient clinics at the provincial level. Incorporate short -bowel syndrome and psoriasis into the scope of special disease protection in the provincial clinic.

(2) Increase the connotation of special diseases. Incorporate "postoperative anti -rejection therapy" into the scope of the "postoperative anti -rejection therapy for organ transplantation" in the provincial -level outpatient clinic.

(3) Adjust special diseases. Adjust the "renewable disorder anemia" in the original 38 chronic diseases into special diseases of outpatient clinics, and no longer retains 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.

3. About the application identification

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.

Fourth, relevant requirements

(1) Strengthen policy publicity and interpretation. In order to promote the implementation of relevant policies and implement it, to ensure that patients who meet the conditions of slow special diseases should do their best, and enjoy medical insurance treatment in a timely manner. Each participating unit shall do a good job of policy propaganda, increase policy awareness, and guide participants to provide objective and real medical history Evil and reported according to the information.

(2) Strengthen the management services identified by the review. Hebei Provincial People's Hospital, the first, second, third, and fourth hospitals of Hebei Medical University, Hebei Provincial Hospital of Traditional Chinese Medicine, Hebei Provincial Studio Hospital, and 8 medical institutions in Shijiazhuang City People's Hospital are responsible for hosting the identification Medical institutions organize the training of physicians in a timely manner, and earnestly implement the "Standards for Chronic Disease Review of Hebei Provincial Medical Insurance Outpatient Clinic" organized by the Hebei Medical Security Bureau to ensure that the evaluation is objective and fair, and at the same time do a good job of application guidance and policy interpretation.

(3) Continue to promote the normalized supervision of the evaluation and identification behavior. 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 (or special) disease application, data review, and qualification identification for the outpatient clinic. Can be checked and checked in time and correction of violations. 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.

(4) Implementation time. This notice will be implemented from August 1, 2022.

Attachment: New and adjusted outpatient chronic disease types and annual limits of basic medical insurance in the provincial level