Sichuan Online reporter Chen Hao
On December 28, a Sichuan Online reporter learned from the Chengdu Municipal Medical Insurance Bureau that the bureau focused on the requirements of the Chengdu Municipal Party Committee and the Municipal Government for Epidemic Prevention and Control, organized and distributed around the epidemic prevention and control service guarantee work, and revised the city’s medical insurance system. Relevant measures to benefit the people and help enterprises under the new stage of control. At present, the “Thirteen Measures to Benefit People, Support Businesses and Medical Insurance” have been issued under the new phase of epidemic prevention and control, the specific contents of which are as follows:
1. Open a green channel for the supply of medicines that are in short supply.Open an online green channel for drugs (medical consumables) involved in the “Pneumonia Diagnosis and Treatment Plan for Novel Coronavirus Infection” formulated by the health department, and help medical institutions connect with the provincial procurement platform of pharmaceutical devices to carry out the temporary procurement of “buy first and then file”. Establish a communication and liaison mechanism for major supplier enterprises, monitor the procurement and supply situation of the provincial pharmaceutical equipment procurement platform in real time, and ensure that drugs (medical consumables) are delivered in a timely manner.
2. Hospital beds and extra beds are included in the medical insurance reimbursement.Under the new phase of epidemic prevention and control, for designated medical institutions that are overloaded with hospitalized patients, extra beds for hospitalization beds will be considered ordinary bed services and included in the medical insurance reimbursement.
3. Hospital preparations of traditional Chinese medicine used in inter-hospital adjustments are included in the medical insurance reimbursement.Hospital preparations of traditional Chinese medicine that can be used for antipyretic, analgesic and other functions approved by the drug regulatory department shall be included in the scope of medical insurance payment according to regulations, and hospital preparations of traditional Chinese medicine which are adapted and used worldwide coordinated regions must be included in the scope of medical insurance payment according to the regulations.
4. Support the masses to seek medical advice online.Encourage qualified designated medical institutions to provide “Internet +” medical services in accordance with prescribed procedures, carry out online medical insurance settlement integrating the registration, consultation and purchase of drugs, and carry out “Internet +” medical service items +” and offline medical services in designated medical institutions Perform the same catalog, Medicare payment categories and payment standards.
5. Allocate treatment costs of medical institutions in advance.According to the current situation of the designated medical institutions, in principle, according to the standard of 2 months of average monthly payment of the medical insurance, the advance payment will be fully allocated by January 5, 2023.
6. Strengthen the security of medicines supply for special populations.Further streamline the drug warranty management process, reduce the identification scope of genetic testing reports, and enable accredited medical institutions to adopt comprehensive assessments of inspection reports issued by unidentified and non-therapeutic medical institutions.
7. Enable medical institutions to deliver care across departments and professions.Encourage medical institutions to optimize the setting of departments, allow admission and interdepartmental and interprofessional rational treatment of critically ill patients, and the medical expenses incurred by them will be included in the scope of medical insurance payment according to the regulations.
8. Ensure the treatment of disabled people.Policyholders applying for long-term care insurance benefits through online, offline, or agency methods must be reviewed and accepted in a timely manner according to regulations. If it is assessed that you meet the conditions for entitlement to benefits, your long-term care insurance benefits will be calculated according to the rules 12 working days from the date of acceptance by the health insurance institution. If the standardized training is suspended due to the new corona virus infection, the training suspension time will not be included in the 3-month training deadline for home nursing staff.
9. Establish rapid review and rapid call mechanism for medical insurance funds.Expedite the clearance and appropriation of designated medical institutions, and initiate clearance application fees for designated medical institutions and designated retail pharmacies. If no review is required, payment will be made within 7 business days; if revision is required, payment will be in place within 20 business days.
10. Accelerate the allocation of funds withheld for centralized procurement of medicines and equipment.In accordance with the award principle, within 20 working days, financial support will be provided to medical institutions to use the remaining funds for personnel awards in accordance with the regulations.
11. Promote the inclusion of convenient service stations for the diagnosis and treatment of fever in the comprehensive settlement coverage of the outpatient medical insurance network.According to the “Pilot plan for the renovation of the nucleic acid sampling hall and the construction of the fever diagnosis and treatment stations” of the Municipal Sanitary and Health Commission, the transformation is completed, and the convenient service stations for the diagnosis and fever treatment operated by public basic health institutions designated by the city medical insurance will be completed under the guidance of the local medical insurance department, according to the regulations Included in the settlement management of the medical insurance network.
12. Continue to improve the capacity of the medical service in rural areas.Fever outpatient clinics (outpatients) set up in qualified village outpatient clinics are included in the settlement management of the health insurance network according to regulation, and outpatient medical expenses incurred in the period are not included in the overall control and management of urban outpatient clinics and rural residents in institutions designated doctors and general medical expenses.
13. Increase the “assisted management” of medical insurance matters.Fully rely on channels such as medical insurance workstations and convenient service points in the masses to promote the realization of comprehensive coverage of high-frequency medical insurance service items such as “online, handheld and self-service” and others “non-face-to-face procedures. For those that cannot be completed on site, we will deploy assistants and agents and complete the process within 2 working days.
