Concerning the new crown treatment medical insurance reimbursement, Shandong clear reimbursement ratio

Read Time:5 Minute, 20 Second

Recently, Shandong Provincial Medical Security Bureau, Shandong Provincial Department of Finance, Shandong Provincial Health and Health Commission jointly issued the “Notice on Conscientiously Implementing the Medical Security Development [2023] No. 1 Document to Optimize the Medical Security Policies Related to the Treatment Costs of Patients with New Coronavirus Infection in Our Province”, which clarifies that the outpatient and emergency medical expenses related to the treatment of new coronavirus infection incurred in the designated medical institutions of primary medical insurance within the scope of the policy, without setting a starting line and a ceiling line, and the reimbursement ratio is unified in the province and implemented until March 31, 2023. The reimbursement ratio is unified at 75% in the province, and will be implemented until March 31, 2023.

The new crown infection patient compliance hospital fees continue to implement the previous protection policy

The notice specifies that the optimization of medical insurance hospitalization payment policy. The new coronavirus infection patients in all the medical institutions, in line with the health department to develop a new coronavirus infection treatment plan of inpatient medical expenses, continue to implement the pre-cost protection policy, by the basic medical insurance, major medical insurance, medical assistance and other payments in accordance with the provisions of the individual burden part of the financial subsidies, the funds required by the municipalities to pay first, the provincial level of finance combined with the central subsidies, to Municipalities (excluding counties under direct provincial financial management) are subsidized at 80% of the actual costs incurred, and counties under direct provincial financial management are subsidized at 90% of the actual costs incurred. The policy is calculated by the time of admission of patients, first implemented until March 31, 2023.

Encourage primary medical institutions with adequate medical insurance catalog of the new crown infection treatment drugs

The notice points out that the level of primary care outpatient coverage should be improved. Collaborate to promote the implementation of graded treatment, guide patients to seek medical treatment at the grassroots level, to ensure smooth and orderly medical services. Increase medical insurance to rural areas, urban communities and other grassroots medical institutions (secondary and lower medical institutions) tilted support to encourage grassroots medical institutions with adequate medical insurance drug catalog (including the province’s temporary additions) of new coronavirus infection treatment drugs. The emergency outpatient clinic expenses for patients with new coronavirus infection and suspected symptoms occurring in primary medical insurance designated medical institutions will be specially protected, and the emergency outpatient clinic expenses related to the treatment of new coronavirus infection occurring in primary medical insurance designated medical institutions will not have a starting line and a ceiling line, and the reimbursement rate will be unified at 75% in the whole province until March 31, 2023.

The outpatient and emergency expenses for the treatment of new coronavirus infection incurred by the insured patients in other medical institutions will be implemented in accordance with the current basic medical insurance outpatient protection policy of each coordinating district.

Advance payment to medical institutions to ensure adequate health insurance funds

Shandong requires that medical institutions to effectively protect the cost of medical treatment. Medical insurance departments at all levels should further improve the pre-allocation of medical insurance funds to ensure that the medical insurance costs of medical institutions for patients with new coronavirus infections are allocated in a timely manner, not less than 1-2 months of medical insurance funds for medical institutions in advance, and additional timely as needed to ensure that the medical insurance funds are sufficient. The treatment costs for patients insured for new coronavirus infection and suspected symptoms are not included in the total control index of medical institutions, to ensure that patients are treated in a timely manner and that the receiving medical institutions are not affected by the total budget management regulations of medical insurance.

In addition, the temporary expansion of the scope of medical insurance drug catalog coverage. For the national “New Coronavirus Infection Treatment Program” (hereinafter referred to as “Treatment Program”) in the new coronavirus treatment drugs that are not in the basic medical insurance catalog, temporarily into the scope of payment of medical insurance funds, with reference to the management of Class A drugs, first implemented until March 31, 2023; for the “Treatment Program” transferred out and not in the basic medical insurance catalog of drugs, to stop medical insurance payments in a timely manner as required. The provincial medical insurance bureau will work with relevant departments to determine the list of new coronavirus infection treatment drugs temporarily included in the medical insurance payment in our province, reported to the National Medical Insurance Bureau for the record after implementation, first implemented until March 31, 2023.

Do a good job “Internet +” medical services and health insurance payments

The notice requires that local health departments should promptly publish a list of medical institutions that provide “Internet +” medical services. For the industry sector permitted online for patients with symptoms related to new coronavirus infection, in line with the “home treatment guidelines for people with new coronavirus infection” to provide the first Internet consultation service, to give price and health insurance policy support, continue to be in accordance with the provincial health insurance bureau, the provincial health and health commission “on the work of the new coronavirus infection Internet medical security services notice” (Lu medical insurance hair [2022] No. 44) implementation. To carry out medical insurance mobile payment services to strictly implement the relevant technical standards of the National Medical Insurance Bureau, relying on the national unified medical insurance information platform, to achieve the flow of medical insurance electronic prescriptions, medical insurance mobile payment and medical insurance electronic vouchers on the ground application, to ensure that the “Internet +” medical insurance services safe and convenient.

In addition, continue to do a good job in the new coronavirus infection patients treatment required drugs and other centralized procurement with the results of the selected landing, green channel listing and offline procurement, medical institutions should be offline procurement products in a timely manner in the procurement platform for the record. Medical insurance designated medical institutions, large chain retail pharmacies as the focus, focus on key drugs to do a good job of price monitoring, and constantly improve the price monitoring mechanism, expand the scope of monitoring, the abnormal price situation with the relevant departments to do a good job of policy guidance and guidance.