Hebei News Network (Reporter Zhang Shuhui) Hebei urban and rural residents within the scope of hypertension and diabetes outpatient medication policy, the overall fund reimbursement ratio is 50%, there is no threshold. For urban and rural medical insurance patients suffering from "two diseases" at the same time, enjoy the corresponding treatments ... Recently, the Hebei Medical Insurance Bureau, the Hebei Provincial Department of Finance, the Hebei Provincial Health and Health Committee, and the Hebei Provincial Drug Administration jointly issued the "About The Opinions on the Implementation of the Medication Guarantee Mechanism for Hypertension and Diabetes Clinics in Urban and Rural Residents aims to accelerate the improvement of the medication guarantee mechanism for hypertension and diabetes outpatients in urban and rural residents in Hebei Province, and further reduce the burden of medical expenses on patients with "two diseases".
Opinions clarify the guarantee object of this policy. The "two diseases" patients (excluding chronic disease and special disease reviewers who have passed the "two diseases" outpatient clinic of residents 'health insurance) who have participated in the residents' medical insurance in Hebei Province and need to take medications have passed. Resident medical insurance "two diseases" outpatient chronic disease, special disease reviewers enjoy treatment in accordance with the existing system arrangements.
According to the opinion, Hebei Province will rely on public health institutions with designated second-level or below medical insurance (excluding village clinics, community health service stations, and clinics, hereinafter referred to as "medical institutions") to reduce the blood pressure, The cost of blood glucose drugs is paid by the pooled fund. The pooled fund's reimbursement ratio is 50% within the scope of the policy. There is no starting payment line. The maximum payment limit of the unified fund is 225 yuan / year / person for hypertension and 375 yuan / year / person for diabetes. Those who are covered by the "two diseases" are entitled to corresponding treatment. The protection object generally selects the nearest medical institution as the personal “two-disease” outpatient medical treatment designated medical institution, and in principle, the first medical institution is used as the personal designated medical institution.
It is understood that the "two diseases" outpatient drug protection policy is limited to eligible patients themselves. If the annual reimbursement amount does not reach the maximum payment limit, it will not be carried forward at the end of the year and family members cannot enjoy it. If the object of protection is one of the circumstances of breaking the insurance, participating in the basic medical insurance for employees, and death, etc., the benefits shall be stopped.
In order to ensure that the level of treatment for the insured does not decrease, the cost of medicines other than the "two diseases" locked drug in Hebei Province and the costs of patients with "two diseases" included in the outpatient chronic disease and special disease coverage will continue to be implemented in accordance with current policies. If the object of the protection is serious and meets the conditions for reviewing outpatient chronic diseases and special diseases in the overall planning area, after the review is passed, the patients will be treated as outpatient chronic diseases and special diseases in accordance with the provisions of the overall planning area. At the same time, they will stop enjoying the "two diseases" outpatient medication guarantee treatment. The medical expenses during the hospitalization period shall be implemented in accordance with the unified regional hospitalization reimbursement policy, and the expenses for outpatient medication for the "two diseases" cannot be reimbursed at the same time. Resolutely put an end to repeated reimbursement and repeated treatment.
In terms of standardizing the service process and simplifying the identification process, the opinion is clear. The diagnosis of "two diseases" is the responsibility of the medical institution. A designated medical staff confirms the diagnosis of the "two diseases" system. Each medical institution appoints qualified medical personnel to be responsible according to the diagnostic criteria. Diagnosis and confirmation of "two diseases". Residents in urban and rural areas visit the medical institutions in the participating insurance sites. The designated medical staff diagnoses patients according to the diagnostic criteria and identifies patients who have been diagnosed with the "two diseases" and need medical treatment. The patients are identified in the residents' medical insurance information system. Since the patient was identified, the purchase of drugs for the "Two Diseases" outpatient medicines at the selected medical institution in the insured place, direct settlement and enjoyment of benefits using social security cards, and the purchase of "Two Diseases" outpatient medicines at non-selected medical institutions is not allowed Reimbursement. The long-term prescription system for out-patient medications for the "two diseases" is implemented for a maximum of three months.
According to reports, Hebei Province will carry out dynamic supervision on the diagnostic criteria of the "two diseases", the scope of protection, the number of medications, and the implementation of fund payments. Medical insurance departments in various places should check the medical institutions' "two diseases" diagnosis and treatment and the number of drugs purchased by the protection target in accordance with the clinical path requirements, include the "two diseases" outpatient drug purchase and inventory situation into the required scope, designated medical institutions and designated medical staff Those who fraudulently obtain medical insurance funds shall be severely cracked down and dealt with in accordance with relevant regulations. The “two diseases” clinic is included in the fund payment risk prevention and control early warning system, which dynamically monitors the medication patients, the number of medications, the quantity and amount of medications, especially the key regional monitoring of urban and rural residents who have not received the current expenditure.
Editor-in-chief: Shan Jie_DW089
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