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About the implementation of "Class B B Pipe"

Optimization of new coronavirus infection patients

Related to medical insurance for treatment costs Interpretation of the policy In order to implement the decisions and deployments of the Party Central Committee and the State Council, and implement the "Category B and B Control" for new coronavirus infection in a smooth and orderly manner, the Comprehensive Team of the Joint Prevention and Control Mechanism of the State Council for New Coronavirus Infection has successively issued "About the Prevention and Control of New Coronavirus Infection" The overall plan for the implementation of "Category B B tube" and supporting plans for infections. In order to provide medical protection for the treatment costs of patients with new coronavirus infection after the implementation of "Class B and B" for new coronavirus infection, the National Medical Insurance Administration, the Ministry of Finance, the National Health Commission, and the National Administration of Disease Control and Prevention jointly issued the "About the Implementation of "Class B" "Notice on Optimizing Policies Related to Medical Security for the Treatment Costs of Patients with Novel Coronavirus Infection" after the "Category B Control", the relevant policies will be implemented from the date of the implementation of the "Category B B Control" for new coronavirus infection (referred to as "COVID-19"). The main contents are now listed Interpretation is as follows.

1. Regarding the protection of hospitalization expenses for COVID-19 patients. In order to ensure that hospitalization expenses will not affect the treatment of COVID-19 patients, the document stipulates that the policy of "Category B and A" will be continued for hospitalized COVID-19 patients, and COVID-19 patients will be fully covered. The patient’s hospitalization expenses. The hospitalization medical expenses incurred by COVID-19 patients in all medical institutions that are in compliance with the diagnosis and treatment plan for novel coronavirus infection formulated by the health and health department will be paid by basic medical insurance, critical illness insurance, medical assistance, etc. in accordance with regulations, and the personal burden will be subsidized by the finance. This policy is calculated based on the admission time of COVID-19 patients and will be implemented until March 31, 2023.

2. Guarantee for outpatient and emergency treatment costs for COVID-19 patients. In order to ensure that COVID-19 patients can receive timely medical services in the early stages of infection, the document requires the implementation of special guarantees to improve the cost of outpatient and emergency treatment in primary-level medical insurance designated medical institutions (level 2 and below). Medical institutions) reimbursement levels for COVID-19 treatment. Increase the preferential support of medical insurance to primary medical institutions in rural areas, urban communities, etc., implement special protection for outpatient and emergency expenses of insured patients with new coronavirus infections and suspected symptoms in designated medical institutions of primary medical insurance, and encourage primary medical institutions to provide sufficient medical insurance In principle, there is no deductible for the new coronavirus infection treatment drugs in the drug catalog (including temporary additions by various provinces), and the outpatient and emergency expenses related to COVID-19 treatment (within the scope of the medical insurance catalog) incurred by insured patients in designated medical institutions of primary medical insurance. and cap line, with the reimbursement ratio not less than 70%. The specific regulations will be determined by the local medical insurance department in consultation with the financial department based on the operation of the medical insurance fund, and will be implemented until March 31, 2023. The outpatient and emergency treatment expenses of COVID-19 incurred by insured patients in other medical institutions should be fully reported in accordance with the medical insurance reimbursement policy for other Class B infectious diseases. All medical expenses and drug expenses included in the scope of medical insurance should be reported.

3. Regarding medication guarantee for COVID-19 patients. In order to adapt to the current epidemic situation and meet the medication needs of COVID-19 patients, it was decided to temporarily expand the medical insurance drug catalog and implement it until March 31, 2023. The current version of the National Medical Insurance Drug List includes 660 drugs for treating COVID-19 symptoms such as fever and cough. On this basis, the COVID-19 treatment drugs included in the diagnosis and treatment plan for novel coronavirus infection are also subject to the temporary payment policy of medical insurance. Local medical insurance departments that still have insufficient drugs can temporarily expand the list of medical insurance drugs by referring to the drug catalog for the treatment of new coronavirus infection identified by the joint prevention and control mechanism of each province, and taking into account the operation of the medical insurance fund.

4. About online diagnosis and treatment of COVID-19 patients. In order to ensure that COVID-19 patients can receive timely treatment, the document requires "Internet +" medical insurance services to facilitate online diagnosis and treatment of COVID-19 patients. Health departments in various places are required to promptly publish the list of medical institutions that provide "Internet +" medical services. For Internet first-diagnosis services approved by industry departments for new coronavirus infections, according to regulations, those with symptoms related to new coronavirus infection and in compliance with the "New Coronavirus" "Guidelines for Home Treatment of Virus Infected Patients" provides medical insurance mobile payment settlement services for COVID-19 patients. Medical insurance departments in various places can support Internet first-diagnosis medical service price policies in accordance with the principles of online and offline consistency, and the reimbursement standards are consistent with those offline. The follow-up consultation service for COVID-19 related symptoms will still be implemented in accordance with the current Internet follow-up consultation reimbursement policy.

5. The document on reducing the cost of COVID-19 treatment and improving the ability of medical insurance guarantees requires improving the price formation mechanism, and continuing to do price negotiations or consultations on drugs needed for the treatment of COVID-19 patients, centralized procurement, online procurement, record-keeping procurement, Price monitoring and other work to reduce the cost of treating COVID-19 patients. Provincial medical insurance departments should combine the actual operation of medical insurance funds in various places, coordinate and promote policy implementation, and scientifically determine the scope and level of protection, so as to reasonably reduce the burden on the people and ensure the safety and sustainability of medical insurance funds. On this basis, if the medical insurance fund is indeed unable to meet its current revenue, the local finance can provide appropriate subsidies. Promote fund adjustments within the province in a timely manner.