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First, the problem of ensuring hospitalization expenses for patients in COVID-19.
In order to ensure that patients in COVID-19 will not be affected by hospitalization expenses, the document stipulates that the policy of "Class B and Class A management" will continue to be implemented for hospitalized patients in COVID-19, and the hospitalization expenses of patients in COVID-19 will be fully guaranteed. COVID-19 patients in all medical institutions, in line with the health sector to develop novel coronavirus infection diagnosis and treatment program of hospitalization medical expenses, by the basic medical insurance, serious illness insurance, medical assistance and other bear. In accordance with the provisions of the payment, the personal burden is partly subsidized by the financial. This policy is based on the admission time of COVID-19 patients and will be implemented until March 3, 20231.
Two, about the cost of outpatient and emergency patients in COVID-19.
In order to ensure that patients in COVID-19 can get medical services in time at the initial stage of infection, the document requires the implementation of special protection to improve the reimbursement level of outpatients and emergency patients in COVID-19 treated by designated medical institutions (secondary and below medical institutions) with primary medical insurance. We will increase the tilt support of medical insurance to rural and urban communities and other primary medical institutions, provide special guarantee for outpatient and emergency expenses of insured patients with novel coronavirus infection and suspected symptoms in designated primary medical institutions, and encourage primary medical institutions to supply enough drugs for treating novel coronavirus infection in the medical insurance drug list (including temporary supplements in various provinces). In principle, there is no deductible line or a capping line for outpatient and emergency expenses related to COVID-19 treatment in designated primary medical institutions (in the medical insurance list), and the proportion of reimbursement. The specific provisions shall be determined by the local medical insurance departments in consultation with the financial department according to the operation of the medical insurance fund, and shall be implemented until March 3, 20231day. The expenses incurred by insured patients in outpatient and emergency departments of other medical institutions in COVID-19 shall be fully reimbursed according to the reimbursement policies of other Class B infectious diseases, and included in the medical expenses and drug expenses of medical insurance coverage.
Three, about COVID-19 patients medication safety.
In order to adapt to the current epidemic situation and meet the drug demand of patients in COVID-19, it was decided to temporarily expand the medical insurance drug list until March 3, 20231day. At present, there are 660 drugs used to treat COVID-19's disease (such as fever and cough) in the national medical insurance drug list. On this basis, the temporary payment policy of medical insurance is also applicable to COVID-19 drugs included in the novel coronavirus infection diagnosis and treatment plan. The local medical insurance departments with insufficient drugs can refer to the list of infectious treatment drugs in novel coronavirus determined by the joint prevention and control mechanism of various provinces, and temporarily expand the list of medical insurance drugs in combination with the operation of medical insurance funds.
Four, about COVID-19 patients online diagnosis and treatment.
In order to ensure that patients in COVID-19 can get timely treatment, the document requires "internet plus" medical insurance service to help patients in COVID-19 make online diagnosis and treatment. Local health departments are required to publish the list of medical institutions providing "internet plus" medical services in a timely manner. For industry departments, it is allowed to provide the first diagnosis service of novel coronavirus infected with open Internet, and provide mobile payment and settlement service for COVID-19 patients who have symptoms related to novel coronavirus infection and meet the Guidelines for Family Treatment of COVID-19 Infected Persons according to regulations. Local medical insurance departments can support the price policy of first-visit medical services on the Internet according to the principle of online and offline consistency, and the reimbursement standard is consistent with offline. The related symptom follow-up service in COVID-19 is still implemented according to the current Internet follow-up reimbursement policy.
Five, on reducing the cost of treatment in COVID-19 and improving the ability of medical security.
The document calls for improving the price formation mechanism and continuing to do a good job in price negotiation or negotiation, centralized procurement, online procurement, filing procurement and price monitoring. Drugs needed for the treatment of patients in COVID-19, thus reducing the treatment cost of patients in COVID-19. Provincial medical insurance departments should combine the actual operation of local medical insurance funds, promote the implementation of policies as a whole, and scientifically determine the scope and level of protection, which not only reasonably reduces the burden on the masses, but also ensures the safety and sustainability of medical insurance funds. On this basis, there is indeed a co-ordination area where the income of the medical insurance fund cannot meet the expenditure, and the local finance can give appropriate subsidies. Promote the adjustment of funds in the province in a timely manner.
Six, about medical insurance service management.
The document calls for optimizing the medical insurance handling process and providing convenient medical insurance services. Continue to provide convenient medical insurance services, implement the long-term prescription medical insurance payment policy, and implement online routine medical insurance handling, timely emergency treatment, private special events, and delay non-urgent matters to eliminate hidden dangers. According to the needs, all localities and non-medical insurance designated medical institutions with COVID-19's treatment capacity signed the Temporary Special Agreement on the Settlement of Medical Insurance Expenses of Medical Institutions for Infected Patients in novel coronavirus, guiding all kinds of medical institutions to do a good job in collecting and uploading relevant information such as novel coronavirus infection diagnosis and treatment settlement and medical insurance expense settlement. Give full play to the handling power and promote the sinking of services. Agencies at all levels should cooperate with relevant departments to do a good job in promoting health in rural and urban communities, popularize knowledge of epidemic prevention and control, raise people's awareness of self-protection, and earnestly ensure that medical insurance management is not relaxed and medical insurance handling services are not interrupted.
Seven. Responsibilities of relevant departments
Implementing "Class B management" for novel coronavirus infection is an important decision made by the CPC Central Committee and the State Council on the basis of comprehensive evaluation of virus variation, epidemic situation and prevention and control work in China. The document calls for strengthening departmental coordination and linkage, and local relevant departments should improve their political positions, earnestly perform their duties, and ensure that policies are effective. The medical insurance department is responsible for the audit and settlement of related expenses and strengthening fund supervision; The financial department is responsible for timely disbursement of financial subsidies; The health department is responsible for guiding medical institutions to do a good job in the identification, information registration and uploading of COVID-19 patients; The CDC is responsible for uploading information and data of COVID-19 patients. Strengthen coordination and linkage to ensure the full implementation of the decision-making arrangements of the CPC Central Committee and the State Council.