unify the scope of diseases, unify payment standards, optimize handling services and strengthen fund supervision.

in order to further improve the treatment guarantee level of outpatient chronic and special diseases in our city and reduce the burden of medical expenses for outpatients with chronic and special diseases, recently, the Municipal Medical Security Bureau, together with the municipal finance and health departments, jointly issued the Notice on Implementing the Unified Scope of Outpatient Chronic and Special Diseases in the Basic Medical Insurance for Employees in the whole province. The Notice consists of four parts: 1. Unify the scope of diseases. On the basis of protecting the original 17 diseases, 28 diseases with wide coverage and heavy long-term cost, such as nephrotic syndrome (primary), chronic heart failure and vitiligo, are included in the scope of protection.

2. unify payment standards. The qifubiaozhun, reimbursement ratio and payment scope of outpatient chronic special diseases of employees shall be implemented in accordance with the provisions of medical insurance policies related to hospitalization, and the payment scope of outpatient chronic special diseases fund does not include outpatient special drugs.

3. Optimize handling services. The Notice requires medical insurance agencies at all levels to further streamline the handling materials, optimize and simplify the handling process, and shorten the reporting and appraisal cycle. For some diseases with definite diagnosis, if the hospital diagnosis certificate, outpatient medical records and relevant inspection reports above Grade II can prove the condition and meet the admission criteria, a copy of hospitalization medical records will no longer be provided. For malignant tumor radiotherapy and chemotherapy, uremia dialysis, organ transplantation anti-rejection treatment and other diseases with clear diagnosis and easy identification, they should be accepted at any time and settled immediately.

4. Strengthen fund supervision. The "Notice" requires medical insurance departments at all levels to establish and improve mechanisms such as supervision and reporting, intelligent monitoring and credit management, and strengthen supervision and management of the use of outpatient medical insurance funds for chronic and special diseases. Accelerate the reform of medical insurance payment methods for outpatient chronic and special diseases, actively explore the payment for outpatient special diseases by disease type and chronic diseases by head, and effectively improve the efficiency of medical insurance fund use.