Legal basis: Notice of Liaoning Provincial Medical Security Bureau on Adjusting the Policy of Special Chronic Diseases in Provincial Medical Insurance Outpatients.
First, a new type of outpatient chronic disease.
(A) AIDS antiviral drug treatment
The maximum payment limit of the overall fund is 2400 yuan/quarter, which is managed according to Class I diseases. The designated medical institutions for patients receiving treatment should be the same as those receiving national free antiviral drugs.
(2) Treatment of chronic heart failure
The maximum payment limit of the overall fund is 1050 yuan/quarter, which is managed according to Class I diseases. The scope of payment of the overall fund is the drugs and diagnosis and treatment items in the medical insurance catalogue for outpatient treatment of the disease in designated medical institutions.
(3) Treatment of chronic obstructive pulmonary disease
The maximum payment limit of the overall fund is 1050 yuan/quarter, which is managed according to Class I diseases. The scope of payment of the overall fund is the drugs and diagnosis and treatment items in the medical insurance catalogue for outpatient treatment of the disease in designated medical institutions.
(4) Biological treatment of rheumatoid arthritis, ankylosing spondylitis and psoriasis.
For patients diagnosed as rheumatoid arthritis, ankylosing spondylitis (excluding early radiation axial spondylitis) or adult moderate and severe plaque psoriasis, the outpatient drug expenses that are suitable for the biological agents in the medical insurance drug list (including tumor necrosis factor α(TNF-α) inhibitors and other biological agents) and meet the payment scope of the medical insurance drug list are included in the payment scope of the provincial medical insurance outpatient special chronic disease co-ordination fund. According to the management of Class I diseases, the payment limit is 650 in the first 6 months. The above treatment can be combined with the original treatment of ankylosing spondylitis, rheumatoid arthritis and psoriasis, and the original psoriasis diseases are no longer classified. Provincial medical insurance designated treatment hospitals should ensure that biological agents such as tumor necrosis factor-α (TNF-α) inhibitors, selective immunosuppressants and interleukin inhibitors necessary for patients' treatment are purchased at the same time, and the dosage should meet the needs of patients. Provincial medical insurance patients can only choose one designated hospital within one year.
Two, adjust the name of chronic diseases in some outpatient clinics and the payment limit of the overall fund.
(1) Adjust "anti-tumor drug therapy for malignant tumor" to "anti-tumor therapy for malignant tumor", and adjust the payment limit of the overall fund to 4200 yuan/year. The scope of payment includes anti-tumor drugs and supportive symptomatic treatment during radiotherapy and chemotherapy (such as blood raising and liver protection treatment). ), postoperative ostomy care and materials, outpatient tumor review (including tumor markers, lung (abdomen) CT, ultrasound examination, nuclear magnetic resonance, bone scan, blood routine, liver and kidney function, blood sugar, blood ions, hepatitis series, thyroid function, electrocardiogram, heart fan scan, etc.
(2) Adjust the payment limit of "Chronic Hepatitis C (antiviral treatment within one year)" as a whole fund. The limit of genotype 1b is 9,000 yuan per person, and those other than genotype 1b are 9,000 yuan per person18,000 yuan. The scope of payment for antiviral treatment is drugs suitable for antiviral treatment of chronic hepatitis C in the medical insurance drug list.
(3) Adjust the payment limit of endocrine therapy for breast cancer and prostate cancer to 3,000 yuan/quarter.
(4) Adjust "chronic hepatitis B and its compensated cirrhosis (antiviral therapy)" to "chronic hepatitis B and its cirrhosis". The criteria for the identification of chronic hepatitis B and cirrhosis caused by it are attached.
(5) Adjust the auxiliary drugs for uremia dialysis. Adjuvant drugs were adjusted to anti-anemia drugs, antihypertensive drugs, phosphorus-reducing drugs, calcium agents, iron agents, calcium and phosphorus metabolism regulators and hemostatic drugs.
(six) the diabetes, hypertension, coronary heart disease (old myocardial infarction), coronary heart disease (PTCA) within one year after surgery, in the anticoagulation clinic for the treatment of chronic diseases in the process of necessary auxiliary examination into the overall fund payment.