Notice of Beijing Municipal Bureau of Medical Security, Beijing Municipal Bureau of Finance and Beijing Municipal Health and Wellness Committee on Optimizing the Medical Insurance Policies for the Tre
Beijing Medical Insurance Fa [2023] No.1
District medical insurance bureaus, finance bureaus, health and wellness committees, social undertakings bureau of Beijing Economic and Technological Development Zone, financial audit bureau, and relevant designated medical institutions:
In order to conscientiously implement the decision-making arrangements of the CPC Central Committee, the State Council, the Municipal Party Committee and the Municipal Government, according to the requirements of the Notice of the National Medical Insurance Bureau, the Ministry of Finance, the National Health and Wellness Commission and the National Disease Control Bureau on Optimizing the Relevant Policies of Medical Insurance for Infected Patients in novel coronavirus after the Implementation of "Class B Management" (No.1 [2023] of Medical Insurance), and to ensure that the people can smoothly spend the peak period of infection, it is decided to optimize and adjust the relevant policies of medical insurance in this Municipality. Relevant matters are hereby notified as follows:
First, optimize the medical insurance payment policy and improve the level of reimbursement for medical treatment at the grassroots level.
Novel coronavirus infected patients in all admitted medical institutions, in line with the novel coronavirus infection diagnosis and treatment plan formulated by the health department of hospitalization medical expenses, the implementation of the upfront cost guarantee policy, by the basic medical insurance, serious illness insurance, medical assistance, etc. in accordance with the provisions of payment, the personal burden of part of the financial subsidies, the required funds paid by the financial sector in advance, the central government according to the actual cost of 60% subsidies. This policy is based on the time of admission of patients and will be implemented until March 31, 2023.
Cooperate to promote the implementation of graded diagnosis and treatment, guide patients to seek medical treatment at the grassroots level, and ensure stable and orderly medical services. According to the actual situation of this Municipality, we will increase the support for bringing village clinics and community health service institutions in rural areas into the designated medical institutions for medical insurance in this Municipality, and sign an agreement on temporary designated medical institutions with interested village clinics and community health service institutions in rural areas. Encourage medical institutions to supply novel coronavirus infection treatment drugs in the medical insurance drug list (including temporary supplements in this Municipality). For the insured patients with novel coronavirus infection and 11 kinds of suspected symptoms (see Annex for details) in the designated medical institutions at the second level and below in this city, special guarantee will be implemented for outpatient and emergency expenses, with no deductible line and capping line, and the reimbursement ratio will be 90%, which will be implemented first until March 31, 2023.
Due to the increased expenses paid by the medical insurance fund due to the adjustment of reimbursement ratio, the medical insurance department automatically made up the difference through the information system in April according to the medical information of the insured patients uploaded by the medical institutions, and directly allocated the difference-making expenses to the entrusted bank account bound by the insured, and the insured did not need to declare.
The outpatient and emergency expenses of novel coronavirus infection treatment for insured patients in other medical institutions shall be implemented in accordance with the medical insurance policies for other Class B infectious diseases.
Two, the implementation of temporary medical insurance drug list, to meet the needs of patients.
According to the "novel coronavirus Infection Diagnosis and Treatment Plan" issued by the National Health and Wellness Commission and the State Administration of Traditional Chinese Medicine, the temporary payment policy for novel coronavirus treatment drugs in the plan will be implemented until March 31, 2023. With the consent of the State Medical Insurance Bureau, the drugs identified by the joint prevention and control mechanism in this Municipality for treating novel coronavirus infection will be temporarily included in the list of medical insurance drugs in this Municipality, and will be implemented first until March 31, 2023.
Third, do a good job in the "internet plus" medical insurance service to help patients with online diagnosis and treatment
The administrative department of health shall promptly publish the list of medical institutions providing Internet diagnosis and treatment services, provide mobile payment and settlement services for patients with symptoms related to novel coronavirus infection and meeting the Guidelines for Home Treatment of Covid-19 Infected Persons, and the medical insurance department shall support the price policy of Internet first-visit medical services according to the principle of online and offline consistency, and the reimbursement standard is consistent with offline. The follow-up service for infection-related symptoms in novel coronavirus is still implemented according to the current reimbursement policy for follow-up visits on the Internet.
Fourth, improve the price formation mechanism and enhance the ability of medical insurance.
We will continue to do a good job in price negotiation or consultation, centralized procurement, online procurement, filing procurement and price monitoring of drugs needed for the treatment of infected patients in novel coronavirus, so as to reduce the treatment cost of infected patients in novel coronavirus. Combined with the actual operation of the medical insurance fund, the medical insurance department promotes the implementation of the policy as a whole and scientifically determines the scope and level of protection, which not only reasonably reduces the burden on the masses, but also ensures the safety and sustainability of the medical insurance fund. On this basis, the medical insurance fund does not meet the expenditure, and the financial department will give appropriate subsidies.
Five, optimize the medical insurance handling process, provide convenient medical insurance services.
We will 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 handling, private special matters, delayed non-urgent matters, and eliminate hidden dangers. According to the needs, and belong to the municipal health department to determine the scope of medical institutions that provide Covid-19 infected patients with the ability to treat novel coronavirus infection, non-medical insurance designated medical institutions signed the Temporary Special Agreement on the Settlement of Medical Insurance Expenses of novel coronavirus Infected Patients, guiding all kinds of medical institutions to do a good job in the collection and uploading of information related to novel coronavirus infection diagnosis and settlement, and the settlement of medical insurance expenses. 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 health promotion in rural areas 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 loose and medical insurance handling services are uninterrupted. All designated medical institutions should diagnose the new coronavirus infection and 11 kinds of suspected symptoms, accurately express the diagnosis information and upload it in time.
Sixth, strengthen departmental coordination and linkage to ensure that policies are effective.
The implementation of "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. All relevant departments should improve their political stance and earnestly perform their duties. The medical insurance department is responsible for the audit and settlement of related expenses and strengthen 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 infected patients in novel coronavirus; The CDC is responsible for uploading information and data of infected patients in novel coronavirus. Strengthen coordination and linkage to ensure that the decision-making and deployment of the CPC Central Committee and the State Council are fully implemented.
This notice shall come into force as of the date of the implementation of the "Class B tube" for novel coronavirus infection.
Beijing Municipal Medical Security Bureau
beijing finance bureau
Beijing Municipal Health and Wellness Committee
January 7, 2023