Rehabilitation is officially included in the medical insurance time

For groups such as the elderly, rehabilitation projects are a considerable medical expense. On June 28, the reporter learned from the Xi'an Municipal Medical Security Bureau that in order to further ensure the basic medical rehabilitation needs of insured persons and improve the medical rehabilitation protection level of insured patients, including the elderly, our city will start from July 1 16 rehabilitation projects such as balance examinations are officially included in the scope of medical insurance payment, benefiting patients with policies that benefit the people. This signifies that the city's insured persons have completed manual function tests, instrument balance function assessments, agnosia and apraxia assessments, memory span tests, cardiac function rehabilitation assessments, pulmonary function rehabilitation assessments, and human disability assessments. There are 16 rehabilitation projects including balance function training, hand function training, joint loosening training (spinal joint loosening training), aerobic training, cultural and sports training, guided educational training, isokinetic muscle strength training, stuttering training, and community rehabilitation assessment. It’s all at your own expense again. This policy to benefit the people will be officially implemented from July 1. The Xi'an Municipal Medical Security Bureau has clarified that medical institutions that implement rehabilitation treatment must determine rehabilitation objects according to the relevant requirements of rehabilitation medicine for rehabilitation diagnosis and treatment, and strictly control rehabilitation project evaluation and treatment access; for insured patients who meet the rehabilitation hospitalization standards, medical institutions must Relevant professionals develop a rehabilitation plan. Rehabilitation plans include: rehabilitation projects, number of project implementations, rehabilitation time, rehabilitation costs, rehabilitation effects, etc. Medical institutions that implement rehabilitation treatment must organize professionals to conduct assessment, inspection, and measurement of rehabilitation subjects on admission, during the rehabilitation process, and before discharge. and other projects. Professionals must meet the relevant requirements set by the health department. Designated medical institutions must strictly implement medical service standards, conscientiously implement designated service agreements, strictly implement the relevant requirements of rehabilitation projects, and are strictly prohibited from inducing hospitalization or hanging beds for insured persons who do not meet the indications for admission; medical insurance handling service agencies must strengthen The management of designated medical institutions for the implementation of rehabilitation treatment focuses on the supervision and audit of the identification of rehabilitation subjects, formulation of rehabilitation plans, and implementation of rehabilitation projects; the medical insurance fund regulatory agency carries out administrative law enforcement such as supervision and inspection of designated medical institutions for the implementation of rehabilitation treatment in accordance with the law. Ensure fund security, improve fund use efficiency, and safeguard the legitimate rights and interests of medical security-related entities.

Limited payment scope for 16 rehabilitation projects. According to the Xi'an Municipal Medical Security Bureau's notice on including 16 rehabilitation projects into the payment scope of medical insurance, the reporter sorted out the limited payment scope for rehabilitation projects. ■

The manual balance function test is carried out by professionals. The assessment results are issued after assessment for patients with clear balance dysfunction. Medical insurance will pay no more than 3 times during one hospitalization. ■

Instrumental balance function assessment is carried out by professionals. The assessment results are issued after the assessment for patients with clear balance dysfunction. Medical insurance will pay no more than 3 times during one hospitalization. ■

The assessment of agnosia and apraxia is carried out by professionals. For patients with clear advanced brain dysfunction, medical insurance will pay no more than three times during one hospitalization. ■

Memory span examination is carried out by professionals. For patients with clear memory impairment, medical insurance will pay no more than three times during one hospitalization. ■

Cardiac function rehabilitation assessment is carried out by professionals. For those with clear cardiac dysfunction, medical insurance will pay no more than twice during one hospitalization. ■

Pulmonary function rehabilitation assessment is carried out by professionals. For those with clear pulmonary dysfunction, medical insurance will pay no more than twice during one hospitalization. ■

Human body disability measurement is carried out by professionals. For patients with clear injuries and disabilities, no more than one payment will be made during a disease process. ■

Balance function training, with clear balance Disability, a disease process is paid not exceeding 90 days. ■

Hand function training, if there is clear hand dysfunction, the payment for a disease process does not exceed 90 days. ■

For joint loosening training, if there is a clear obstacle to joint movement, the payment will not exceed 180 days for a disease process; for spinal joint loosening training, if there is a clear obstacle to spinal joint movement, the payment will not exceed 180 days for a disease process.

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For aerobic training, for those with clear cardiopulmonary dysfunction, payment will not exceed 180 days for a disease process, and no more than once a day. ■

Style and sports training, for patients with clear physical and mental dysfunction (physical, language, cognitive, psychological, social, emotional, etc.), payment will not exceed 180 days for a disease process, and no more than once a day. ■

Guided education and training, for patients with clear physical and mental dysfunction (physical, language, cognitive, psychological, social, emotional, etc.), payment for a disease process does not exceed 180 days, for children under 16 years old No more than 2 times a day, no more than 1 time a day for other people. ■

Isokinetic muscle strength training, for patients with clear movement disorders, including bedside manual and equipment training, the payment shall not exceed 180 days for a disease process, and shall not exceed 1 time per day. ■

Stuttering training is limited to moderate and severe language disorders caused by organic lesions. Payment for 1 disease process does not exceed one year, and no more than two payments are made per day. After one year, if the patient's function continues to improve after comprehensive rehabilitation assessment, payment can continue. ■

Community rehabilitation tests are carried out by professionals and are used daily for people with clear physical dysfunction (evaluation of muscle strength, muscle tension, joint range of motion, balance ability, abnormal body movements, gait analysis, etc.) Living ability (assessment of daily living abilities, assessment of functional independence), mental psychology (psychology, intelligence, dementia screening, emotional state), quality of life (assessment of quality of life, assessment of social functions), environmental assessment (assessment of family and community environment) , no more than 2 payments will be made for one disease process.