Sichuan medical insurance policy in 2023

The good news is that COVID-19's medical expenses will be included in the medical insurance reimbursement, including hospitalization reimbursement and outpatient reimbursement, and some drugs will be included in the medical insurance catalogue.

Sichuan COVID-19 medical insurance reimbursement policy in 2023 is as follows:

Notice of Sichuan Provincial Medical Insurance Bureau, Sichuan Provincial Department of Finance and Sichuan Provincial Health and Wellness Committee on Optimizing the Medical Insurance Policy for the Treatment Expenses of Infected Patients in novel coronavirus after the Implementation of Class B Management

Sichuan Medical Insurance Fa [2023] 1

Municipal (state) medical insurance bureaus, finance bureaus, and health and wellness committees: In order to implement the decision-making arrangements of the CPC Central Committee and the State Council, according to the requirements of "keeping health and preventing serious diseases" in the overall plan of "Class B management", and ensuring the people to smoothly spend the peak period of infection, according to the provisions of the National Medical Insurance Bureau,

Ministry of Finance, National Health and Wellness Commission

The Notice of the National Bureau for Disease Control and Prevention on Optimizing the Relevant Policies of Medical Insurance for the Treatment Expenses of Infected Patients in novel coronavirus after the Implementation of Class B Management (Medical Insurance [2023]1No.) decided to optimize and adjust the relevant policies of medical insurance in our province, and the relevant matters are hereby notified as follows.

The first is to optimize the medical insurance payment policy and improve the level of reimbursement for medical treatment at the grassroots level.

Hospitalization reimbursement: The hospitalization expenses incurred by infected patients in novel coronavirus in all medical institutions that meet the novel coronavirus infection diagnosis and treatment plan formulated by the health department are paid by basic medical insurance, serious illness insurance and medical assistance according to regulations, and the personal burden is subsidized by the finance. The required funds shall be paid in advance by the local finance, and the central finance shall subsidize 60% of the actual expenditure.

This policy is based on the patient's admission time and will be implemented until March 3, 20231day. Cooperate to promote the implementation of graded diagnosis and treatment, guide patients to seek medical treatment at the grassroots level, ensure stable and orderly medical services, and increase medical insurance support for grassroots medical institutions (secondary and below medical institutions) such as rural areas and urban communities.

Outpatient reimbursement: if the outpatient and emergency expenses of novel coronavirus infection and suspected symptoms of insured patients in designated primary health care institutions meet the scope of medical insurance policy (including the scope of temporary payment policy), special guarantee will be implemented, with no deductible line and capping line, and 70% will be paid directly from the overall fund.

Overall fund payment is not included in the basic medical insurance outpatient overall payment limit, not included in the annual cap line of basic medical insurance. Encourage primary medical institutions to be equipped with drugs for the treatment of novel coronavirus infection in the medical insurance drug list (including drugs temporarily included). The special guarantee will be implemented until March 3, 20231.

The outpatient and emergency expenses of the insured patients for novel coronavirus infection treatment in other medical institutions shall be implemented in accordance with the current relevant medical insurance policies. The medical expenses of infected patients in novel coronavirus are budgeted separately, which are not included in the total budget index of designated medical institutions, and are not included in the DRG/DIP payment scope, and are paid according to the project.

Two, the implementation of temporary medical insurance directory, to meet the needs of patients.

In the Notice on Temporary Inclusion of Hospital Preparations such as Qingfei Paidu Mixture (COVID-19 1No.) into the Payment Scope of Medical Insurance Fund (Sichuan Medical Insurance Fa [2020] No.3) issued by five departments, including novel coronavirus's infection diagnosis and treatment plan, novel coronavirus's therapeutic drugs and medical services, and Sichuan Medical Security Bureau, the policy of temporary payment for the continuation of medical insurance for preparations in novel coronavirus treatment medical institutions will be implemented until March 3, 20231day.

Drugs included in medical insurance: compound paracetamol and amantadine (oral sustained-release dosage form), pediatric paracetamol and amantadine (oral sustained-release dosage form), paracetamol and amantadine (oral liquid dosage form), and Bernoulli hydrochloride (oral sustained-release dosage form) are temporarily included in the basic medical insurance payment scope of our province, and will be implemented in advance until March 2023 according to Class A drugs.

Third, do a good job in the "internet plus" medical insurance service to help patients make online diagnosis and treatment.

Local health departments should promptly publish the list of medical institutions providing "internet plus" medical services. For the industry sector to allow the opening of the first consultation service for novel coronavirus infected with the Internet, provide medical insurance settlement service for patients who have symptoms related to novel coronavirus infection and meet the guidelines for family treatment of COVID-19 infected people, and provide medical insurance mobile payment settlement service if conditions permit, and implement it according to the current offline consultation fee price policy (general outpatient fee, expert outpatient fee, expert outpatient consultation fee, deputy chief physician and expert outpatient consultation fee), and include it in the payment scope of basic medical insurance in our province.

Follow-up services for infection-related symptoms in novel coronavirus are still implemented according to the current Internet follow-up reimbursement policy.

Fourth, improve the price formation mechanism and enhance the ability of medical security.

Continue to do a good job in centralized procurement, online procurement, filing procurement and price monitoring of drugs needed for the treatment of infected people in novel coronavirus, so as to reduce the treatment costs of infected people in novel coronavirus.

Local medical insurance departments should strictly implement policies, improve the fund risk early warning mechanism, strengthen fund supervision, and ensure 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.

Five, optimize the medical insurance handling process, to provide 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 signed the Temporary Special Agreement on the Settlement of Medical Insurance Expenses of novel coronavirus Infected Patients in Medical Institutions with non-medical insurance designated medical institutions that have the ability to treat novel coronavirus infection, and guided all kinds of medical institutions to collect and upload relevant information on the settlement of novel coronavirus infection diagnosis and treatment, and settle medical insurance expenses.

All relevant medical institutions should complete the adaptation and transformation of information systems.

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.

Sixth, strengthen departmental coordination and linkage to ensure that policies are effective.

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.

All relevant departments should improve their political positions and earnestly perform their duties. 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 infected patients in novel coronavirus; The CDC is responsible for uploading the information and data of infected people in novel coronavirus.

Strengthen coordination and linkage to ensure the full implementation of the decision-making arrangements of the CPC Central Committee and the State Council.

This notice shall come into effect as of the implementation date of "Class B and B Management" of infection in novel coronavirus (1.8).

Sichuan Provincial Health Insurance Bureau, Sichuan Provincial Department of Finance, Sichuan Provincial Health and Wellness Committee 202365438+1October 7

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