On June 28, the medical insurance bureau of Hebei Province issued the notice on carrying out the pilot work of including some medical service items and medical consumables into the payment scope of medical insurance at the provincial level, and decided to carry out the pilot work of including some medical service items and medical consumables into the payment scope of medical insurance at the provincial level.
According to the contents of the notice, the medical expenses incurred by the insured at the provincial level in the designated medical institutions at the provincial level and the sporadic reimbursement expenses of the insured at the provincial level are included in the pilot scope.
The notice points out that new payment items and consumables are added. 50 medical service items and 242 medical consumables are included in the payment scope of medical insurance and managed according to category B. For medical service items with limited price, the limited price shall be taken as the payment standard of medical insurance; For medical consumables with limited price, the limited price shall be taken as the payment standard of medical insurance.
It is necessary to standardize the policy of self-payment for medical insurance diagnosis and treatment projects and consumables at the provincial level. On the basis of implementing the policies and price limits of the catalogue of diagnosis and treatment items and medical service facilities of basic medical insurance in Hebei Province and the catalogue of management of disposable items charged separately in Hebei Province (version 2021), “class a” diagnosis and treatment items and consumables do not set the proportion of individual self-payment in advance, and are paid by the basic medical insurance pooling fund in accordance with the regulations; For “class B” diagnosis and treatment items and consumables, the insured shall first pay 10% by himself, and for those who participate in the civil service subsidy (or 10% supplement), some individuals shall not pay by himself; “Class C” or “self-funded” diagnosis and treatment items and consumables shall be borne by the insured.
The notice also emphasizes that the provincial medical insurance bureau will strengthen the supervision and inspection of medical service items and medical consumables, and timely interview the main principals of relevant medical institutions and notify the whole province when necessary for the high proportion of patients at their own expense, the excessive use of self-funded consumables by medical institutions and the unreasonable use of self-funded items.
Previously, high-value consumables in most parts of the country mainly relied on diagnosis and treatment service projects for medical insurance payment management, and only a few regions developed separate medical insurance access directories according to the types of consumables. In 2020, the National Medical Insurance Bureau issued the Interim Measures for the management of medical consumables for basic medical insurance (Draft for comments), proposing to adopt catalog access management for consumables.
In November last year, the National Medical Insurance Bureau issued the Interim Measures for the payment management of medical consumables for basic medical insurance (Draft for comments), revised the above-mentioned documents based on widely soliciting opinions from all parties, and studied and drafted the specification for the naming of “medical insurance common name” of medical consumables for medical insurance (Draft for comments).
Post time: Jul-04-2022