China News Service, July 26. According to the website of the National Medical Insurance Bureau on the 26th, the National Medical Insurance Bureau and the Ministry of Finance issued a notice on further improving the direct settlement of basic medical insurance for medical treatment in different provinces.
The notice clarifies that by the end of 2025, the direct settlement system and handling management service system for inter-provincial medical treatment in different places will be more complete, the supporting role of the national unified medical insurance information platform will continue to be strengthened, and the national settlement capacity for medical treatment in different places will be significantly improved; the rate of inter-provincial direct settlement of hospitalization expenses Increase to more than 70%, double the number of designated medical institutions in the inter-provincial network of general outpatient clinics, and gradually include outpatient chronic and special disease-related treatment expenses that are widely demanded by the masses and widely carried out in various regions into the scope of direct inter-provincial settlement. Realize that medical insurance reimbursement can be handled both online and offline across provinces.
The notice proposes to improve the direct settlement policy for cross-provincial medical treatment in different places.
Including the unified payment policy of cross-provincial direct settlement fund for inpatient, general outpatient and outpatient chronic diseases.
The medical expenses for inpatient, general outpatient and outpatient chronic and special diseases that are directly settled for cross-province and out-of-town medical treatment shall, in principle, be subject to the payment scope and relevant regulations (basic medical insurance, medicines, medical service items and medical consumables, etc.) stipulated by the medical treatment place. The basic medical insurance fund minimum payment standard, payment ratio, maximum payment limit, and the scope of outpatient chronic and special diseases stipulated by the insurance land are related policies.
Clarify the scope of personnel who seek medical treatment in other places.
Insured persons who live for a long time in different provinces or go out for medical treatment temporarily in different provinces can enjoy the direct settlement service for medical treatment in different places after filing for medical treatment in different places.
Among them, inter-provincial and non-local long-term residents include retirees who are resettled in non-local places, long-term residents in non-local places, and resident non-local staff members who work, live and live outside the insured provinces, autonomous regions, and municipalities directly under the Central Government (hereinafter collectively referred to as provinces) for a long time; inter-provincial temporary residents Those who go out for medical treatment include those who are referred for medical treatment in other places, emergency rescue personnel in other places due to work, travel and other reasons, and other people who go out to seek medical treatment temporarily across provinces.
Standardize the validity period of medical records in different places.
After the long-term residents of different provinces and regions go through the registration and filing, the filing is valid for a long time; the time limit for changing or canceling the filing can be set at the insured place, which in principle does not exceed 6 months.
In principle, the validity period of the filing of inter-provincial people who go out for medical treatment is not less than 6 months, and within the validity period, they can visit the doctor for many times in the medical treatment place and enjoy the direct settlement service for inter-provincial medical treatment in different places.
In addition, it is allowed to make up the record for medical treatment in other places and the insured people with no third-party responsibility for trauma can enjoy direct settlement services for medical treatment in different places in different provinces. It supports long-term residents living in different places in different provinces to enjoy medical insurance treatment in both the place of filing and the place of insurance. Reimbursement policy for out-of-home medical personnel.
The notice is clear and standardizes the direct settlement management services for cross-provincial medical treatment in different places.
Including standardizing the filing process for medical treatment in different places, facilitating the referral of eligible insured persons for medical treatment across provinces, standardizing insured personnel for medical treatment with medical insurance electronic certificates and social security cards, standardizing the direct settlement process across provinces, implementing unified management of medical treatment places, and strengthening medical treatment in different places Business collaboration management.
The notice mentioned that the management of funds for cross-provincial medical treatment in different places should be strengthened.
The medical insurance fund payment part of inter-provincial and non-local medical expenses shall be prepaid and then liquidated between regions.
The settlement of inter-provincial and non-local medical expenses shall be settled in accordance with the national unified settlement, and the settlement at the provincial and municipal levels shall be settled in full on a monthly basis.
The notice also proposes to improve the standardization support of medical insurance informatization, and strengthen the supervision of direct settlement funds for medical treatment in different provinces.
(Zhongxin Finance)
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