Since the launch of the provincial medical insurance, outpatient special chronic diseases have been implemented fixed-point management, outpatient special chronic disease patients must choose a hospital in the provincial directly designated hospital as the treatment hospital for outpatient special chronic diseases, in principle, it must not be changed within one year, if special circumstances need to be changed, it must be changed through online or offline methods, and the medical expenses incurred in the selected treatment hospital can be reimbursed according to regulations.
From October 1, 2021, the relevant policies of the provincial medical insurance outpatient special chronic diseases have been adjusted, and the restrictions on outpatient special chronic disease designated treatment hospitals have been abolished. In addition to organ transplantation anti-rejection, uremia dialysis and tuberculosis (including multi-drug resistant tuberculosis), other outpatient special chronic diseases, patients can arbitrarily choose designated hospitals with treatment capacity for medical settlement, which greatly facilitates the province's direct chronic disease patients.
Taking diabetes comorbidities, hypertensive comorbidities, and coronary heart disease (old myocardial infarction) as an example, before the policy adjustment, patients with the above outpatient special chronic diseases could only choose a provincial designated hospital as the treatment hospital, and the medical insurance fund for medical expenses incurred in non-selected provincial directly designated hospitals would not be reimbursed; After the policy adjustment, patients can be treated at any time in 34 designated hospitals with treatment capabilities, without going through the change procedures, and the medical expenses incurred by the medical insurance fund can be reimbursed according to regulations.
In addition, our province has also cancelled the provincial direct medical insurance diabetes comorbidities and hypertension comorbidities.
Diabetic comorbidities and hypertensive comorbidities are two kinds of outpatient special chronic diseases of provincial medical insurance, including: peripheral neuropathy, cerebral hemorrhage, cerebral infarction (except asymptomatic lacunar cerebral infarction), chronic retinopathy, coronary atherosclerotic heart disease, diabetic nephropathy; Hypertensive comorbidities include: cerebral hemorrhage, cerebral infarction (except for asymptomatic lacunar cerebral infarction), heart failure of more than 2 degrees, myocardial infarction, renal failure (clinically greater or greater than four stages of renal disease), fundus hemorrhage or exudation, with or without papilledema of the optic nerve. In the previous policy, if the comorbidities did not appear at the same time, each comorbidity needed to participate in a centralized physical examination, that is, to handle the identification of diabetes comorbidities and hypertension complications.
From October 1, 2021, cancel the identification of diabetes comorbidities and hypertensive comorbidities, and appropriately relax the restrictions on the use of diabetes and hypertension comorbidities. Patients who have been identified as diabetic comorbidities and hypertensive comorbidities, who suffer from diabetes mellitus and other comorbidities of hypertension that meet the policy provisions, do not need to apply for additional identification, and when outpatient special chronic diseases are sought, they can issue corresponding prescriptions for diabetes and hypertension comorbidities that comply with the policy.
Taking diabetic comorbidities as an example, if the patient has already applied for an outpatient special chronic disease with diabetic and coronary atherosclerotic heart disease, and then diabetic nephropathy occurs, there is no need to go through the additional identification procedures, and the treatment costs of diabetic nephropathy can be included in the medical insurance fund reimbursement.
Liaoshen Evening News reporter Hu Tingting