Notice of Beijing Municipal Health Insurance Bureau on Incorporating Outpatient Treatment of Severe Mental Illness into the scope of special diseases in this Municipality’s basic medical insurance out
Jing Jian Bao Fa [2020] No.25
Medical and Social Security Bureau of each district, Social Affairs Bureau of Beijing Economic and Technological Development Zone, and designated medical institutions:
In order to further reduce the burden of medical expenses of the insured persons of basic medical insurance and improve the relevant policies of this Municipality, the relevant issues are hereby notified as follows:
First, the "severe psychosis", "targeted treatment of pulmonary hypertension", "multi-drug resistant tuberculosis", "Niemanpick’s disease type C", "biological agent treatment of moderate and severe allergic asthma" and "anti-fibrosis treatment of idiopathic pulmonary fibrosis" will be included in the scope of special diseases in the basic medical insurance clinic of this municipality. Among them, severe psychosis refers to schizophrenia, bipolar disorder, schizoaffective mental disorder, paranoid mental disorder, mental disorder caused by epilepsy and severe mental retardation.
Two, outpatient special disease reimbursement scope is limited to outpatient examination, treatment and use of related drugs (see Annex 1), and in line with the basic medical insurance payment scope and standards of medical expenses.
Three, to further increase the malignant tumor outpatient treatment, renal dialysis two outpatient special disease drug reimbursement varieties (see Annex 2).
Iv. Insured persons who meet the requirements of newly-added special diseases in outpatient service shall enjoy the reimbursement treatment for special diseases in outpatient service after filing and auditing in the designated medical institutions for special diseases selected by them in accordance with the Notice on Issues Related to Adjusting the Filing Process of Special Diseases in Beijing Basic Medical Insurance (J.H.F. [2016] No.30). The related expenses that have not been reviewed for the record or occurred in the designated medical institutions for special diseases selected by me are not included in the scope of reimbursement for medical expenses for special diseases in outpatient department.
Five, the city’s basic medical insurance, outpatient use of "infliximab injection" and other nine kinds of drugs (see Annex 3), the basic medical insurance fund for urban workers is paid by 80%, the basic medical insurance fund for urban and rural residents is paid by 70%, and the medical insurance fund payment part is included in the accumulated hospitalization expenses, and the capping line is implemented according to the hospitalization standard (for Trial Implementation).
Six, the relevant designated medical institutions should earnestly do a good job in the insured for the record review, strictly implement the clinical diagnosis and treatment norms and the relevant provisions of the basic medical insurance, in accordance with the requirements of reasonable inspection, reasonable treatment and rational drug use, to ensure the basic drug demand of the insured, and not to settle medical expenses unrelated to the treatment of special outpatient diseases according to special outpatient diseases.
Seven, the medical insurance agencies should take effective measures, do a good job in the audit and settlement of medical expenses of the insured, do a good job in the statistical analysis and monitoring of drugs and medical expenses, continuously strengthen the management of the use of medical insurance funds, and improve the efficiency of the use of medical insurance funds.
Eight, this notice shall be implemented as of October 1, 2020.
Attachment: 1. The scope of reimbursement for outpatient special diseases such as severe psychosis.
2. Malignant tumors and special diseases in renal dialysis clinics increase the scope of drug reimbursement.
3. Outpatient service pays drug varieties according to a fixed proportion.
Beijing Municipal Medical Security Bureau
September 10, 2020
