Good policy for village clinics! Tianjin medical insurance reimbursement 80%

Source: Tianjin Health Committee Editor: Liu Xiaolin On the other hand, the medical insurance card can be swiped in the village clinics, and the reimbursement rate is as high as 80% Recently, Tianjin Municipal Health and Health Commission issued the notice on supporting the integrated management of township and village health services to include the outpatient medical expenses of village clinics into the reimbursement of medical insurance (hereinafter referred to as the notice) According to the notice, eligible village clinics can apply for outpatient medical expenses to be included in medical insurance reimbursement It is in line with the standardized construction conditions of village clinics in Tianjin, and implements the integrated "Five Unifications" management of town and village health services with health centers (township hospitals, community health service centers, the same below) It can apply for the outpatient medical expenses to be included in the medical insurance reimbursement ① Unified personnel management ② Unified business management ③ Unified financial revenue and expenditure management ④ Unified purchase and sale management of drugs and medical devices ⑤ Unified performance appraisal and salary distribution management The medical expenses incurred by the insured in the outpatient service of the village health room shall be reimbursed in accordance with the relevant policies of the outpatient service of the designated medical institutions at the first level Among them, the general diagnosis and treatment fees collected by the village health office according to the regulations, and the medical expenses below the maximum payment limit in the outpatient department shall be reimbursed 80% by the basic medical insurance fund and 20% by the individual According to the relevant regulations of this Municipality, the insured who sign the family doctor contract service can enjoy the relevant medical insurance treatment at the same time According to the notice, it is necessary to complete the following steps for eligible village clinics to apply for outpatient medical expenses to be included in medical insurance reimbursement (1) Submit written application: submit written application to the Health Committee of the jurisdiction in the name of the health center; (2) Verification by the superior: verify the setting of village health rooms, the configuration of village doctors and the "Five Unifications" management of the integration of town and village health services, and transfer to the District Medical Security Bureau if it meets the relevant provisions of the application of the institution; Monitor system monitor system (3): village health room should install "Internet plus video surveillance" and other intelligent monitoring devices, and connect with the city medical insurance monitoring system (4) Negotiation and signing agreement: negotiate with the hospital affiliated to the village health office to determine the list of village health offices to be included in the outpatient medical insurance reimbursement After reporting to the Municipal Medical Insurance Center for filing, the district medical insurance sub center and the health center affiliated to the village health office under its jurisdiction shall sign a medical insurance designated service agreement Note: the information of village health room and village doctor shall be reported by the health center to the medical insurance sub center of the jurisdiction in accordance with the relevant provisions of this Municipality, and included in the management of medical insurance information system In case of information change, relevant change procedures shall be handled According to the notice, the village clinics will be supervised in three aspects: total amount management, agreement management and supervision management First, the outpatient medical expenses of village clinics are included in the total medical insurance payment management index accounting scope of the affiliated hospital On the basis of accounting according to the unified plan of the whole city, the total outpatient management index of the affiliated hospital will be increased by no more than 20% Second, the daily management of village clinics and township medical practitioners will be strengthened, and any violation of the service agreement will be dealt with in a timely manner Third, the online settlement of outpatient fees in village clinics is included in the management scope of intelligent medical insurance audit system and real-time monitoring system Serious punishment shall be given to the illegal behaviors, which shall be reported to the relevant departments for handling in accordance with the regulations Those with serious circumstances shall be included in the "blacklist" of medical insurance for joint punishment, and those suspected of crimes shall be transferred to the judicial organ for criminal responsibility At present, many parts of the country have carried out the pilot work of village clinics included in the designated medical insurance Take Tianjin as an example As early as 2017, 18 village health offices in DAZHANGZHUANG town and xiditou town have carried out medical insurance online settlement.