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All provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps medical insurance bureaus and finance departments (bureaus):
In order to implement the key tasks of the 2021 "Government Work Report" and the "Guiding Opinions of the General Office of the State Council on Accelerating the Promotion of "Trans-provincial Administration" of Government Services" (Guobanfa [2020] No.
35) The problem of “emergency and worry” in the settlement of medical treatment in different places has been accelerated to promote the direct settlement of outpatient expenses across provinces.
The relevant matters are hereby notified as follows:
1.
Work objectives
By the end of 2021, more than 60% of the counties in each province will have at least one inter-provincial networked medical institution for general outpatient expenses, and each coordinating area will basically achieve direct settlement of ordinary outpatient expenses across provinces; for outpatient radiotherapy and chemotherapy for hypertension, diabetes, malignant tumors, and uremia In five outpatient clinics for chronic diseases, including dialysis, anti-rejection treatment after organ transplantation, etc.
, which are in high demand by the masses and are commonly carried out in various regions, each province has at least one coordinating area to achieve direct settlement of related treatment costs across the provinces.
By the end of 2022, each county has at least one designated medical institution that can provide direct settlement services for medical expenses including outpatient expenses across provinces; basically realize the direct settlement of related treatment expenses for the above-mentioned 5 major outpatient chronic diseases across provinces and coordinate areas Full coverage, promote direct settlement of other outpatient chronic diseases related treatment costs across provinces or sporadic online reimbursement.
2.
(1) Expand the coverage of direct settlement of general outpatient expenses across provinces.
(2) Actively promote cross-provincial direct settlement of related treatment costs for outpatient chronic diseases.
(3) Fully promote the networking of designated medical institutions.
(4) Continue to optimize online services for medical records in different places.
The pilot provinces for self-service direct settlement services for medical treatment in different places must grasp and track the implementation and operation of the pilot in a timely manner, and submit the self-assessment report to the National Medical Insurance Bureau by the end of June 2021.
(5) Ensure that the upgrading and transformation of the inter-provincial direct settlement information system is in place and runs smoothly.
(6) Strengthen the coordination and efficiency of cross-provincial and remote medical settlement business.
(7) Strengthen the cross-provincial direct settlement of prepayments and clearing funds management for medical expenses in different places.
3.
(1) Strengthen organization and leadership.
(2) Strengthen overall planning and coordination.
Provincial medical insurance departments coordinate the reform and operation of the medical security system during the "14th Five-Year Plan" period, adhere to the uniformity and standardization of the policy and management of direct settlement of outpatient expenses across provinces, and take into account the construction of a unified national medical security information platform and 15 business codes.
Implement the progress of the implementation of the standards, strengthen system integration, and focus on the coordinated advancement of various reforms.
Provinces that have not yet started direct settlement of outpatient expenses in different places within the province must follow the arrangement of inter-provincial networking, and realize the settlement of intra-provincial networking at the same time.
(3) Strengthen dispatch and supervision.
Before April 30, 2021, the provincial medical insurance department will submit the work plan for direct settlement of outpatient expenses for the period of 2021-2022 to the National Medical Insurance Bureau.
All provinces should establish special work supervision accounts within the province, and regularly schedule and coordinate regional access, expansion of designated medical institutions, and system operation.
The National Medical Insurance Bureau will report on a monthly basis the status of direct settlement and expansion of cross-provincial medical treatment in different places and the system operation error report, and the Ministry of Finance will report quarterly the receipt and payment of funds for direct settlement of medical treatment in cross-province and different places, and organize inter-provincial direct settlement of outpatient expenses in a timely manner.
Actual business measurement, interviews and supervision of provinces with slow progress and poor implementation of work.
National Medical Insurance Administration Ministry of Finance
April 12, 2021
