- Date:2011-10-18
- Click:11457Times
Outpatient chronic diseases for Medicare patients
((I) Treatment:If a participant suffers from a chronic disease that requires long-term outpatient treatment and is approved, he/she is entitled to the following medical treatment:1) Outpatient medical expenses incurred for the treatment of approved diseases and complications and comorbidities are reimbursed.2) Outpatient patients with chronic diseases are exempted from the starting standard for outpatient hospitalization treatment.
(ii) Scope of diseases:
(1) Radiotherapy and chemotherapy for malignant tumor patients (2) Dialysis treatment for uremia patients
(3) Anti-rejection treatment for organ transplant patients (4) Myelodysplastic syndromes
5) Pulmonary heart disease (those who develop right heart failure) 6) Asthma (annual hospitalization for more than three years)
7) Parkinson's syndrome 8) Necrosis of the femoral head
(9) severe hepatitis, cirrhosis 10) chronic nephritis, purpura kidney
11) Ankylosing spondylitis 12) Coronary heart disease
(13) rheumatoid arthritis (active) (14) leukemia
(15) Diabetes mellitus (with infection or one of the heart, kidney, liver, nerve complications)
(16) Systemic lupus erythematosus (one of the complications of heart, lungs, kidneys, liver and nerves)
(17) aplastic anemia leukemia (need to continue chemotherapy)
(18) cerebrovascular disease (cerebral hemorrhage, cerebral infarction, cerebral vascular malformation)
(19) Hypertension grade 3 (heart, brain, kidney, one of the complications)
(20) primary thrombocytopenic purpura
(C) application procedures: fill out the Liaocheng City Health Insurance Outpatient Chronic Disease Treatment Review Form, bring the original outpatient medical records of the last three years, the discharge records of recent hospitalization or copies of medical records and other relevant information, and report it to the labor security administrative department (Municipal Administrative Service Center Labor Security Window) for approval. The labor security administrative department organizes a medical expert group to evaluate the applicant according to the type of disease he/she applies for. If the evaluation is approved, the applicant will receive the Special Disease Outpatient Medical Certificate, Special Disease Outpatient Medical Record and Special Disease Outpatient Prescription Book at the Municipal Health Insurance Office, and the scope of medication for the approved types of diseases will be approved.
(d) Consultation and purchase of medicines: Holding the Special Disease Outpatient Medical Card, Special Disease Outpatient Medical Record and Special Disease Outpatient Prescription Sheet, you can go to the Labor Security Chronic Disease Clinic of Liaocheng City People's Hospital No.2 to consult the doctor, receive treatment and purchase medicines. If you need to purchase medicines that are not available in the Labor Security Chronic Disease Clinic, or if you need to go to a designated hospital for further examination and treatment, you have to be approved by the Municipal Health Insurance Office.
(e) Reimbursement of medical expenses: (1) Medical expenses incurred in the outpatient clinics for chronic diseases of labor protection are settled instantly through the computer network, with the starting standard waived, and the reimbursement ratio of the first-class hospitals is settled, and the individual only needs to pay for the out-of-pocket portion of the expenses.
(2) Approved medical expenses incurred outside the Labor Security Chronic Disease Outpatient Clinic shall be paid in advance by the individual first. If the advance payment exceeds 5,000 yuan, you can go to the Municipal Medical Insurance Office at the beginning of each month with valid medical expense documents for review and reimbursement. If it is less than 5,000 RMB, reimbursement will be made according to the time specified by the Municipal Health Insurance Office and in the order of the number of the Special Disease Outpatient Medical Card.
(3) Medical expenses incurred during the period after the declaration of outpatient chronic diseases and before the approval will only be reimbursed for those incurred in the Labor Security Chronic Diseases Clinic.
(6) Annual review: Bring the Special Disease Outpatient Medical Card, Special Disease Outpatient Medical Record, Special Disease Outpatient Prescription Booklet, and all the examination and treatment data in the past year (if you were hospitalized during the period, bring a copy of the medical record or the discharge record) to the Special Medical Care Management Section of the Municipal Health Insurance Office. Follow the time and order of the annual examination set by the Municipal Health Insurance Office and go to a designated medical institution for a physical examination. Failure to attend the annual examination at the specified time is considered as automatic abandonment, and the outpatient chronic disease treatment will be terminated.