According to the notice on promoting the pilot work of cross provincial direct settlement of outpatient expenses issued by the State Medical Security Bureau and the Ministry of finance, it is proposed that by the end of 2020, relying on the "national remote medical treatment management system", the pilot scope of cross provincial direct settlement of outpatient expenses will be further expanded, and a unified system, operation mechanism and implementation path of cross provincial direct settlement of outpatient expenses will be explored.
China plans to initially build a national unified medical insurance information platform by the end of 2021, including 14 business subsystems, such as public service, cross provincial medical management, etc. Among them, the trans provincial remote medical treatment management subsystem, also known as "national remote medical treatment management system", has been officially put into use in early May 2020.
According to the circular, 12 pilot provinces, autonomous regions and cities in Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang, Anhui, Chongqing, Sichuan, Guizhou, Yunnan and Tibet will be guided to access the national remote medical treatment management system, and further expand the pilot areas, pilot medical institutions and direct settlement scope. Adhere to the principle of "first within the province, then cross province, first general outpatient service and then outpatient service". In combination with the actual situation of information platform construction in various regions and the construction requirements of national unified information platform, give priority to the areas with centralized medical treatment places and high willingness to participate, and steadily promote the pilot work of cross provincial direct settlement of outpatient fees.
At the same time, other provinces with conditions and willingness, such as having basically realized the direct settlement of outpatient expenses within the province, and being able to complete the interface transformation with high quality on time, can submit the pilot application to the National Health Insurance Bureau before October 10, complete the system transformation before the end of November, and test run after the acceptance of the National Health Insurance Bureau before the end of December.
According to the notice, the pilot project of cross provincial direct settlement of outpatient expenses will adhere to the hierarchical diagnosis and treatment system, and guide the insured to seek medical treatment in an orderly manner. We should adhere to the basic medical insurance policy, process, and settlement method to be basically stable, and integrate the remote medical treatment into the negotiation and consultation, total amount control, intelligent monitoring, medical doctor management, medical service quality supervision and other management services between the local medical institutions and designated medical institutions.
According to the requirements of the notice, the payment scope and relevant provisions (payment scope of basic medical insurance drugs, medical service items and medical consumables) stipulated by the medical treatment place shall be implemented in principle for the outpatient expenses directly settled by cross provincial medical personnel. The basic medical insurance fund payment standard, payment proportion, maximum payment limit, outpatient chronic diseases and other reimbursement policies shall be implemented in accordance with the provisions of the insured place.