1、 What diseases are included in the chronic disease clinic?

At present, it is tentatively divided into 12 categories: hypertension, diabetes, Alzheimer's disease, Parkinson's disease, coronary atherosclerotic heart disease, chronic kidney disease, bronchial asthma, tuberculosis, peritoneal dialysis, chronic obstructive pulmonary disease, schizophrenia, affective psychosis, etc.

    2、 Who are the people enjoying the outpatient service for chronic diseases?

Those who have been diagnosed as chronic diseases within the scope of outpatient diseases of chronic diseases of medical insurance, and who have signed a contract with a family doctor for service specifications, and have accepted the service signed by a family doctor for basic medical insurance at the municipal level.

    3、 What are the coverage of outpatient service for chronic diseases?

The expenses incurred by the basic medical insurance insured personnel who suffer from chronic diseases in the targeted dispensing of drugs in the designated medical institutions are included in the medical insurance coverage of chronic disease outpatient clinics.

The scope of targeted drugs for chronic diseases shall be determined by the contracted family doctor of the designated medical institution for chronic diseases, and a continuous (external) prescription for drugs for chronic diseases shall be issued. The targeted drugs for chronic diseases can be supplied by the designated medical institutions for chronic diseases that accept the contracted services of family doctors, or sold by the designated retail pharmacies for chronic diseases with reference to the registration and filing of special drugs.

    4、 How to create designated medical institutions for chronic disease clinics?

The designated medical institution for chronic diseases shall be the designated primary medical institution for basic medical insurance that provides contracted services for family doctors; The designated retail pharmacies for chronic diseases are designated pharmacies for basic medical insurance. There are no more than two in each town (street), and they should meet the following requirements at the same time: 1. Drug retail chain enterprises; 2. It can meet the demand of chronic disease medication; 3. Previous sales experience in registration and filing of special drugs.

Qualified medical institutions and drug retail chain enterprises can apply to the social insurance agency, which will be reviewed by the audit department of the social insurance agency, and announced to the public after the human resources and social security department organizes relevant departments to determine (the list is attached).

    5、 How about the registration process of chronic disease clinic?

The basic medical insurance participants at the municipal level who meet the conditions for enjoying the outpatient treatment of chronic diseases must record the outpatient treatment of chronic diseases through a contracted family doctor before they can enjoy the relevant treatment.

Chronic disease record process: when a contracted family doctor carries out chronic disease contract services, if he finds that the insured person meets the conditions for chronic disease outpatient treatment, he shall record the record information truthfully as required, and then transmit it to the social insurance agency for review and confirmation. In addition to the basic information of the insured, the filing information should also include the following contents: 1. specific diseases of 12 chronic diseases such as hypertension and diabetes; 2. Name of designated medical institution for chronic diseases; 3. Continuous (external) prescription of drugs for chronic diseases.

    6、 How about the treatment of chronic disease clinic?

1. Continuous (external) prescription for chronic diseases. If the insured needs to use targeted drugs for their chronic diseases, the contracted family doctor will issue a continuous (external) prescription for chronic diseases; The one-time dosage is determined by the family doctor and generally does not exceed 12 weeks.

2. Improve the treatment guarantee. The medical insurance payment standard for targeted drugs for chronic diseases that meet the payment scope of medical insurance increased by 3 percentage points for the insured personnel who meet the treatment conditions for outpatient services for chronic diseases through the registration of treatment for outpatient services for chronic diseases; The maximum payment limit for general outpatient service of basic medical insurance will be increased, and some of the expenses for targeted drugs for chronic diseases will be included in the limit. The annual maximum compensation for outpatient service of the Fund for Residents' Medical Insurance Participants will be increased by 500 yuan/person, and the maximum payment limit for outpatient service of employees' medical insurance participants will be increased by 2000 yuan/person.

3. Unified payment standard. The insured personnel who meet the treatment conditions of chronic disease outpatient service will be paid according to the outpatient payment standard of community health service institutions after the treatment records of chronic disease outpatient service are filed, and the targeted drugs for chronic diseases that meet the payment scope of medical insurance will be allocated in the designated medical institutions for chronic diseases.

    7、 What circumstances need to be changed for filing?

The insured person needs to apply for change of filing in case of the following circumstances: 1. New chronic diseases; 2. The designated medical institution has changed; 3. The continuous (external) prescription of drugs for chronic diseases has changed.

    8、 In what circumstances should the filing be terminated?

The improvement of the chronic disease of the insured does not meet the treatment conditions of the chronic disease clinic, or the condition of chronic kidney disease, pulmonary tuberculosis, abdominal dialysis, schizophrenia, affective psychosis and other conditions meet the disease type standard of basic medical insurance.

    Appendix: List of Designated Medical Institutions for Chronic Diseases under Jiaxing Basic Medical Insurance