What are the new rules for reimbursement of chronic special diseases in 2024

The new rules for the reimbursement of slow special diseases in 2024 include:

1, outpatient chronic diseases: urban and rural residents outpatient chronic diseases to implement the fixed amount management, in the second level and above the fixed-point medical institutions and township health centers in the city outpatient examination and treatment, the starting standard is 300 yuan, the reimbursement rate of 60%, the maximum cumulative payment of single disease per person within the year 1,800 yuan, more than two kinds of disease within the year The maximum cumulative payment limit is 2500 yuan.

2. Outpatient Special Diseases: For outpatient examination and treatment at Level 2 or above designated medical institutions, the starting payment standard for urban and rural residents is 300 yuan; the reimbursement rate is 85%.

3. Medical treatment for outpatient chronic and special diseases for urban and rural workers: the starting payment standard for outpatient chronic diseases is 200 yuan, and the reimbursement rate is 80%; the starting payment standard for outpatient special diseases is 200 yuan, and the reimbursement rate is 85%.

4. Determination of outpatient slow special diseases: For diseases that can be clearly diagnosed by outpatient examination, hospitalization shall not be a necessary condition for determining outpatient slow special diseases.

5, outpatient reimbursement rate of slow special diseases: a class of outpatient slow special disease reimbursement by project, the reimbursement rate from the original 80% to 85%; the second class of outpatient chronic diseases to implement the limit of payment management, the reimbursement rate from the original 70% to 75%.

Procedure for reimbursement of chronic and special diseases:

1. The patient himself applies to the social security center and fills in the official application form.

2. Submit the necessary supporting documents for the chronic disease case card, and see the doctor and buy medicines at the outpatient department of the designated hospital.

3. Within the stipulated time, bring the list of outpatient medical expenses for chronic and special diseases, prescription invoices, case certificates, and various examination reports to the social security center to reimburse the medical expenses.

In summary, the new regulations on the reimbursement of medical insurance for slow and special diseases in 2024 involve the updating of drug catalogs, the optimization of reimbursement policies, and the funding policies for special groups, which are aimed at improving the level of protection and fairness of the medical insurance system.

Legal basis:

The Law of the People's Republic of China on Social Insurance

Article 28

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards, as well as those for emergencies and salvage, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.