晋江市医疗保险管理中心门诊特殊病种申请和审批指南

晋江市医疗保险管理中心门诊特殊病种申请和审批指南 一、办理依据:《关于我市基本医疗保险门诊特殊病种和治疗项目的通知》(泉劳医[2010]210号) 二、办理条件或:经二级以上(含二级)定点医疗机构确诊患有11项门诊特殊病种的一种或多种的参保人员 三、办事程序:二级以上(含二级)定点医疗机构填写申请表 市医保中心医务科审批 市医保中心主任审批 市医保医务科登记、发给门诊特殊病种诊疗证。 四、提供材料: 1、《门诊特殊病种、家庭病床审批表》一式两份, 2、医院诊断证明, 3、辅助检查及化验报告单等～具体按各病种规定执行,详见办理门诊特殊病种注意事项,, 4、本人IC卡, 5、一寸正面、免冠近期彩照1张, 五、承诺时限:手续齐全，现场办理。 六、收费标准:免费 七、收件窗口:市医保中心医务科窗口 八、联系电话:85678062 85678065 办理门诊特殊病种注意事项 参保人员经二级以上(含二级)定点医疗机构确诊患有11项门诊特殊病种的一种或多种，可由确诊的定点医疗机构提出申请，填写《门诊特殊病种申请表》并附相关的诊断依据和一张近期1寸彩色照片到晋江市医保中心医务科办理门诊特殊病种和诊疗项目审批手续。具体如下: 一、恶性肿瘤化学治疗和放射治疗 1、定点医院 经基本医疗保险经办机构确认的二级(含二级)以上的定点综合性医院和肿瘤专科医院。 2、审批手续 须由定点医院经治主治医师提出申请，临床科主任签字，医院出 具诊断证明书，并附下列相关诊断依据之一，报经医保经办机构确认。 ?、组织学诊断; ?、细胞学诊断; ?、影像学诊断。 注:单纯凭影像学诊断，须经三级医院副主任医师(含副主任医师)以上的医师做出。 At present, the County personnel totaled 93,000 people, is three times times of 2010. Review the work of the past five years, the County formed to encourage innovation, innovation, participation in innovative atmosphere, a large number of innovations emerging high-level personnel leading the increasingly strong role; innovative idea further innovations gradually expanded from economic to social governance, public safety, intelligence and other areas of urban construction, innovation and talent support becomes increasingly important. Of hard work, the county levels to cherish, continue to consolidate, improve and, for the future development, to remain sober-minded, scientific foresight, courage to play. Under the influence of complicated international and domestic situation, the domestic economic situation, and General Secretary of "stability, but downward pressure on large trend of differentiation and deepening of structural adjustment" sums up the current situation. From Dongping actual see, "Thirteen-Five" during, County faced stable economic growth, and deepening structure adjustment of double task, both faced with economic total small, and per capita level low, and industry structure not reasonable, and economic development way extensive, basic situation, more has industry cluster early now prototype, and Park hosted capacity constantly enhanced, and resources traffic location advantage increasingly appeared, and cadres masses innovation venture passion 二、重症尿毒症透析门诊特殊病种 1、定点医院 经基本医疗保险经办机构确认的二级甲等(含二级甲等)以上并具备相应专科设置的综合性医院。 2、审批手续 凡重症尿毒症患者需进行透析治疗的应由专科副主任以上的医师(含副主任医师)作出诊断，医院出具诊断证明书，并附相关诊断依据，最后经医保经办机构确认。 相关诊断依据和诊治项目详见《关于我市基本医疗保险门诊特殊病种和治疗项目管理办法的通知》(泉劳医[2000]210号)附件一《关于印发基本医疗保险门诊甲类特殊病种和治疗项目管理暂行办法的通知》(闽劳社[2000]442号)。 三、结核病治疗 1、定点医院 经基本医疗保险经办机构确认的结核病防治院(所)。 2、审批手续 结核病的诊断由专科主治医师以上(含主治医师)的医师作出，结核病防治院(所)出具诊断证明书，并附下列相关诊断依据，并经医保经办机构确认。 肺结核病的确诊必须具有下列辅助诊断依据之一; ?细菌学诊断; ?影像学诊断; ?病理学诊断; 肺外结核病的诊断必须根据病情和相关检查(如结肠镜、 腹腔镜、膀胱镜检查、泌尿系统造影、脑脊液等检查)做出。 四、器官移植抗排异反应治疗 1、定点医院 经基本医疗保险经办机构确认的三级乙等(含三级乙等)以上综合性医院。 2、器官移植的适用范围 肾脏、心脏瓣膜、角膜、血管和骨髓五种移植术。 3、审批手续 须由专科主治医师以上(含主治医师)的医师做出诊断，医院出 具诊断证明书，并附相关诊断依据，最后经医保经办机构确认。 五、精神分裂症 1、定点医院 经基本医疗保险经办机构确认的精神病专科医院和二级(含二级)以上具有精神病专科设置的综合性医院。 2、审批手续 At present, the County personnel totaled 93,000 people, is three times times of 2010. Review the work of the past five years, the County formed to encourage innovation, innovation, participation in innovative atmosphere, a large number of innovations emerging high-level personnel leading the increasingly strong role; innovative idea further innovations gradually expanded from economic to social governance, public safety, intelligence and other areas of urban construction, innovation and talent support becomes increasingly important. Of hard work, the county levels to cherish, continue to consolidate, improve and, for the future development, to remain sober-minded, scientific foresight, courage to play. Under the influence of complicated international and domestic situation, the domestic economic situation, and General Secretary of "stability, but downward pressure on large trend of differentiation and deepening of structural adjustment" sums up the current situation. From Dongping actual see, "Thirteen-Five" during, County faced stable economic growth, and deepening structure adjustment of double task, both faced with economic total small, and per capita level low, and industry structure not reasonable, and economic development way extensive, basic situation, more has industry cluster early now prototype, and Park hosted capacity constantly enhanced, and resources traffic location advantage increasingly appeared, and cadres masses innovation venture passion 须由专科主治医师以上(含主治医师)的医师做出诊断，医院 具诊断证明书，并附相关诊断依据，最后经医保经办机构确认。 六、高血压?期、?期门诊特殊病种 1、定点医院 经基本医疗保险经办机构确认的二级(含二级)以上医院。 2、审批手续 须由二级(含二级)以上医院心血管副主任(含副主任)以上医师做出诊断，医院出具诊断证明书，并附相关诊断依据，最后经医保经办机构确认。 ?病历摘要(包括主诉、病史、体格查检等); ?相关的X线检查、心电图、眼底检查、血常规、尿常规、肾功能等实验室检查报告单。 注:根据泉劳医[2002]278号文规定，从2003年1月1日起对高血压病特殊门诊费实行年度最高支付金额管理，即每人每年高血压特殊病种最高实报3500元，超过部分统筹基金不予支付。 七、糖尿病1型、2型 1、定点医院 经基本医疗保险经办机构确认的二级(含二级)以上医院。 2、审批手续 须由二级(含二级)以上医院专科副主任(含副主任)以上医师做出诊断，医院出具诊断证明书，并附相关诊断依据，最后经医保经 办机构确认。 ?病历摘要(包括主诉、病史、并发症、体格检查等); ?实验室检查:尿糖、血糖、糖耐量试验等检查结果报告单。 ?其他检查:视力、眼底镜检查、心电图等。 注:根据泉劳医[2002]278号文规定，从2003年1月1日起对糖尿病特殊门诊费实行年度最高支付金额管理，即每人每年每个糖尿病特殊病种最高实报3500元，超过部分统筹基金不予支付。 八、再生障碍贫血 1、定点医院 经基本医疗保险经办机构确认的二级(含二级)以上综合性医院及中医院。 2、审批手续 须由二级(含二级)以上医院专科(血液科)副主任(含副主任)以上医师做出诊断，医院出具诊断证明书，并附相关诊断依据及审批表;最后经医保经办机构确认。 ?临床特征性症状; ?化验检查:血象、骨髓象等检查报告。 九、慢性心功能衰竭(II期、III期)门诊 1、定点医院 At present, the County personnel totaled 93,000 people, is three times times of 2010. Review the work of the past five years, the County formed to encourage innovation, innovation, participation in innovative atmosphere, a large number of innovations emerging high-level personnel leading the increasingly strong role; innovative idea further innovations gradually expanded from economic to social governance, public safety, intelligence and other areas of urban construction, innovation and talent support becomes increasingly important. Of hard work, the county levels to cherish, continue to consolidate, improve and, for the future development, to remain sober-minded, scientific foresight, courage to play. Under the influence of complicated international and domestic situation, the domestic economic situation, and General Secretary of "stability, but downward pressure on large trend of differentiation and deepening of structural adjustment" sums up the current situation. From Dongping actual see, "Thirteen-Five" during, County faced stable economic growth, and deepening structure adjustment of double task, both faced with economic total small, and per capita level low, and industry structure not reasonable, and economic development way extensive, basic situation, more has industry cluster early now prototype, and Park hosted capacity constantly enhanced, and resources traffic location advantage increasingly appeared, and cadres masses innovation venture passion 经基本医疗保险经办机构确认的二级(含二级)以上医院。 2、审批手续 须由二级(含二级)以上医院心血管专科副主任(含副主任)以上医师做出诊断，医院出具诊断证明书，并附相关诊断依据，最后经医保经办机构确认。 3、相关诊断依据: X线、心电图、超声检查、相关实验室检查报告 十、系统性红斑狼疮 1、定点医院 经基本医疗保险经办机构确认的二级(含二级)以上综合性医院和中医院。 2、审批手续 须由三级综合性医院免疫、风湿专科副主任(含副主任)以上医师做出诊断，医院出具诊断证明书，并附相关诊断依据，最后经医保经办机构审批确认。