Ngabe Ingabe Abahlinzeka Ngayo Imithi Bangakwazi Ukubala Ukutholakala Kwezidakamizwa Ezihlanganisiwe?
Ezinsukwini ezimbalwa zokubika ukuthi ukuqubuka kokufa kwe-fungal meningitis cishe kungabangelwa ama-steroid angcolile aphethwe yinkampani ebhizinisini njengekhemisi eliyinkimbinkimbi, iziguli nabaqondisi bebuza ukuthi kungani i-US Food and Drug Administration ingazange ingenele ukuqinisekisa ukuphepha imithi eyenziwe yenkambiso.
Iyini Ukudakwa Kwezidakamizwa?
Ubuciko kanye nesayensi yokulungiselela imithi eyenziwe ngeziguli ezibizwa ngeziguli kuthiwa yizidakamizwa ezihlanganiswayo.
Ngokwesigwebo somdokotela, ikhemisi elixubayo lizoxuba izithako ezihlangene ndawonye ngamandla namandla kanye nesilinganiso esidingeka isiguli.
Umhlomulo Wezokwelapha: Izidakamizwa ezihlanganisiwe
Izitolo zezindaba zakamuva zabuza ukuthi uhlelo lweMedricare, olubonakala lukhokhelwe imikhiqizo eminingana elalinikezwa iziguli ezinezinhlungu zasemuva, lungavimbela le nkinga. I- Associated Press , iphawula ukuthi amaCenter for Medicare & Medicaid Services (CMS) anemithetho ephikisana nokukhokha izinguqulo ezihlanganisiwe zemithi ngokuvamile etholakala kwabakhiqizi bemithi.
Leli phepha lathi ikakhulukazi isinqumo se-CMS sokuyeka ukuhlanganisa cishe zonke izixazululo ezifakwe ngaphakathi kwe-nebulizer.
I-Medicare iyaqhubeka nokumboza izidakamizwa eziningi ezakhiwe, kepha ababhali namakhemikhali kumele balandele imithetho ye-ejensi ukuqinisekisa ukuthi iziguli ezifanelekile zithola amafayili ama-dosage abadinga ngaphandle kokukhokha izindleko ezigcwele ngaphandle kwephaketheni.
Imithetho ye-Medicare
Ngaphandle kokuba kukhonjiswe ngenye indlela, i- Medicare Part B ihlanganisa izidakamizwa ezihlanganisiwe ezihlinzekwe ezibhedlela kanye nezindawo zokunakekelwa isikhathi eside. Lokhu kuhlanganisa ama-powders abuyiselwa kabusha nge-saline.
Ukwenqaba ukuPhila
Ukwenqaba ukuhlinzekwa kungabangela ukuzimisela kwe-CMS noma i-FDA ukuthi imithi ayidingekile kwezokwelapha, inqunywe ngokungemthetho futhi ihlinzekwe yi-pharmacy ekhiqiza amanani amaningi njengomuthi wezidakamizwa.
Ngo-Feb. 19, 2010, i- Medicare Prescription Drug Benefit Manual ichaza ngokucacile incazelo nenqubo yokufakazela imithi ehlanganisiwe eyinikezwa abazuzi beNgxenye D:
Imikhiqizo yezidakamizwa ezakhiwe ngezidakamizwa ingaqukatha: (1) zonke izingxenye zomkhiqizo woMuthi D Ingxenye D; (2) ezinye izingxenye zomkhiqizo wesiDakamizwa D; noma (3) ayikho izingxenye zomkhiqizo weDi D D izidakamizwa. Izindleko kuphela ezihambisana nalezo zakhi ezanelisa incazelo yeDesign D izidakamizwa yizindleko ezivumelekile ngaphansi kweNgxenye D ....
Izindleko zomsebenzi ezihlotshaniswa nokuxuba umkhiqizo ohlanganisiwe oqukethe okungenani ingxenye eyodwa Yengxenye D yezidakamizwa ingafakwa kwimali yokuhambisa. ...
Ngamakhemikhali aqukethe yonke imikhiqizo yama generic, ukwabelana ngezindleko ezijwayelekile kumele kusetshenziswe [okungukuthi, icala kumguli]. Uma i-compound iqukethe noma yimaphi imikhiqizo yegama lomkhiqizo, ixhasi leNgxenyana D lingasebenzisa ukwabelana ngezindleko zegama lomkhiqizo ophakeme kulo lonke ihlanganisi.
Ngokujwayelekile, izinga lokubuyiselwa kwe-CMS yesidakamizwa esikhiqizwayo lubonisa ingxenye B noma ingxenye yeDesilinganiso yentengo yokuthengisa noma yokudayiswa komkhiqizo otholakale emakethe oqukethe izithako ezisebenzayo zokwelapha kanye nezindleko ezivamile zokuhambisa. Izinkokhelo zemikhiqizo ethize ziyahlukahluka ngokususelwa ezintweni zonyaka zomkhiqizo wezidakamizwa nempahla eminingi yama-API.
Amalungiselelo eNgxenye D abuye aguqule ukubuyiswa kwemali ngokwemigomo yemvumelwano yekhemisi. Isigaba 20.1.2 salesi siqondiso sohlelo lwe- CMS sichaza ukubalwa kokubuyisela okuyisisekelo.
Indlela Yokuqokwa Ngokufanele
Ukulungiselela, ukuhlinzeka nokuhambisa imithi ehlanganisiwe yomhlomulo weMedare kumele ikhokhelwe "isigameko." Lokhu kusho ukuthi okokuqala, isiguli kumele sibe ngaphansi kokwelashwa udokotela, umhlengikazi noma omunye umhlinzeki wezempilo owaziwayo we-CMS obeka umuthi. Okwesibili, imithi ehlanganisiwe kumele isetshenziswe njengengxenye yokwelapha okuqhubekayo. Umhlahlandlela wokukhokha wamakhodi amakhodi ukuthi izimangalo zokujova futhi ezifakelwe izidakamizwa ezikhokhelwa ngaphansi kweNgxenye B cishe zikhokhwa ngaphandle kwezinselelo.
Ngaphansi kohlelo lweCoding Common Procedure Coding System, noma i-HCPS J3490, izidakamizwa ezihlanganisiwe zithola izidakamizwa ezingekho emthethweni. I-Current Procedural Terminology, noma i-CPT, amakhodi akhona ezinhlobonhlobo zamakhemikhali. Ngokubili izinhlelo zokukhokha, i-API kufanele icaciswe.
Kuthiwani Nge-Medicaid?
Ukubuyiswa kwemali kanye nezinqubo zokukhokhisa izidakamizwa ezixubeke ezihlinzekwa abahlomuli beMedicaid zihluke kusuka kuhulumeni ukuya kuhulumeni ngoba isimo ngasinye sisebenzisa imithetho ebanzi ehlelwe yi-CMS ngezindlela ezahlukene. Ezingeni likahulumeni, i- Medicaid idinga ukufakwa kwezidakamizwa ezixubekile lapho
- Ama-API asetshenzisiwe aphethwe yi-FDA.
- Izinhlelo zikahulumeni ziye zafaka amanani okukhokha kanye nokubuyiswa kwemikhiqizo yemikhiqizo equkethe ama-API.
- Isilinganiso esenziwe ngokwezifiso sasilungiswa futhi sinikezwa ngokulandela umyalelo osemthethweni wokugulisa isiguli esinesidingo esinqunyiwe.
Ukuchaza imithetho yohlelo ngalunye lweMedicaid kungathatha incwadi. I-National Association of Medicaid Directors ikhomba izivakashi kwiwebhusayithi yomhlaba wonke ye-Medicaid, ezoba nokucaciswa kwezidakamizwa zeziguli ze-Medicaid.