The first is to raise the funding standard for residents' medical insurance. According to the circular, in order to adapt to the increase of medical expenses and the increase of basic medical needs, in 2022, the per capita medical insurance subsidy standard for residents at all levels will be increased to 6 10 yuan per person per year on the basis of 202 1. In 2023, the individual contributions of residents' medical insurance will be paid according to the standard of not less than 350 yuan per person per year.
The second is to steadily improve the level of residents' medical insurance benefits. The "Notice" stipulates that it is necessary to consolidate and improve the level of medical security benefits, give full play to the comprehensive security efficiency of the triple security system of basic medical insurance, serious illness insurance and medical assistance, and ensure that the proportion of fund payment within the scope of residents' medical insurance hospitalization policy is stable at around 70%. Improve the level of outpatient medical security for residents, include the high medical expenses of outpatient special chronic diseases and outpatient special drugs within the scope of the policy into the scope of serious illness insurance, implement the medical assistance treatment for outpatient special chronic diseases of medical assistance objects according to regulations, and effectively reduce the burden of outpatient medical expenses for insured personnel. Fully implement the maternity insurance policy, support the three-child policy, and promote the long-term balanced development of the population.
The third is to grasp the people's livelihood security network. The "Notice" emphasizes that it is necessary to make concerted efforts to ensure that the people in need should be fully insured. Those who participate in residents' medical insurance during the centralized insurance period, those who participate in urban and rural residents' medical insurance within three months after the interruption of employees' medical insurance, and special groups such as newborns and rural low-income households enjoy the waiting period and enjoy the new basic medical insurance benefits from the month of insurance. Serious illness insurance and medical assistance will continue to implement the policy of giving priority to low-income people in rural areas, give full play to the effect of reducing burdens, and ensure that people in need should do their best and be saved.
The fourth is to expand the coverage of reform in the field of medical insurance. The Notice also puts forward requirements for medical insurance payment management, centralized procurement of medical consumables, fund supervision and other medical insurance field reforms. It is clear that the coverage rate of DRG payment fund for hospitalization medical expenses is 70%. This year, the total number of generic names of drugs purchased with quantity in Guangxi exceeds 350, and the number of medical consumables purchased with quantity reaches 10. By adopting a series of reform measures, the medical expenses such as medical expenses, medicines and consumables will be continuously reduced, the loss of medical insurance funds will be reduced, the efficiency of the use of medical insurance funds will be improved, and the reform results will benefit the majority of insured people better.
Fifth, simplify administration and decentralize power, and deepen the reform of "simplify administration and decentralize power, combine management with management, and improve services". The Notice requires that we should continue to improve the management services of medical insurance companies, simplify the process of handling medical insurance matters, and realize the joint operation of "one insurance and one birth". We will promote the inter-provincial direct settlement of outpatient expenses. Before the end of 2022, we will open inter-provincial direct settlement services for five outpatient chronic diseases and special diseases, including hypertension, diabetes, radiotherapy and chemotherapy for malignant tumors, uremia dialysis and anti-rejection treatment after organ transplantation. Promote the standardization and informatization of medical insurance, strengthen the "internet plus" medical insurance service, promote the activation and application of medical insurance electronic certificates, and further improve the quality of medical insurance direct settlement service.
Guangxi Zhuang Autonomous Region Medical Security Bureau Guangxi Zhuang Autonomous Region Finance Department State Taxation Administration of The People's Republic of China Guangxi Zhuang Autonomous Region Taxation Bureau Notice on Doing a Good Job in Basic Medical Security for Urban and Rural Residents in 2022
Gui medical insurance [2022] No.30
Municipalities, counties (cities, districts) Medical Insurance Bureau, Finance Bureau and Taxation Bureau:
In order to further deepen the reform of the medical security system, promote the high-quality development of medical security and achieve new results, and ensure the stable operation of the basic medical insurance system for urban and rural residents (hereinafter referred to as residents' medical insurance), according to the Notice of People's Republic of China (PRC) State Taxation Administration of The People's Republic of China, the Ministry of Finance of the State Medical Insurance Bureau, the Opinions on Doing a Good Job in the Basic Medical Security for Urban and Rural Residents in 2022 (Medical Insurance [2022] No.20) and the Notice of the Autonomous Region Party Committee and the Autonomous Region People's Government on Printing and Distributing the Implementation Opinions on Deepening the Reform of the Medical Security System () And the Notice of the General Office of the People's Government of Guangxi Zhuang Autonomous Region on Printing and Distributing the Implementation Plan for the Reform of the Division of Financial Affairs and Expenditure Responsibilities in the Medical and Health Field in Guangxi (Zheng Gui Office [2019] No.48), we hereby earnestly do a good job in the work related to the basic medical security for urban and rural residents in Guangxi in 2022 as follows:
First, reasonably determine the funding standards for residents' medical insurance.
(1) Optimize the financing structure. In order to adapt to the increase in medical expenses and the increase in basic medical needs, and to protect the rights and interests of insured persons, the funding standard for residents' medical insurance will continue to be raised in 2022. Explore the establishment of a dynamic financing mechanism linked to residents' medical insurance financing standards and per capita disposable income, and further optimize the financing structure.
(2) Continue to raise the standard of financial subsidies. In 2022, on the basis of 20021,the subsidy standard for residents' medical insurance by governments at all levels will be increased by 30 yuan, reaching 6 10 yuan per person per year. We will continue to implement the financial subsidy system for residents' medical insurance at all levels, with the central financial subsidy of 488 yuan/person-year and the local financial subsidy of 65438 yuan +022 yuan/person-year. In the part of local financial subsidies, the autonomous region grants 9 1.5 yuan/person-year to poor counties (cities, districts), and the financial burden of poor counties (cities, districts) is 30.5 yuan/person-year; The financial subsidy of the autonomous region to the districts, cities and other counties is 6 1 yuan/person-year, and the financial burden of the districts, cities and other counties is 6 1 yuan/person-year respectively. If college students directly under the autonomous region participate in local residents' medical insurance, the local financial subsidy 122 yuan/person-year shall be borne by the autonomous region. Local governments at all levels should arrange financial subsidies in full and allocate them in time according to regulations. Release the household registration restrictions of flexible employees such as employees with new forms of employment. Conscientiously implement the provisions of the "Provisional Regulations on Residence Permit", and grant subsidies to those who hold residence permits to participate in medical insurance for local residents according to the same standards as local residents.
(3) Steadily raise the individual payment standard. In 2023, the individual contributions of residents' medical insurance will be paid according to the standard of not less than 350 yuan per person per year; Where the state has new provisions on individual payment, those provisions shall prevail. Individual contributions shall be paid annually within the prescribed payment period.
Second, consolidate and improve the level of medical security benefits.
(1) Appropriately raise the level of basic medical insurance benefits. Adhere to the principle of "fixed income and expenditure, balance of payments, and slight surplus", do your best and do what you can, give full play to the comprehensive security efficiency of the triple security system of basic medical insurance, serious illness insurance and medical assistance, and scientifically and reasonably determine the level of basic medical insurance. Stabilize the level of residents' medical insurance hospitalization treatment and ensure that the proportion of fund payment is stable at around 70% within the scope of the policy. Implement the unified outpatient special chronic disease policy in the whole region, improve the outpatient security level of key outpatient special chronic diseases, continue to implement the outpatient drug security policy for hypertension and diabetes (hereinafter referred to as "two diseases"), strengthen the management of drug allocation and use in outpatient clinics for "two diseases", ensure the reasonable matching and availability of drugs for "two diseases", and improve the standardized management level of "two diseases".
(two) to enhance the function of serious illness insurance and medical assistance outpatient support. For the high medical expenses of outpatient special chronic diseases and outpatient special drugs, the triple protection of basic medical insurance, serious illness insurance and medical assistance will be implemented as a whole, and the high medical expenses of outpatient special chronic diseases and outpatient special drugs within the policy scope will be included in the coverage of serious illness insurance. According to the provisions of the medical assistance object to implement outpatient special chronic disease medical assistance treatment.
(3) Implementing the maternity protection policy. Maternity-related medical expenses incurred by insured persons participating in residents' medical insurance in outpatient department shall be paid according to the provisions of outpatient medical co-ordination; The medical expenses incurred in hospitalization shall be reimbursed according to the prescribed hospitalization ratio. The implementation of maternity insurance to support the three-child policy will reduce the burden of maternity medical expenses and promote the long-term balanced development of the population.
Third, keep the bottom line of people's livelihood security.
(1) Make joint efforts to ensure that people in need are fully guaranteed. Consolidate and expand the achievements of medical insurance in tackling poverty, resolutely adhere to the bottom line of returning to poverty on a large scale due to illness, do a good job in subsidizing individual contributions for residents' medical insurance according to regulations, and include all the people in need who meet the conditions for insurance into the coverage of the basic medical security system. Residents who participated in the medical insurance payment during the centralized insurance period, those who participated in the medical insurance for urban and rural residents within 3 months after the employee's medical insurance payment was interrupted, and special groups such as newborns, rural low-income people (including destitute people, orphans, children who are actually not raised, low-income marginal objects, poor people, monitoring objects to prevent poverty return and poor people identified by rural revitalization departments, the same below) will enjoy the new basic medical insurance benefits from the month of insurance.
(2) Give full play to the triple guarantee and burden reduction function. Strengthen the connection of the triple security system of basic medical insurance, serious illness insurance and medical assistance, and give full play to the comprehensive security function. Serious illness insurance will continue to implement preferential policies for low-income people in rural areas and play a role in reducing the burden.
Fully implement the policy of medical assistance according to application and consolidate the function of medical assistance. Standardize the referral and medical treatment in the province, and if the personal burden of the relief object within the policy scope after the triple system guarantee is still heavy, all localities should formulate the implementation plan of inclined relief according to the actual situation, and report it to the superior medical insurance and financial departments for the record. Make overall plans to improve the efficiency of the use of medical assistance funds, make full use of policies such as subsidized insurance and direct assistance, and ensure that all resources are used and all resources are saved.
(three) to improve the long-term mechanism to prevent and solve the problem of returning to poverty due to illness. We will continue to implement monitoring and early warning in the whole process of medical insurance before, during and after the event, prevent poverty, improve the working mechanisms such as dynamic monitoring of insurance participation, early warning of high-cost patients, information sharing among departments, and collaborative risk disposal, and ensure early detection, prevention and rescue of risks. We will improve the mechanism for applying for assistance, implement classified assistance to people in need identified and approved by relevant departments, and implement medical assistance policies in a timely manner. For the needy people whose personal expenses are still heavy after the triple system guarantee, it is necessary to make a good connection between temporary assistance and charitable assistance, accurately implement classified assistance, and work together to prevent the risk of poverty caused by returning to poverty due to illness.
Fourth, promote the unification of institutional norms.
Resolutely implement the spirit of the Opinions of the Ministry of Finance of the National Medical Insurance Bureau on Establishing the Medical Insurance Treatment List System (No.5 of Medical Insurance Fa [2021]), standardize the decision-making authority, promote the standardization and unification of the system, and enhance the balance and coordination of the development of the medical insurance system. According to the requirements of "Three-year Action Plan for Implementing the Medical Insurance Treatment List System (20021-2023)", the institutional framework of all co-ordination areas will be unified before the end of 2022, and the off-list policies will be cleared up in all co-ordination areas, and the implementation of the medical insurance treatment list system in all co-ordination areas will be included in the relevant work performance appraisal. Strengthen overall planning and coordination, and steadily promote the provincial overall planning of basic medical insurance in accordance with the direction of unifying and standardizing policies, balancing fund transfers, improving hierarchical management, strengthening budget assessment and improving management services. Promote the basic unification of the scope of medical insurance drugs nationwide. Strictly implement the reporting system for major decisions, major issues and major issues, and implement new situations, new problems and major policy adjustments after timely reporting.
Five, do a good job in medical insurance payment management.
Strictly implement the national medical insurance drug list, and complete the digestion of the original self-supplemented Class B drugs in our district before the end of June 38+February 2022. Ensure that the "dual-channel" supply of negotiated drugs is timely and smooth. Strengthen the statistical analysis of pilot drugs of medical insurance payment standard. Standardize the medical insurance access management of ethnic medicines, preparations of medical institutions, Chinese herbal pieces and Chinese herbal formula granules. A new edition of "Guangxi Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Medical Service Project" will be issued to guide all localities to implement the payment management policy of medical consumables for basic medical insurance. Continue to promote the reform of medical insurance payment methods, implement the second three-year action plan of DRG payment reform, and the coverage rate of DRG payment fund for hospitalization medical expenses will reach 70%. Piloting DRG payment for hospitalization expenses in different places, payment for contracted county doctors and payment for superior diseases of traditional Chinese medicine. Improve the designated management of medical security in medical institutions and retail pharmacies. Continue to promote the medical insurance management of internet plus medical service.
Six, strengthen the centralized procurement and price management of pharmaceutical consumables.
Regularly and institutionally carry out centralized procurement of medical consumables with quantity, do a good job in landing the collected batches of varieties, carry out the extension of expired varieties, and continuously expand the coverage of purchased varieties with quantity, and strive to purchase more than 350 generic names of drugs with quantity in Guangxi this year, and purchase medical consumables with quantity above 10 category. Implement the new policy of online purchasing drugs and medical consumables, realize all online purchasing, and improve the online collection rate of drugs and high-value medical consumables in public medical institutions. Implement the policy of retaining the balance of medical insurance fund for centralized procurement of pharmaceutical consumables, and timely complete the allocation of the balance retention funds. According to the national deployment, we will promote the reform of medical service prices, carry out the adjustment and evaluation of medical service prices during the year, and adjust the prices of some projects in combination with the dynamic price adjustment mechanism. Implement the management policy of new medical service items, carry out the declaration and demonstration of new medical service price items, evaluate the new medical service price items that have been carried out, and support the new medical technology to enter clinical application.
Seven, strengthen the supervision and operation analysis of funds.
Strengthen the construction of supervision system and improve the supervision system and mechanism. Strengthen the daily supervision and management of the use of medical insurance funds, continue to carry out special rectification actions against fraud and insurance fraud, and continuously expand the breadth and depth of special rectification actions. Promote the informationization and standardization of medical insurance fund supervision. Implement grid supervision and establish a sound medical insurance credit management system. We will improve the supervision linkage mechanism led by the medical insurance department and involving multiple departments, improve the working systems of information sharing, collaborative law enforcement, joint defense linkage, execution linkage and discipline linkage, promote the coordinated application of comprehensive supervision results, and form a fund supervision work pattern of multi-case investigation, multi-case handling and joint management.
Strengthen fund budget performance management and improve revenue and expenditure budget management. Comprehensive aging population, chronic diseases and other disease spectrum changes, the application of new medical technology, the increase of medical expenses and other factors, to carry out the fund income and expenditure forecast analysis, improve the risk early warning, evaluation, resolution mechanism and plan, effectively prevent and resolve the fund operation risks.
Eight, improve medical insurance management services.
Strengthen the capacity building of primary medical insurance handling services, promote the inclusion of medical insurance handling services in the construction of county, township and village services, and achieve full coverage of autonomous regions, cities, counties, townships (streets) and villages (communities). Carry out the construction of "standard year" for medical insurance handling, promote the standardization of handling service standards, and create a number of standardized windows and demonstration sites for medical insurance. We will fully implement the basic medical insurance management procedures, strengthen source control and repeated insurance management, and promote the "one thing insurance" in one place. Optimize insurance payment services, adhere to the parallel innovation of intelligent online payment channels and traditional offline payment methods, and continuously improve the level of payment facilitation. Fully implement the Interim Measures for the Transfer and Continuation of Basic Medical Insurance Relationship, and continue to do a good job in the transfer and continuity of "inter-provincial communication". Actively participate in promoting the "one thing and one life" joint office. Continue to do a good job in the settlement and settlement of medical expenses of patients in COVID-19, vaccines and vaccination expenses in COVID-19. Improve the process of medical treatment in different places, implement unified management services for medical treatment in different places in the whole region, expand the coverage of direct settlement of medical treatment in different places, promote direct settlement of outpatient expenses across provinces, and realize direct settlement of five outpatient chronic diseases and special diseases such as hypertension, diabetes, malignant tumor outpatient radiotherapy and chemotherapy, uremia dialysis and anti-rejection treatment after organ transplantation in all co-ordination areas before the end of 2022.
Nine, promote standardization and information construction
Continue to deepen the application of the national unified medical insurance information platform, optimize and improve the medical insurance information platform, continue to do a good job in functional development, optimization and operation and maintenance management, and give full play to the effectiveness of the platform. Solidly promote the dynamic maintenance and deepening application of coding, and establish a standard application assessment mechanism. Steadily promote data governance and application, and promote the quality and efficiency of medical insurance data. Promote the "internet plus" medical insurance service, and realize the medical insurance service in the whole process of Internet diagnosis and treatment, electronic prescription circulation, online fee settlement and drug distribution. Promote the construction of mobile payment for medical insurance, strengthen the activation and application promotion of medical insurance e-certificate, effectively improve the utilization rate, continuously enrich and expand the application of medical insurance e-certificate, and accelerate the application of medical insurance e-certificate in the whole process. Strengthen the information exchange between departments, and further reduce and facilitate the license through information enjoyment. Strengthen the management of medical security information security, and protect the basic information and data security of insured persons according to law.
Ten, grasp the organization and implementation.
(1) Strengthen organizational guarantee. The medical security of urban and rural residents is related to the vital interests of the insured masses and is an important starting point for deepening the reform of the medical security system. All localities should further improve their political stance, strengthen their responsibilities, compact their responsibilities at different levels, and carefully organize and implement them to ensure the effectiveness of various policies and measures for medical security for urban and rural residents.
(2) Strengthen departmental coordination. Medical security departments at all levels should strengthen service awareness, improve service quality, do a good job in the implementation and management of residents' medical insurance benefits, financial departments should arrange and allocate financial subsidies in full and on time according to regulations, and tax departments should do a good job in the collection of residents' personal medical insurance contributions, optimize channels and facilitate the masses to pay. All departments should strengthen work linkage and information communication, establish and improve departmental information communication and work coordination mechanisms, do a good job in fund operation evaluation and risk monitoring, formulate work plans, and report major issues in a timely manner.
(3) Strengthen policy propaganda. All localities should further increase policy propaganda, organize grassroots cadres to widely publicize and promote medical insurance policies, popularize the concepts of mutual assistance, responsibility and sharing, enhance the people's sense of identity with the medical security system, enhance the people's awareness of insurance payment, reasonably guide social expectations, and do a good job in coping with public opinion risks.