Prevention and control of epidemic situation
Recently, the Municipal Medical Insurance Bureau, the Municipal Finance Bureau, the Municipal People's Social Security Bureau and the Municipal Taxation Bureau issued a notice on doing a good job in the basic medical security for urban and rural residents in 222. This notice shall come into force as of the date of issuance and shall be valid for 5 years. In 223, Tianjin's individual medical insurance payment standard and treatment guarantee level were improved:
Improve individual medical insurance payment standard: In 223, the individual medical insurance payment standard of residents in this city will be improved in 3 yuan, specifically, 98 yuan per person per year for high-end and 35 yuan per person per year for low-end people. Students and children are subject to low-grade individual payment standards and enjoy high-grade payment reimbursement treatment.
consolidate and improve the level of treatment guarantee: from 223, the maximum payment limit for residents' medical insurance hospitalization (excluding outpatient chronic and special diseases) will be raised to 25, yuan; The reimbursement ratio of major illness insurance for urban and rural residents increased by 5 percentage points; Incorporate the medical expenses borne by individuals within the scope of residents' medical insurance policy into the coverage of residents' serious illness insurance. The employee's serious illness insurance shall be implemented with reference.
first, raise the financing standard reasonably
(1) raise the financial subsidy standard. In 222, the financial subsidy standard for residents' medical insurance in this city is 1,1 yuan per year for low-end people and 1,1 yuan per year for high-end people; For those who hold Tianjin residence permit to participate in medical insurance for residents in this city, financial subsidies will be given according to the same standards for residents in this city. In 223, the per capita financial subsidy standard for residents' medical insurance in this city will be adjusted according to national requirements.
(2) raise the individual payment standard. In 222, the individual payment standard of medical insurance for residents in this city shall be implemented in accordance with the Notice of the Municipal Medical Insurance Bureau, the Municipal Finance Bureau, the Municipal People's Social Security Bureau and the Municipal Taxation Bureau on Doing a Good Job in the Basic Medical Insurance for Urban and Rural Residents in 221 (No.86 [221] of Tianjin Medical Insurance Bureau). In 223, the individual payment standard of medical insurance for residents in this city will be raised in 3 yuan, specifically, 98 yuan per person per year for high-grade residents and 35 yuan per person per year for low-grade residents. Students and children are subject to low-grade individual payment standards and enjoy high-grade payment reimbursement treatment.
(3) Improve the fund-raising and payment mechanism. Since 223, the payment mechanism for college students has been adjusted, and new students from all kinds of colleges and universities in this city declare and pay residents' medical insurance premiums on an annual basis; In accordance with the relevant provisions of this Municipality, the elderly in urban and rural areas who receive the living allowance voluntarily choose the payment grade to participate in the residents' medical insurance, and no longer implement the withholding system from the living allowance; College students who enjoy the national student loan in this city shall be identified by the Municipal Education Commission to guide colleges and universities according to the regulations, and the financial department shall arrange a budget quota to support residents' medical insurance.
second, consolidate and improve the level of treatment guarantee
(1) consolidate and improve the basic medical insurance benefits. We will fully implement the policy of liberalizing the reimbursement for outpatient (emergency) clinics in tertiary hospitals for residents' medical insurance, and increase the reimbursement ratio for outpatient (emergency) clinics in primary and secondary hospitals for high-end payers, and reduce the increase in the proportion of medical consumables for inpatients and outpatients. Since 223, the maximum payment limit for residents' medical insurance hospitalization (excluding outpatient chronic and special diseases) has been raised to 25, yuan. Continue to do a good job in ensuring the use of drugs in outpatients with hypertension and diabetes.
(2) improve the protection function of serious illness insurance. Since 223, the reimbursement ratio of major illness insurance for urban and rural residents has increased by 5 percentage points; Incorporate the medical expenses borne by individuals within the scope of residents' medical insurance policy into the coverage of residents' serious illness insurance. The employee's serious illness insurance shall be implemented with reference.
(3) Strengthen the guarantee of medical assistance. We will comprehensively implement several measures to improve the medical insurance and assistance system for serious and serious diseases. Since 223, there will be no deductible for hospitalization medical assistance for poor people and low-income people, and the proportion of assistance will be 75% and 7% respectively. The minimum living allowance marginal family members hospitalization assistance deductible standard is determined according to 1% of the per capita disposable income of residents in this city released last year, and the assistance ratio is 65%. For the needy people who are still heavily burdened with personal expenses after the triple system guarantee, we should do a good job of connecting with temporary assistance and charitable assistance, and accurately implement hierarchical and classified assistance.
Third, firmly grasp the bottom line of people's livelihood security
Continue to consolidate the achievements of medical security in tackling poverty and do a good job in connecting with rural revitalization. Further optimize the way of information exchange and enjoyment of medical assistance objects between medical insurance and civil affairs departments, and gradually realize the automatic handling of insurance payment and treatment for difficult groups through the system. In accordance with the provisions of the classification of poor people, low-income groups and other difficult groups to participate in residents' medical insurance. Continue to do a good job in outpatient service, hospitalization and medical assistance for serious and serious diseases, carry out medical assistance according to the application, and improve the efficiency of the use of medical assistance funds.
IV.
Promote the unification of system norms
Resolutely implement the national and municipal medical insurance treatment list management system, and promote the three-year special action to clean up norms. Clean up and standardize the city's accident insurance system, and do a good job of policy convergence, and related expenses are included in the scope of reimbursement of the basic medical insurance system according to regulations. Since 223, children with autism spectrum disorder's disease, cerebral palsy, tuberculosis, severe mental disorder and other diseases can continue to enjoy reimbursement treatment such as serious illness insurance and medical assistance according to the current regulations of this Municipality. Implement the active maternity insurance policy, revise and improve the maternity insurance regulations for employees, clean up and standardize the maternity insurance system for urban and rural residents, ensure the medical expenses and maternity allowance for three children, and adjust and improve the reimbursement policy for maternity medical expenses.
V. Strengthening the management of medical insurance payment
Implement the 221 edition of the national medical insurance drug list, and fully complete the task of cleaning up the self-supplemented drug varieties. Solidly promote the "dual-channel" management of negotiated drugs, and strengthen the supply guarantee and landing monitoring of negotiated drugs. Improve the management methods of hospital preparations and dynamically adjust the catalogue of hospital preparations. Improve the management of medical consumables and medical services in medical insurance. Deepen the reform of medical insurance payment methods, solidly promote the reform of grouping according to disease diagnosis and paying by disease score, covering more than 7% of hospitalization medical expenses. Promote outpatient chronic diseases such as diabetes to pay per head. Improve the management of designated medical institutions and the management policy of medical insurance payment for "Internet" medical services.
VI. Strengthening the centralized procurement and price management of pharmaceutical consumables
Continue to implement the centralized procurement and use of drugs organized by the state, and accelerate the implementation of the centralized procurement results of drugs such as insulin organized by the state. Do a good job in the implementation of the seventh batch of centralized procurement of drugs organized by the state and the landing of the selected results of centralized procurement of spinal consumables organized by the state. Actively promote the centralized procurement of drugs and consumables in the "3 N" medical procurement alliance of Beijing, Tianjin and Hebei. We will do a good job in implementing the results of centralized procurement of drugs and high-value medical consumables, and implement supporting policies such as direct settlement of medical insurance, coordination of payment standards, and retention of balances. Implement the dynamic adjustment mechanism of medical service price and formulate the medical service price adjustment plan. Organize the compilation of medical price index, and implement the credit evaluation system of medical price and recruitment.
VII. Strengthening fund supervision and operation analysis
We will continue to carry out special rectification actions to crack down on fraud and insurance fraud, focus on investigating and handling cases, seriously investigate and deal with fraud and insurance fraud cases, resolutely expose typical cases, fully take comprehensive measures such as cost review, agreement handling and administrative punishment, increase the punishment for violations of laws and regulations, and further strengthen the high-pressure strike situation. Give full play to the multi-sector participation in the supervision linkage mechanism, actively carry out information sharing, collaborative law enforcement, execution convergence and discipline convergence, promote the coordinated use of comprehensive supervision results, and implement joint punishment. Organize the final accounts and budget preparation of the medical insurance fund, strengthen the monitoring of the budget implementation of the medical insurance fund, and do a good job in the analysis of the implementation progress. Establish an early warning mechanism for normalized fund operation. Prepare a report on the risk assessment and early warning mechanism of medical insurance fund operation, strengthen the monitoring of fund operation, and improve the risk early warning, assessment and resolution mechanism through in-depth analysis of important indicators such as participation and fund revenue and expenditure scale, so as to effectively prevent and resolve fund operation risks.
VIII. Comprehensively improve the management and service capacity of the company
According to national requirements, comprehensively strengthen the construction of the handling service system. Carry out the construction of "standard year" for medical insurance handling, and fully implement the list of handling government services and operational norms. We will fully implement the interim measures for the transfer and continuation of the basic medical insurance relationship, and continue to do a good job in the transfer and continuation of the "inter-provincial general office." Solidly promote the construction of a demonstration window for handling services. Continue to do a good job in the settlement and liquidation of COVID-19 patients' medical expenses, COVID-19 vaccines and vaccination expenses. Promote "one thing for insurance" and "one thing for newborn". Deepen the direct settlement of medical treatment in different places, continue to expand the scope of designated medical institutions for outpatient settlement in different places, and include some outpatient treatment expenses related to chronic and special diseases into the scope of reimbursement for medical treatment in different places.
IX. Promote standardization and informatization construction
Improve the unified, efficient, convenient, safe and intelligent medical insurance information platform. We will further promote the application of medical insurance standardization, actively explore scenario applications, and form a linkage effect. Further expand medical insurance electronic certificate, activation rate of electronic social security card and application scenarios. Strictly implement information management, network security management and data security management measures, and comprehensively strengthen data security protection. Do a good job in the promotion and application of "Tianjin medical insurance" and expand the function of convenient service carrier.
X. Do a good job in organizing and implementing
The medical security, finance and taxation departments at all levels in this Municipality should further improve their political stance, strengthen their responsibility and compact their work responsibilities. It is necessary to strengthen overall coordination among departments and coordinate the implementation and management services of residents' medical insurance benefits. It is necessary to further intensify policy propaganda, popularize the concept of medical insurance mutual assistance, responsibility and enjoyment, enhance people's awareness of insurance payment, and reasonably guide social expectations.
source: Tianjin government affairs network.