Notice on Doing a Good Job in Basic Medical Security for Urban and Rural Residents in 2022
Medical insurance [2022] No.20
All provinces, autonomous regions, municipalities directly under the central government, medical insurance bureaus and finance departments of Xinjiang Production and Construction Corps, and state taxation bureaus of all provinces, autonomous regions, municipalities directly under the central government and cities under separate state planning:
In order to implement the decision-making arrangements of the CPC Central Committee and the State Council and the relevant task requirements of the 2022 government work report, further deepen the reform of the medical security system, and promote the high-quality development of medical security to achieve new results, we are hereby notified as follows:
First, raise the fund-raising standard reasonably.
In order to adapt to the growth of medical expenses and basic medical needs, and protect the medical insurance rights and interests of the insured, the financing standard of basic medical insurance for urban and rural residents will continue to be raised in 2022. Finance at all levels will continue to increase subsidies for residents' medical insurance. The per capita financial subsidy standard will be raised in 30 yuan, reaching not less than 6 10 yuan per person per year, and the individual payment standard will be raised in 30 yuan, reaching 350 yuan per person per year. The central government will continue to subsidize local governments in different grades according to regulations. The western and central regions respectively give subsidies according to 80% and 60% of the per capita financial subsidy standard, and the eastern provinces respectively give subsidies according to a certain proportion. Co-ordinate arrangements for urban and rural residents' serious illness insurance funds to ensure that the funding standards and treatment levels are not reduced. 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. 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.
Second, consolidate and improve the level of treatment.
It is necessary to adhere to the principle of "fixed income and expenditure, balanced income and expenditure, and slight surplus", do our best and do what we can, give full play to the comprehensive guarantee efficiency of the triple 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. Improve outpatient support measures, continue to ensure outpatient medication for patients with hypertension and diabetes, and improve outpatient support for chronic diseases and special diseases. Strengthen the outpatient support function of serious illness insurance and medical assistance, explore the inclusion of high outpatient medical expenses within the policy scope in the calculation of compliance medical expenses of serious illness insurance, make overall use of outpatient and inpatient assistance funds, and use the annual assistance limit. Reasonably raise the level of residents' medical insurance and maternity medical expenses, effectively support the three-child birth policy, reduce the burden of maternity medical expenses, and promote long-term balanced population development.
Third, earnestly grasp the bottom line of people's livelihood security.
It is necessary to consolidate and expand the achievements of medical security in poverty alleviation, consolidate the function of medical assistance, and resolutely hold the bottom line of returning to poverty on a large scale without illness. We will continue to do a good job in helping people in need to participate in the classified medical assistance work funded by individual contributions of residents' medical insurance, provide full subsidies to the extremely poor, and provide subsidies to low-income households and people returning to poverty. 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. We will improve the long-term mechanism for preventing and resolving the problem of returning to poverty due to illness, and 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 to 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.
We must resolutely implement the medical insurance treatment list system, standardize the decision-making authority, promote the unification of system norms, and enhance the balance and coordination of the development of the medical insurance system. In strict accordance with the requirements of the "Three-year Action Plan for Implementing the Medical Security Treatment List System", the institutional framework of all co-ordination areas will be unified by the end of 2022, and 40% of the co-ordination areas will complete the clean-up of off-list policies. Adhere to the principle of striving for progress while maintaining stability, first establish and then break, coordinate the connection of funds and benefits, and promote functional integration. Promote the basic unification of the scope of medical insurance drugs nationwide. Gradually standardize and unify policies such as the scope of chronic diseases and special diseases in outpatient clinics of basic medical insurance in the province. Strengthen overall planning and coordination, and steadily promote provincial overall planning in accordance with the direction of unifying and standardizing policies, balancing fund transfers, improving hierarchical management, strengthening budget assessment, and improving management services. Employee medical insurance and resident medical insurance can be promoted in an orderly manner. It is necessary to 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. The implementation of the medical insurance treatment list system in each province will be included in the relevant work performance appraisal.
Five, do a good job in medical insurance payment management.
It is necessary to strengthen the management of medical insurance drug list, do the "dual-channel" management of detailed negotiation drugs, and strengthen the supply guarantee and landing monitoring of negotiation drugs. Do a good job in the pilot work of medical insurance payment standards and strengthen monitoring. By the end of June, 2022, the digestion of self-supplemented drugs in various provinces will be completed. Standardize the medical insurance access management of ethnic medicines, preparations of medical institutions, Chinese herbal pieces and Chinese herbal formula granules. Improve the management of consumables and medical services for traditional Chinese medicine in medical insurance. Continue to promote the reform of medical insurance payment methods, solidly implement the "three-year action plan for DRG/DIP payment method reform", accelerate the reform of DRG/DIP payment methods, and cover at least 40% of the overall planning areas within the jurisdiction. Explore outpatient payment by head, promote the reform of TCM medical insurance payment methods, and explore TCM diseases to pay according to disease score. Improve the designated management of medical insurance in medical institutions and retail pharmacies, strengthen the medical insurance management of "internet plus" medical services, and smooth the follow-up, drug collection and distribution.
Six, strengthen the centralized procurement and price management of pharmaceutical consumables.
It is necessary to promote the centralized procurement of drugs and medical consumables in an all-round and multi-level way, and coordinate the centralized procurement of national organizations and inter-provincial alliances. By the end of 2022, the cumulative number of national and provincial centralized drugs will not be less than 350, and the cumulative number of high-value medical consumables will reach more than 5. Do a good job in the implementation of centralized procurement results and the continuation after the expiration of the procurement agreement, and implement supporting policies such as prepayment of medical insurance funds, coordination of payment standards, and retention of balances. Improve the function of centralized drug procurement platform, strengthen performance evaluation, improve the online collection rate of public medical institutions, and promote online settlement. We will steadily and orderly promote the deepening of the pilot reform of medical service prices, and guide and urge the overall planning areas to do a good job in price adjustment evaluation and dynamic adjustment in 2022. Start the medical price monitoring project, compile the medical price index, strengthen the normalization supervision of the prices of drugs and medical consumables, and continue to promote the implementation of the medical price and recruitment integrity evaluation system.
Seven, strengthen the supervision and operation analysis of funds.
It is necessary to speed up the construction and improvement of the medical insurance fund supervision system and law enforcement system, promote the establishment of incentive and accountability mechanisms, and incorporate the work of combating fraud and insurance fraud into the relevant work assessment. Continue to carry out special rectification actions against fraud and insurance fraud, and constantly expand the breadth and depth of special rectification actions. 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.
It is necessary to do a good job in the performance management of capital budget and improve the management of revenue and expenditure budget as required. 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.
It is necessary to enhance the public service ability of primary medical security and strengthen the handling power of medical security. We will fully implement the list of government services and operational norms, promote the standardization of medical security government services, and improve the level of medical insurance convenience services. 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. Before the end of 2022, at least 1 designated medical institutions with inter-provincial networking for general outpatient expenses will be opened in each county, and five inter-provincial direct settlement services for chronic diseases and special diseases such as hypertension, diabetes, radiotherapy and chemotherapy for malignant tumors, uremia dialysis and anti-rejection treatment after organ transplantation will be opened in all co-ordination areas.
Nine, promote standardization and information construction
We should continue to deepen the application of the national unified medical insurance information platform and give full play to the platform's effectiveness. Comprehensively deepen the maintenance and application of business coding standards, and establish a standard application assessment mechanism. Establish and improve the information system operation and maintenance management and security management system, and explore the establishment of information sharing mechanism. Give full play to the role of the national comprehensive government service platform, commercial banks, government applications and other channels, and explore cooperation mechanisms in the fields of inter-provincial medical records and the activation and application of medical insurance electronic certificates.
Ten, grasp the organization and implementation.
It is necessary to further improve the political position, strengthen the responsibility, compact the work responsibility, ensure that all policies and measures for medical security for urban and rural residents are effective, and continue to promote security and improve people's livelihood. Medical security departments at all levels should strengthen overall planning and coordination, strengthen departmental coordination, do a good job in the implementation and management of residents' medical insurance benefits, the financial department should arrange and allocate financial subsidies in full and on time according to regulations, and the tax department should do a good job in the collection of individual contributions of residents' medical insurance, facilitate the masses to pay fees, and strengthen the work linkage and information communication between departments. It is necessary to further strengthen policy propaganda, popularize the concept of mutual aid, responsibility and enjoyment of medical insurance, enhance the awareness of people's participation in insurance payment, reasonably guide social expectations, and do a good job in coping with public opinion risks.
I hereby inform you.
People's Republic of China (PRC) State Taxation Administration of The People's Republic of China, Ministry of Finance, National Health Insurance Bureau
June 30(th), 2022