One is to raise the standard of financing for residents' health insurance. Notice clear, in order to adapt to the growth of medical costs and basic health care needs to enhance the 2022 residents of medical insurance at all levels of financial subsidy standards in 2021 on the basis of a new 30 yuan, to 610 yuan per person per year. 2023 residents of medical insurance personal contributions, according to the standard of no less than 350 yuan per person per year.
The second is to steadily improve the level of treatment of residents' health insurance. "Notice" stipulates that we should consolidate and improve the level of medical insurance treatment, give full play to the basic medical insurance, major illness insurance and medical assistance system to ensure that the proportion of residents' medical insurance hospitalization within the policy scope of the fund to stabilize at about 70%. To improve the level of outpatient coverage under residents' medical insurance, to include outpatient special chronic diseases within the scope of policy and outpatient special medicines with high medical costs in the scope of major disease insurance coverage, and to implement medical aid treatment for outpatient special chronic diseases for medical aid recipients in accordance with the regulations, so as to effectively alleviate the burden of outpatient medical expenses on insured persons. We are fully implementing maternity insurance to support the three-child policy and promote the long-term balanced development of the population.
The third is to cover the livelihood protection network. The Notice emphasizes the need to make concerted efforts to ensure that the needy are insured to the fullest extent possible, the residents of the medical insurance in the centralized enrollment period to enroll in the payment of premiums, in the employee's medical insurance interrupted within three months of the payment of premiums to participate in urban and rural residents of the medical insurance, as well as newborns, low-income people in rural areas and other special groups, there is no treatment enjoyment of the waiting period from the month of the enrollment in the enjoyment of the basic medical insurance treatment of the new occurrence. Major illness insurance and medical assistance will continue to be implemented in favor of the rural low-income population, giving full play to the effectiveness of burden reduction and ensuring that the needy are funded and rescued as much as possible.
The fourth is to expand the coverage of the reform of the medical insurance field.
Notice also puts forward requirements for the management of health insurance payment, centralized purchasing of medicines and consumables in quantities and supervision of the fund and other reforms in the field of health care insurance, a clear hospitalization of medical costs DRG payment fund coverage of up to 70%, and strive for this year, Guangxi quantities of purchased medicines with a total of more than 350 generic, quantitative purchasing of medical supplies to reach the target of reforms of more than 10 categories. By adopting a series of reform measures, we will continue to reduce the cost of medical treatment, drugs and consumables, reduce the loss of medical insurance funds, enhance the efficiency of the use of medical insurance funds, and make the results of the reform better benefit the majority of insured people.
Fifth, decentralization and deepening of the "administrative" reform. "Notice" requires that we continue to improve the health insurance public **** management services, simplify the process of health insurance matters, realize the "insurance a thing" once to do, the transfer and continuation of "cross-provincial", "birth", "a thing" joint office and so on. The process of handling medical insurance matters has been simplified, realizing one-time handling of "one thing for enrollment", "common handling across provinces" for transfer and continuation, and "joint handling of one thing for birth". Promoting cross-provincial direct settlement of outpatient expenses, and opening cross-provincial direct settlement services for five types of outpatient chronic and special illnesses, namely hypertension, diabetes, outpatient radiotherapy for malignant tumors, dialysis for uremia, and post-operative anti-rejection treatment for organ transplantation, in all coordinated areas by the end of 2022. It also promotes the standardization and informatization of medical insurance, strengthens the "Internet+" medical insurance service, promotes the activation of the application of medical insurance electronic vouchers, and further improves the quality of the direct settlement service of medical insurance.
Guangxi Zhuang Autonomous Region Medical Security Bureau Guangxi Zhuang Autonomous Region Department of Finance State Administration of Taxation Guangxi Zhuang Autonomous Region Taxation Bureau on doing a good job in 2022 urban and rural residents of the basic medical care notice of the work
Guangxi Zhuang Autonomous Region medical care hair [2022] No. 30
Municipalities, counties (cities and districts) Medical Security Bureau, Finance Bureau, Tax Bureau: In order to further deepen the reform of the medical security system, promote the high-quality development of medical security to achieve new results, and to ensure the sound operation of the urban and rural residents' basic medical insurance (hereinafter referred to as residents' medical insurance) system, according to the "Circular of the State Medical Security Bureau of the Ministry of Finance of the State Administration of Taxation on the Doing a Good Job of the Work of the Urban and Rural Residents' Basic Medical Security in 2022 (Medical Insurance Development [2022] No. 20), "the regional party committee and autonomous regional people's government issued" on deepening the reform of the medical security system of the implementation of the views "(Gui Fa [2020] No. 18) and" the General Office of the People's Government of the Guangxi Zhuang Autonomous Region on the issuance of the implementation of the reform of the division of financial rights and expenditure responsibilities in the field of medical and health care in Guangxi notice" (Gui Zhengban Fa [2019] No. 48) and other documents, is now on the effective doing a good job in Guangxi in 2022 urban and rural residents of the basic medical protection of the relevant work is notified as follows:A, reasonably determine the residents of the medical insurance financing standards
(a) Optimize the financing structure. In order to adapt to the growth of medical costs and basic medical needs, to protect the rights and interests of the insured, in 2022 to continue to raise the residents of medical insurance financing standards. Explore the establishment of residents' health insurance financing standards and residents' per capita disposable income linked to the dynamic financing mechanism, to further optimize the financing structure. (ii) continue to raise the standard of financial subsidies. 2022 residents of medical insurance at all levels of financial subsidies per capita standard in 2021 on the basis of a new 30 yuan, to 610 yuan per person per year. Continue to implement the resident health insurance financial subsidies at all levels of financial burden system, the central financial subsidies 488 yuan per person - year, local financial subsidies 122 yuan per person - year. Local financial subsidies, autonomous regions of the financial subsidies to poverty-stricken counties (cities, districts) 91.5 yuan / person - year, poverty-stricken counties (cities, districts) financial burden 30.5 yuan / person - year; autonomous regions of the financial subsidies to cities and other counties of 61 yuan / person - year, cities and other counties of the financial burden of 61 yuan / person - year. Autonomous region directly under the college students to participate in the local residents of medical insurance, local financial subsidies of 122 yuan / person - year, all by the autonomous region of the financial burden. Local financial institutions at all levels shall, in accordance with the regulations, arrange for the full amount of financial subsidy funds and timely payment in place. Liberalization of the new employment pattern employees and other flexible employment personnel to participate in the household registration restrictions. Effective implementation of the "Interim Regulations on Residence Permits" with a residence permit to participate in the policy provisions, for residents with a residence permit to participate in the local health insurance, financial resources at all levels should be based on the same standards as local residents to give subsidies. (C) steadily increase the standard of individual contributions. 2023 residents of medical insurance individual contributions, in accordance with the standard of no less than 350 yuan per person per year to pay; the state of the individual contributions have new provisions, from its provisions. Individual contributions should be paid on an annual basis within the stipulated contribution period.Second, consolidate and improve the level of medical insurance treatment
(a) moderately increase the level of basic medical insurance treatment. Adhere to the principle of "income to determine expenditure, balance of income and expenditure, a slight surplus", do their best, according to their means, and give full play to the comprehensive protection of basic health insurance, major illness insurance and medical assistance system, scientific and reasonable determination of the level of basic health insurance protection. Stabilize the level of inpatient treatment under the residents' medical insurance, and ensure that the proportion of payment from the fund within the scope of the policy is stabilized at around 70%. Implement the unified outpatient special chronic disease policy for the whole region, raise the level of outpatient protection for major outpatient special chronic diseases, continue to implement the outpatient medication protection policy for hypertension and diabetes mellitus (hereinafter referred to as the "two diseases"), and strengthen the equipment and use management of outpatient medication for the "two diseases" to ensure that the outpatient medication for the "two diseases" is provided and utilized. The use of management, to ensure that the "two diseases" medication with a full, open, enhance the "two diseases" standardized management level. (ii) Enhance the function of outpatient protection of major disease insurance and medical assistance. Outpatient special chronic diseases and outpatient special drugs high medical costs, the integrated implementation of basic health insurance, major medical insurance and medical assistance triple protection, the policy scope of outpatient special chronic diseases and outpatient special drugs high medical costs into the scope of coverage of major medical insurance. According to the provisions of the implementation of medical aid recipients outpatient special chronic disease medical aid treatment. (C) the implementation of maternity protection policy. Participating in the residents of the medical insurance participants in the outpatient maternity-related medical expenses incurred in accordance with the provisions of the outpatient medical co-ordination; in the hospitalization of medical expenses incurred in accordance with the hospitalization of the prescribed proportion of reimbursement. The implementation of maternity insurance supports the three-child policy, reduces the burden of maternity medical expenses, and promotes the long-term balanced development of the population.Three, to cover the bottom line of people's livelihood protection
(a) to ensure that the people in difficulty should be insured as much as possible. Consolidate and expand the results of the medical protection against poverty, resolutely guard the bottom line does not occur due to the scale of poverty, in accordance with the regulations to do a good job of the people in difficulty to participate in the residents of the medical insurance personal contribution subsidies, will meet the conditions of participation in the difficult masses of people all into the basic medical insurance system coverage. There is no waiting period for newborns, rural low-income populations (including special hardship cases, orphans, de facto unsupported children, low-income insurance recipients, low-income insurance marginal recipients, people who have escaped from poverty, people who are subject to monitoring to prevent the return of poverty, and people identified by the rural revitalization department as having returned to poverty and causing poverty, hereinafter referred to as the same) and other special groups to be entitled to treatment. Waiting period, from the month of enrollment to enjoy the new basic medical insurance treatment. (ii) the integrated function of the three guarantees to reduce the burden. Strengthen the basic medical insurance, major medical insurance and medical assistance system to give full play to the function of comprehensive protection. Major illness insurance continues to implement tilted protection policies for low-income rural populations, giving full play to its burden-reducing effects. Comprehensively implement the policy of medical assistance based on the application, and consolidate the function of medical assistance to support the bottom. To standardize the referral and in the province to seek medical assistance by the three heavy system of protection within the policy scope of the individual burden is still heavy, to give a tilt aid, localities should be based on the actual, the development of tilt aid implementation program, and reported to the higher level of medical insurance, financial departments for the record. Coordinate to improve the efficiency of medical assistance funds, make good use of subsidized insurance, direct assistance policy, to ensure that should be funded as much as possible, should be saved as much as possible. (C) improve the long-term mechanism to prevent and resolve poverty due to illness. Continue to implement the medical insurance to prevent poverty before, during and after the whole process of monitoring and early warning, improve the dynamic monitoring of participation, high cost burden patients warning, interdepartmental information **** enjoy, risk of collaborative disposal and other working mechanisms to ensure that the risk of early detection, early prevention, early help. Improvement of the mechanism for applying for assistance, the implementation of categorized assistance for people in difficulty whose status has been recognized and approved by the relevant departments in accordance with the regulations, and the timely implementation of medical assistance policies. After the triple system of protection of the individual cost burden of the people in need is still heavy, do a good job with the temporary assistance, charity assistance, etc., the precise implementation of stratified and categorized assistance, and joint efforts to prevent the risk of poverty due to illness.Four, promote the system standardization and unity
Firmly implement the "National Health Insurance Bureau of the Ministry of Finance on the establishment of the medical insurance treatment list system of opinions" (medical insurance issued [2021] No. 5), standardize the decision-making authority, promote the system standardization and unity, and enhance the development of the medical insurance system balance, coordination. In accordance with the requirements of the Three-Year Action Plan for Implementing the List System of Medical Insurance Benefits (2021-2023), the unification of the system framework in all integrated regions will be realized by the end of 2022, the clean-up and standardization of off-list policies will be completed in all integrated regions, and the implementation of the list system of medical insurance benefits in all integrated regions will be included in the performance assessment of the relevant work. Strengthening coordination, and steadily advancing the provincial-level coordination of basic medical insurance in accordance with the directions of policy unification and standardization, fund transfer and balance, improvement of hierarchical management, reinforcement of budgetary assessment, and upgrading of management services. It has also pushed forward the realization of the basic unification of the scope of medicines used in national medical insurance. Strictly implement the system of requesting instructions and reports on major decisions, issues and matters, and promptly request instructions and reports on new situations, new issues and major policy adjustments before implementing them.Fifth, do a good job of health insurance payment management
Strict implementation of the national health insurance drug catalog, before the end of December 2022, all completed the original self-increase in the region of the digestion of Category B drugs. The company's products and services have been widely recognized as one of the best in the world, and the company's products and services have been widely recognized as one of the best in the world. Strengthening the statistical analysis of the pilot medicines of the medical insurance payment standard. Standardizing the management of access to medical insurance for ethnic medicines, preparations for medical institutions, Chinese medicine tablets and Chinese medicine formula granules. Issuing a new version of "Guangxi's basic medical insurance, industrial injury insurance and maternity insurance medical service programs", and guiding localities to implement the basic medical insurance medical consumables payment management policy. It has continued to push forward the reform of medical insurance payment methods, implemented the second three-year action plan for the reform of DRG payment, and achieved a 70% coverage rate of the DRG payment fund for hospitalized medical expenses. Pilot projects have been carried out on DRG payment for hospitalized medical expenses for medical treatment in other places, payment by close-knit county medical ****bodies, and payment by Chinese medicine for dominant types of illnesses. Improving the fixed-point management of medical insurance for medical institutions and retail pharmacies. Continuously promote the "Internet +" medical services medical insurance management.Sixth, strengthen the centralized purchasing of drugs and consumables and price management
Standing institutionalized to carry out centralized purchasing of drugs and consumables, do a good job has been collected and purchased varieties of the batch landing work, to carry out the expiry of the varieties of the successive work, and constantly expand the scope of coverage of varieties of banded purchasing, and strive to purchase drugs within the banded purchasing of the total number of generic names of drugs within the current year Guangxi More than 350 generic names of medicines in Guangxi this year, and more than 10 categories of band purchased medical consumables. Implementation of the new drugs and medical consumables net procurement policy, realize should be hung as much as possible, improve the public medical institutions drugs, high-value medical consumables net procurement rate. Implementing the policy of retaining the balance of medical insurance funds for centralized procurement of medicines and consumables, and completing the allocation of the balance of retained funds in a timely manner. According to the national deployment to promote medical service price reform, the year to carry out a medical service price adjustment assessment, combined with the price dynamic adjustment mechanism, adjust the price of some items. Implementation of the new medical service program management policy, to carry out the new medical service price project declaration demonstration work, the new medical service price project has been carried out to assess the new medical service price project, to support the new medical technology into clinical application.Seven, strengthen the fund supervision and operation analysis
Strengthen the construction of the regulatory system, improve the regulatory system and mechanism. Strengthen the day-to-day supervision and management of the use of medical insurance funds, continue to carry out the fight against fraudulent insurance special rectification action, and continue to expand the breadth and depth of the special rectification action. Promote the informationization and standardization of medical insurance fund supervision. Implementing grid-based supervision and establishing a sound medical insurance credit management system. Improve the supervision and linkage mechanism led by the medical insurance department and participated by many departments, improve the working system of information***sharing, coordinated law enforcement, joint prevention and linkage, criminal and disciplinary linkage, and promote the coordinated application of the results of the comprehensive supervision and the formation of a multi-case investigation, a multi-case investigation, and the supervision of the fund of the work pattern of the joint grasp***management. Strengthen the fund budget performance management, improve the income and expenditure budget management. Comprehensive population aging, chronic diseases and other changes in the disease spectrum, the application of new medical technology, medical cost growth and other factors, to carry out the fund income and expenditure forecasting and analysis, improve the risk early warning, assessment, resolution mechanism and plan, effectively prevent and resolve the risk of fund operation.Eight, sound health insurance public **** management services
Strengthen the grass-roots health insurance service capacity building, promote health insurance services into the county, townships and villages in the integration of public **** services, to achieve the autonomous region - the city - the county - townships (streets) - the full coverage of the village (community). To carry out a "standardized year" of construction of the medical insurance administration, to promote the standardization of administration services, and to create a number of standardized windows and demonstration points for medical insurance. It has fully implemented basic medical insurance participation management and handling procedures, strengthened source control and duplicate participation management, and pushed forward the one-time handling of "one thing for participation in insurance". Optimizing insurance payment services, insisting on the parallel innovation of intelligent online payment channels and traditional offline payment methods, and continuously improving the level of payment facilitation. We have fully implemented the interim measures for the transfer and continuity of basic medical insurance relations, and continue to do a good job of transferring and continuity of relations "across provinces". We are actively involved in promoting the "one birth" joint operation. We will continue to do a good job of settling and clearing the medical expenses of patients with new coronary pneumonia and the expenses of new coronary vaccines and vaccinations. It will improve the regulations on the handling of medical treatment in other places, implement unified management services for medical treatment in other places, expand the coverage of direct settlement of medical treatment in other places, promote direct settlement of outpatient expenses across provinces, and realize the opening of direct settlement of expenses for five kinds of outpatient chronic and special diseases, namely, hypertension, diabetes mellitus, malignant neoplasm outpatient radiation and chemotherapy, dialysis for uremia, and post-operative antirejection treatment for organ transplantation, in all the coordinated areas by the end of 2022.Nine, promote standardization and information construction
Continuously promote the national unified medical insurance information platform to deepen the application, optimize and improve the medical insurance information platform, continue to do a good job in the development of the function, optimization, operation and maintenance management, to give full play to the effectiveness of the platform. It has also promoted the dynamic maintenance and deepening application of codes, and established an assessment and evaluation mechanism for the application of standards. Steadily push forward data governance and application, and promote the quality and efficiency of medical insurance data. Promoting "Internet+" health insurance services, realizing the whole process of health insurance services such as Internet diagnosis and treatment, electronic prescription flow, online expense settlement and home delivery of medicines. Promote the construction of medical insurance mobile payment, strengthen the activation and application promotion of medical insurance electronic vouchers, effectively improve the utilization rate, continuously enrich and expand the application of medical insurance electronic vouchers, and accelerate the realization of the application of medical insurance electronic vouchers for the whole process of medical treatment. Strengthening the inter-departmental information exchange, and further reducing licenses and facilitating people's convenience through information ****sharing. Strengthen the information security management of medical insurance, and protect the basic information and data security of insured persons in accordance with the law.Ten, do a good job of organizing and implementing
(a) Strengthen the organizational security. Urban and rural residents of medical insurance work related to the majority of the insured people's interests, is to deepen the reform of the medical insurance system is an important hand, around the political position should be further enhanced, strengthen the responsibility to bear, layer by layer to strengthen the responsibility for the work of the organization and implementation of the careful organization, to ensure that urban and rural residents of the medical insurance policies and measures to achieve results. (ii) Strengthen departmental coordination. Health care departments at all levels to strengthen the sense of service, improve the quality of service, grasp the implementation of the residents of the health insurance treatment and management services, the financial sector should be in accordance with the provisions of the full amount of financial subsidies and timely disbursement of funds in place, the tax department to do a good job of residents of the health insurance personal contributions to the work of collection, optimization of channels to facilitate the payment of the masses. Inter-departmental work to strengthen the linkage and information communication, the establishment of a sound departmental information communication and work coordination mechanism, do a good job of fund operation assessment and risk monitoring, the development of the work plan, the major issues to be reported in a timely manner. (C) strengthen the policy publicity. All localities should further increase the policy propaganda, organizing the majority of grassroots cadres to carry out a wide range of health insurance policy propaganda and publicity, popularize the concept of medical insurance mutual ****ji, responsibility ****take ****build ****share **** to enhance the masses of the medical insurance system identity, enhance the masses of the awareness of the insurance premiums, and reasonably guide the expectations of the community to do a good job of responding to the risk of public opinion.