Medical丨Policy Interpretation of the Notice on Doing a Good Job of Basic Medical Protection for Urban and Rural Residents in 2022

A few days ago, in order to implement the decision-making and deployment of the CPC Central Committee and the State Council and the requirements of the relevant tasks of the Government Work Report in 2022, further deepen the reform of the medical security system, and promote the high-quality development of medical security to achieve new results, the State Medical Insurance Bureau, together with the Ministry of Finance and the State Administration of Taxation, issued the "Circular on the Doing a Good Job of Basic Medical Security for Urban and Rural Residents in 2022" (Medical Insurance Fa [2022] No. 20 ), hereinafter referred to as the Circular). The relevant content is interpreted as follows: First, how to adjust the basic medical insurance financing standards for urban and rural residents?

In order to adapt to the growth of medical costs and consolidate and enhance the level of health insurance treatment, to ensure that the rights and interests of insured persons health insurance, "Notice" requires a reasonable increase in the financing standards for residents' health insurance, per capita financing standards to 960 yuan, of which the financial at all levels to further increase the subsidies for residents' health insurance premiums, 2022 residents' health insurance participation in the financial subsidies per capita of an additional 30 yuan to reach a per capita of not less than 610 yuan per year; the corresponding synchronization of the residents of basic medical insurance? 610 yuan; the corresponding synchronization of individual contribution standards by 30 yuan, to 350 yuan per person per year. Continue to set aside a certain amount from the residents' medical insurance fund for urban and rural residents' major medical insurance funds, individuals do not need to pay separate contributions to enjoy the benefits of major medical insurance, reduce the burden of high medical costs. In addition, the "Notice" also emphasizes the need to effectively implement the policy of holding a residence permit to participate in the policy provisions, to liberalize the restrictions on participation in the household registration, for holding a residence permit to participate in the local residents of the health insurance, financial resources at all levels should be given according to the same standard of local residents to give subsidies.

Secondly, what are the requirements for consolidating and improving the treatment level of residents' health insurance?

The Notice proposes to adhere to the principle of "income and expenditure, balanced income and expenditure, and a slight surplus", and to give full play to the effectiveness of the three-tier system of comprehensive protection of basic health insurance, major medical insurance and medical assistance. Mainly from three aspects of the 2022 residents of medical insurance treatment guarantee put forward work requirements. First, stabilize the level of inpatient treatment, and stabilize the proportion of medical expenses paid by the fund within the scope of the policy at around 70%. The second is to improve outpatient protection measures, continue to do a good job of hypertension, diabetes outpatient medication protection, improve outpatient chronic diseases, special diseases (hereinafter referred to as "outpatient chronic special diseases") protection, enhance the function of major disease insurance, medical assistance to outpatient medical cost protection, and make concerted efforts to reduce the burden of outpatient medical costs. The third is to reasonably increase the residents of the medical insurance maternity medical expenses treatment, do a good job to protect the maternity medical expenses of the insured.

Third, in the consolidation and expansion of health insurance to fight poverty what specific measures?

In order to effectively cover the bottom line of people's livelihood protection, the "Notice" puts forward four requirements, one is to continue to do a good job of subsidizing the people in need to participate in the work of the full subsidy of special hardship case, fixed subsidies for low-income objects, back to the poverty of the poor population, to ensure that should be insured as much as possible, should be funded as much as possible. The second is to improve the long-term mechanism for preventing and resolving poverty caused by illness, and to improve the mechanisms for dynamic monitoring of insurance participation, early warning of patients with high cost burdens, interdepartmental information***sharing, and collaborative risk management. Third, improving the mechanism for assistance based on applications. The fourth is to do a good job of connecting with temporary assistance, charity assistance and so on.

Fourth, how to enhance the balance and coordination of the development of the health insurance system?

The Notice proposes to promote the standardization and unification of the system, including four requirements. First, the implementation of the three-year action plan for the medical insurance treatment list system, standardize decision-making authority, and promote the rule of law, standardization and standardization of the management of the medical insurance system. The second is to promote the realization of the basic unity of the scope of the national medication, and gradually standardize and unify the scope of outpatient chronic and special diseases and other policies of the basic medical insurance within the province. Third, we are steadily pushing forward provincial-level coordination, so that employees' and residents' health insurance can be categorized and pushed forward in a consistent manner. Fourth, the strict implementation of the major matters request for instructions reporting system, the provinces to implement the treatment list into the performance evaluation.

V. What are the specific requirements for the management of health insurance payment?

The Notice puts forward four requirements, one is to strengthen the management of the medical insurance drug catalog, to do a detailed negotiation drug "dual-channel" management. The second is to standardize the management of national medicine, medical institution preparations, Chinese medicine tablets and Chinese medicine granules medical insurance access. Third, it will solidly implement the Three-Year Action Plan for the Reform of DRG/DIP Payment Methods, and explore and promote the reform of the payment methods for outpatient and traditional Chinese medicine. Fourth, improve the medical institutions and retail pharmacies medical insurance designated management.

Six, what are the specific requirements of the centralized band purchasing and price management of drugs and consumables?

The "Notice" puts forward four requirements, one is to coordinate the national organization and inter-provincial alliance mining. 2022 the end of the national and provincial (or inter-provincial alliance) mining drug varieties cumulative total of not less than 350, high-value medical supplies varieties cumulative total of 5 or more. The second is to improve the function of the pharmaceutical procurement platform and strengthen performance evaluation. Thirdly, the pilot project of deepening the reform of medical service prices will be carried out in a steady and orderly manner. The fourth is to start the pharmaceutical price monitoring project, continue to promote the implementation of pharmaceutical prices and procurement credit evaluation system.

VII. How to strengthen the fund supervision and performance management?

The Notice emphasizes that in 2022, we should continue to strengthen the fund supervision and performance management, first, accelerate the construction of the fund to improve the regulatory system and law enforcement system. Second, continue to carry out special rectification actions to combat fraud and insurance fraud. Third, improve the fund supervision joint mechanism, improve the working system and form a working pattern. Fourth, do a good job of fund budget performance management, carry out fund revenue and expenditure forecasting and analysis, and improve the risk early warning, assessment and resolution mechanism and plan.

Eight, health insurance public **** management services how to continue to optimize?

The Notice puts forward five requirements for the management of management services, first, the full implementation of the list of administrative services and operating norms, to promote the standardization of medical insurance services standardization, improve the level of convenience. The second is to fully implement the basic medical insurance participation and management procedures and interim measures for the transfer and continuity of relationships, and to continue to do a good job of transferring and continuity of "inter-provincial common office". Third, we will optimize insurance payment services, adhere to the parallel innovation of intelligent online payment channels and traditional offline payment methods, and enhance the level of payment facilitation. Fourth, we will continue to do a good job of settling the medical expenses of patients with new crown pneumonia, and settle the expenses for new crown vaccines and vaccinations in a timely manner. Fifth, to do a good job of direct settlement of medical care in other places, to promote five kinds of outpatient slow special disease costs across the provincial direct settlement services.

Nine, how to promote the standardization of health insurance and information construction?

The "Notice" requires that we continue to promote the deepening of the application of the national unified health insurance information platform, comprehensively deepen the application of business coding standard maintenance, the establishment of a perfect information system operation and security management system, to enhance the level of health insurance services and governance capacity.