Recently, the Municipal Health Insurance Bureau, the Municipal Finance Bureau, the Municipal Bureau of Human Resources and Social Security, and the Municipal Taxation Bureau issued a notice on doing a good job of basic medical insurance for urban and rural residents in 2022. This notice is effective for 5 years from the date of issuance. 2023, tianjin medical insurance individual contribution standard, treatment and protection level have been increased:
improve individual contribution standard: 2023 the city residents medical insurance individual contribution standard increased by 30 yuan, specifically for high-grade per person per year 980 yuan, low-grade per person per year 350 yuan. Students and children in accordance with the low-grade individual contribution standards, enjoy high-grade contribution reimbursement treatment. Consolidation and enhancement of treatment and protection level: from 2023, the maximum payment limit of residents' medical insurance for hospitalization (excluding outpatient chronic and special diseases) has been increased to 250,000 yuan; the reimbursement ratio of urban and rural residents' major disease insurance for each cost segment has been increased by 5 percentage points; and medical expenses borne by individuals within the scope of the policy of residents' medical insurance for outpatient (emergency) consultation have been included in the coverage of residents' major disease insurance. Employee medical insurance reference implementation.A reasonable increase in financing standards
(a) Increase the standard of financial subsidies. In 2022, the financial subsidy standard of the city's residents' health insurance is 610 yuan per person per year for low-grade, and 1,100 yuan per person per year for high-grade; for the people who hold a Tianjin residence permit to participate in the city's residents' health insurance, the financial subsidy will be given according to the same standard for the city's residents. 2023 per capita financial subsidy standard of the city's residents health insurance adjusted in accordance with national requirements.
(2) Increase the standard of individual contributions. 2022 the city's residents health insurance individual contribution standards in accordance with the "Municipal Health Insurance Bureau Municipal Finance Bureau Municipal Human Resources and Social Security Bureau Municipal Taxation Bureau on doing a good job in 2021 urban and rural residents of the work of the basic medical security notice" (Jin Medical Insurance Bureau issued [2021] No. 86). In 2023, the individual contribution standard of the city's residents' medical insurance will be increased by 30 yuan, specifically 980 yuan per person per year for high-grade and 350 yuan per person per year for low-grade. Students and children in accordance with the low-grade individual contribution standards, enjoy high-grade contribution reimbursement.
(C) improve the financing and payment mechanism. From 2023 onwards, adjusting the contribution mechanism for students in institutions, newly enrolled students at all levels and in all types of institutions in the city will declare and pay the residents' health insurance premiums on an annual basis; urban and rural elderly people who receive living allowance in accordance with the relevant provisions of the city will voluntarily choose their contribution level to participate in the residents' health insurance, and will no longer implement the system of deduction from the living allowance; students of higher education in the city who enjoy national Student loans for college students by the Municipal Education Commission to guide the higher education institutions in accordance with the provisions of the identification, and by the financial sector to arrange for a fixed amount of budgetary support to participate in the residents' health insurance.
Second, consolidate and improve the level of treatment and protection
(a) consolidate and improve the basic medical insurance treatment. fully implement the liberalization of residents' health insurance outpatient (emergency) clinic reimbursement policy of the third-level hospitals and increase the proportion of high-grade contributors of outpatient (emergency) clinic reimbursement ratio of the first and second-level hospitals, reduce the proportion of inpatient and outpatient medical consumables individual incremental payment policy. From 2023, the maximum payment limit for inpatient hospitalization (excluding outpatient chronic special diseases) under the residents' health insurance has been raised to 250,000 yuan. Continuing to do a good job of guaranteeing outpatient medication for hypertension and diabetes.
(2) Improve the function of major disease insurance protection. Since 2023, the reimbursement ratio of urban and rural residents' major disease insurance for all cost segments has been increased by 5 percentage points; medical expenses borne by individuals within the scope of the outpatient (emergency) consultation policy of the residents' health insurance have been included in the scope of coverage of residents' major disease insurance. The employee's major medical insurance reference implementation.
(C) to strengthen the medical assistance bottom guarantee. fully implement a number of measures to improve the health insurance and assistance system for serious illnesses, from 2023 onwards, the special hardship cases, low-income recipients of hospitalization medical assistance does not set a starting line, the proportion of assistance for 75%, 70%, respectively; low-income marginal family members in hospitalization assistance starting line standard in accordance with the previous year's release of the per capita disposable income of the residents of the city, determined by 10% of the assistance ratio. 10% of the income of the city's residents to determine the proportion of assistance is 65%. After the triple system of protection of the individual cost burden is still heavy people in need, and do a good job with temporary assistance, charity assistance, etc., the precise implementation of stratified and categorized help.
Three, the actual pocket pocket solid livelihood protection bottom line
Continuously consolidate the medical insurance poverty alleviation results, and do a good job with the rural revitalization work convergence. Further optimize the medical insurance, the civil affairs department between the medical assistance object information interaction *** enjoy the way, gradually realize the difficult groups of people to participate in the insurance premiums and treatment enjoyment through the system automatically. In accordance with the provisions of the classification of subsidies for special hardship cases, low-income recipients and other groups in difficulty to participate in the residents' health insurance. To continue to do a good job of providing outpatient, inpatient, and medical assistance for serious illnesses, to carry out medical assistance based on applications, and to improve the effectiveness of the use of medical assistance funds.
Four,Promoting the standardization and unification of the system
Firmly implement the national and municipal medical insurance treatment list management system, and promote the three-year clean-up and standardization of special action. Clean up and standardize the city's accident insurance and other systems, and do a good job of policy convergence, the relevant costs are included in the basic health insurance system reimbursement in accordance with the provisions. Since 2023, children with autism spectrum disorders and cerebral palsy, tuberculosis, severe mental disorders and other diseases can continue to enjoy the reimbursement treatment of major disease insurance and medical aid in accordance with the regulations after reimbursement in accordance with the current regulations of the city. Implement active maternity insurance policy, revise and improve the provisions of employee maternity insurance, clean up and standardize the maternity insurance system for urban and rural residents, do a good job of protecting the medical expenses and maternity allowances for the three children, and adjust and improve the reimbursement policy for maternity medical expenses.
V. Strengthening the management of health insurance payment
Implementation of the 2021 version of the National Health Insurance Drug Catalog, and the full completion of the task of cleaning up the varieties of self-increased drugs. The company has been promoting the "dual-channel" management of negotiated medicines, and has strengthened the supply guarantee and monitoring of negotiated medicines. Improving the management of hospital preparations and dynamically adjusting the catalog of hospital preparations. Improve the management of medical consumables and medical service programs. Deepening the reform of health insurance payment methods, and solidly promoting the reform of payment methods according to disease diagnosis-related grouping and value-added payment according to diseases, covering more than 70% of inpatient medical expenses. Promote diabetes and other outpatient slow special disease capitation payment. Improve the management of designated medical institutions and "Internet +" medical services health insurance payment management policy.
Sixth, strengthen the centralized banded procurement of drugs and consumables and price management
Continuously implement the centralized banded procurement of drugs and the use of national organizations, and accelerate the implementation of the results of the centralized procurement of drugs such as insulin from national organizations. Do a good job in the implementation of the seventh batch of national organization of centralized procurement of drugs and national organization of centralized banded procurement of spinal consumables selected results landing work. Actively promoting the centralized procurement of medicines and consumables under the Beijing-Tianjin-Hebei "3+N" Pharmaceutical Purchasing Alliance. It has done a good job of implementing the results of the centralized procurement of medicines and high-value medical consumables, and has implemented supporting policies such as direct settlement of medical insurance, synergy of payment standards, and retention of balances. Implementing the dynamic adjustment mechanism for medical service prices and formulating a medical service price adjustment program. Organize the compilation of pharmaceutical price index, the implementation of pharmaceutical prices and procurement credit evaluation system.
Seven, strengthen fund supervision and operation analysis
Continuing to carry out in-depth combating fraudulent and fraudulent insurance special rectification action, focus on the investigation and handling of cases, seriously investigating and dealing with fraudulent and fraudulent cases, resolutely exposing the typical cases, and fully adopting the cost of auditing, agreement processing, administrative penalties and other comprehensive measures The company has also increased penalties for illegal and non-compliant behavior, and further strengthened the high-pressure crackdown situation. It has given full play to the multi-departmental supervisory linkage mechanism, actively carried out information***sharing, coordinated law enforcement, criminal and disciplinary linkage, etc., and promoted the coordinated application of the results of comprehensive supervision and the implementation of joint disciplinary measures. It has organized the final accounts and budgeting of the medical insurance fund, strengthened the monitoring of the implementation of the medical insurance fund's budget, and done a good job of analyzing the progress of implementation. Establishing a regularized early warning mechanism for the operation of the fund. Prepare a report on the risk assessment and early warning mechanism for the operation of the medical insurance fund, strengthen the monitoring of the fund's operation, and through in-depth analysis of the participation situation, the scale of fund revenues and expenditures, and other important indicators and items, improve the risk early warning, assessment, and resolution mechanism, so as to effectively prevent and resolve the risks of the fund's operation.
VIII, comprehensively enhance the public **** management service capacity
In accordance with national requirements, comprehensively strengthen the construction of the service system. We will carry out the construction of the "standardization year" for the medical insurance administration, and fully implement the list of administrative service matters and the operation standard for the administration. We will fully implement the interim measures for the transfer and continuation of basic medical insurance relations, and continue to do a good job of transferring and continuation of "inter-provincial common office". Solidly promoting the construction of model windows for administrative services. Continuing 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. Promoting the joint handling of "one thing for insurance participation" and "one thing for the birth of a newborn". Deepening the direct settlement of outpatient medical care in other places, continuing to expand the scope of designated medical institutions for outpatient settlement in other places, and including some of the treatment costs related to outpatient chronic and special diseases into the scope of reimbursement for outpatient medical care in other places.
Nine, promote standardization and information construction
Improve the unified, efficient, convenient, safe and intelligent health insurance information platform. We will further promote the application of standardization of medical insurance, actively explore scenario application, and form a linkage effect. Further expand the activation rate and application scenarios of medical insurance electronic vouchers and electronic social security cards. Strictly implement informationization management, network security management and data security management measures, and comprehensively strengthen data security protection. It has also done a good job in promoting the application of "Jinmedipao" and expanding the functions of convenient service carriers.
Ten, grasp the organization and implementation
The city's medical insurance, finance and tax departments at all levels should further raise the political position, strengthen the responsibility to bear, and pressure work responsibility. To strengthen the interdepartmental coordination, synergize the implementation of residents' health insurance treatment and management services. To further increase the policy publicity, popularize the concept of medical insurance mutual ****ji, responsibility ****take, ***build ****share, enhance the awareness of the masses to participate in the premiums, and reasonably guide the social expectations.