Related policies for Tianjin!It is related to residents' medical insurance payment, subsidies, reimbursement ...

Tianjin Medical Insurance Bureau issued a notice

As for the "Notice on Doing the Basic Medical Guarantee Work of Urban and Rural Residents in 2022"

Soliciting opinions for the society

It is intended to adjust the medical insurance for residents in 2023

Personal payment standards, fiscal subsidies and improvement of fundraising mechanisms

Resident medical insurance

In accordance with the requirements of the "Notice", the city intends to adjust the personal payment standards, financial subsidies, and improve the funding payment mechanism of personal medical insurance for residents in 2023. At the same time, it has also clarified key tasks in key areas such as medical insurance payment, fund management, medical service management, and medical insurance management services.

Improve personal payment standards. In 2023, the personal payment standards for residents' medical insurance were increased by 30 yuan simultaneously, specifically 980 yuan per person per year and 350 yuan per person per year.

Since 2023, the student payment mechanism of colleges and universities is adjusted, and new enrollment students at all levels of colleges and universities at all levels in the city shall declare and pay residents' medical insurance premiums in accordance with the annual declaration of residents; No longer implement the deduction system from the living subsidy fee.

Comprehensively implement the reimbursement policy for residents' medical insurance (urgent) consultation and increase the proportion of reimbursement proportion of first and second -level hospitals in high -end payment personnel, and reduce the proportion of personal additional payment proportion of hospitalization and outpatient medical consumables.

Based on the comprehensive implementation of the medical insurance policy introduced in 2022, since 2023, the maximum payment limit for the improvement of residents' medical insurance hospitalization (excluding outpatient clinics) is about 6 times the disposable income of urban and rural residents. Continue to do a good job in the guarantee of hypertension and diabetic clinics.

Since 2023, the proportion of reimbursement of each cost of major illness insurance for urban and rural residents will be incorporated into the scope of medical expenses that resident medical insurance (urgent) diagnosis policies (urgent) diagnosis policies.

The point is to comprehensively implement and improve the medical insurance and rescue systems of major diseases and rescue systems. Since 2023, the interested personnel and minimum -living medical assistance will not set up a line of payment. The rescue ratio is 75%and 70%; The membership payment line standard is determined by 10%of the per capita disposable income released by the residents released in the previous year, with a rescue ratio of 65%.

The full text of the comments draft is as follows

In order to further deepen the reform of the medical security system and promote the new results of the high -quality development of medical security, on June 30, the State Medical Insurance Administration, the Ministry of Finance, and the State Administration of Taxation issued the "Notice on Doing the Basic Medical Guarantee of Urban and Rural Residents in 2022" ( Medical Insurance Distribution [2022] No. 20), it is clearly required that the per capita financial subsidy standard for residents' medical insurance in 2022 will be added 30 yuan to reach less than 610 yuan per person per year. Give full play to the effectiveness of the comprehensive guarantee of basic medical insurance, major illness insurance and medical assistance, and scientifically and reasonably determine the level of basic medical insurance guarantee. At the same time, it has also clarified key tasks in key areas such as medical insurance payment, fund management, medical service management, and medical insurance management services. According to the national requirements, the Tianjin Medical Insurance Bureau drafted the "Notice" and has solicited opinions in various aspects to form a public solicitation draft.

Because the relevant policies need to be introduced in August, the time is urgent, and the time limit for disclosure is appropriately compressed. The public can check and make amendments through the following methods before 18:00 on July 24, 2022. Please send it to: [email protected], or feedback from the letter, please mail it to: the Guarantee Office "Opinions of resident medical security work".

Notice on the basic medical security work of urban and rural residents in 2022 (draft for public solicitation)

In order to further consolidate and improve the basic medical security of urban and rural residents in our city (hereinafter referred to as "residents' medical insurance"), promote the high -quality and sustainable development of medical security, and promote the well -being of people's livelihood protection. The State Administration of Taxation on the relevant task requirements of the task requirements of the basic medical security work of urban and rural residents in 2022 (Medical Insurance Fa [2022] No. 20), and now do a good job of the relevant work notice of the basic medical security of urban and rural residents in the city in 2022:

1. Reasonable improvement of fundraising standards

(1) Improve fiscal subsidy standards. In accordance with the requirements of national documents, the per capita financial subsidy standards for residents in the city will be raised in compliance; the per capita financial subsidy standards of residents in the city will be given to the city's residents 'medical insurance personnel to participate in the city's residents' medical insurance personnel, and financial subsidies will be given in accordance with the same standards of the residents of the city. In 2023, the per capita financial subsidy standards of residents' medical insurance are adjusted simultaneously in accordance with national requirements.

(2) Improve personal payment standards. In 2022, the personal payment standards for the payment of various residents' medical insurance for medical insurance in accordance with the "Notice of the Municipal Human Resources and Social Affairs Bureau of the Municipal Human Resources and Social Affairs Bureau of the Municipal Medical Insurance Bureau and the Municipal Human Resources and Social Security Bureau on the basic medical security work of urban and rural residents in 2021" (Jin Medical Insurance Bureau issued [2021] 86 86 Number) Execution. In 2023, the personal payment standards for residents' medical insurance were increased by 30 yuan simultaneously, specifically 980 yuan per person per year and 350 yuan per person per year.

(3) Improve the funding payment mechanism. Since 2023, the student payment mechanism of colleges and universities is adjusted, and new enrollment students at all levels of colleges and universities at all levels in the city shall declare and pay residents' medical insurance premiums in accordance with the annual declaration of residents; No longer implement the deduction system from the living subsidy fee. The university students who enjoy a student loan shall be guided by the Municipal Education Commission to guide colleges and universities in accordance with regulations, and will arrange budget quotas to fund residents' medical insurance by the financial department. 2. Consolidate and improve the level of treatment guarantee

(1) Consolidate and improve basic medical insurance benefits. Comprehensively implement the reimbursement policy for residents' medical insurance (urgent) consultation and increase the proportion of reimbursement proportion of first and second -level hospitals in high -end payment personnel, and reduce the proportion of personal additional payment proportion of hospitalization and outpatient medical consumables. Since 2023, the maximum payment limit of residents' medical insurance hospitalization (excluding outpatient clinics) is up to about 6 times the disposable income of urban and rural residents. Continue to do a good job in the guarantee of hypertension and diabetic clinics.

(2) Improve the function of major illness insurance. Since 2023, the proportion of reimbursement of each cost of major illness insurance for urban and rural residents will be incorporated into the scope of medical expenses that resident medical insurance (urgent) diagnosis policies (urgent) diagnosis policies. Due to the policy adjustment factors, the capital and rural residents 'major illness insurance funds shall be applied to the underwriting commercial insurance institutions according to the actual situation of the medical insurance agency, and when a new round of public bidding, it will coordinate and improve the funding funding standards for residents' illness insurance.

(3) Strengthen the guarantee of medical assistance. Several measures to comprehensively implement and improve the medical insurance and rescue system for major diseases. Since 2023, the interested personnel and subsistence allowances are not set up for rescue for hospitalization medical assistance. The rescue ratio is 75%and 70%; The rescue line payment standard is determined by 10%of the per capita disposable income of the residents released in the previous year, with a rescue ratio of 65%. For people with heavy personal expenses after the triple system guarantee, the connection with temporary assistance, charity assistance, etc., and accurately implement layered classification assistance.

Third, effectively hold the bottom line of the people's livelihood guarantee

Continue to consolidate the results of poverty alleviation for medical security, and do a good job of connecting with rural revitalization. Further optimize the information interaction and sharing method of medical insurance and civil affairs departments, and gradually realize the automatic processing of the insurance payment and treatment of difficult groups in difficulties. In accordance with regulations, groups of difficulties and subsistence allowances to participate in residents' medical insurance. Continue to do medical assistance in outpatient clinics, hospitalization and severe diseases, and carry out medical assistance in accordance with the application of medical assistance to improve the effectiveness of medical assistance funds.

Fourth, promote the unified institutional norms

Resolutely implement the management system for the state and the city's medical insurance treatment list, and promote the special actions of three -year cleanup specifications. Clean up the system of accident insurance in this city, and do a good job of policy connection. The relevant expenses are included in the scope of the reimbursement of the basic system in accordance with regulations. Since 2023, diseases such as children's loneliness spectrum and cerebral paralysis, tuberculosis, severe mental disorders and other diseases can continue to enjoy reimbursement benefits such as major illness insurance and medical assistance in accordance with the current regulations. Implement the active maternity insurance policy, revise and improve the regulations on maternity insurance for employees, clean up and standardize the urban and rural residents' maternity insurance system, do a good job in the protection of three -child medical expenses and maternity allowances, and adjust and improve the reimbursement policy for maternity medical expenses.

5. Strengthen medical insurance payment management

Implement the 2021 version of the National Medical Insurance Drug Catalog, and complete the task of cleaning the drug varieties by themselves. Promote the improvement of the "dual -channel" management mechanism, strengthen the protection of negotiated drug supply and landing monitoring. Improve the management measures in the hospital, dynamically adjust the internal preparation directory, carry out the purchase of traditional Chinese medicine formula pellets, and simultaneously clarify the relevant medical insurance payment standards. In accordance with the national medical service price project specifications, do a good job of docking the price of medical service projects in our city and medical insurance payment standards. Deepen the reform of medical insurance payment methods, solidly promote the reform of related groups according to the diagnosis of diseases and payment of diseases according to the type of disease, and cover more than 70%of inpatient medical expenses. Promote slow special diseases such as diabetes and other clinics. Improve the management policy of fixed -point pharmaceutical institutions and strengthen the "Internet+" medical service medical insurance management.

6. Strengthen the purchasing and price management of centralized bands of drug consumables

Continue to implement the procurement and use of national organizational drugs, and accelerate the implementation of the results of the national organic insulin and other drugs. Do a good job of the seventh batch of centralized procurement and implementation of drugs and the results of national organizational spine consumables. Actively promote the collection of drugs and consumables of Beijing -Tianjin -Hebei "3+N" pharmaceutical procurement alliance. Careful implementation of the collection of medical insurance for medical insurance funds. Actively explore the establishment of the results of the selection results in high -value pharmaceutical consumables and the medical insurance payment standard. Implement the dynamic adjustment mechanism of medical services, and formulate medical service price adjustment plans. Organize the preparation of the medical service price index to implement the medical price and recruitment credit evaluation system.

7. Strengthen fund supervision and operation analysis

In -depth implementation of the "Several Measures for the Reform of the Management System for Promoting the Medical Security Fund in Tianjin". Continue to carry out special rectification operations to combat fraud. Continue to strengthen intelligent monitoring, promote the construction of medical insurance fund supervision knowledge bases and rules banks, and strictly investigate illegal and illegal acts. Continue to carry out uniform supervision of different places. Further improve the comprehensive regulatory mechanism of multiple departments. Actively do a good job of "dual random, one open" supervision. Organize the final accounts and budget preparation of the medical insurance fund, strengthen the supervision of the budget implementation of the medical insurance fund, and do a good job of implementing the progress of implementation. Establish a normalized fund operation early warning mechanism. Prepare the report of the risk assessment and early warning mechanism of the medical insurance fund, strengthen the monitoring of the operation of the fund, and analyze the in -depth analysis of important indicators such as the insurance participation situation and the scale of the fund revenue and expenditure. Essence 8. Comprehensively improve public management service capabilities

In accordance with national requirements, the construction of the service system is comprehensively strengthened. Carry out the construction of the "Normal Year" of the Medical Insurance Office, and comprehensively implement the list of government service services and operation specifications. Comprehensively implement the temporary measures for the transfer of basic medical insurance relations, and continue to do a good job of "cross -provincial generalization". Promote the construction of service demonstration windows for the service. Continue to do medical expenses, new crown vaccines and vaccination costs for new crown pneumonia. Promote the co -organizing "one thing to participate in the insurance" and "the birth of the newborn". Deepen the direct settlement of medical treatment in different places, continue to expand the scope of fixed -point pharmaceutical institutions in outpatient clinics, and incorporate some outpatient clinics -related treatment costs into the scope of the reimbursement of the network of medical network.

Nine, promote standardization and information construction

Improve uniform, efficient, convenient, safe, and intelligent medical insurance information platform. In -depth promotion of the application of medical insurance standardization work, actively explore the application of scenarios, and form a linkage effect. Further expand the activation rate and application scenario of medical insurance electronic vouchers. Strict implementation of information management, network security management and data security management measures, and comprehensively strengthen data security protection. Do a good job of promoting the application of "Jinyi Tong" and expanding the function of convenient service carrier.

10. Do a good job of organizing organization

The medical security, finance and tax departments at all levels in this city shall further improve their political standing, strengthen responsibility, and compact work responsibilities. It is necessary to strengthen overall coordination between departments and cooperate with the implementation and management services of residents' medical insurance treatment. It is necessary to further increase policy propaganda, popularize the concepts of mutual assistance to mutual assistance, share responsibilities, co -construction and sharing, enhance the awareness of the masses' insurance payment, and reasonably guide social expectations.

This notice will be implemented from the date of issuance and is valid for 5 years.

Comprehensive: The official website of Tianjin Medical Insurance Bureau, Tianjin Broadcasting

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Review: Wang Shaoyun

Editor: Wang An

Material arrangement: Xu Xiaowei, Wang An

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