Three departments issued a document: Do a good job in the basic medical security work of urban and rural residents in 2022

State Administration of Medical Insurance Bureau Finance of the State Administration of Taxation

Notice on the basic medical security work of urban and rural residents in 2022

Medical Insurance Distribution [2022] No. 20

All provinces, autonomous regions, municipalities, and Xinjiang Production and Construction Corps Medical Insurance Bureau, Finance Department (Bureau), and State Administration of Taxation's provinces, autonomous regions, municipalities and planned municipal tax bureaus:

In order to implement the requirements of the Party Central Committee and the State Council's decision -making and deployment and the relevant task requirements of the "Government Work Report" in 2022, further deepen the reform of the medical security system, and promote the new results of high -quality development of medical security. The relevant work notice is as follows:

1. Reasonable improvement of fundraising standards

In order to meet the growth of medical expenses and the improvement of basic medical demand and ensure the rights and interests of the insured persons, in 2022, we will continue to increase the funding standards for urban and rural residents 'basic medical insurance (hereinafter referred to as "residents' medical insurance"). The finances at all levels continue to increase subsidies for the payment of medical insurance insurance for residents. The per capita financial subsidy standards will be added 30 yuan to reach less than 610 yuan per person per year. Simultaneously increase personal payment standards 30 yuan to reach 350 yuan per person per year. The central government continues to implement sub -grading subsidies in accordance with regulations, and subsidies to the western and central regions in accordance with the per capita subsidy standards of 80%and 60%, respectively, and will be subsidized according to a certain proportion of provinces in the eastern region. Overall and arrange the capital of urban and rural residents' serious illness insurance (hereinafter referred to as "major illness insurance") funds to ensure that fundraising standards and treatment levels are not reduced. Explore the establishment of a dynamic fundraising mechanism for the establishment of a fundraising standard for residents' medical insurance and the per capita disposable income of residents, and further optimize the fundraising structure. Let go of the restrictions on the household registration of flexible employment personnel such as new employment forms. Effectively implement the "Interim Regulations on Residence Permits" to hold the policy of residence permits. For those who hold residents to participate in local residents' medical insurance, finances at all levels shall be subsidized in accordance with the same standards of local residents.

2. Consolidate and improve the level of treatment

It is necessary to adhere to the principle of "receiving and expenditure, balance of revenue and expenditure, and slight balance", do our best to do it, and take advantage of the efficiency of basic medical insurance, major illness insurance and medical assistance. Stable residents' medical insurance hospitalization level to ensure that the fund payment ratio within the policy scope is stable at about 70%. Improve the outpatient guarantee measures, continue to do a good job in the guarantee of hypertension and diabetes outpatient clinics, and improve the guarantee of chronic diseases and special diseases (hereinafter referred to as the "outpatient slow special disease") protection. Strengthen the function of major illness insurance and medical assistance outpatient clinics, explore the incorporation of high medical expenses within the scope of policies into the calculation caliber of the medical expenses of major illness insurance compliance medical expenses, coordinate the use of outpatient and inpatient rescue funds, and share the annual rescue limit. Reasonably improve the level of guarantee for the medical insurance medical expenses of residents, effectively support the three -child maternity policy, reduce the burden on maternity medical expenses, and promote the long -term balanced development of the population.

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

It is necessary to consolidate and expand the results of poverty alleviation in medical security, consolidate the function of medical assistance, and resolutely keep the bottom line of returning to poverty due to the scale of the disease. Continue to do a good job of medical assistance to the people of difficult people to participate in the personal payment of the residents' medical insurance. The full funding is funded, and the excess funding is funded to the poor and returned to the poor. Improve the efficiency of the use of medical assistance funds in overall planning, use enough funding to participate in insurance and direct rescue policies to ensure that they should do their best and rescue them. We will improve the long -term mechanism of preventing and poverty -elitative poverty due to illness, improve the dynamic monitoring of insurance participation, the early warning of patients with high cost burden, information sharing between departments, and risk collaborative disposal to ensure early discovery, early prevention, and assistance. Improve the application rescue mechanism, and implement classified assistance in accordance with regulations for difficult people who have approved the identity approved by relevant departments, and implement medical assistance policies in a timely manner. For those who have a heavy person who still have heavy personal expenses after the triple system guarantee, do a good job of connecting with temporary assistance, charity assistance, etc., accurately implement layered classification assistance, and jointly prevent the risk of returning to poverty due to illness.

Fourth, promote the unified institutional norms

It is necessary to resolutely implement the system of medical security treatment list, standardize decision -making authority, promote the unity 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 (2021-2023)" of the "Implementation of the Medical Guarantee Treatment Listing System (2021-2023), the unity of all the regional system frameworks will be achieved by the end of 2022, and 40%of the regional coordinated regions will complete the cleanup and specifications of the policy outside the list. Persist in steady stability, first establishment, then break, coordinate funds, transfer and benefit connection, and promote the integration of function. Promote the basic unified scope of medical insurance for medical insurance. Gradually regulate policies such as the scope of slow disease diseases in basic medical insurance clinics in the province. Strengthen coordination and coordination, follow the direction of unified policy and standardization, fund adjustment, improve hierarchical management, strengthen budget assessment, improve management services, steadily promote provincial -level overall planning, and promote the classification order of employee medical insurance and residents' medical insurance. The system should be strictly implemented, please report the reporting system for major decision -making, major issues, and major matters. New situations, new issues and major policy adjustments shall be implemented in a timely manner. The system of implementing the medical security treatment list system will be included in the relevant work performance assessment.

Fifth, do a good job of medical insurance payment management

It is necessary to strengthen the management of medical insurance and drug catalogs, do "dual channels" management of drugs and negotiate drugs, and strengthen negotiating drug supply guarantee and landing monitoring. Do a good job of piloting the medical insurance payment standard and strengthen monitoring. Before the end of June 2022, the original provinces were completed by the digestive work of the original provinces. Standardize the management of ethnic medicine, medical institution preparations, traditional Chinese medicine tablets and traditional Chinese medicine formulas. Improve medical insurance medical consumables and medical service project management. Continue to promote the reform of medical insurance payment methods, solidly implement the "Three -Year Action Plan for the Reform of DRG/DIP Payment Methods", accelerate the reform of the DRG/DIP payment method, and cover at least 40%of the regions in the jurisdiction. Explore the outpatient clinic, promote the reform of traditional Chinese medicine and medical insurance payment, and explore the payment of traditional Chinese medicine diseases according to the type of disease. Improve medical institutions and retail pharmacy medical security designated management, strengthen "Internet+" medical service medical insurance management, and unblocked the consultation, medicine collection, and distribution links. 6. Strengthen the purchasing and price management of centralized bands of drug consumables

It is necessary to promote the collection of drugs and medical consumables in a comprehensive and multi -level, and coordinate and coordinate the development of national organizations and inter -provincial alliance collection. At the end of 2022, the number of cumulative number of drugs for the national and provincial (or cross -provincial alliances) has not less than 350 drugs, and the cumulative high -value medical consumables have reached more than 5. Do a good job in the implementation of the implementation and procurement agreement on the implementation of the collection results, and implement the supporting policies such as prepaid payment, payment standards, and balance retention of medical insurance funds. Improve the function of improving the pharmaceutical collection platform, strengthen performance evaluation, improve the network mining rate of public medical institutions, and promote online settlement. Promoting the pilot reform of deepening medical services in an orderly manner, and guiding the supervision and urging regions to do a good job in the 2022 price adjustment evaluation and dynamic adjustment work. Start the medical price monitoring project, prepare the pharmaceutical price index, strengthen the normalized supervision of drugs and medical consumables, and continue to promote the implementation of medical prices and recruitment credit evaluation systems.

7. Strengthen fund supervision and operation analysis

It is necessary to accelerate the construction and improve the regulatory system and law enforcement system of the medical insurance fund, promote the establishment of an incentive accountability mechanism, and incorporate the crackdown on fraudulent insurance work into the relevant work assessment. Continue to carry out special rectification actions to crack down on fraud, and continue to expand the breadth and depth of special rectification actions. Improve the supervision linkage mechanism led by the medical insurance department and the participation of multiple departments, improve the work systems such as information sharing, collaborative law enforcement, joint defense linkage, execution, and discipline connection. 2. Grasp the joint fund supervision work pattern.

We must do a good job of fund budget performance management as required and improve the management of revenue and expenditure budgets. Comprehensive population spectrum such as aging population, chronic diseases such as chronic diseases, application of new pharmaceutical technology, and growth of medical expenses, carry out the analysis of fund revenue and expenditure, improve risk early warning, evaluation, resolution mechanism and plan, and effectively prevent and resolve the risk of fund operation.

8. Improve public management services for medical insurance

It is necessary to enhance the public service capabilities of grassroots medical security and strengthen medical security forces. Comprehensively implement the list of government services and standardized operations, promote the standardization and standardization of medical security government services, and improve the level of medical insurance and convenience services. Comprehensively implement the regulations for the management of basic medical insurance participation, strengthen source control and repeated insurance governance, and promote the "one thing in insurance" at one time. Optimize insurance payment services, adhere to intelligent online payment channels with traditional offline payment methods to innovate parallel, and continue to improve the level of payment facilitation. Comprehensively implement the temporary measures for the transfer of basic medical insurance relations, and continue to do a good job of "cross -provincial general management". Actively participate in the promotion of "one thing for birth". Continue to do medical expenses, new crown vaccines and vaccination costs for new crown pneumonia. Before the end of 2022, at least one ordinary outpatient cost of each county will be opened to open a designated medical institution for connected provincial networks. Conduct of Slow Special Diseases Cross -provincial Direct Settlement Services.

Nine, promote standardization and information construction

It is necessary to continue to advance the national unified medical insurance information platform and give full play to the efficiency of the platform. Comprehensively deepen the maintenance application of business coding standards, and establish an assessment and evaluation mechanism for standard applications. Establish a complete information system operation and maintenance management and security management system, and explore the establishment of an information sharing mechanism. Give full play to the role of national integrated government service platforms, commercial banks, government affairs applications and other channels, and explore cooperation mechanisms in the fields of cross -provinces and other fields, medical insurance electronic vouchers activation applications.

10. Do a good job of organizing implementation

It is necessary to further improve political standing, strengthen responsibility, compact work responsibilities, ensure that all policies and measures for urban and rural residents' medical security are effective, and continue to promote protection and improve people's livelihood. Medical security departments at all levels should strengthen overall coordination, strengthen departmental coordination, and do a good job of implementing and management services for residents' medical insurance treatment. The financial department shall arrange financial subsidy funds in full in accordance with regulations. Payment of payment and facilitation of payment of the masses must strengthen work linkage and information communication between departments. It is necessary to further increase policy propaganda, popularize the concepts of mutual assistance to mutual help, share responsibilities, co -construction and sharing, enhance the awareness of the masses to participate in insurance payment, rationally guide social expectations, and do a good job of public opinion risks.

Features notified.

National Medical Insurance Administration

Ministry of Finance

State Administration of Taxation

June 30, 2022

Interpretation

The interpretation of the "Notice of the State Administration of Taxation of the Ministry of Finance of the National Medical Insurance Bureau on Doing a Better Medical Guarantee Work in Urban and Rural Residents in 2022" was a few days ago. Deepen the reform of the medical security system, and promote new results to promote high -quality development of medical security. The State Medical Insurance Administration, together with the Ministry of Finance and the State Administration of Taxation, issued the "Notice on Doing a Good House for the Basic Medical Guarantee of Urban and Rural Residents in 2022" (Medical Insurance [2022] 20 20 No.), hereinafter referred to as "Notice"). The interpretation of the relevant content is as follows:

1. How to adjust the basic medical insurance funding standards for urban and rural residents?

In order to adapt to the growth of medical expenses and consolidate and improve the level of medical insurance treatment, and ensure the medical insurance rights and interests of participants, the "Notice" requires rationally improving the fundraising standards of residents' medical insurance. The per capita fundraising standards reached 960 yuan. For the subsidy for insurance payment, in 2022, the financial subsidy standard of residents' medical insurance participation in insurance is added by 30 yuan per capita, reaching no less than 610 yuan per person per year; the corresponding increase of personal payment standards is 30 yuan per person, reaching 350 yuan per person per year. Continue to draw a certain amount from the residents 'medical insurance fund to be used for urban and rural residents' major illness insurance funds. Individuals can enjoy major illness insurance benefits without paying separately and reduce the burden on high medical expenses. In addition, the "Notice" also emphasizes that it is necessary to effectively implement the provisions of the residence permit participation policy, liberalize the restrictions on participating household registration, and give subsidies at all levels to the same standards of local residents to participate in local residents' medical insurance.

2. What are the work requirements for consolidating and improving the level of medical insurance treatment?

The "Notice" proposes to adhere to the principle of "balance, balance of payments, balances, and slight balance", and coordinate the effectiveness of the comprehensive guarantee of basic medical insurance, major illness insurance and medical assistance. Mainly put forward work requirements for residents' medical insurance treatment in three aspects in three aspects. The first is to stabilize the level of hospitalization, and the proportion of payment of medical expenses funds within the scope of the policy is stable at about 70%. The second is to improve the outpatient guarantee measures, continue to do a good job in the guarantee of hypertension, diabetes outpatient medication, and improve the guarantee of chronic diseases, special diseases (hereinafter referred to as "outpatient disease") protection, and enhance the guarantee function of the medical expenses of the outpatient medical treatment for major disease insurance and medical assistance. Co -force to reduce the burden of medical expenses for outpatient clinics. The third is to reasonably improve the medical insurance costs for residents' medical insurance, and do a good job of guaranteeing the fertility medical expenses of insured people.

3. What are the specific measures for consolidating and expanding the results of poverty alleviation in medical insurance?

In order to effectively hold the bottom line of the people's livelihood guarantee, the "Notice" proposes four requirements. One is to continue to do a good job of funding for the people in difficulties, and fund the total amount of insights, the quota -funded funding objects, returning to the poor and poor people to ensure that the guarantee should be guaranteed Be sure to guarantee, and should do their best. The second is to improve the long -term mechanism of preventing and poverty in the poor and poverty due to illness, improve the dynamic monitoring of insurance participation, the early warning of patients with high cost burden, information sharing between departments, and risk collaborative disposal. The third is to improve the application rescue mechanism. The fourth is to do a good job of connecting with temporary assistance and charitable assistance.

4. How to enhance the balance and coordination of the development of the medical insurance system?

The "Notice" proposes to promote the unity of system norms, including four aspects. The first is to implement the three -year action plan of the medical security treatment list system, standardize decision -making authority, and promote the management of the rule of law, standardization, and standardization of the management of the medical security system. The second is to promote the basic unity of the scope of medication nationwide, and gradually regulate policies such as the scope of slow diseases in the basic medical insurance clinic in the province. The third is to steadily promote provincial -level overall planning, and employee medical insurance and residents' medical insurance can be promoted in classification. The fourth is to strictly implement the report system for major issues, and incorporate the implementation of the province's implementation of the treatment list into the performance assessment.

5. What are the specific requirements of medical insurance payment management?

The "Notice" proposes four requirements, one is to strengthen the management of medical insurance and drugs, and do a detailed negotiation of "dual channels" management of drugs. The second is to regulate the management of ethnic drugs, medical institutions, traditional Chinese medicine tablets, and traditional Chinese medicine formula pellet medical insurance. The third is to solidly implement the "Three -Year Action Plan for the Reform of DRG/DIP Payment Methods", and explore the reform of outpatient clinics and traditional Chinese medicine medical insurance payment methods. The fourth is to improve the designated management of medical institutions and retail pharmacies.

6. What are the specific requirements for the purchase and price management of pharmaceutical consumables?

The "Notice" proposes four requirements, one is to coordinate and coordinate the development of national organizations and inter -provincial alliance collection. At the end of 2022, the number of cumulative number of drugs for the national and provincial (or cross -provincial alliances) has not less than 350 drugs, and the cumulative high -value medical consumables have reached more than 5. The second is to enhance the function of improving the pharmaceutical collection platform and strengthen performance evaluation. The third is to promote the pilot reform of deepening medical services in order. The fourth is to launch a medical price monitoring project and continue to promote the implementation of medical prices and recruitment credit evaluation systems.

7. How to strengthen fund supervision and performance management?

The "Notice" emphasizes that in 2022, we must continue to strengthen fund supervision and performance management. First, it is to accelerate the construction and improvement of the fund supervision system and law enforcement system. The second is to continue the special rectification operation of cracking down fraud. The third is to improve the fund supervision linkage mechanism, improve the working system, and form a working pattern. The fourth is to do a good job of management of fund budget performance, carry out the analysis of fund revenue and expenditure, and improve risk early warning, evaluation, resolution mechanism and plan.

8. How does medical insurance public management services continue to optimize?

The "Notice" puts forward five aspects of the management services. First, the list of government services and operation standards for the comprehensive implementation of the administrative service services, promote the standardization and standardization of medical security government services, and improve the level of convenience services. The second is to fully implement the temporary measures for the management of basic medical insurance participation management management and relationship transfer, and continue to do a good job of "cross -provincial generalization". The third is to optimize the insurance payment service, adhere to the intelligent online payment channels and the traditional offline payment method to innovate parallel, and improve the level of payment facilitation. The fourth is to continue the medical expenses of patients with new crown pneumonia, and timely settle the new crown vaccine and vaccination costs in a timely manner. Fifth, do a good job of direct settlement in different places, and promote the 5 -out -of -the -lesions of slow specialties for direct settlement services. 9. How to promote the standardization and information construction of medical insurance?

The "Notice" requires that we must continue to promote the deepening application of the national unified medical insurance information platform, comprehensively deepen the maintenance application of business coding standards, establish a sound information system operation and maintenance and security management system, and improve the level of medical insurance services and governance capabilities.

In addition, the "Notice" also put forward work requirements for relevant departments from various regions from the aspects of compacking work responsibilities, strengthening departmental coordination, and increasing publicity to ensure that various policies and measures are effective and continuously promoting protection and improving people's livelihood.

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