Recently, the Municipal Medical Insurance Bureau, the Municipal Finance Bureau, the Municipal People's Social Security Bureau and the Municipal Taxation Bureau issued a notice on doing a good job in the basic medical security for urban and rural residents in 2022. This notice shall come into force as of the date of issuance and shall be valid for 5 years. In 2023, Tianjin medical insurance individual payment standard and treatment guarantee level will be improved;
Raise the individual payment standard: In 2023, the individual payment standard of medical insurance for residents in this city will be raised in 30 yuan, specifically, 980 yuan per year for high-grade residents and 350 yuan per year for low-grade residents. Students and children apply low-grade individual payment standards and enjoy high-grade payment reimbursement treatment.
Consolidate and improve the level of treatment guarantee: from 2023, the maximum payment limit for residents' medical insurance hospitalization (excluding outpatient chronic diseases and special diseases) will be raised to 250,000 yuan; The proportion of reimbursement for serious illness insurance for urban and rural residents increased by 5 percentage points; The medical expenses borne by individuals within the scope of residents' medical insurance policy will be included in the coverage of residents' serious illness insurance. The employee's serious illness insurance shall be implemented with reference.
First, raise the financing standard reasonably.
(1) Raise the financial subsidy standard. In 2022, the financial subsidy standard for residents' medical insurance in this city is 6 10 yuan per year for low-grade residents and 0100 yuan per year for high-grade residents; Those who hold Tianjin residence permit to participate in medical insurance for residents in this Municipality shall be given financial subsidies according to the same standards of residents in this Municipality. In 2023, the per capita financial subsidy standard for residents' medical insurance in this city will be adjusted according to national requirements.
(2) Improve the individual payment standard. In 2022, the individual payment standard of medical insurance for residents in this city shall be implemented in accordance with the Notice of the Municipal Medical Insurance Bureau, the Municipal Finance Bureau, the Municipal People's Social Security Bureau and the Municipal Taxation Bureau on Doing a Good Job in the Basic Medical Insurance for Urban and Rural Residents in 20021(J.F.F. [202 1] No.86). In 2023, the individual payment standard of medical insurance for residents in this city will be raised to 30 yuan, specifically, 980 yuan per year for high-level residents and 350 yuan per year for low-level residents. Students and children apply low-grade individual payment standards and enjoy high-grade payment reimbursement treatment.
(3) Improve the financing and payment mechanism. From 2023, the payment mechanism for college students will be adjusted, and all kinds of college freshmen in this city will declare and pay residents' medical insurance premiums on an annual basis; In accordance with the relevant provisions of this Municipality, if the elderly in urban and rural areas who receive living allowances voluntarily choose the payment grade to participate in residents' medical insurance, the system of withholding and remitting living allowances will no longer be implemented; College students who enjoy the national student loan in this city are determined by the Municipal Education Commission to guide colleges and universities in accordance with the regulations, and the financial department arranges budget quotas to support residents' medical insurance.
The second is to consolidate and improve the level of treatment guarantee.
(1) Consolidate and improve the basic medical insurance benefits. We will fully implement the policy of liberalizing reimbursement for outpatient (emergency) clinics in tertiary hospitals with residents' medical insurance, increase the proportion of reimbursement for outpatient (emergency) clinics in primary and secondary hospitals for high-end payers, and reduce the increase in the proportion of medical consumables in inpatient and outpatient departments. Since 2023, the maximum payment limit for residents' medical insurance hospitalization (excluding outpatient chronic diseases and special diseases) has been raised to 250,000 yuan. Continue to do a good job in ensuring medication for outpatients with hypertension and diabetes.
(2) Improve the protection function of serious illness insurance. Since 2023, the reimbursement rate of major illness insurance for urban and rural residents has increased by 5 percentage points; The medical expenses borne by individuals within the scope of residents' medical insurance policy will be included in the coverage of residents' serious illness insurance. The employee's serious illness insurance shall be implemented with reference.
(3) Strengthen medical assistance. Some measures to comprehensively implement and improve the medical insurance and assistance system for serious and serious diseases. Since 2023, there will be no deductible for hospitalization medical assistance for poor people and low-income people, and the proportion of assistance will be 75% and 70% respectively. The deductible standard of hospitalization assistance for marginal family members with minimum living security is determined according to 10% of the per capita disposable income of residents in this city released last year, and the proportion of assistance is 65%. For the needy people whose personal expenses are still heavy after the triple system guarantee, we should do a good job of connecting with temporary assistance and charitable assistance, and accurately implement hierarchical and classified assistance.
The third is to effectively grasp the bottom line of people's livelihood security.
Continue to consolidate the achievements of medical security in tackling poverty and do a good job in connecting with rural revitalization. Further optimize the information exchange and sharing mode of medical insurance and civil affairs departments' medical assistance objects, and gradually realize the automatic payment and treatment of insurance for difficult groups through the system. According to the regulations, it is classified as poor people, low-income groups and other difficult groups to participate in residents' medical insurance. Continue to do a good job in outpatient service, hospitalization and medical assistance for serious diseases, carry out medical assistance according to applications, and improve the efficiency of the use of medical assistance funds.
Fourth,
Promote the unification of institutional norms
Resolutely implement the national and municipal medical insurance treatment list management system, and solidly promote the three-year special action of cleaning up and standardizing. Clean up and standardize the accidental injury insurance system in our city, and do a good job in policy convergence, and include related expenses into the reimbursement scope of the basic medical insurance system according to regulations. Since 2023, children with autism spectrum disorders, cerebral palsy, tuberculosis, severe mental disorders and other diseases can continue to enjoy reimbursement benefits such as major illness insurance and medical assistance according to the current regulations of this Municipality. We will implement the active maternity insurance policy, revise and improve the regulations on maternity insurance for employees, clean up and standardize the maternity insurance system for urban and rural residents, guarantee the maternity medical expenses and maternity allowance for three children, and adjust and improve the reimbursement policy for maternity medical expenses.
Five, strengthen the management of medical insurance payment
Implement the 202 1 version of the national medical insurance drug list, and fully complete the task of cleaning up the varieties of self-supplemented drugs. Solidly promote the "dual-channel" management of negotiated drugs, and strengthen the supply guarantee and landing monitoring of negotiated drugs. Improve the management methods of hospital preparations and dynamically adjust the catalogue of hospital preparations. Improve the management of medical consumables and medical services in medical insurance. Deepen the reform of medical insurance payment methods, solidly promote the reform of grouping by disease diagnosis and paying by disease score, covering more than 70% of hospitalization medical expenses. Promote outpatient chronic diseases such as diabetes to pay per head. Improve the management of designated medical institutions and the "internet plus" medical service medical insurance payment management policy.
Six, strengthen the centralized procurement and price management of pharmaceutical consumables.
Continue to implement the centralized procurement and use of drugs organized by the state, and accelerate the implementation of the results of centralized procurement of drugs such as insulin organized by the state. Do a good job in the implementation of the seventh batch of centralized procurement of drugs organized by the state and the landing of the selected results of centralized procurement of spinal consumables organized by the state. Actively promote the Beijing-Tianjin-Hebei "3+N" medical procurement alliance to collect medicines and consumables. We will do a good job in implementing the results of centralized procurement of drugs and high-value medical consumables, and implement supporting policies such as direct settlement of medical insurance, coordination of payment standards, and retention of balances. Implement the dynamic adjustment mechanism of medical service price and formulate the medical service price adjustment plan. Organize the compilation of pharmaceutical price index, and implement the evaluation system of pharmaceutical price and recruitment credit.
Seven, strengthen the supervision and operation analysis of funds.
We will continue to carry out in-depth special rectification actions to crack down on fraud and insurance fraud, focus on investigating cases, severely investigate and deal with fraud and insurance fraud cases, resolutely expose typical cases, fully take comprehensive measures such as cost review, agreement handling and administrative punishment, increase punishment for violations of laws and regulations, and further strengthen the high-pressure strike situation. Give full play to the multi-sector participation in the supervision linkage mechanism, actively carry out information sharing, collaborative law enforcement, execution convergence and discipline convergence, promote the coordinated use of comprehensive supervision results, and implement joint punishment. Organize the final accounts and budget preparation of the medical insurance fund, strengthen the monitoring of the implementation of the medical insurance fund budget, and do a good job in analyzing the implementation progress. Establish an early warning mechanism for normalized fund operation. Prepare a report on the risk assessment and early warning mechanism of medical insurance fund operation, strengthen the monitoring of fund operation, and improve the risk early warning, assessment and resolution mechanism through in-depth analysis of important indicators such as participation and fund revenue and expenditure scale, so as to effectively prevent and resolve fund operation risks.
Eight, comprehensively improve the ability of public management services
In accordance with national requirements, comprehensively strengthen the construction of handling service system. Carry out the construction of "standard year" for medical insurance handling, and fully implement the list of administrative services and operational norms. Fully implement the interim measures for the transfer and continuation of the basic medical insurance relationship, and continue to do a good job in the transfer and continuation of the "inter-provincial general office". Solidly promote the construction of a service demonstration window. Continue to do a good job in the settlement and liquidation of COVID-19 patients' medical expenses, COVID-19 vaccines and vaccination expenses. Promote "one thing to protect" and "one thing for newborns". Deepen the direct settlement of medical treatment in different places, continue to expand the scope of designated medical institutions for outpatient settlement in different places, and include some outpatient treatment expenses related to chronic diseases and special diseases into the scope of reimbursement for medical treatment in different places.
Nine, promote standardization and information construction
Improve the unified, efficient, convenient, safe and intelligent medical insurance information platform. Further promote the standardized application of medical insurance, actively explore scenario applications, and form a linkage effect. Further expand the activation rate and application scenarios of medical insurance electronic certificate and electronic social security cards. Strictly implement information management, network security management and data security management measures to comprehensively strengthen data security protection. Do a good job in the popularization and application of "Tianjin medical insurance" and expand the function of convenient service carrier.
X. Do a good job in organizing implementation.
The medical security, finance and taxation departments at all levels in this Municipality should further improve their political position, strengthen their responsibility and compact their work responsibilities. It is necessary to strengthen the overall coordination of departments and coordinate the implementation and management of residents' medical insurance benefits. It is necessary to further intensify policy propaganda, popularize the concepts of mutual assistance in medical insurance, shared responsibility, joint construction and sharing, enhance people's awareness of insurance payment, and reasonably guide social expectations.