Notice of Jinhua Municipality on the full implementation of the municipal overall implementation plan of basic medical insurance

Unify policies and promote fairness. We will improve and perfect the unified basic medical insurance policies for employees and urban and rural residents in the city, unify and improve policies such as coverage, financing standards, treatment guarantee, fund supervision and handling services, and strive to break the fragmentation of the system and promote a fairer basic medical insurance system.

As a whole, the fund bears risks. The basic medical insurance fund shall be co-ordinated at the municipal level, establish and improve the risk responsibility sharing mechanism of city and county funds, reasonably balance the burden of county funds within the city, and improve the mutual aid and anti-risk ability of funds.

Improve the mechanism and strengthen management. Balance the interests of all parties, and establish an incentive and restraint mechanism linked to management performance in accordance with the requirements of municipal overall planning and hierarchical management. Clarify the responsibilities of cities and counties in insurance collection, financing subsidies, total budget management and fund supervision. To achieve accurate and efficient management of the whole process of capital revenue and expenditure.

Actively, steadily and orderly advance. Adhere to the problem orientation, focus on solving difficult problems, start with improving the overall planning system and overall planning funds, and realize unified fund collection and expenditure according to the principle that existing funds are gradually in place and incremental funds are in place in one step, so as to ensure that the overall treatment of insured personnel will not be reduced, ensure the safety and sustainability of medical insurance funds, and ensure the smooth operation of the basic medical insurance system.

primary objective

From June 5438+1 October1in 2022, the basic medical insurance will be co-ordinated at the municipal level according to the standards of unified system and policy, unified fund income and expenditure, and integrated management and service, so as to realize high-quality medical insurance with equal rights and interests in financing, fair treatment and no difference in handling services in the whole city. Establish a fair and unified policy system, strengthen the basic and comprehensive protection for people in need, further narrow the gap between urban and rural areas, and achieve a high-level unification of treatment policies. Establish a scientific and efficient governance system, rationally divide the management responsibilities of cities and counties, and explore a new mechanism for municipal co-ordination of medical insurance governance at cities and counties. Strengthen the functions of municipal policy formulation and overall management, and highlight the functions of county-level fund supervision and specific handling. Establish an efficient service system that benefits the people and facilitates the people, focus on solving the difficulties and blocking points of people's medical insurance, and promote the standardization, informationization and convenience of medical insurance public services with high quality.

primary mission

Unification of system and policy

1. Uniform coverage. The city implements a unified coverage of employee medical insurance and resident medical insurance, and employees who participate in employee medical insurance also participate in maternity insurance. Encourage individual industrial and commercial households without employees, part-time employees who have not participated in employee medical insurance in the employer and other flexible employees to participate in employee medical insurance. On the basis of consolidating the participation of registered population, the permanent population will be included in the scope of participation.

2. Uniform funding standards. The city implements a unified employee medical insurance payment base and payment ratio. The total wages of the employees of the employing unit shall be determined according to the sum of the payment wages of the insured employees of the unit, and the base of the payment wages of the employees shall be determined according to the average monthly salary of the employees in the previous year. If the salary paid by employees is lower than 60% of the average monthly salary of employees in all social units in Zhejiang Province last year, it shall be determined according to 60%; If the average monthly salary of employees in all social units in Zhejiang Province is higher than 300% in the previous year, it shall be determined as 300%. The implementation of the city's employer employee medical insurance payment ratio is 7.5%, the on-the-job employee individual payment ratio is 2%, and the flexible employment personnel basic medical insurance payment ratio is 9%. Implement unified personal account transfer payment methods and standards. Implement a unified personal payment standard for residents' medical insurance and a policy of subsidizing the insured for the needy. The individual payment standard of residents' medical insurance is determined in accordance with the Measures of Jinhua Municipality on Basic Medical Insurance. Implement a unified financial subsidy policy for residents' medical insurance. From 2022, the city will determine three levels of financial subsidies according to the level of economic development, and it will take three years to realize the unified financial subsidy standard of the city. In 2022, the financial subsidy standard for residents' medical insurance is determined in principle as 1 100 yuan per person per year in Yiwu, 980 yuan per person per year in urban areas, Dongyang and Yongkang, and 930 yuan per person per year in Lanxi, Pujiang, Wuyi and Pan 'an. Counties and cities can set high standards according to the level of economic development and the balance of funds. For those who hold residence permits to participate in the insurance, governments at all levels shall give subsidies according to the same standards as local residents.

3. Unified guarantee treatment. Strictly implement the medical security treatment list system. Implement the unified coverage and standards of outpatient and inpatient treatment in the city, and seek medical treatment in different places. Implement a unified catalogue of basic medical insurance drugs and medical services in the province. We will continue to deepen the graded diagnosis and treatment system and the construction of county-level medical institutions, further improve the differential payment policy for medical insurance, give full play to the regulatory role of medical insurance funds in the diagnosis and treatment and medical expenses structure inside and outside the county, and guide graded diagnosis and treatment and insured personnel to seek medical treatment in a reasonable and orderly manner.

4. Unified payment method. Under the management of the city's total budget, hospitalization medical expenses are paid according to the relevant groups of disease diagnosis, and paid according to the "PDPM integral method". Outpatient medical expenses are signed with family doctors and paid according to "APG integral method". Actively explore medical insurance payment methods in specific fields and specific groups.

5 unified management of drug prices and bidding. Fully implement the national, provincial and municipal joint centralized procurement policies for drugs and medical consumables, and health and medical insurance departments at all levels should supervise the strict implementation of medical institutions. Implement the unified medical service price and medical insurance payment standard in the whole city, reasonably refer to the price of provincial public hospitals, focus on raising the price of medical service items that reflect the technical and labor value of medical personnel, and comprehensively promote the standardized development of medical institutions and the improvement of service quality. The reform plan of medical service price in Jinhua public hospitals shall be formulated separately by the municipal medical insurance department in conjunction with the municipal health department.

Unified collection and expenditure of funds

Since June 65438+ 10/day, 2022, the basic medical insurance fund has been unified, collected, allocated and liquidated in the whole city.

6 unified fund budget and final accounts management. Formulate measures for the budget management of Jinhua basic medical insurance fund. According to the relevant provisions of the budget management of social insurance funds and the principle of fixed income and expenditure, balance of payments and slight balance, our city has compiled the fund budget and final accounts in a unified way, strictly standardized the contents, standards and scope of fund revenue and expenditure, and strengthened the binding force of budget implementation.

7. Unified fund revenue and expenditure management. Unify the subject of fund collection, adjust the income level, and unify the management rules of income transfer, fund use and payment. Further improve the collection and management mechanism and improve the efficiency of collection and management. Strengthen data sharing and comparison among departments, accurately expand the scope, realize all insurance coverage and pay basic medical insurance premiums. Unified fund transfer and deposit. Conduct a comprehensive audit of the funds of the counties before the overall planning, and the cumulative gap of funds caused by the problem of overcharge and underexpenditure confirmed by the audit and the cumulative gap of funds revenue and expenditure formed on the accrual basis before the overall planning shall be borne by the counties themselves. From June 5438+ 10, 2022, the accumulated balance of medical insurance funds in each county will be coordinated by the whole city. In addition to the collection of funds, the temporary stay of counties and cities is managed and dispatched by the municipal level, which is mainly used to make up for the gap of local funds in the future. According to the operation of the city's funds, it is gradually collected into the municipal financial accounts. The accumulated balance of temporary funds in counties and cities is maintained and increased by all localities according to the requirements of competition, and the results of competition are reported to the Municipal Finance Bureau for the record.

8. Unified responsibility sharing. Formulate measures for the municipal responsibility sharing of Jinhua basic medical insurance. According to the principle of unified fund revenue and expenditure, responsibility classification and reasonable gap sharing, the responsibility sharing mechanism of city and county governments with equal rights and obligations, matching of affairs and financial rights and combining incentives and constraints is established.

Management and service integration

System standardization promotes digital reform, improves handling management, optimizes medical insurance services, promotes upward concentration of data and downward extension of services, and realizes homogenization of management services within the city.

9. Unified protocol management. Improve the management of access, exit and service agreement of designated qualifications, implement the unified management measures of designated medical institutions for medical insurance in the city, and unify the assessment methods of designated medical institutions.

10. Unified service procedures. Strengthen the standardization, informationization and convenience of medical security services, and implement the unified medical insurance business handling process and service norms in the city. Strengthen vertical contact, improve the four-level management service network of city, county, township and village, deepen the construction of "15 minute service circle" for medical insurance handling, and promote the sinking of service; Strengthen horizontal interconnection and realize high-quality medical insurance matters, such as "handling in the same city", "settling in different places" and "enjoying mutual recognition"; Continue to deepen the reform of "running at most once" and promote "handheld office" and "online office". Realize the 3+N one-stop settlement service for basic medical insurance, serious illness insurance and medical assistance. Explore one-stop settlement of maternity medical expenses in the city.

1 1. Unified information system construction. Relying on the integrated and intelligent public * * * data platform, we will promote business process reengineering and data information sharing, accelerate the centralized management of medical insurance data, establish a new mechanism for public * * * services to enjoy high quality * * *, support the city's basic medical insurance municipal-level overall management of various handling services, and realize business and financial integration. Strengthen the safety management of medical insurance information network, provide necessary talents and technical support, and ensure the smooth operation of various municipal-level handling businesses of basic medical insurance.

12. Unified division of labor management. Establish a medical security governance mechanism that is compatible with the municipal overall planning of basic medical insurance. The municipal government and its relevant departments should, within the limits of authority determined by laws, regulations and relevant norms, study and formulate the city's medical security policies, strengthen the supervision and management of the use of funds, build a comprehensive management platform for all people's peace of mind medical insurance cities, carry out dynamic monitoring of the city's fund operation, deepen the construction of the credit system for medical insurance fund supervision, promote the integration of fund supervision in the city, and make overall plans for the assessment of county and district work. The county government and its relevant departments should strictly implement the unified medical security policy, strengthen the supervision and management of fund use, and improve the ability and level of management services.

Organizational guarantee

Strengthen organizational leadership. Set up a leading group for the overall implementation of municipal basic medical insurance, with the main leaders of the municipal government as the leader and the leaders in charge as the deputy leader, and the main responsible persons of medical insurance, organization, education, civil affairs, finance, health, retired military personnel, auditing, market supervision, big data, the Disabled Persons' Federation, taxation, the People's Bank of China and other departments and county-level governments as members. The office of the leading group is located in the Municipal Medical Insurance Bureau, and a special class is set up to be responsible for the daily work of the leading group. All counties have established a medical insurance joint conference system and carried out the overall reform of medical insurance.

Strengthen departmental responsibilities. All relevant departments should unify their thinking, raise awareness, carry out their duties, cooperate closely, intensify their work, and steadily promote the municipal overall planning of basic medical insurance. The medical security department takes the lead in organizing the implementation of the municipal overall planning of basic medical insurance, formulates municipal overall planning supporting policies jointly with relevant departments, and strengthens the guidance and supervision of county business. The financial department is responsible for implementing the financial burden of funds and allocating them in place according to the regulations, strengthening the budget management of medical insurance funds, ensuring the working funds, and doing a good job in fund supervision in conjunction with relevant departments. The health department takes the lead in grading diagnosis and treatment, building medical institutions, signing family doctors and improving the service capacity of primary medical and health institutions, strengthening the management of medical institutions, standardizing the behavior of diagnosis and treatment services, and urging the implementation of medical security policies. The tax authorities shall perform the duties of collection and management of basic medical insurance premiums according to law, do a good job in the adjustment and collection of collection levels, and cooperate with the preparation of the annual budget and final accounts of medical insurance funds. The audit department should do a good job in the audit of local medical insurance funds before the municipal overall planning, and strengthen the special audit. The preparation department is responsible for ensuring the preparation of municipal overall planning institutions. The market supervision department is responsible for the drug quality management of designated medical institutions. The big data management department is responsible for the supervision and security of the e-government cloud platform. Education, civil affairs, veterans affairs, the Disabled Persons' Federation and other departments are responsible for the identification of students with difficulties, people with difficulties, key entitled groups and qualified disabled people, and do a good job in information sharing with the medical insurance department. The People's Bank of China should do relevant work according to its responsibilities.

Strengthen assessment and incentives. Since 2022, the policy implementation, insurance coverage, payment level, fund collection, budget management, financial subsidies, responsibility commitment, total budget, handling services, fund supervision, etc. have been comprehensively assessed, and included in the county work target responsibility system assessment, and a reward and punishment mechanism linked to the assessment results has been established.

Strengthen publicity and guidance. All counties and districts should give full play to the role of newspapers, radio, television, internet, WeChat and other media, widely publicize and deeply interpret the relevant policy practices and significance of municipal overall planning, and effectively improve the awareness rate of policies. Respond to the insured's concerns about insurance payment, treatment enjoyment and relationship transfer in time, and create a good public opinion atmosphere for the smooth implementation of municipal basic medical insurance. Summarize and publicize good experiences and practices in time to ensure the smooth progress of municipal overall planning of basic medical insurance.

This scheme will be implemented from June 65438+1 October12022. If the previous provisions are inconsistent with this plan, this plan shall prevail.