Guangxi medical insurance policy in 223

in order to promote the high-quality development of medical insurance and achieve new results, and ensure the stable operation of the basic medical insurance system for urban and rural residents (hereinafter referred to as residents' medical insurance), in accordance with the relevant work arrangements of the state and the autonomous region, the Medical Insurance Bureau of the autonomous region, together with the Finance Department of the autonomous region and Guangxi Taxation Bureau, recently issued the Notice on Doing a Good Job in the Basic Medical Insurance for Urban and Rural Residents in 222 (hereinafter referred to as the Notice), clearly continuing to raise the funding standards for residents' medical insurance. We will steadily improve the level of medical security benefits, give full play to the synergy of structural reform on the medical supply side, promote the quality and efficiency of medical insurance settlement services, and effectively improve the sense of acquisition of insured persons.

First, raise the funding standard for residents' medical insurance. According to the Notice, in order to adapt to the increase of medical expenses and the improvement of basic medical needs, in 222, 3 yuan will be added to the financial per capita subsidy standard of residents' medical insurance at all levels on the basis of 221, reaching the annual 61 yuan for each person. In 223, the individual contributions of residents' medical insurance shall be paid according to the standard of not less than 35 yuan per person per year.

the second is to steadily improve the level of residents' medical insurance benefits. The "Notice" stipulates that it is necessary to consolidate and improve the level of medical security benefits, make overall plans to give full play to the comprehensive security efficiency of the triple security system of basic medical insurance, serious illness insurance and medical assistance, and ensure that the proportion of fund payment within the scope of residents' medical insurance hospitalization policy is stable at around 7%. Improve the level of outpatient medical insurance for residents, include the high medical expenses for outpatient special chronic diseases and outpatient special drugs within the scope of the policy into the scope of major illness insurance, implement the medical assistance treatment for outpatient special chronic diseases for medical assistance objects according to regulations, and effectively reduce the burden of outpatient medical expenses for insured personnel. We will fully implement the maternity insurance policy to support the three-child policy and promote the long-term balanced development of the population.

thirdly, it is necessary to secure the people's livelihood safety net. The "Notice" emphasizes that it is necessary to make concerted efforts to ensure that people in need should be fully insured. Those who participate in the medical insurance for residents during the centralized insurance period, those who participate in the medical insurance for urban and rural residents within three months after the employee's medical insurance is interrupted, and special groups such as newborns and rural low-income people will enjoy the waiting period without treatment, and enjoy the new basic medical insurance benefits from the month of enrollment. Serious illness insurance and medical assistance continue to implement the policy of preferential protection for rural low-income population, give full play to the effect of reducing the burden, and ensure that the needy people should do their best and save them.

the fourth is to expand the coverage of medical insurance reform. The "Notice" also puts forward requirements for the reform work in the medical insurance field, such as medical insurance payment management, centralized procurement of medical consumables and fund supervision. It is clear that the coverage rate of DRG payment fund for hospitalization medical expenses will reach 7%, and the total number of generic names of drugs purchased in Guangxi will exceed 35 this year, and the procurement of medical consumables will reach more than 1 categories. By adopting a series of reform measures, we will continue to reduce the cost of medical treatment, such as medical expenses, drugs and consumables, reduce the loss of medical insurance funds, improve the efficiency of the use of medical insurance funds, and make the reform results better benefit the majority of insured people.

Fifth, simplify administration and decentralize power to deepen the "streamline administration, delegate power, strengthen regulation and improve services" reform. The "Notice" requires that we should continue to improve the management services of medical insurance companies, simplify the process of handling medical insurance matters, and realize the joint operation of "one thing for insurance", "one thing for birth" and so on. We will promote the inter-provincial direct settlement of outpatient expenses, and by the end of 222, we will open inter-provincial direct settlement services for five outpatient chronic and special diseases such as hypertension, diabetes, radiotherapy and chemotherapy for malignant tumors, uremia dialysis and anti-rejection treatment after organ transplantation in all co-ordination areas. Promote the standardization and informatization of medical insurance, strengthen the "internet plus" medical insurance service, promote the application of medical insurance electronic certificate activation, and further improve the quality of medical insurance direct settlement service.

Notice of the Finance Department of Guangxi Zhuang Autonomous Region, Guangxi Zhuang Autonomous Region, and the Taxation Bureau of State Taxation Administration of The People's Republic of China Guangxi Zhuang Autonomous Region on Doing a Good Job in the Basic Medical Security for Urban and Rural Residents in 222

No.3 [222] of Guangxi Medical Insurance Bureau, municipal and county (city, district) medical insurance bureaus, finance bureaus and tax bureaus: In order to further deepen the reform of medical insurance system and promote the high-quality development of medical insurance to achieve new results, Ensure the steady operation of the basic medical insurance system for urban and rural residents (hereinafter referred to as residents' medical insurance), According to the Notice of State Taxation Administration of The People's Republic of China, the Ministry of Finance of the National Medical Insurance Bureau, on doing a good job in the basic medical security for urban and rural residents in 222 (No.2 [222] of Medical Insurance) and the Notice of the People's Government of the Autonomous Region Party Committee and Autonomous Region on Printing and Distributing the Implementation Opinions on Deepening the Reform of the Medical Security System (No.18 [22] of Gui Fa). And the Notice of the General Office of the People's Government of Guangxi Zhuang Autonomous Region on Printing and Distributing the Implementation Plan for the Reform of the Division of Financial Affairs and Expenditure Responsibilities in the Medical and Health Field in Guangxi (Zheng Gui Ban Fa [219] No.48), and other documents, the relevant work on the basic medical security for urban and rural residents in Guangxi in 222 is hereby notified as follows:

1. Reasonably determine the financing standards for residents' medical insurance (1) Optimize the financing structure. In order to adapt to the growth of medical expenses and the improvement of basic medical needs, and to protect the rights and interests of insured persons, the funding standard for residents' medical insurance will continue to be raised in 222. Explore the establishment of a dynamic financing mechanism linked to residents' medical insurance financing standards and per capita disposable income, and further optimize the financing structure. (2) Continue to raise the standard of financial subsidies. In 222, 3 yuan will be added to the per capita subsidy standard of residents' medical insurance at all levels on the basis of 221, reaching 61 yuan per person per year. We will continue to implement the financial burden system of residents' medical insurance financial subsidy funds at all levels, with the central financial subsidy of 488 yuan/person-year and the local financial subsidy of 122 yuan/person-year. In the part of local financial subsidies, the autonomous region's financial subsidies to poverty-stricken counties (cities, districts) are 91.5 yuan/person-year, and the financial burden of poverty-stricken counties (cities, districts) is 3.5 yuan/person-year; The financial subsidies of the autonomous region to the districts, cities and other counties are all 61 yuan/person-year, and the finances of the districts, cities and other counties bear 61 yuan/person-year respectively. If college students directly under the autonomous region participate in the medical insurance for local residents, the local financial subsidy is 122 yuan/person-year, all of which shall be borne by the autonomous region. Local governments at all levels should arrange financial subsidies in full according to regulations and allocate them in time. Let go of the restrictions on the household registration of flexible employees such as employees with new employment forms. Earnestly implement the "Provisional Regulations on Residence Permit", which stipulates that those who hold residence permits to participate in local residents' medical insurance should be subsidized according to the same standards as local residents. (3) Steadily raise the individual payment standard. In 223, the individual contributions of residents' medical insurance shall be paid according to the standard of not less than 35 yuan per person per year; Where the state has new provisions on individual payment, those provisions shall prevail. Individual contributions should be paid annually within the prescribed payment period.

second, consolidate and improve the level of medical insurance benefits (1) moderately improve the level of basic medical insurance benefits. Adhere to the principle of "fixed income and expenditure, balance of payments and slight surplus", do our best and do what we can, give full play to the comprehensive security efficiency of the triple security system of basic medical insurance, serious illness insurance and medical assistance, and scientifically and reasonably determine the level of basic medical insurance. Stabilize the level of residents' medical insurance hospitalization treatment and ensure that the proportion of fund payment is stable at around 7% within the scope of the policy. Implement the unified outpatient special chronic disease policy in the whole region, improve the outpatient security level of special chronic diseases in major outpatient clinics, continue to implement the outpatient drug security policy for hypertension and diabetes (hereinafter referred to as "two diseases"), strengthen the management of drug allocation and use in outpatient clinics for "two diseases", ensure that the drugs for "two diseases" are properly matched and available, and improve the standardized management level of "two diseases". (two) to enhance the function of serious illness insurance and medical assistance outpatient support. For the high medical expenses of outpatient special chronic diseases and outpatient special drugs, the triple protection of basic medical insurance, serious illness insurance and medical assistance will be implemented as a whole, and the high medical expenses of outpatient special chronic diseases and outpatient special drugs within the policy scope will be included in the coverage of serious illness insurance. According to the provisions of the implementation of medical assistance object outpatient special chronic disease medical assistance treatment. (3) Implementing the maternity protection policy. The maternity-related medical expenses incurred by the insured participating in residents' medical insurance in the outpatient department shall be paid according to the provisions of outpatient medical co-ordination; The medical expenses incurred in hospitalization shall be reimbursed according to the prescribed proportion of hospitalization. Implement maternity insurance to support the three-child policy, reduce the burden of maternity medical expenses, and promote long-term balanced population development.

third, hold fast to the bottom line of people's livelihood security (1) work together to ensure that the people in need should be fully insured. Consolidate and expand the achievements of medical security in tackling poverty, resolutely stick to the bottom line of not returning to poverty on a large scale due to illness, do a good job in subsidizing individual contributions for residents' medical insurance in accordance with regulations, and include all the people in need who meet the conditions for insurance into the coverage of the basic medical security system. For residents who participate in medical insurance payment during the centralized insurance period, those who participate in medical insurance for urban and rural residents within 3 months after the employee's medical insurance payment is interrupted, and special groups such as newborns, rural low-income population (including destitute people, orphans, children who are actually not raised, low-income objects, low-income marginal objects, poverty-stricken people, monitoring objects to prevent poverty return and poverty-stricken people identified by rural revitalization departments, the same below), they will enjoy the new basic medical insurance benefits from the month of enrollment. (2) Give full play to the triple guarantee and burden reduction function. Strengthen the convergence of the triple security system of basic medical insurance, serious illness insurance and medical assistance, and give full play to the comprehensive security function. The serious illness insurance will continue to implement the preferential protection policy for the rural low-income population and give play to the effect of reducing the burden. Fully implement the medical assistance policy according to the application, and consolidate the function of medical assistance. To standardize the referral and seek medical treatment in the province, if the personal burden of the relief object within the policy scope is still heavy after the triple system guarantee, all localities should formulate the implementation plan of the tilt relief according to the actual situation and report it to the superior medical insurance and financial departments for the record. Make overall plans to improve the efficiency of the use of medical assistance funds, make full use of the policies of subsidizing insurance and direct assistance, and ensure that all resources should be used and all resources should be saved. (3) improve the long-term mechanism to prevent and resolve poverty caused by returning to poverty due to illness. We will continue to implement the whole process monitoring and early warning before, during and after the medical insurance to prevent poverty, and improve the working mechanisms such as dynamic monitoring of insurance participation, early warning of patients with high expenses, information sharing among departments, and collaborative risk disposal to ensure early detection, prevention and assistance of risks. We will improve the mechanism of applying for assistance, provide classified assistance to people in need who have been identified and approved by relevant departments, and timely implement the medical assistance policy. For the needy people who are still heavily burdened with personal expenses after the triple system guarantee, we should do a good job of connecting with temporary assistance and charitable assistance, accurately implement hierarchical and classified assistance, and work together to prevent the risk of poverty caused by returning to poverty due to illness.

fourth, promote the unification of system norms, resolutely implement the spirit of the Opinions of the Ministry of Finance of the National Medical Insurance Bureau on Establishing a Medical Insurance Treatment List System (No.5 [221] of the Medical Insurance Bureau), standardize decision-making authority, promote the unification of system norms, and enhance the balance and coordination of the development of the medical insurance system. According to the requirements of the "Three-year Action Plan for Implementing the Medical Security Treatment List System (221-223)", the system framework of all co-ordination areas will be unified by the end of 222, and all co-ordination areas will complete the off-list policy cleaning norms, and the implementation of the medical security treatment list system in all co-ordination areas will be included in the relevant work performance appraisal. Strengthen overall planning and coordination, and steadily promote the provincial overall planning of basic medical insurance in accordance with the direction of unified and standardized policies, balanced fund adjustment, improved hierarchical management, strengthened budget assessment and improved management services. Promote the basic unification of the scope of medical insurance drugs in the country. Strictly implement the reporting system for major decisions, major issues and major issues, and implement new situations, new problems and major policy adjustments in a timely manner after reporting.

5. Do a good job in the management of medical insurance payment, strictly implement the national medical insurance drug list, and complete the digestion of the original self-supplemented Class B drugs in our district before the end of December 222. Ensure the "dual-channel" supply of negotiated drugs in a timely and smooth manner. Strengthen the statistical analysis of pilot drugs of medical insurance payment standard. Standardize the medical insurance access management of ethnic medicines, preparations of medical institutions, Chinese herbal pieces and Chinese herbal formula granules. A new edition of "Guangxi Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Medical Service Project" will be issued to guide all localities to implement the payment management policy of basic medical insurance medical consumables. We will continue to promote the reform of medical insurance payment methods and implement the second three-year action plan of DRG payment reform, and the coverage rate of DRG payment fund for hospitalization medical expenses will reach 7%. We will carry out pilot projects of DRG payment for hospitalization expenses in different places, payment for compact county doctors, and payment for superior diseases of traditional Chinese medicine. Improve the designated management of medical security in medical institutions and retail pharmacies. Continue to promote the medical insurance management of "internet plus" medical service.

VI. Strengthen the centralized procurement of pharmaceutical consumables and normalize and institutionalize the price management, do a good job in landing various batches of varieties that have been collected, carry out the succession of expired varieties, and continuously expand the coverage of varieties purchased with quantity, so as to strive to make the total number of generic names of drugs purchased with quantity in Guangxi exceed 35 and medical consumables purchased with quantity reach more than 1 categories this year. Implement the new online procurement policy for drugs and medical consumables, realize all the online purchases, and improve the online collection rate of drugs and high-value medical consumables in public medical institutions. Implement the policy of retaining the balance of medical insurance funds for centralized procurement of pharmaceutical consumables, and timely complete the disbursement of the balance of retained funds. According to the national deployment, we will promote the reform of medical service price, carry out an evaluation of medical service price adjustment during the year, and adjust the prices of some projects in combination with the dynamic price adjustment mechanism. Implement the management policy of new medical service items, carry out the declaration and demonstration of new medical service price items, evaluate the new medical service price items that have been carried out, and support the new medical technology to enter clinical application.

VII. Strengthen fund supervision and operation analysis, strengthen the construction of supervision system and improve the supervision system and mechanism. Strengthen the daily supervision and management of the use of medical insurance funds, continue to carry out special rectification actions against fraud and insurance fraud, and continuously expand the breadth and depth of special rectification actions. Promote the informatization and standardization of medical insurance fund supervision. Implement grid supervision and establish and improve the medical insurance credit management system. We will improve the supervision linkage mechanism led by the medical insurance department and involving multiple departments, improve the working systems of information sharing, collaborative law enforcement, joint defense linkage, execution linkage and discipline linkage, promote the coordinated use of comprehensive supervision results, and form a fund supervision work pattern in which multiple cases are investigated, multiple cases are handled, and * * * is managed together. Strengthen fund budget performance management and improve revenue and expenditure budget management. Comprehensive aging population, chronic diseases and other disease spectrum changes, the application of new medical technology, the increase of medical expenses and other factors, to carry out the fund income and expenditure forecast analysis, improve the risk early warning, evaluation, resolution mechanism and plan, and effectively prevent and resolve the fund operation risks.

VIII. Improve the management service of medical insurance company, strengthen the capacity building of primary medical insurance handling service, promote the integration of medical insurance handling service into the service of county, township and village, and realize the full coverage of autonomous region, city, county, township (street) and village (community). Carry out the construction of "standard year" for medical insurance handling, promote the standardization of handling service standards, and create a number of standardized windows and demonstration sites for medical insurance. Fully implement the basic medical insurance management procedures, strengthen source control and repeated insurance management, and promote "one thing to participate in insurance" at a time. Optimize the insurance payment service, adhere to the parallel innovation of intelligent online payment channels and traditional offline payment methods, and continuously improve the level of payment facilitation. We will 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 "inter-provincial communication". Actively participate in the promotion of the "one thing for birth" joint office. Continue to do a good job in the settlement and liquidation of COVID-19 patients' medical expenses, COVID-19 vaccines and vaccination expenses. Improve the procedures for handling medical treatment in different places, implement unified management services for medical treatment in different places in the whole region, and expand medical treatment in different places.