Notice from the National Medical Insurance Administration on the implementation of medical insurance for urban and rural residents in 2022

The medical insurance bureaus and finance departments of all provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps, and the taxation bureaus of all provinces, autonomous regions, municipalities directly under the Central Government and cities under separate state planning under the State Administration of Taxation:

In order to implement the provisions of the Party Central Committee, In accordance with the decisions and arrangements of the State Council and the relevant task requirements of the 2022 "Government Work Report" to further deepen the reform of the medical security system and promote the high-quality development of medical security to achieve new results, the relevant work on basic medical security for urban and rural residents in 2022 is hereby notified as follows: < /p>

1. Reasonably raise the financing standards

In order to adapt to the increase in medical expenses and the increase in basic medical needs, and to ensure the medical insurance rights and interests of insured persons, the financing standards for basic medical insurance for urban and rural residents will continue to be raised in 2022. Finance at all levels will continue to increase subsidies for residents' medical insurance contributions. The per capita financial subsidy standard will be increased by 30 yuan, reaching no less than 610 yuan per person per year. The individual payment standard will also be increased by 30 yuan to 350 yuan per person per year. The central government will continue to implement graded subsidies to local governments in accordance with regulations. The western and central regions will be subsidized at a rate of 80% and 60% of the per capita financial subsidy standards respectively, and the eastern provinces will be subsidized at a certain proportion. Make overall arrangements for critical illness insurance funds for urban and rural residents to ensure that financing standards and treatment levels are not reduced. Explore and establish a dynamic financing mechanism that links residents' medical insurance financing standards with residents' per capita disposable income to further optimize the financing structure. Relax the household registration restrictions for employees in new employment forms and other flexible employment personnel. Effectively implement the "Interim Regulations on Residence Permit" policy provisions for holders of residence permits to participate in insurance. For those who hold residence permits to participate in local residents' medical insurance, finance at all levels must provide subsidies according to the same standards as local residents.

2. Consolidate and improve the level of benefits

We must adhere to the principle of "determining expenditures based on revenue, balancing revenue and expenditure, and making a slight surplus", do our best, within our capabilities, and coordinate basic medical insurance , critical illness insurance and medical assistance triple system comprehensive protection effectiveness, scientific and reasonable determination of basic medical insurance protection level. Stabilize the level of hospitalization benefits of residents' medical insurance and ensure that the fund payment ratio within the scope of the policy is stable at around 70%. Improve outpatient protection measures, continue to provide outpatient medication protection for hypertension and diabetes, and improve outpatient chronic disease and special disease protection. Strengthen the outpatient protection functions of critical illness insurance and medical assistance, explore the inclusion of high outpatient medical expenses within the scope of the policy into the calculation of compliant medical expenses for critical illness insurance, coordinate the use of outpatient and inpatient assistance funds, and maximize the use of annual assistance limits. Reasonably improve the level of coverage of maternity medical expenses under residents' medical insurance, effectively support the three-child policy, reduce the burden of maternity medical expenses, and promote long-term balanced development of the population.

3. Effectively secure the bottom line of people's livelihood security

It is necessary to consolidate and expand the achievements of medical security in poverty alleviation, consolidate the basic function of medical assistance, and resolutely guard against large-scale epidemics due to disease. The bottom line of returning to poverty. We will continue to do a good job in providing medical assistance to the needy people in the category of individual contributions to the resident medical insurance, fully subsidize the extremely poor, and provide fixed-amount subsidies to subsistence allowance recipients and those who have returned to poverty. Make overall plans to improve the efficiency of the use of medical assistance funds, make full use of subsidized insurance and direct assistance policies, and ensure that all funds are used and all rescues are provided. Improve the long-term mechanism to prevent and resolve the return to poverty caused by illness, improve the dynamic monitoring of insurance participation, early warning of patients with high cost burdens, inter-departmental information sharing, and risk collaborative processing to ensure early detection, early prevention, and early help of risks. help. Improve the application-based assistance mechanism, implement classified assistance according to regulations for people in need who have been identified and approved by relevant departments, and implement medical assistance policies in a timely manner. For people in need who still have a heavy personal cost burden after being protected by the triple system, we should make a good connection with temporary assistance, charity assistance, etc., accurately implement layered and classified assistance, and work together to prevent the risk of returning to poverty due to illness.

4. Promote the unification of system norms

We must resolutely implement the medical security benefit list system, standardize decision-making authority, promote the unification of system norms, and enhance the balance and coordination of the development of the medical insurance system. Strictly follow the requirements of the "Three-Year Action Plan for Implementing the Medical Security Benefit List System" and achieve unified system frameworks in all coordinating regions by the end of 2022, and 40% of coordinating regions will complete the cleanup and standardization of policies outside the list. Adhere to a steady approach, establish first and then break, coordinate the transfer of funds and the connection of benefits, and promote functional integration.

Promote the basic unification of the scope of medical insurance drugs across the country. Gradually standardize and unify policies such as the scope of chronic and special diseases in basic medical insurance outpatient clinics in the province. Strengthen overall planning and coordination, and steadily promote provincial-level coordination in accordance with the direction of unifying policies, balancing fund adjustments, improving hierarchical management, strengthening budget assessments, and improving management services. Employees' medical insurance and resident medical insurance can be advanced in a classified and sequential manner. It is necessary to strictly implement the system for requesting instructions and reporting on major decisions, major problems, and major matters. New situations, new problems, and major policy adjustments must be promptly requested and reported before implementation. The implementation of the medical security benefit list system in each province will be included in the relevant work performance assessment.

V. Do a good job in medical insurance payment management

It is necessary to strengthen the management of the medical insurance drug catalog, implement and detail the "dual-channel" management of negotiated drugs, and strengthen the supply guarantee and implementation monitoring of negotiated drugs. Carry out pilot work on medical insurance payment standards and strengthen monitoring. By the end of June 2022, the digestion work of all provinces’ original supplementary drugs will be completed. Standardize the medical insurance access management of ethnic medicines, medical institution preparations, traditional Chinese medicine pieces and traditional Chinese medicine formula granules. Improve the management of medical insurance medical consumables and medical service projects. Continue to promote the reform of medical insurance payment methods, solidly implement the "Three-Year Action Plan for DRG/DIP Payment Method Reform", accelerate the reform of DRG/DIP payment methods, and cover at least 40% of the coordinated areas within the jurisdiction. Explore per-capita payment for outpatient services, promote the reform of traditional Chinese medicine medical insurance payment methods, and explore payment for traditional Chinese medicine diseases based on disease scores. Improve the designated management of medical insurance in medical institutions and retail pharmacies, strengthen the medical insurance management of "Internet +" medical services, and smooth the follow-up visits, medicine collection, and distribution links.

6. Strengthen centralized bulk purchase and price management of pharmaceutical consumables

It is necessary to promote the centralized procurement of pharmaceuticals and medical consumables in an all-round and multi-level manner, and coordinate the development of national organizations and inter-provincial alliances Centralized purchasing. By the end of 2022, the cumulative number of national and provincial centralized drug collections will be no less than 350, and the cumulative number of high-value medical consumables will reach more than 5. We will do a good job in the implementation of centralized procurement results and the renewal of procurement agreements upon expiration, and implement supporting policies such as prepayment of medical insurance funds, coordination of payment standards, and balance retention. Improve the functions of the pharmaceutical centralized procurement platform, strengthen performance evaluation, increase the online procurement rate of public medical institutions, and promote online settlement. Promote the pilot reform of medical service prices in a steady and orderly manner, and guide and urge coordinating regions to conduct price adjustment assessments and dynamic adjustments in 2022. Launch the pharmaceutical price monitoring project, compile pharmaceutical price indexes, strengthen normalized supervision of pharmaceutical and medical consumable prices, and continue to promote the implementation of pharmaceutical price and procurement credit evaluation systems.

7. Strengthen fund supervision and operation analysis

It is necessary to accelerate the construction and improvement of the medical insurance fund supervision system and law enforcement system, promote the establishment of incentive and accountability mechanisms, and incorporate the fight against fraud and insurance fraud into relevant Work assessment. Continue to carry out special rectification actions to combat fraud and insurance fraud, and continuously expand the breadth and depth of special rectification actions. Improve the supervision linkage mechanism led by the medical insurance department and involving multiple departments, improve the working systems of information sharing, coordinated law enforcement, joint prevention, execution connection, and business discipline connection, promote the coordinated use of comprehensive supervision results, and form one case with multiple investigations and one The fund supervision work pattern includes multiple cases and centralized management.

It is necessary to do a good job in fund budget performance management as required and improve revenue and expenditure budget management. Taking into account factors such as population aging, changes in the disease spectrum such as chronic diseases, the application of new medical technologies, and the growth of medical expenses, we will carry out forecast analysis of fund income and expenditure, improve risk warning, assessment, resolution mechanisms and plans, and effectively prevent and resolve fund operation risks.

8. Improve medical insurance public service management services

It is necessary to enhance the service capabilities of grassroots medical security public services and strengthen medical security management capabilities. Comprehensively implement the list of government service items and operational specifications, promote the standardization and standardization of medical security government services, and improve the level of medical insurance convenience services. Comprehensively implement basic medical insurance participation management and handling procedures, strengthen source control and management of repeated insurance participation, and promote "one insurance matter" to be handled at once. Optimize insurance payment services, adhere to the innovation of intelligent online payment channels and traditional offline payment methods in parallel, and continue to improve the level of payment facilitation. Comprehensively implement the interim measures for the transfer and continuation of basic medical insurance relationships, and continue to do a good job in "inter-provincial universal processing" of transfer and continuation. Actively participate in promoting the joint organization of "Birth Matter". Continue to do a good job in the settlement and settlement of medical expenses for COVID-19 patients, COVID-19 vaccines and vaccination expenses.

By the end of 2022, each county will have at least one inter-provincial networked designated medical institution for general outpatient services, and all coordinated areas will open five outpatient clinics for hypertension, diabetes, malignant tumor outpatient radiotherapy and chemotherapy, uremic dialysis and anti-rejection treatment after organ transplantation. Inter-provincial direct settlement service for chronic and special diseases.

9. Promote standardization and informatization construction

We must continue to promote the in-depth application of the national unified medical insurance information platform and give full play to the platform's effectiveness. Comprehensively deepen the maintenance and application of business coding standards and establish an assessment and evaluation mechanism for standard application. 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 the national integrated government service platform, commercial banks, government applications and other channels, and explore cooperation mechanisms in areas such as cross-provincial medical registration and medical insurance electronic voucher activation and application.

10. Do a good job in organization and implementation

It is necessary to further improve the political position, strengthen responsibility, consolidate work responsibilities, ensure that various policies and measures for medical security for urban and rural residents are implemented and effective, and continue to promote Protect and improve people's livelihood. Medical security departments at all levels must strengthen overall planning and coordination, strengthen departmental coordination, and do a good job in the implementation and management services of residents' medical insurance benefits. The financial department must arrange financial subsidy funds in full and timely in accordance with regulations, and the taxation department must do a good job in resident medical insurance for individuals. To facilitate payment collection and payment by the public, departments must strengthen work linkage and information communication. It is necessary to further increase policy publicity, popularize the concepts of mutual assistance, economic responsibility, and shared construction in medical insurance, enhance the public's awareness of insurance premiums, reasonably guide social expectations, and prepare for public opinion risks. response.

Notice hereby.

National Medical Insurance Bureau, Ministry of Finance and State Administration of Taxation

June 30, 2022