What are the new rules for uremia medical insurance in 2023

A reasonable increase in financing standards

In order to adapt to the growth of medical costs and basic medical needs, to ensure that the rights and interests of insured persons, 2022 continue to increase the urban and rural residents of the basic medical insurance (hereinafter referred to as the "residents of the medical insurance") financing standards. All levels of finance continue to increase the subsidies for residents' health insurance contributions, per capita financial subsidy standard new 30 yuan, to not less than 610 yuan per person per year, and simultaneously increase the individual contribution standard 30 yuan, to 350 yuan per person per year. The central financial authorities continue to subsidize local governments in accordance with the regulations, and subsidize the western and central regions in accordance with the ratio of 80% and 60% of the per capita financial subsidy standard, and subsidize the provinces in the eastern region in accordance with a certain ratio. Coordinated arrangements are being made for the funding of major disease insurance for urban and rural residents (hereinafter referred to as "major disease insurance"), to ensure that financing standards and treatment levels are not lowered. Exploring the establishment of a dynamic financing mechanism that links the financing standard for residents' health insurance to the per capita disposable income of residents, and further optimizing the financing structure. Liberalizing the restrictions on household registration for the participation of flexibly employed persons, such as those in new employment patterns. Effectively implement the "Interim Regulations on Residence Permits" to participate in insurance policies with a residence permit, for residents with a residence permit to participate in the local residents' health insurance, financial subsidies at all levels should be based on the same standards as local residents.

Second, consolidate and enhance the level of treatment

We must adhere to the principle of "income to determine expenditures, revenue and expenditure balance, a slight surplus", do our best, according to our ability, and give full play to the effectiveness of the basic medical insurance, major illness insurance and medical assistance threefold system of comprehensive protection, scientific and reasonable to determine the level of basic medical insurance protection. Stabilize the level of inpatient treatment under residents' health insurance, and ensure that the proportion of fund payments within the scope of the policy is stabilized at around 70%. Improving outpatient protection measures, continuing to do a good job of guaranteeing outpatient medication for hypertension and diabetes, and improving the protection of outpatient chronic diseases and special diseases (hereinafter referred to as "outpatient chronic and special diseases"). Enhancing the outpatient protection function of major disease insurance and medical assistance, exploring the inclusion of outpatient high-cost medical expenses within the scope of policy in the calculation of major disease insurance compliant medical expenses, integrating the use of outpatient and inpatient assistance funds, and *** using the annual assistance limit. Reasonably increase the level of coverage for maternity medical expenses under residents' health insurance, effectively support the three-child birth policy, reduce the burden of maternity medical expenses, and promote the long-term balanced development of the population.

Three, the actual pocket pocket firmly livelihood protection bottom line

To consolidate and expand the results of the medical insurance poverty alleviation, tamping medical assistance bottom function, resolutely guarded firmly not to occur due to the scale of the disease back to the bottom line of poverty. Continue to do a good job of medical assistance to the people in need to participate in the residents of medical insurance individual contribution classification funding work, full funding for special hardship case, fixed funding for low-income recipients, return to poverty and poverty population. To improve the efficiency of the use of medical assistance funds in an integrated manner, and to make full use of the policies of subsidized participation and direct assistance to ensure that all funds are available to the fullest extent possible, and that all people are rescued to the fullest extent possible. It has also improved the long-term mechanism for preventing and resolving poverty caused by illness, and has perfected the mechanisms for monitoring the dynamics of insurance participation, early warning of patients with high cost burdens, interdepartmental information*** sharing, and coordinated risk management, so as to ensure early detection, prevention and assistance. It has improved the mechanism for applying for assistance, implemented categorized assistance for people in difficulty whose status has been recognized and approved by the relevant departments in accordance with the regulations, and implemented medical assistance policies in a timely manner. After the triple system of protection of the individual cost burden is still heavy people in need, do a good job with the temporary assistance, charity assistance, etc., the precise implementation of stratified and categorized assistance, and joint efforts to prevent the risk of poverty due to illness.

Four, promote the system standardization and unity

We must resolutely implement the medical insurance treatment list system, standardize the decision-making authority, promote the system standardization and unity, and enhance the balance and coordination of the development of the medical insurance system. Strictly in accordance with the "implementation of the medical insurance treatment list system three-year action plan (2021-2023)" requirements, by the end of 2022 to realize the unity of the system framework in all integrated areas, 40% of integrated areas to complete the list of policies outside the cleanup and standardization. Adhering to the principle of steady progress and establishing before breaking, we will do a good job in integrating the transfer of funds and the convergence of treatment, and promote the integration of functions. Promoting the basic unification of the scope of medication under the national health insurance scheme. Gradually standardize and unify policies on the scope of outpatient chronic and special diseases under the provincial basic medical insurance. Strengthening coordination, steadily advancing provincial-level coordination in accordance with the direction of policy unification and standardization, fund transfer and balance, improving hierarchical management, strengthening budget assessment and enhancing management services, and advancing employee and resident health insurance in a categorized sequence. The system of requesting instructions and reports on major decisions, issues and matters should be strictly implemented, and new situations, issues and major policy adjustments should be implemented after timely instructions and reports. The implementation of the medical insurance treatment list system in each province will be included in the relevant work performance assessment.

Fifth, do a good job of health insurance payment management

To strengthen the management of health insurance drug catalog, do a detailed negotiation drug "dual-channel" management, strengthen the negotiation drug supply guarantee and landing monitoring. The pilot work of medical insurance payment standard and strengthen the monitoring. 2022 before the end of June to complete the digestion of the original self-supplementation of drugs in each province. Standardize the management of access to medical insurance for ethnic medicines, preparations for medical institutions, Chinese medicine tablets and Chinese medicine formula granules. Improve the management of medical consumables and medical service programs under medical insurance. Continuously pushing forward the reform of medical insurance payment methods, solidly implementing the Three-Year Action Plan for the Reform of DRG/DIP Payment Methods, and accelerating the reform of DRG/DIP payment methods to cover at least 40% of the co-ordination areas under its jurisdiction. Explore outpatient capitation payment, push forward the reform of Chinese medicine medical insurance payment method, and explore the payment of Chinese medicine diseases according to the value of diseases. Improve medical institutions and retail pharmacies medical insurance fixed-point management, strengthen the "Internet +" medical services health insurance management, smooth follow-up, medicine, distribution links.

Sixth, strengthen the centralized band purchasing and price management of drugs and consumables

We should promote the collection of drugs and medical consumables in an all-round and multi-level manner, and carry out the collection of national organizations and inter-provincial alliances in an integrated and coordinated manner. 2022 the end of the state and the provincial level (or the inter-provincial alliance) the collection of the number of varieties of drugs cumulative total of not less than 350, the cumulative total of varieties of high-value medical consumables to reach more than 5. Doing a good job in the implementation of the results of the collection and procurement agreement expiration of the work, the implementation of the health insurance fund prepayment, payment standards synergistic, balance retention and other supporting policies. Improve the functions of the pharmaceutical procurement platform, strengthen performance evaluation, increase the online procurement rate of public medical institutions, and promote online settlement. Advancing the pilot project of deepening medical service price reform in a steady and orderly manner, and guiding and supervising the coordinated regions to do a good job of price adjustment assessment and dynamic adjustment in 2022. Launching the medicine price monitoring project, compiling the medicine price index, strengthening the normalized supervision of the prices of medicines and medical consumables, and continuing to promote the implementation of the credit evaluation system for medicine prices and recruitment and procurement.

Seven, strengthen fund supervision and operation analysis

We should accelerate the construction of perfect health insurance fund supervision system and law enforcement system, promote the establishment of incentive and accountability mechanisms, and incorporate the fight against fraudulent insurance work into the relevant work assessment. Continue to carry out special remedial actions to combat fraud and insurance fraud, and constantly expand the breadth and depth of special remedial actions. Improve the supervision and linkage mechanism led by the medical insurance department and involving multiple departments, improve the working system of information*** sharing, coordinated law enforcement, joint defense and linkage, criminal and disciplinary linkage, and promote the coordinated application of the results of the comprehensive supervision, so as to form the working pattern of fund supervision of investigating more than one case, dealing with more than one case, and controlling more than one case in a concerted effort***.

To do a good job of fund budget performance management as required, improve revenue and expenditure budget management. Comprehensive population aging, chronic diseases and other changes in the disease spectrum, the application of new pharmaceutical technology, medical cost growth and other factors, to carry out the fund revenue and expenditure forecasting and analysis, improve the risk early warning, assessment, and resolution mechanism and plan, and effectively prevent and resolve the risks of fund operation.

VIII, sound medical insurance public **** management services

To enhance the grass-roots medical insurance public **** service capacity, and strengthen the medical insurance handling power. Fully implement the list of administrative service matters and operational norms, promote the standardization of medical insurance government services, and improve the level of convenient medical insurance services. It has fully implemented basic medical insurance participation management and handling procedures, strengthened source control and the management of duplicated participation, and promoted the one-time handling of "one thing for participation". It has optimized insurance payment services, insisted on the parallel innovation of intelligent online payment channels and traditional offline payment methods, and continued to raise the level of payment facilitation. We are fully implementing the Interim Measures for the Transfer and Continuation of Basic Medical Insurance Relationships, and will continue to do a better job of transferring and continuing the transfer and continuation of the "inter-provincial common office". We are actively involved in promoting the "one event at birth" joint operation. It will continue to do a good job of settling and clearing the medical expenses of patients with new coronary pneumonia and the expenses of new coronary vaccines and vaccinations, and by the end of 2022, it will realize the opening of at least one cross-provincial network of designated medical institutions for general outpatient expenses in each county, and the opening of cross-provincial direct settlement services for the expenses of five kinds of outpatient chronic special diseases, namely hypertension, diabetes, outpatient radiotherapy for malignant tumors, dialysis for uremia, and post-operative antirejection therapy for organ transplantation, in all the coordinated areas.

Nine, promote standardization and information construction

To continue to promote the national unified health insurance information platform to deepen the application, give full play to the effectiveness of the platform. We will comprehensively deepen the application of business coding standards for maintenance, and establish an assessment and evaluation mechanism for the application of standards. Establish a perfect information system operation and maintenance management and security management system, and explore the establishment of information **** enjoyment 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 filing and the activation of medical insurance electronic voucher applications.

Ten, do a good job of organizing and implementing

We must further raise the political position, strengthen the responsibility to bear, and pressure the responsibility to ensure that the urban and rural residents of the medical insurance policies and measures to achieve results, and continue to promote the protection and improvement of people's livelihood. Medical insurance departments at all levels to strengthen coordination, strengthen departmental coordination, grasp the implementation of the residents of the medical insurance treatment and management services, the financial sector in accordance with the provisions of the full arrangement of financial subsidies and timely payment in place, the tax department to do a good job of residents of the medical insurance personal contribution collection, to facilitate the public to pay the bill, the interdepartmental work to strengthen the linkage and communication of information. To further increase the policy publicity, popularize the concept of medical insurance mutual *** relief, responsibility *** share, *** build *** enjoy, enhance the awareness of the masses to participate in the insurance premiums, reasonable guidance of social expectations, and do a good job of public opinion risk response.

This notice is hereby issued.

Beginning in January of this year 2022, people who participate in the urban workers' health insurance will fully enjoy the reimbursement treatment of outpatient medical insurance, the reimbursement rate from 50% upwards, go to the third-class hospitals to see the doctor, probably in accordance with the proportion of 50% to be reimbursed, and if it is said to be the reimbursement of the second-class hospitals, and even can reach more than 60% reimbursement rate. It's clear that the benefits of outpatient treatment will be greater than in the past.

Register at the hospital, pay the fee to the toll gate, the cost of the first own payment, and then by the unit or individual to the insurance social security bureau reimbursement. After treatment, bring the invoice issued by the hospital, billing statements and other documents to the local social security center to reimbursement procedures can be.

Second, the uremia health insurance dialysis reimbursement percentage uremia health insurance dialysis reimbursement percentage employee health insurance participants in the general outpatient clinic medical fees can be paid by the balance of the personal account of the health insurance. Reimbursement for outpatient special diseases. When the balance of the employee health insurance individual account is greater than 2,000 yuan, medical expenses will be paid from the individual account. If the balance of the individual account is less than or equal to RMB 2,000, the proportion of medical expenses above the starting line that meet the scope of payment for outpatient special diseases to be paid by the integrated fund is 85%.

The cost of dialysis can be reimbursed by the medical insurance, but the specific reimbursement rate should be based on the actual situation in your local area and the provisions of the hospital. It is recommended that you go to your local hospital and local government to inquire about it, and consider it according to the actual situation in your local area. At the same time, it is recommended that you should actively cooperate with the treatment to avoid other adverse consequences.

Legal basis:

Code for the Management of Hemodialysis Units in Medical Institutions

Article 4 The health administrative departments at all levels shall strengthen the management of hemodialysis units in medical institutions, provide guidance and inspections of hemodialysis units in medical institutions under their jurisdiction, strengthen the quality management of hemodialysis treatments, and safeguard patient safety.

Article 10 The physician of the hemodialysis room is responsible for formulating and adjusting the dialysis treatment plan of the patient, assessing the quality of dialysis of the patient, dealing with the complications of the patient, and making relevant records in accordance with the relevant provisions.