People in all cities and counties Government, provincial government departments and directly affiliated institutions:
In order to thoroughly implement the spirit of the Twentieth National Congress of the Communist Party of China and speed up the promotion of the provincial overall planning of basic medical insurance (hereinafter referred to as basic medical insurance), according to the requirements of the Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System and the Notice of the General Office of the State Council on Printing and Distributing the "Fourteenth Five Year" National Medical Security Plan, in combination with the actual situation of our province and with the consent of the provincial government, The following implementation suggestions are proposed.
1、 Key tasks
（1） Unified coverage. We will implement the national plan for universal insurance coverage and improve the insurance system. Employers and employees participate in basic medical insurance for employees according to law (hereinafter referred to as "employee medical insurance"). Individual businesses without employees, part-time employees who do not participate in employee medical insurance in employers and other flexible employees can participate in employee medical insurance. All urban and rural residents, except those who should participate in the staff medical insurance or those who enjoy other guarantees according to regulations, shall participate in the basic medical insurance for urban and rural residents (hereinafter referred to as the resident medical insurance) according to law, and shall not participate in the insurance repeatedly. Establish and improve the data sharing mechanism between the medical security department and the education, public security, civil affairs, human resources and social security, health, tax, market supervision, agriculture and rural areas, the Disabled Persons' Federation and other departments and units, improve the insurance database covering the whole people, and stabilize the basic medical insurance coverage rate at 95% above.
（2） Unified financing and payment policy 。 The medical insurance premiums of employees shall be jointly paid by the employer and employees. The employer shall pay a certain proportion of the total wages of employees according to laws and regulations, and the employee's payment proportion is his own wages 2% 。 When the insured reaches the statutory retirement age, if the cumulative payment period reaches the specified number of years, they will no longer pay the employee medical insurance premiums after retirement and enjoy the employee medical insurance benefits of retirees; If the cumulative payment period does not reach the specified period, the payment can be continued to the specified period, or it can be paid to the specified period in a lump sum according to the payment base at retirement. The cumulative payment period includes the actual payment period and the deemed payment period. The legal retirement age shall be subject to the relevant provisions of the State.
The medical insurance premiums for residents shall be paid by individuals and government subsidies. In principle, the insurance premiums shall be paid on an annual basis twelve month thirty-one The medical insurance payment of residents in the next year was completed by the end of the day. Newborns, newly identified aid recipients and persons who have withdrawn from other security services can participate in insurance and pay fees in the non concentration period as required. The individual contributions of the aid recipients who participate in the residents' medical insurance enjoy classified subsidies according to regulations.
The specific financing policy and payment period of employee medical insurance and resident medical insurance are formulated and adjusted by the provincial medical insurance department together with the finance department. The current financing policy of each city is inconsistent with the provincial regulations, two thousand and twenty-five By the end of the year, it will be unified by the province.
（3） Unified treatment guarantee policy 。 In principle, employees who participate in medical insurance shall enjoy medical insurance benefits from the next month after the employer transacts insurance for them and pays fees as required. Flexible employees who apply for insurance for the first time shall pay fees continuously according to regulations three After six months, the employee will enjoy medical insurance benefits. In principle, residents can enjoy the medical insurance benefits on an annual basis. Except for special circumstances, the insurance period is one month one Solstice twelve month thirty-one Day. The transfer and connection of basic medical insurance relationship and the connection of benefits shall be implemented in accordance with the relevant provisions of the state and our province.
Implement the list system of medical security benefits. The minimum payment standard for hospitalization expenses of employee medical insurance and resident medical insurance is set according to a certain proportion of the average wage of the employees of the province's full caliber urban units and the per capita disposable income of residents in the previous year. The payment proportion within the scope of medical insurance policy is respectively stable at 80% 、 70% Left and right, maintenance between medical institutions at different levels 5—15 The maximum payment limit is the average wage of the employees of the province's full caliber urban units in the previous year, and the per capita disposable income of the province's residents in the previous year six Times. We will improve the outpatient medical insurance policies for employees and residents, and improve the unified outpatient chronic and special diseases insurance measures across the province.
The specific policy standards of medical insurance for employees and medical insurance for residents shall be formulated and adjusted by the provincial medical insurance department together with the finance department.
（4） Unified fund operation management 。 We will improve budget management and performance evaluation methods for basic medical insurance funds, fully implement budget performance management, and strengthen the rigid binding force of budget and final accounts. Adhere to the principle of determining expenditure based on income, balancing income and expenditure, and making a slight balance, and comprehensively, accurately and completely prepare the income budget of the basic medical insurance fund. The annual expenditure budget is prepared by comprehensively considering the scale of expenditure in previous years, the control target of medical expenses, the age structure of the insured, the adjustment of treatment policies and other factors. In principle, the deficit budget of the current year and the cumulative balance deficit budget of the Fund over the years will not be prepared. The basic medical insurance fund shall be earmarked for specific purposes, and shall not be used to balance the financial budget. The content, standard and scope of fund revenue and expenditure shall be strictly standardized.
We will improve the operational analysis and risk early warning mechanism of the basic medical insurance fund, and promote the long-term balance and sustainability of the fund operation. We will improve the strict and powerful fund supervision system and mechanism, compact the municipal and county (city, district) territorial supervision responsibilities, and fully incorporate the fund raising, use, handling, settlement and other links into the supervision scope, so as to achieve full coverage of medical insurance fund supervision. Continue to improve the supervision and inspection, intelligent monitoring, credit management, comprehensive supervision, social supervision and other systems, crack down on fraud and insurance fraud, and ensure the safe, efficient and reasonable use of funds.
（5） Unified fund reallocation management 。 We will establish a provincial adjustment mechanism for basic medical insurance. The basic medical insurance fund will be adjusted from province to city to prevent major risks of the basic medical insurance fund in the province. The provincial-level adjustment fund is withdrawn separately according to the employee medical insurance and resident medical insurance, and the withdrawal proportion is not higher than the income collected from the basic medical insurance pooling fund of the previous year 5% , incorporated into the special account management of provincial finance, set up separate accounts, and earmark funds for special purposes. The accumulated balance of provincial adjustment funds reached the revenue collected from the basic medical insurance pooling fund of the province last year 10% , pause extraction. In addition to the above adjustment funds, the basic medical insurance funds (including the new balance over the years) of the cities divided into districts are retained in the city and included in the annual fund budget management of the cities divided into districts.
When there is a gap in the current fund income and expenditure due to the adjustment of national and provincial medical insurance policies, payment of medical insurance for medical treatment of sudden major epidemic, reasonable expenditure of other medical insurance, and increase of maintenance ratio, the provincial adjustment fund and the local accumulated balance fund over the years shall share a certain proportion according to the income and expenditure gap limit of each district and city, provincial assessment and evaluation and other factors. The provincial financial department, together with the medical insurance, health and other departments, shall formulate the administrative measures for the provincial adjustment funds of basic medical insurance.
（6） Unified medical insurance payment mechanism 。 Strictly implement the national basic medical insurance directory, strengthen the standardized, standardized and dynamic management of the province's medical insurance drugs, medical service items, and medical consumables directory, and gradually unify the proportion of personal advance payment in category B of the medical insurance directory. We will establish and improve the national working mechanism for negotiating the implementation of drugs, and accelerate the establishment of a unified provincial access and exit mechanism for medical insurance payment of ethnic drugs, Chinese herbal pieces, and preparations of medical institutions according to the authority specified by the state.
We will improve the management of the total budget, and promote a diversified and composite medical insurance payment method based on payment by disease. We will fully realize the goals of the three-year action plan for the reform of pay by disease group or pay by disease type. For mental illness and other diseases requiring long-term hospitalization and with stable daily average cost, the bed day fee shall be paid. Actively explore the management of general outpatient service and outpatient medical service for chronic and special diseases according to the total head amount. Exploring TCM to pay by disease score. Summarize and promote the compact county medical community in our province We should reform the practice of payment and promote the "package" payment reform of compact medical consortia 。
（7） Unified medical insurance public service 。 Establish an administrative management and handling service system compatible with the overall planning level, and explore and promote the vertical management of medical security departments below the municipal level. Establish a medical security public service system covering five levels of province, city, county, township and village, unify the provincial medical insurance handling process and service specifications, vigorously promote the sinking of services, and achieve one-stop service, one window processing, and one order settlement. Implement the settlement for medical treatment in other places, and promote the convenient sharing of medical security services in the Yangtze River Delta. We will strengthen the construction of service teams and personnel training, and improve the ability and level of medical security services.
The province has built and applied the national (Anhui Province) medical security information system, built a unified, efficient, compatible, convenient and safe medical security digital platform, and gradually realized information sharing and application across departments, regions and medical institutions. We will improve the standardization system of medical insurance, promote online processing of medical insurance government services, and conduct qualification verification, insurance registration, treatment payment, fund settlement, transfer and continuation, audit and monitoring, and medical procurement "All in one network" is realized in purchase and other aspects. Deepen the application of medical insurance big data in decision-making analysis, fund supervision, business handling and other work, and improve the governance level and support ability of medical insurance big data power.
2、 Implementation steps
（1） Phase I ： two thousand and twenty-four By the end of the year, standardize and unify the supporting policies such as medical insurance benefits for residents; Formulate the management measures of provincial adjustment funds for basic medical insurance.
（2） Phase II ： two thousand and twenty-five Since, we have organized and implemented policies related to the overall planning of residents' medical insurance at the provincial level, and implemented the provincial adjustment system of residents' medical insurance; Standardize and unify supporting policies such as employee medical insurance financing and treatment guarantee.
（3） Phase III ： two thousand and twenty-six Since, we have organized and implemented policies related to the overall planning of employees' medical insurance at the provincial level, and implemented the provincial adjustment system of employees' medical insurance.
3、 Safeguard measures
Governments at all levels and relevant provincial departments should further improve their political positions, improve the work coordination mechanism, place the promotion of basic medical insurance as a whole at the provincial level in an important position, and comprehensively compact the territorial management responsibilities and departmental responsibilities. On the basis of smoothly promoting the provincial overall planning of basic medical insurance, timely study and promote the provincial overall planning of major disease insurance, medical assistance and other work, promote the complementarity and convergence of various medical security, and achieve a more mature and stereotyped medical security system. It is necessary to establish and improve the major risk prevention and disposal mechanism, actively interpret and publicize relevant policies, respond to social concerns in a timely manner, and actively and steadily deal with various risks and hidden dangers in the reform process.
General Office of Anhui Provincial People's Government
two thousand and twenty-four year four month eight day
