Guiding opinions on expanding the pilot long-term care insurance system

I. General requirements

(1) Guiding ideology.  We will continue to enhance the people's sense of gain, happiness and security in jointly building and sharing development.

(2) Basic principles. Adhere to the people-oriented, focus on solving the problem of long-term care for severely disabled people. Adhere to independent operation, focus on the establishment of independent insurance, independent design, independent promotion. Adhere to the basic guarantee, start at a low level, determine the cost of income, and reasonably determine the scope of insurance and treatment standards. We should share responsibilities and properly divide the responsibility for financing and ensuring security. We will adhere to institutional innovation, explore operational mechanisms for sustainable development, and improve the efficiency and management of support. Adhere to overall planning and coordination, and do a good job with the relevant social security system and commercial insurance functions.

(3) Work objectives. Explore the establishment of a social insurance system that raises funds through mutual assistance and provides services or financial guarantees for basic living care and closely related medical care for people with long-term disabilities. Strive to form a long-term care insurance system policy framework that ADAPTS to China's economic development level and aging development trend during the "14th Five-Year Plan" period, and promote the establishment and improvement of a multi-level long-term care security system that meets the diverse needs of the masses.

2. Basic Policies

(4) The insured objects and the scope of protection. The pilot phase starts from the insured group of basic medical insurance for employees, focuses on solving the basic care security needs of severely disabled people, and gives priority to protecting eligible disabled elderly people and severely disabled people. Where conditions permit, the pilot can be explored further, taking into account factors such as the level of economic development, the ability to raise funds and the need for security, and gradually expanding the scope of insured objects and adjusting the scope of protection.

(5) Fund raising. We will explore ways to establish a multi-channel financing mechanism featuring mutual assistance and shared responsibility. Scientifically calculate the corresponding capital needs of basic nursing services, and reasonably determine the annual total funding of the overall planning area. The financing is mainly paid by units and individuals, and the contributions of units and individuals are shared in the same proportion in principle. The contribution base of units is the total salary of employees, and the initial stage can be carved out from their basic medical insurance premiums for employees, without increasing the burden of units. The individual contribution base is his or her salary income, which can be withheld from his or her employee's personal account for basic medical insurance. Where conditions permit, localities may explore other financing channels such as finance to provide appropriate subsidies for the contributions of retired employees with special difficulties. Establish a dynamic adjustment mechanism for financing commensurate with economic and social development and the level of social security.

(6) Treatment payment. The long-term care Insurance Fund is primarily used to cover expenses incurred by qualified institutions and personnel in providing basic care services. The disabled insured persons who have been diagnosed and treated by medical institutions or rehabilitation institutions and whose disability status has lasted for more than 6 months, and who have applied for and passed the assessment, can enjoy relevant treatment according to regulations. We will implement differentiated treatment protection policies based on different levels of care and ways of providing services, and encourage the use of home and community care services. For nursing service expenses that meet the regulations, the fund's payment level is generally controlled at about 70%. We will do a good job in linking long-term care insurance with policies such as subsidies for elderly people with financial difficulties, disabled elderly people and care subsidies for severely disabled people.

3. Management services

(7) Fund management. The management of long-term care insurance fund shall be carried out in accordance with the relevant system of the existing social insurance fund. The fund shall be accounted for separately. Establish and improve the fund supervision mechanism, innovate the fund supervision means, improve the risk management system such as reporting complaints, information disclosure, internal control, fraud prevention, etc., to ensure the safety of the fund.

(8) Service management. Further explore and improve the protocol management and supervision and audit system for nursing service institutions and practitioners. Record and manage information such as insurance payment and benefits. Establish and improve the management and operation mechanism of long-term care insurance, and clarify the scope of protection, relevant standards and management methods. We will introduce and improve third-party supervision mechanisms, and strengthen supervision over handling services and nursing services. We will strengthen cost control, implement budget management, and explore appropriate payment methods.

(9) Handling and management. Social forces should be introduced to participate in long-term care insurance management services to enrich the management forces. Establish performance evaluation, assessment and incentive mechanisms, and risk prevention mechanisms simultaneously, and improve the ability and efficiency of handling and management services. We will improve handling procedures and service standards, optimize service processes, and strengthen agreement management, supervision and inspection of entrusted handling agencies. The service fee of social forces can be paid from the long-term care insurance fund in proportion or according to a fixed amount, taking into account factors such as the service population, the operating cost of the institution and the work performance, and the specific method should be agreed in the management agreement. Accelerate the construction of long-term care insurance system platform, promote the application of innovative technologies such as "Internet +", and gradually realize information sharing and interconnection with agreement nursing service institutions and other industry information platforms.

4. Organization and implementation

10. Expanding the scope of trials. The original pilot cities of the Ministry of Human Resources and Social Security and the two key provinces of Jilin and Shandong will continue to carry out the pilot according to the requirements of this opinion, and other provinces that have not carried out the pilot can add 1 city to carry out the pilot, which will be launched within this year, and the pilot period will be 2 years. Without the approval of the National Medical Insurance Administration and the Ministry of Finance, localities are not allowed to expand the scope of the pilot on their own.

11. Strengthen organizational leadership. Provincial people's governments should attach great importance to the pilot work of long-term care insurance system and strengthen the guidance of pilot cities. Pilot cities should set up pilot work leading groups, strengthen departmental coordination, and jointly promote the orderly implementation of pilot work. The newly launched pilot cities shall prepare pilot implementation plans in accordance with the requirements of this opinion, report to the provincial medical security and finance departments for approval, and report to the National Medical Insurance Bureau and the Ministry of Finance for the record before starting implementation. The pilot areas should further promote the pilot work in accordance with the requirements of this opinion, improve the policy framework, and strengthen the construction of long-term care service system.

12. Improving work mechanisms. Medical security departments at or above the provincial level shall specify special persons to be responsible for the long-term care insurance pilot work, establish and improve the work supervision mechanism together with relevant departments, track and guide the progress of the pilot, and submit operational data and pilot conditions as required. It is necessary to establish a sound evaluation mechanism, promptly study new situations and problems in the pilot, sum up good experiences and practices, and strengthen horizontal exchanges to ensure balanced progress of the pilot work. We will coordinate the resources of all social parties, strengthen cooperation and consultation, and promote the steady development of the pilot work. In the pilot policy adjustment or other major matters, the provincial medical security and financial departments should report to the National Medical Insurance Bureau and the Ministry of Finance in a timely manner.

13. Strengthen publicity and guidance. All localities and relevant departments should strengthen publicity work, do a good job of policy interpretation, respond to social concerns in a timely manner, and reasonably guide expectations. Fully mobilize the enthusiasm and initiative of all parties to support and cooperate with the pilot work, gather social consensus, and build a good social atmosphere for the smooth progress of the pilot.