The National Medical Security Administration recently issued the “Guiding Opinions on Accomplishing the Administration of Long-term Care Insurance Payments”, which clarifies the scope of long-term care insurance payments, payment methods, payment standards, and fund supervision and risk prevention mechanisms. 1. Clarify the scope of payment Long-term care insurance funds can reimburse these expenses: the cost of disability assessment by disability rating agencies, long-term care service fees provided by designated nursing care institutions, and expenses related to the help of management by third party agencies. The cost of the disability assessment will be shared between the fund and the individual according to the actual situation to prevent everyone from applying casually and making excessive assessments. Generally speaking, insured persons pass the disability assessment for the first time, and are also reimbursed by the health insurance fund for the cost of regular review and evaluation according to regulations. For nursing items on the long-term care insurance service list stipulated by the state, funds are reimbursed according to regulations; services exceeding the list require personal expenses. At the same time, separate the reimbursement boundaries between basic medical insurance and long-term care insurance. In principle, the two types of insurance cannot be reimbursed repeatedly. 2. Standardized payment method evaluation services are mainly charged per person. Nursing services are mainly billed based on length of service: home nursing is generally calculated on an hourly basis; nursing in nursing homes is calculated based on the number of days of hospitalization; and community nursing determines the billing method based on actual service content. In the future, as policies are improved, the country will also unify and explore smart nursing equipment, assistive devices, etc., and implement fixed packages or pay for individual projects. 3. Reasonably determine payment standards Each region should reasonably determine reimbursement standards based on the financial resources of the fund, the basic care needs of the elderly, and the level of fees charged by the local nursing industry, and adjust them dynamically according to the situation. Nursing reimbursement standards are set according to the local financial level, average salary, and professional level of nursing staff. The maximum reimbursement amount of long-term care insurance funds for insured persons in a year is not more than 50% of the per capita disposable income of local urban and rural residents in the previous year. All regions should consider forms of nursing services such as home, institutions, and communities in an integrated manner to encourage the use of home and community nursing services. 4. Strict fund management and supervision “Guiding Opinions” require optimizing settlement processes, using intelligent systems to review reimbursements, and speed up disbursements. If the evaluation service is not implemented in accordance with the regulations, the evaluation pass rate is abnormally high or low, the nursing service is not implemented in accordance with the nursing service plan, the requirements of the service project catalogue are not met, and the social power management agency fails to manage it in accordance with the regulations, the fund will be deducted by a certain percentage until payment is refused. Long-term care insurance fund payments cannot be managed by a third party social force. The use of long-term care insurance funds will be included in normalized inspections, including special flight inspections, routine inspections, social supervision, and intelligent monitoring. The establishment of a credit blacklist system will also be studied. At the same time, fees from evaluation agencies and nursing institutions are monitored in real time to protect the rights and interests of insured persons.

The National Medical Security Administration recently issued the “Guiding Opinions on Accomplishing the Administration of Long-term Care Insurance Payments”, which clarifies the scope of long-term care insurance payments, payment methods, payment standards, and fund supervision and risk prevention mechanisms. 1. Clarify the scope of payment Long-term care insurance funds can reimburse these expenses: the cost of disability assessment by disability rating agencies, long-term care service fees provided by designated nursing care institutions, and expenses related to the help of management by third party agencies. The cost of the disability assessment will be shared between the fund and the individual according to the actual situation to prevent everyone from applying casually and making excessive assessments. Generally speaking, insured persons pass the disability assessment for the first time, and are also reimbursed by the health insurance fund for the cost of regular review and evaluation according to regulations. For nursing items on the long-term care insurance service list stipulated by the state, the fund is reimbursed according to regulations; services exceeding the list require the individual's own expenses. At the same time, separate the reimbursement boundaries between basic medical insurance and long-term care insurance. In principle, the two types of insurance cannot be reimbursed repeatedly. 2. Standardized payment method evaluation services are mainly charged per person. Nursing services are mainly billed based on length of service: home nursing is generally calculated on an hourly basis; nursing in nursing homes is calculated based on the number of days of hospitalization; and community nursing determines the billing method based on actual service content. In the future, as policies are improved, the country will also unify and explore smart nursing equipment, assistive devices, etc., and implement fixed packages or pay for individual projects. 3. Reasonably determine payment standards Each region should reasonably determine reimbursement standards based on the financial resources of the fund, the basic care needs of the elderly, and the level of fees charged by the local nursing industry, and adjust them dynamically according to the situation. Nursing reimbursement standards are set according to the local financial level, average salary, and professional level of nursing staff. The maximum reimbursement amount of long-term care insurance funds for insured persons in a year is not more than 50% of the per capita disposable income of local urban and rural residents in the previous year. All regions should consider forms of nursing services such as home, institutions, and communities in an integrated manner to encourage the use of home and community nursing services. 4. Strict fund management and supervision “Guiding Opinions” require optimizing settlement processes, using intelligent systems to review reimbursements, and speed up disbursements. If the evaluation service is not implemented in accordance with the regulations, the evaluation pass rate is abnormally high or low, the nursing service is not implemented in accordance with the nursing service plan, the requirements of the service project catalogue are not met, and the social power management agency fails to manage it in accordance with the regulations, the fund will be deducted by a certain percentage until payment is refused. Long-term care insurance fund payments cannot be managed by a third party social force. The use of long-term care insurance funds will be included in normalized inspections, including special flight inspections, routine inspections, social supervision, and intelligent monitoring. The establishment of a credit blacklist system will also be studied. At the same time, fees from evaluation agencies and nursing institutions are monitored in real time to protect the rights and interests of insured persons.