The new policy of long-term medical care insurance for workers has been implemented now, and the payment standard for long term care is even higher.
http://sd.sdnews.com.cn/jinan/201708/t20170811_2279603.htm
reporter from the Municipal Social Security Bureau, we have learned from the municipal social security bureau that the city has been further improved and improved in terms of widening the financing channels, easing the standard of access, expanding the scope of payment, improving the standard of treatment and widening the management service. The treatment of long-term medical care for high workers. The new deal began in August 11th.
reduce the threshold
treatment enjoy the conditions to relax the
to allow more disabled people to enjoy the treatment of nursing insurance. This adjustment further improved the assessment of disability assessment, evaluation criteria, and improved the rating of the disabled people - that is, the threshold of the evaluation of the loss of energy is reduced, and the loss of intelligence is increased. The assessment of mental diseases.
specifically, after this adjustment, when the participants applied for nursing care and home care, the assessment score of the daily living ability assessment scale was adjusted to less than 55 points from the original score of 50. At the same time, it should be one of the following conditions: long term nonunion of fracture of the patients with nasal feeding tube and urethral catheter should be retained for a long time to meet the application standard of special nursing, and other chronic diseases suffer from severe irreversible disease resulting in disability or half loss of energy, and long term care is needed.
increased treatment
the scope of long care payment expanded
this adjustment fully analyzed the medical care and living care needs of the disabled people, and humanized the service items such as the daily life care and the basic life closely related to the medical care of the insured persons were all included in the payment range,
and the system A special "nursing insurance service project catalogue" has been set up, which includes "clean care, sleep care, excretory nursing, incontinence nursing, manual stool nursing, helping turn over and coughing and expectoration, lying position nursing, safety management, psychological comfort, self-care training, cleaning and disinfection" and other basic medical insurance coverage. Service items are included in the payment scope of nursing insurance funds.
the newly developed nursing insurance service directory includes 15 basic nursing items and 27 nursing items. There are not only medical care such as subcutaneous injection, oxygen inhalation and enema, but also daily life nursing items such as head and face cleaning, shampoo and even bathing, so as to solve the heavy nursing needs of the disabled people.
standard
the standard of payment for long care treatment is higher than
for the participants who enjoy the care of the hospital and the treatment of home care, and can enjoy the medical care and the general treatment of the general outpatient service at the same time. Proper improvement of special care treatment was raised from 200 yuan per person / day to 220 yuan per day, respectively, and 260 yuan / man / day (for comprehensive medical institutions above two level). The cost is divided into two parts: "basic nursing fee" and "care cost". The "basic nursing fee" is 35 yuan per person / day, and the "care cost" is divided into the "nursing insurance account" by 450 yuan per person per person per person per month.
"basic nursing fee" is mainly used for medical care costs closely related to living care, including bed fee, general diagnosis and treatment fee, medical inspection fee, patrol fee, door-to-door service fee and the medical care cost in the project of long-term care insurance service for staff and workers. The "care cost" mainly pays the cost of care related to the care of the insured in the range of the insurance coverage of the insured.
related links
which people can enjoy long-term care insurance?
the long-term care insurance system is the guarantee of the staff of the basic medical insurance insured for a long time in the state of disability. Medical insurance recipients can enjoy the regulations without additional payment. When applying for this treatment, the insured needs to carry out the evaluation of action force, identify the state of disability, and obtain 3 levels of long care treatment, such as medical care, medical care and home care. It is worth noting that the long term care policy is not limited to the elderly, but only those who are disabled and semi disabled can enjoy the treatment according to the regulations.
how to apply for long-term care insurance treatment?
for long-term medical care, it is necessary to carry out the applicant's personal or family members' or their family members to carry the applicant's social security card, ID card, effective diagnostic certificate, and a complete medical record copy to a designated medical institution according to the relevant provisions of medical records management. Please. Subsequently, the fixed-point medical and nursing institutions arrange the medical insurance practitioners and nurses to conduct on-site audit and evaluation on the condition and self-care of the applicant, and make a score according to the rating scale. After the agencies receive the materials, the experts shall arrange for the audit.
what is the assessment of daily living ability?
the assessment of daily living ability is organized by a designated medical institution, and the organization is organized to review. The main purpose is to assess ten daily activities, such as daily eating, bathing, dressing, dressing, stool control, toilet process, bed chair movement, walking and up and down staircase on the basis of understanding the applicant's condition. Rating system is used to judge moderate dysfunction. It needs great help to complete daily life activities and have severe dysfunction. Most daily activities can not be completed or need to be taken care of, and can apply for long-term care treatment according to the regulations.