Ji'nan workers' long-term medical care insurance new deal begins tomorrow
Qilu Evening News reporter Zhou Guofang correspondent in summer
10 day, from the Social Security Bureau of Ji'nan City, Ji'nan city recently widened funds to raise channels, relax The standard of admission, the scope of payment, the improvement of the standard of treatment and the widening of the mode of management and service are further improved and improved the treatment of long-term medical care for the workers. The new deal began in August 11th.
reduce the threshold, the 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 methods, evaluation criteria, improved the score of the disabled persons, and reduced the threshold of the evaluation of disability level, and added the assessment of mental illness and mental illness. .
specifically, after this adjustment, when the insured person applied for nursing care and home care, the assessment score of the daily living ability assessment scale was adjusted to.Amp by the original.Amp; the Le 50 score was adjusted to le, and the le was 55 points. At the same time, one of the following conditions should be met:
1. meets the application standards of special care;
2. needs to retain nasal feeding tube and urinary catheter for a long time;
3. patients have long nonunion of fracture and other chronic diseases;
4. suffers from severe irreversible disease resulting in disability or half loss of energy, and needs long-term care.
increased treatment, the scope of long care payment expanded
this adjustment fully analyzed the medical care and living care needs of the disabled people. The humanized service items such as the daily life care of the insured and the medical care closely related to the basic life were all included in the payment model, and a special "nursing insurance" was formulated. The service item catalogue includes.Quot, such as clean nursing, sleep care, excretory nursing, incontinence nursing, manual stool nursing, helping turn over and cough expectoration, lying position nursing, safety management, psychological comfort, self-care training, cleaning and disinfecting.Quot; and other services outside the coverage of basic medical insurance coverage. The scope of the payment of insurance funds. The reporter saw that the newly developed nursing insurance service directory includes 15 basic nursing items and 27 nursing items. There are not only professional 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, which can really solve the heavy nursing needs of the disabled people.
standards, the payment standard of long care treatment is higher
one is to enjoy the nursing staff of the hospital and the treatment of the home care, and can enjoy the basic medical insurance outpatient regulations and the general treatment of the general outpatient service at the same time. The two is to improve the treatment of special care, which is raised from 200 yuan / person / day to 220 yuan per day, respectively, and 260 yuan / man / day (for the comprehensive medical institutions above two levels). The three is to divide the cost into.Quot; basic nursing fee.Quot; and.Quot; care cost.Quot; the two part. Among them,.Quot; basic nursing fee.Quot; for 35 yuan / man / day, as a whole by fixed-point medical and nursing institutions;.Quot; care cost.Quot; 450 yuan per person per person per month into the social security card of the insured person.Quot; and the nursing insurance account.Quot;
.quot; basic nursing fee.Quot; mainly used for medical care costs closely related to living care, including bed fee, general diagnosis and treatment fee, diagnosis fee, patrol fee, door-to-door service fee and the medical care cost in "long-term care insurance service for staff and workers". .quot; the cost of care.Quot; mainly pays the cost of care related to the care of the insured in the range of the insurance coverage of the insured.
according to the staff of the Social Security Bureau, Ji'nan has promulgated and implemented the long-term medical care insurance policy for the first time for the first time in June 2016. It has been running for more than one year. There are 111 medical and nursing institutions. As of the end of June 2017, a total of nearly 1500 people had applied for long-term care insurance; the agencies handled 1220 times for the record of nursing insurance and 1554 cases of nursing insurance inpatient settlement.
news link:
who can enjoy long-term care insurance?
long term care insurance system takes the insured workers who have long been in disability status as the protection object. 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 three 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 apply for the medical care institutions of the designated medical care institutions to carry out the applicant's social security card, ID card, an effective diagnostic certificate, and a complete medical record copy in accordance with the relevant provisions of medical records management. 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 are the contents of daily life assessment?
the assessment of daily living ability is organized by the designated health care organization, and the staff of the organization is rechecked. 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.