国家医保局印发指导意见 规范长期护理保险报销管理

国家医疗保障局近日印发《关于做好长期护理保险支付管理工作的指导意见》1。该文件明确了长期护理保险的支付范围、支付方式、支付标准以及基金监管和风险防范机制1。

根据指导意见，长期护理保险基金可报销失能评估费用、定点养老护理机构长期照护服务费以及第三方机构经办管理费1。在报销额度方面，参保人一年内长护险基金最高报销额度不超过当地上一年城乡居民人均可支配收入的50%1。此外，文件规范了按人头、时长等计费方式，要求各地合理确定报销标准并加强基金监督管理，同时明确长期护理保险基金支付不得由第三方社会力量代管代拨1。

The National Healthcare Security Administration has recently issued the "Guiding Opinions on Doing a Good Job in the Payment Management of Long-Term Care Insurance" to standardize the reimbursement management of the scheme 1. This document explicitly defines the payment scope, payment methods, and payment standards for long-term care insurance, while also establishing mechanisms for fund supervision and risk prevention 1.

Under the new guidelines, the long-term care insurance fund is permitted to reimburse expenses related to disability assessments, long-term care service fees provided by designated elderly care institutions, and management fees charged by third-party agencies 1. The policy also standardizes billing approaches based on per capita and duration, urging local authorities to set reasonable reimbursement standards and enhance fund oversight 1. Additionally, the document stipulates that the maximum annual reimbursement limit for an insured individual from the long-term care insurance fund must not exceed 50% of the local per capita disposable income of urban and rural residents from the previous year 1. To ensure financial security, the payment and disbursement of the long-term care insurance fund are strictly prohibited from being managed or handled by third-party social entities 1.