According to the Notice of Chongqing Municipal Medical Security Bureau and Chongqing Municipal Finance Bureau on Further Promoting the Pilot Work of the Long-term Care Insurance System (Yu Yi Bao Fa 2023 No. 40) (hereinafter referred to as the "Notice"), from March 1, 2024, the disability standard for long-term care insurance will be expanded from Level 3 (severe disability (severe disability (severe disability) to Level 2 (moderate disability). It means that Level 2 (moderately disabled) personnel are included in the scope of long-term care insurance benefits according to regulations.
1. Improve the way to enjoy treatment.
In order to better provide nursing services for those who enjoy treatment, and improve the level of nursing services for those who enjoy home treatment, the treatment method is improved to:
1) Combined care at home. Home care provided by designated nursing facilities (referred to as institutional care) and personal care provided by individual caregivers (referred to as personal care);
2) Institutional home care. Same as the original home care.
3) Institutional centralized care. Centralized care at the same institution.
Before the implementation of the "Notice", the insured who has been entitled to the treatment according to the original home personal care treatment can continue to enjoy the treatment according to the original treatment method and standard, and the insured is encouraged to change the treatment method.
2. Raise the standard of treatment settlement.
The settlement standard for the treatment of severely disabled persons is adjusted to: 50 yuan per person per day for combined home care (including 30 yuan per day for institutional care and 20 yuan per person for personal care), 60 yuan per day per person for institutional home care, and 60 yuan per person for institutional centralized care.
The settlement standard for the treatment of moderately disabled persons is: 20 yuan per person per day for combined home care (including 12 yuan per day for institutional care and 8 yuan per person for personal care), 20 yuan per day per person for institutional home care, and 20 yuan per day per person for institutional centralized care.
If the insured person is hospitalized during the period of enjoying the benefits, the settlement shall be based on the nursing services actually enjoyed by the insured according to the above-mentioned standards.
3. Adjust nursing service items.
The basic nursing service items have been further divided into 28 items in 6 categories from the original 24 items in 5 categories, and the category of "** care" has been added, and the original items have been adjusted perfectly. According to different levels of disability and treatment enjoyment, various service packages have been developed in a targeted manner.
4. Explanation is calculated as the number of years of payment.
It shall be calculated in accordance with the provisions of the "Notice on the Handling of Opinions on Issues Related to the Transfer and Continuation of Medical Insurance Relationship" (Yu Ren She Fa 2014 No. 128) and other documents. The actual payment period of resident medical insurance can be converted into the actual payment period of the first level of employee medical insurance at a ratio of 8:1, and it is calculated together with the payment period of employee medical insurance. If the basic medical insurance is continuously insured and the payment period after the merger is greater than or equal to 24 months, it is deemed to be "the insurance payment record (including the deemed payment period) of the employee's medical insurance for 24 consecutive months (including the deemed payment period)".
5. Clarify the four types of refunds.
From January 1, 2022, those who meet the following conditions for a refund can apply for a refund.
1) Refund for death. After paying the long-term care insurance premiums for the following year on an annual basis, the insured person dies before 24:00 on December 31 of the same year; or those who need to pay back premiums for less than 15 years to enjoy benefits, and die after paying back premiums but before enjoying benefits;
2) Refund of duplicate payment. After paying the long-term care insurance premium on an annual basis, the individual insured person is transferred to the insurance with the employer in the middle of the year to form a duplicate payment;
3) Pay more refunds after retirement. Insured persons with individual status, who retire in the middle of the year after paying a one-time long-term care insurance premium in the current year, resulting in overpayment;
4) Handling of overpayment in the course of handling. Overpayment due to delays in handling retirement or death procedures for employees, system failures, etc.
The Notice will come into effect on March 1, 2024. Those who enjoy the benefits from March 1, 2024 will be implemented according to the new treatment methods.
Chongqing Jiangjin District Medical Security Bureau.
February 28, 2024.