Core tip: According to the website of the National Medical Insurance Administration, in order to ensure that the general public enjoys long-term care insurance benefits more fairly, justly, and in a timely manner, we will promote the designated management of institutions for assessing the disability level of long-term care insurance



According to the website of the National Medical Insurance Administration, in order to ensure that the general public can enjoy long-term care insurance benefits more fairly, justly, and in a timely manner, and to promote the standardized, standardized, and scientific management of designated institutions for assessing the disability level of long-term care insurance, the National Medical Insurance Administration has recently issued the "Management Measures for Designated Institutions for Evaluating the Disability Level of Long term Care Insurance (Trial)" (Medical Insurance Development [2024] No. 13, hereinafter referred to as the "Designated Management Measures").



The assessment of disability level in long-term care insurance is an important component of the long-term care insurance system mechanism, and the evaluation conclusion is an important basis for enjoying benefits and fund payments. The standardized determination and management of evaluation subjects is a key link in ensuring the professionalization and standardization of evaluation work. On the basis of summarizing the pilot experience, the National Medical Insurance Administration has studied and formulated the "Designated Management Measures", clarifying the specific requirements for the designated management of long-term nursing insurance disability level evaluation institutions, and promoting the standardized and unified management of designated evaluation institutions.



The Measures for Designated Management mainly stipulate the determination, operation management, supervision and management of designated evaluation institutions. One is to clarify the application conditions and determination procedures for designated evaluation institutions. Specify the basic conditions and determination procedures required for applying to become a designated evaluation institution, as well as the circumstances in which designated applications are not accepted. The second is to propose operational management requirements for designated evaluation institutions. Require designated evaluation institutions to strengthen internal construction, clearly propose the establishment and improvement of internal quality control systems, personnel management systems, evaluation file management systems, information security management systems, etc. The third is to establish supervision and management requirements for designated evaluation institutions. Clarify the supervision, assessment, and daily management of designated evaluation institutions by the medical security department, and specify the regulatory responsibilities and contents of the medical insurance administrative department and handling institutions. In addition, if the evaluation is based on other forms of entities, the management of relevant institutions shall be carried out in accordance with these measures.



Next, the National Medical Insurance Administration will guide medical insurance departments in pilot areas of the long-term care insurance system to implement the "Fixed Point Management Measures", timely summarize experience and practices, continuously improve the evaluation standard system and management methods for the disability level of long-term care insurance, and better protect the legitimate rights and interests of insured persons.



Source: Medical Chemical Network