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广州失能人员长期护理费可报销70%

2016-07-13 15:40:50   羊城晚报

  羊城晚报讯 记者罗仕报道:广州失能人员家庭的负担将得到大幅度减轻!近日,人社部公布了《关于开展长期护理保险制度试点的指导意见》(以下简称《指导意见》),包括广州在内的15个城市年内将开展长期护理保险制度试点工作。

据悉,该制度将以长期处于失能状态的参保人群为保障对象,重点解决重度失能人员基本生活照料和与基本生活密切相关的医疗护理等所需费用。对符合规定的长期护理费用,基金支付水平总体上控制在70%左右。

试点阶段覆盖职工医保参保人

《指导意见》明确,试点目标是,探索建立以社会互助共济方式筹集资金,为长期失能人员的基本生活照料和与基本生活密切相关的医疗护理提供资金或服务保障的社会保险制度。利用1-2年试点时间,积累经验,力争在“十三五”期间,基本形成适应我国社会主义市场经济体制的长期护理保险制度政策框架。

主要任务是探索长期护理保险的保障范围、参保缴费、待遇支付等政策体系;探索护理需求认定和等级评定等标准体系和管理办法;探索各类长期护理服务机构和护理人员服务质量评价、协议管理和费用结算等办法;探索长期护理保险管理服务规范和运行机制。

据悉,长期护理保险制度以长期处于失能状态的参保人群为保障对象,重点解决重度失能人员基本生活照料和与基本生活密切相关的医疗护理等所需费用。试点地区可根据基金承受能力,确定重点保障人群和具体保障内容,并随经济发展逐步调整保障范围和保障水平。

试点阶段,长期护理保险制度原则上主要覆盖职工基本医疗保险(以下简称职工医保)参保人群。试点地区可根据自身实际,综合平衡资金筹集和保障需要等因素,合理确定参保范围并逐步扩大。

年内试点地区要启动实施

在资金筹集方面,试点阶段,可通过优化职工医保统账结构、划转职工医保统筹基金结余、调剂职工医保费率等途径筹集资金,并逐步探索建立互助共济、责任共担的长期护理保险多渠道筹资机制。筹资标准根据当地经济发展水平、护理需求、护理服务成本以及保障范围和水平等因素,按照以收定支、收支平衡、略有结余的原则合理确定。建立与经济社会发展和保障水平相适应的动态筹资机制。

在待遇支付方面,长期护理保险基金按比例支付护理服务机构和护理人员为参保人提供的符合规定的护理服务所发生的费用。根据护理等级、服务提供方式等制定差别化的待遇保障政策,对符合规定的长期护理费用,基金支付水平总体上控制在70%左右。具体待遇享受条件和支付比例,由试点地区确定。

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