國家醫保局出臺長期護理保險失能等級評估機構定點管理辦法
核心提(ti)示：據(ju)國(guo)家(jia)醫(yi)保局網(wang)站消息，為確保廣大人民群眾更加公(gong)平、公(gong)正(zheng)、及時享受長期護(hu)理保險待遇，推動長期護(hu)理保險失能(neng)等級評(ping)估機構(gou)定點管
據國(guo)家(jia)醫(yi)保(bao)(bao)局(ju)網站消息，為確保(bao)(bao)廣大人民群眾更加(jia)公平、公正(zheng)、及時享受長(chang)(chang)期護(hu)理保(bao)(bao)險待遇，推動長(chang)(chang)期護(hu)理保(bao)(bao)險失(shi)能等級評(ping)估機構定點(dian)(dian)管(guan)理更加(jia)規范(fan)化、標準(zhun)化、科(ke)學化，近日，國(guo)家(jia)醫(yi)保(bao)(bao)局(ju)印發了《長(chang)(chang)期護(hu)理保(bao)(bao)險失(shi)能等級評(ping)估機構定點(dian)(dian)管(guan)理辦法(fa)（試行）》（醫(yi)保(bao)(bao)發〔2024〕13號，以下簡稱(cheng)《定點(dian)(dian)管(guan)理辦法(fa)》）。
長(chang)期護理(li)保險(xian)失(shi)能等級評(ping)估是長(chang)期護理(li)保險(xian)制(zhi)度機(ji)(ji)(ji)制(zhi)的重要組成部分，評(ping)估結(jie)論是待遇享受和基(ji)金支付的重要依(yi)據。對(dui)評(ping)估主(zhu)體的規(gui)(gui)范(fan)確(que)定和管(guan)(guan)理(li)，是確(que)保評(ping)估工作專業化、規(gui)(gui)范(fan)化的關鍵環節。在梳(shu)理(li)總(zong)結(jie)試(shi)點經驗基(ji)礎上，國家(jia)醫保局研究制(zhi)定《定點管(guan)(guan)理(li)辦(ban)法》，明確(que)長(chang)期護理(li)保險(xian)失(shi)能等級評(ping)估機(ji)(ji)(ji)構(gou)定點管(guan)(guan)理(li)具體要求，推(tui)進(jin)評(ping)估機(ji)(ji)(ji)構(gou)定點管(guan)(guan)理(li)規(gui)(gui)范(fan)統一。
《定(ding)(ding)(ding)(ding)點(dian)(dian)管(guan)理(li)(li)(li)(li)辦法》主要(yao)對定(ding)(ding)(ding)(ding)點(dian)(dian)評(ping)(ping)(ping)(ping)估(gu)機(ji)(ji)構(gou)的(de)確定(ding)(ding)(ding)(ding)、運(yun)行管(guan)理(li)(li)(li)(li)、監(jian)(jian)督管(guan)理(li)(li)(li)(li)等(deng)方面作出規(gui)定(ding)(ding)(ding)(ding)。一是明確定(ding)(ding)(ding)(ding)點(dian)(dian)評(ping)(ping)(ping)(ping)估(gu)機(ji)(ji)構(gou)的(de)申請(qing)條件(jian)和(he)確定(ding)(ding)(ding)(ding)程序。規(gui)定(ding)(ding)(ding)(ding)申請(qing)成為定(ding)(ding)(ding)(ding)點(dian)(dian)評(ping)(ping)(ping)(ping)估(gu)機(ji)(ji)構(gou)應具(ju)備的(de)基(ji)本條件(jian)、確定(ding)(ding)(ding)(ding)程序，以及不(bu)予(yu)受(shou)理(li)(li)(li)(li)定(ding)(ding)(ding)(ding)點(dian)(dian)申請(qing)的(de)情(qing)形(xing)等(deng)。二是提出定(ding)(ding)(ding)(ding)點(dian)(dian)評(ping)(ping)(ping)(ping)估(gu)機(ji)(ji)構(gou)的(de)運(yun)行管(guan)理(li)(li)(li)(li)要(yao)求。要(yao)求定(ding)(ding)(ding)(ding)點(dian)(dian)評(ping)(ping)(ping)(ping)估(gu)機(ji)(ji)構(gou)應加(jia)強內部(bu)建設，明確提出建立健全(quan)(quan)內部(bu)質量控(kong)制(zhi)制(zhi)度、人(ren)員管(guan)理(li)(li)(li)(li)制(zhi)度、評(ping)(ping)(ping)(ping)估(gu)檔案(an)管(guan)理(li)(li)(li)(li)制(zhi)度、信息安全(quan)(quan)管(guan)理(li)(li)(li)(li)制(zhi)度等(deng)。三(san)是規(gui)定(ding)(ding)(ding)(ding)對定(ding)(ding)(ding)(ding)點(dian)(dian)評(ping)(ping)(ping)(ping)估(gu)機(ji)(ji)構(gou)的(de)監(jian)(jian)督管(guan)理(li)(li)(li)(li)要(yao)求。明確醫療保障部(bu)門(men)對定(ding)(ding)(ding)(ding)點(dian)(dian)評(ping)(ping)(ping)(ping)估(gu)機(ji)(ji)構(gou)加(jia)強監(jian)(jian)督、考核、日常(chang)管(guan)理(li)(li)(li)(li)，規(gui)定(ding)(ding)(ding)(ding)醫保行政部(bu)門(men)和(he)經辦機(ji)(ji)構(gou)監(jian)(jian)管(guan)職責和(he)內容等(deng)。此(ci)外，明確依托(tuo)其他(ta)形(xing)式主體實施評(ping)(ping)(ping)(ping)估(gu)的(de)，對有關機(ji)(ji)構(gou)的(de)管(guan)理(li)(li)(li)(li)，參照(zhao)本辦法執(zhi)行。
下一步，國家醫保局(ju)將指導長(chang)期護(hu)理(li)保險(xian)制度試點地區醫保部門做(zuo)好(hao)《定點管理(li)辦法》試行，及時總(zong)結(jie)經驗做(zuo)法，不斷健全長(chang)期護(hu)理(li)保險(xian)失(shi)能等級評(ping)估(gu)標準體系(xi)和管理(li)辦法，更好(hao)維護(hu)廣大參保人合法權(quan)益(yi)。
來源：醫化網
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