国家医保局近日出台《关于做好长期护理保险支付管理工作的指导意见》，对长护险的支付范围、支付方式和支付标准进行了系统规范1。指导意见明确了失能评估费用和长护服务费用的报销范围，建立了差异化的付费机制：评估服务以按人次付费为主，护理服务以按时长付费为主1。其中，居家护理服务按小时付费，机构护理服务按床日付费1。
参保人员基金年度最高支付限额不超过统筹地区上年度城乡居民人均可支配收入的50%1。为确保待遇平稳过渡，试点地区将利用3年左右时间逐步推进新规落地，确保参保群众待遇稳定衔接1。此外，指导意见明确长护险基金支付不得由第三方社会力量代管代拨，进一步规范了基金管理1。
The National Medical Insurance Administration has introduced comprehensive guidelines for managing long-term care insurance payments, establishing clear frameworks for coverage scope, payment methods, and reimbursement standards.1
The new directive specifies the reimbursable expenses for disability assessments and long-term care services.1 Assessment services will be compensated on a per-visit fee basis, while care services will be reimbursed according to the duration of service provided.1 Specifically, home-based care services are charged hourly, whereas institutional care services are billed on a per-bed-day basis.1
To ensure a smooth transition, pilot regions will have approximately three years to gradually implement these new payment standards while maintaining stable benefit continuation for enrolled participants.1 The maximum annual fund payout per participant is capped at 50 percent of the previous year's per capita disposable income for urban and rural residents in the coordinating region.1 Additionally, the guidelines explicitly prohibit third-party social organizations from managing or distributing long-term care insurance funds.1
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