Procedures of Shanghai Municipality on the Unified Needs Assessment and Service Administration of the Elderly Nursing

(January 5, 2018)

SMPG GO D [2018] No. 2

Article 1(Purpose)

With a view to regulating the work on the unified needs assessment for the elderly nursing in this Municipality, these Procedures are hereby formulated in accordance with the Regulations of Shanghai Municipality on the Protection of the Rights and Interests of the Aged People.

Article 2 (Definition)

The unified needs assessment for the nursing of the elderly (hereinafter referred to as the unified needs assessment) mentioned in these Procedures means the assessments made, according to the municipal unified assessment standard and upon the application raised by the elderly who need the nursing and meet the required conditions, on their disability degrees, disease cases and nursing status, with a defined assessment grading. The assessment grading shall be used as the premise and the basis for the applicant to enjoy the policies of the long-term nursing insurance benefits and the elderly nursing service subsidies.

Article 3(Scope of Application)

An elderly citizen who has reached the age of or over 60 and met any one of the following conditions may apply for the unified needs assessment:

1. a policy holder of the employees’ basic medical insurance in this Municipality;

2. a policy holder of the basic medical insurance for urban and rural residents in this Municipality; and

3. a person who is neither a policy holder of the employees’ basic medical insurance nor a policy holder of the basic medical insurance for urban and rural residents, but with a household registration in this Municipality.

Article 4(Division of Responsibility)

The Municipal Human Resources and Social Security Bureau (the Municipal Medical Insurance Office) is the competent department of conducting the unified needs assessment, responsible for formulating and perfecting the process for the assessment, exercising a contractual administration over the designated assessment institutions, and engaging in the formulation and perfection of the assessment standards and operation norms.

The Municipal Health and Family Planning Commission shall, jointly with the Municipal Civil Affairs Bureau, exercise a professional administration over the assessment institutions, formulate and perfect the assessment standards and the operation norms for the unified needs assessment, and supervise the quality of the assessment.

The Municipal Civil Affairs Bureau and the Municipal Health and Family Planning Commission shall be responsible for formulating and perfecting the administration standards of the public service for the elderly nursing, organizing service supply and arranging the service waiting list.

Each district people’s government shall be responsible for organizing the detailed implementation of these Procedures within its own administrative area.

Article 5(Requirements for Assessment Institutions)

An assessment institution shall be a social service agency, an enterprise or a public institution with a legally independent registration and with a stable team of assessors, an office site, sound financial conditions, and other management systems of human resources, finance, archiving, assessment business and quality control.

The number of assessors in an assessment institution shall be no less than 10, among which at least five shall be full-time. The director(s) and assessors of an assessment institution shall have no record of violations of relevant laws and regulations.

An eligible assessment institution shall first sign a service contract according to relevant provisions of this Municipality, and then become a designated assessment institution. The Municipal Human Resources and Social Security Bureau (the Municipal Medical Insurance Office) shall publicize to the society the name list of the designated assessment institutions, which is subject to a dynamic adjustment.

Article 6(Assessors)

The assessors refer to those with relevant professional technique background, employed by an assessment institution, and with a qualification obtained after a municipal unified training and implementing the unified needs assessment either full-time or part-time.

The assessors are classified as Class A and Class B according to their professional technique background. Class A assessors refer to those with practical experience in elderly nursing service, medical care or social work and with a secondary technical degree or above. Class B assessors refer to those who have obtained medical practitioner qualifications or assistant medical practitioner qualifications.

Article 7(Norms of Assessment Operation)

The assessment institutions shall organize and implement the work on the assessment by strictly observing the municipal unified assessment standards and operation norms.

A door-to-door assessment shall be made by no less than two assessors, and one must be a Class B assessor among them. When a door-to-door assessment is made, there shall be, in principle, an agent or guardian of the assessed on site.

The assessment shall be objective, fair and independent from any organization or individual. The assessment institution shall be responsible for the assessment conclusion.

Article 8(Assessment Method)

The assessors shall make an on-site assessment by using the Inquiry Form of Shanghai Municipal Unified Needs Assessment of the Elderly Nursing, and reach the conclusion through relevant procedures.

Article 9(Assessment Application)

Anyone who meets the requirements as provided in Article 3 and needs to apply for the long-term nursing insurance benefits, and/or the elderly nursing service subsidies may, in person or by way of agent or guardian, submit a written application to the nearest community service center or its branch together with other relevant materials, and choose a desired service institution.

Article 10 (Acceptance and Verification)

Where the application conforms to relevant conditions after verification, the municipal human resources and social security department shall direct a designated assessment institution to make the assessment. Where the application does not conform to the conditions, the community service center shall inform the applicant (or the agent or guardian) of the decision.

Article 11(Initiation of Assessment)

Upon receiving an assessment directive, the designated assessment institution shall appoint its assessors to complete, keep a record and make a conclusion of the door-to-door assessment, and give a feedback on the conclusion to the community service center.

Article 12(Notification of Conclusion)

The community service center shall, on behalf of the assessor, inform the applicant of the assessment conclusion, which shall be confirmed by the applicant (or the agent or guardian).

Article 13(Assessment Conclusion)

An assessment conclusion shall include the assessment grading and other cases. The assessment grading/nursing shall be defined as Grading 1, Grading 2, Grading 3, Grading 4, Grading 5 and Grading 6 Nursing. Other cases refer to a conclusion that the applicant fails to be eligible for Grading 1 Nursing and that the applicant is advised to seek medical treatment in a medical institution.

The assessment institution may suggest a service plan according to its assessment grading as a reference for the service institution to make its own service plan.

The community service center shall adopt a proper means to make the public know of the unified needs assessment grading, which shall be subject to the social supervision.

Article 14(Validity Period of Assessment Conclusion)

The validity period of an assessment conclusion shall not exceed two years.

An applicant may, within the validity period of the assessment conclusion, apply for an assessment again if the applicant’s ability in self-care changes.

The applicant shall apply for a re-assessment within 60 calendar days before the expiry of the existing assessment conclusion.

Article 15(Review and Final Review of Assessment Conclusion)

An applicant (or the agent or guardian) may, in case of having a disagreement with the assessment conclusion, apply to the original community service center for a review within 30 working days upon receiving the assessment conclusion. The human resources and social security department (the medical insurance department) shall direct an assessment institution to review the case while the original assessment institution shall be recused. The reviewing assessment institution shall complete the review within 15 working days and give a feedback on the review conclusion to the community service center. The community service center shall, on behalf of the assessor, inform the applicant (or the agent or guardian) of the conclusion.

An applicant (or the agent or guardian) may, in case of challenging the review results, apply through the original application channel for a final review. The Municipal Health and Family Planning Commission and the Municipal Civil Affairs Bureau shall direct a municipal assessment institution to make the final review. The final review results shall be binding.

Article 16(Assessment Fees)

The unified needs assessment shall be charged in accordance with the charging standards regulated by relevant municipal department.

The fees charged against a policy-holder shall be jointly paid by the holder and the long-term nursing insurance fund. The proportion of payment by the long-term nursing insurance fund and the measures for payment shall be separately formulated by the Municipal Human Resources and Social Security Bureau (the Municipal Medical Insurance Office) in collaboration with relevant departments. Non-policy-holders shall bear the fees by themselves.

People in economic difficulties like those who receive subsistence allowances or earn low salary may apply for a financial subsidy for the assessment fees charged against them. The measures for such financial subsidy shall be separately formulated by the Municipal Civil Affairs Bureau, the Municipal Human Resources and Social Security Bureau and the Municipal Finance Bureau.

Article 17(Service Provision)

The eligible applicant shall, after the unified needs assessment, confirm and register with a desired service institution to enjoy the service. Where the desired service institution cannot meet the applicant’s needs, the applicant may, in accordance with relevant provisions, choose another institution or apply for waiting.

The civil affairs and health and family planning departments shall, based on their own division of responsibilities, provide convenience and service for the eligible applicants when they choose the service institution or apply to be put in the waiting list.

Article 18(Service Plan)

After the applicant confirms the service institution, the service institution shall, according to the applicant’s assessment grading and the service plan suggested by the assessment institution, formulate the service plan, and inform the applicant of the long-term nursing insurance benefits and the elderly nursing service subsidies.

The service plan shall be confirmed by the applicant (or the agent or guardian) and may be adjusted properly based on the actual circumstances of the applicant. The service plan adjustment shall be confirmed by the applicant (or the agent or guardian).

Article 19(Service Fees)

The service charges for home elderly nursing in community and institutional nursing shall be paid in accordance with relevant provisions on the management of the elderly nursing service in community and the management of the elderly nursing institutions’ service charge. Where the charges are within the coverage of the long-term nursing insurance, the long-term nursing insurance fund shall pay accordingly; where the charges are within the scope of the elderly nursing subsidy, the finance shall give the subsidy.

Article 20(Supervision on Assessment and Service)

The Municipal Human Resources and Social Security Bureau (the Municipal Medical Insurance Office), the Municipal Health and Family Planning Commission, and the Municipal Civil Affairs Bureau shall, based on their own division of responsibilities, reinforce supervision over and give more guidance to the assessment and service institutions.

Article 21(Information System)

The application, acceptance, assessment, service, settlement, and supervision of the unified needs assessment shall be implemented within the information system. The relevant departments shall continuously improve the information system to realize an interconnection and sharing of information.

Article 22(Confidentiality)

The personal privacy involving the assessment shall be protected by law. No institution or individual may disclose, or illegally inquire or use the applicant’s information.

Article 23(Miscellaneous)

These Procedures shall be effective as of January 1, 2018 and be valid until December 31, 2022. In the event of any discrepancy between these Procedures and prior provisions on the unified needs assessment upon the implementation of these Procedures, these Procedures shall prevail.