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In order to further improve and perfect the urban and rural medical assistance system in our county, solve the medical problems of people in difficulty, and ensure the healthy development of medical assistance in our county, these detailed rules are formulated according to the spirit of the Notice on Adjusting the Urban and Rural Medical Assistance Policy and Perfecting the Urban and Rural Medical Assistance System issued by Hunan People's Government [2008] No.60, combined with the actual situation of our county.
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Guided by Scientific Outlook on Development, guided by the spirit of the 17th National Congress of the Communist Party of China, and in accordance with the principles of "emergency assistance, simplicity, focusing, classified assistance, government-led, social participation, integration and coordination, and * * * common promotion", we will comprehensively innovate the medical assistance mechanism in our county and establish a medical assistance mechanism based on "fund-raising participation, outpatient medical assistance and inpatient medical assistance".
Chapter II Working Organization
essay
County Social Assistance Administration is the county's urban and rural medical assistance examination and approval management department; The township civil affairs office is responsible for the preliminary examination of local medical assistance and part of the rescue work; The village (neighborhood) committee is entrusted by the medical assistance management organ and is responsible for assisting in the medical assistance work within its jurisdiction.
Article 4
The county health bureau and the county labor and social security bureau are the management institutions of rural medical assistance object participation and medical compensation, and urban medical assistance object participation and medical compensation. We should actively cooperate with the medical assistance for urban and rural residents with difficulties within their respective responsibilities.
Chapter III Medical Assistance Service Institutions
Article 5 Designated medical assistance service institutions shall hold a legal Medical Practice License, which shall be applied by medical institutions. Only after passing the examination by the county civil affairs bureau and the county health bureau and being awarded the license by the county civil affairs bureau can it be regarded as a designated medical assistance service institution.
Article 6
Designated medical assistance service institutions shall carry out standardized construction in accordance with the basic standards of medical assistance service institutions in our county and the unified standards stipulated by the health administrative department, and carry out medical assistance work in accordance with the rules and regulations and job responsibilities formulated by the county medical assistance management department. According to the policy, formulate preferential standards and measures for aid recipients and announce them to the public, and accept social supervision.
Article 7
The basic treatment and medication of medical assistance service institutions for needy objects shall comply with the relevant provisions of the medical insurance drug list and medical assistance management institutions. The county civil affairs department shall, jointly with the county health bureau and the labor and social security bureau, regularly and irregularly inspect and supervise the designated medical institutions.
Chapter IV Objects of Medical Assistance
Article 8 The object of medical assistance in urban and rural areas of our county is the following persons who hold urban and rural resident accounts in our county and live in our county:
(a) the minimum living guarantee for urban residents.
(two) the minimum living guarantee for rural residents.
(three) rural five guarantees.
(four) centenarians and other people with special difficulties.
Ninth, if public medical emergencies such as major epidemic diseases need medical assistance from the civil affairs department, emergency medical assistance shall be given in accordance with the relevant policies of the higher authorities.
Chapter V Contents, Standards and Procedures of Medical Assistance
Tenth according to the medical needs of all kinds of relief objects, the establishment of participation insurance, inpatient medical assistance, outpatient medical assistance, temporary medical assistance, charity assistance in five ways.
Article 11 Subsidize participation in insurance.
First, funding to participate in the new rural cooperative medical system.
(1) Funding targets: rural five-guarantee recipients and rural poor and low-income recipients.
(2)
Funding criteria: rural five-guarantee households are fully funded by the county civil affairs department; The individual contributions of seriously ill and severely disabled households in rural low-income households are partly funded by the rural medical assistance fund according to the standards stipulated in the current year and borne by individuals.
(3)
Handling procedures: within the annual participation time, the township civil affairs office will dock with the township joint management office according to the objects approved by the county social assistance management agency, and uniformly handle the participation procedures for township-funded participants. The required funds are allocated to the special financial account of the new rural cooperative medical system through the county finance, and the rural cooperative management office issues the Anxiang new rural cooperative medical system certificate.
(4)
According to the relevant regulations of the new rural cooperative medical system, the recipients enjoy the compensation benefits of the new rural cooperative medical system like other rural participants. There is no deductible for the hospitalization of rural five-guarantee households in the designated medical institutions in the county, and the compensation ratio is increased, that is, 90% in the first-level hospitals and 80% in the second-level hospitals in the county, and the accidental injury of the irresponsible party is compensated according to the hospitalization compensation ratio. Rural five guarantees to visit outside the county, not to increase the proportion of compensation.
Two, to participate in the basic medical insurance for urban residents.
(1) Subsidies target: urban "three noes" households and severely disabled people in urban low-income households.
(II) Funding criteria: The individual contributions of the target individuals that fall within the scope of funding shall be classified and funded by the medical assistance fund according to the standards stipulated in the current year.
(III) Handling procedures: After the civil affairs department has examined and approved the objects and subsidy standards, the urban subsistence allowances shall be handled by the corresponding institutions (township governments or communities) where the household registration is located with the effective Urban Low Guarantee in accordance with the provisions of the county medical insurance office. According to the standards approved by the civil affairs department, the payment shall be reduced or exempted, and relevant registration shall be made. After the completion of the annual insurance work, the township (community) statistics will send the list of insured objects and insurance certificates to the county-level civil assistance management institutions. After examination, all the funded objects will be allocated to the financial accounts of the urban residents' medical co-ordination fund through finance, and the funded funds will be charged in the medical assistance fund.
(5) The recipients, like other urban residents' basic medical insurance participants in Anxiang, enjoy the medical compensation benefits of urban residents' medical insurance.
Three, the financing standard of participating insurance can be adjusted according to the relevant national policies and the actual operation of medical assistance.
Thirteenth outpatient medical assistance
I. Daily outpatient assistance
(1) Aid recipients: rural five-guarantee households, urban three-unemployed people, severely disabled people who have lost their ability to work, seriously ill patients who need long-term out-of-hospital treatment, and elderly people over 100 years old.
(2)
Assistance standard: County-level medical assistance management institutions shall issue daily outpatient assistance cards not less than 50 yuan every year for outpatient service and medicine purchase. The expenses incurred within the limit shall be paid in advance by designated medical institutions or pharmacies, and settled regularly with urban and rural medical assistance funds.
Second, outpatient assistance for special chronic diseases
(1) Aid recipients: rural five-guarantee households and urban and rural low-guarantee households.
(2) Rescue diseases: advanced cirrhosis, cerebrovascular accident (hemiplegia), psychosis, lupus erythematosus, Parkinson's disease, epilepsy, chronic renal insufficiency, advanced schistosomiasis, tuberculosis, type I diabetes, etc.
(3)
Assistance standard: The county medical assistance management authority issues 200 yuan's "Special Chronic Disease Outpatient Medical Card" every year for outpatient service and medicine purchase. The expenses incurred within the limit shall be paid in advance by designated medical institutions or pharmacies, and settled regularly with urban and rural medical assistance funds.
The third is the quota outpatient assistance for serious and serious diseases.
(1) Aid objects and diseases: Five-guarantee households in rural areas and low-income households in urban and rural areas were not hospitalized due to economic difficulties and poor treatment effect.
(2) Diseases to be rescued and rescue standards: those suffering from malignant tumor, uremia, organ transplantation, leukemia and aplastic anemia.
A, severe pancreatitis, severe extensive burns and other serious diseases, the relief object every year by the county social assistance management bureau according to the different major diseases, in principle, not more than 1000 yuan.
Fourth,
Outpatient medical assistance procedures: in addition to daily outpatient assistance, I need to apply, the village (neighborhood) committee to verify, the township civil affairs office to declare, the township civil affairs office to review (organize materials), the county social assistance administration to declare for approval.
Five, the applicant shall provide the following materials: my application report; Fill in the application form for outpatient assistance; Raw materials for hospital diagnosis and treatment; My ID card or household registration book; Copy of rural five-guarantee certificate or low-guarantee fund.
Six, the relief object can only enjoy a kind of outpatient assistance every year, can not be repeated. Seven, "outpatient medical assistance card" issued by the county medical assistance management organs.
Article 14 Hospitalization medical assistance
First, the target of assistance: rural five-guarantee households, urban and rural low-guarantee households and centenarians who really need hospitalization after being diagnosed with illness.
Second, the standard of assistance: hospitalization assistance is provided according to the following standards.
( 1)
Rural five-guarantee households and rural low-guarantee households participating in the new rural cooperative medical system will pay the remaining out-of-pocket hospitalization expenses after receiving policy subsidies such as new rural cooperative medical subsidies and fee reduction and exemption by designated medical institutions. For rural five-guarantee households and rural low-guarantee households hospitalized in township-level designated medical institutions, the rural medical assistance fund shall provide medical assistance of not less than 50% and 20% respectively; In the designated medical institutions at the county level, the rural medical assistance fund will give no less than 20% and 15% medical assistance.
(2)
The recipients who have participated in the basic medical insurance for urban residents are ill and hospitalized. After receiving policy subsidies such as reimbursement of urban residents' basic medical insurance and fee reduction by designated medical institutions, the remaining out-of-pocket hospitalization expenses will be given assistance at the rate of 15%. For the seriously ill and severely disabled people who lose their ability to work and the self-paid part of urban low-income households, assistance will be given according to the proportion of 20%. Medical assistance recipients who have not participated in the residents' basic medical insurance are hospitalized and given assistance according to the ratio of 10%, and the maximum amount of assistance is 1500 yuan.
(three) medical expenses incurred outside the basic medical insurance and the basic medical catalogue and diagnosis and treatment items of the new rural cooperative medical system are not included in the calculation of hospitalization assistance.
In principle, the maximum amount of hospitalization assistance shall not exceed 2000 yuan.
Three. Procedures: I apply, the village (neighborhood) committee verifies, the township civil affairs office declares, the township civil affairs office rechecks (sorts out materials), and the county social assistance administration declares for approval.
Four, the applicant shall provide the following materials: my application report; Fill in the "urban and rural medical assistance application approval form"; Proof of disease diagnosis; Raw materials for hospital diagnosis and treatment; List of hospitalization expenses, hospitalization settlement documents, detailed list of hospitalization expenses subsidies for medical insurance or new rural cooperative medical system; My ID card or household registration book; Copy of rural five-guarantee certificate or subsistence allowance, etc.
Five, enjoy the hospitalization medical assistance, in principle, no longer repeat the special chronic disease outpatient assistance and special disease quota outpatient assistance.
Article 15 Temporary medical assistance
First, the target of assistance: other low-income families except rural five-guarantee households and urban and rural low-guarantee households, whose family life is particularly difficult because of the extremely high medical expenses for serious illness.
Second, temporary medical assistance is implemented by the township and county medical assistance management organs, the township civil affairs office is responsible for the preliminary examination, and the county medical assistance management organs are responsible for the examination and approval, and a certain amount of temporary medical assistance is given according to family difficulties and illness. In principle, the maximum amount of assistance shall not exceed 1 1,000 yuan.
3. The proportion of temporary medical assistance funds within 10% of the total annual medical assistance funds.
Four, apply for temporary medical assistance conditions:
(1) Poor marginal people with family difficulties due to serious illness hospitalization.
(two) must be hospitalized this year, and apply for temporary medical assistance within three months after discharge;
(three) other poor people who have been resolved with the consent of the county people's government.
Verb (abbreviation of verb) Handling procedure: To apply for temporary medical assistance, the patient must produce an application report, and the village (neighborhood) committee will sign an opinion, and fill in the application form for temporary medical assistance at the township civil affairs office. The township civil affairs office conducts a preliminary examination of the original medical data provided by the patient, such as disease diagnosis, drug invoice, medical insurance (new rural cooperative medical system) subsidy certificate, household registration book or copy of ID card. Those who pass the preliminary examination are stamped with the official seal, and the patient carries a copy of the above information to the county-level medical assistance management organ for handling.
Article 16 Charity medical assistance
For families suffering from major diseases, if the medical expenses reach more than 50,000 yuan, and the treatment needs cannot be met through medical assistance or temporary medical assistance, an application can be made to a charity, and the charity will give a one-time charitable medical assistance according to relevant regulations.
Chapter VI Raising, Appropriation and Supervision of Funds
Seventeenth sources of funds for urban and rural medical assistance include higher-level grants, budget funds at the same level, welfare lottery tickets, social donations, charitable funds and other funds.
Article 18
Urban and rural medical assistance funds should be stored in special accounts, managed in special accounts and used for special purposes. The county finance bureau set up a special account for urban and rural medical assistance funds in the financial and social security account for the collection, disbursement and payment of funds; The county social assistance management bureau shall set up a special account for the allocation of urban and rural medical assistance funds for the allocation, payment and distribution of medical assistance funds, and establish a detailed account for urban and rural medical assistance funds.
Nineteenth rational planning and scientific use of medical assistance funds, with reference to the total amount of medical assistance funds in the previous year, a reasonable division of the proportion of special medical assistance funds.
Twentieth county medical assistance management organs in conjunction with the county finance bureau according to the actual needs and financial resources of medical assistance work, the preparation of medical assistance funds annual revenue and expenditure plan, submitted to the government for approval before implementation.
Article 21
Medical assistance funds must be operated in strict accordance with the procedures, and the departments of civil affairs, finance, health, labor and social security, auditing and supervision at the county level should strengthen the management of medical assistance funds in accordance with the relevant provisions of fund management. The financial, auditing and supervision departments shall supervise and audit the urban and rural medical assistance funds, correct the problems found in time, and ensure the rational use of funds.
Article 22
The collection, management and use of urban and rural medical assistance funds should be announced to the public regularly, and the parties and relevant responsible persons should be seriously investigated for violations of discipline, rules and regulations. If a crime is constituted, criminal responsibility shall be investigated according to law.
Chapter VII Supplementary Provisions
Twenty-third the detailed rules for the implementation by the Anxiang Municipal Social Assistance Administration is responsible for the interpretation of.
Article 24 These Rules shall come into force as of the date of promulgation. The original Detailed Rules for the Implementation of Medical Assistance for Major Diseases of Rural Poor People in Anxiang shall be abolished at the same time.