Chapter I General Principles
Article 1 In order to further improve the urban and rural medical assistance system, according to the relevant national laws and regulations and the Ministry of Civil Affairs, Ministry of Finance, Ministry of Health, Ministry of Human Resources and Social Security on further improving the urban and rural medical assistance system of the views of the Ministry of Civil Affairs (Minfa 〔2009〕 No. 81) and other relevant documents, combined with the province's The actual, the formulation of this approach.
Article 2 The urban and rural medical assistance referred to in these measures refers to the government and society to meet the conditions of assistance to urban and rural residents in need, according to the prescribed manner, procedures and standards to give subsidies for medical expenses and diagnostic and treatment concessions, and at the same time to participate in the basic medical insurance for urban residents or the new rural cooperative medical care to give financial support to the system.
Article 3 urban and rural medical assistance in accordance with the following principles:
(a) the level of medical assistance and economic and social development, financial capacity to pay, to solve the basic medical needs of residents in need;
(b) the medical assistance system and the urban workers, residents of the basic medical insurance and the new rural cooperative medical care system, to improve the overall effectiveness of health care resources;
(c) medical assistance system and urban workers, residents of the basic medical insurance and new rural cooperative medical system;
(d) medical assistance system and urban workers, residents of the basic medical insurance and new rural cooperative medical system, improve the overall effectiveness of health care resources. p>
(3) government assistance combined with social contributions, charitable assistance, government assistance is the main;
(4) urban and rural areas, active and prudent, focused, categorized assistance;
(5) open and transparent, fair and just, timely and convenient, to save the urgent and difficult.
Article IV urban and rural medical assistance in the implementation of local government responsibility, governments at all levels should provide the necessary organizational conditions and material assurance for medical assistance work, equipped with the appropriate work force.
Medical assistance is led by the civil affairs departments at all levels of government responsible for the implementation of local management. All levels and departments should cooperate with the relevant work according to the division of responsibilities.
Village (neighborhood) People's Committee entrusted by the township government (street office), undertake medical assistance related services.
Article V of the medical assistance in the work of the units and individuals to make outstanding achievements, in accordance with relevant regulations to give recognition.
Chapter II Medical Assistance Objects, Methods and Standards
Article VI urban and rural medical assistance objects include:
(a) rural five guaranteed support objects;
(b) urban and rural minimum subsistence guarantee objects;
(c) due to the disease caused by the life of the special difficulties, approved by the local government of the other people.
Each region should reasonably determine the object of medical assistance, and gradually expand the scope of assistance. The specific scope of the relief object, by the localities according to the size of the medical assistance fund, the ability to pay the people in need and basic medical needs and other factors.
Article 7 urban and rural medical assistance to adhere to the hospitalization of major illnesses as the main aid, according to the different medical needs of medical assistance to carry out services. The main ways include:
(a) subsidized insurance (co-operation). In accordance with the policy, the government subsidizes all or part of the fees to be paid by the rural five guaranteed dependent objects, the urban and rural minimum subsistence guarantee objects, etc. to participate in the basic medical insurance for urban residents or the new rural cooperative medical care.
(ii) Hospitalization assistance for major diseases. Medical aid recipients hospitalized, their medical expenses after deducting all kinds of medical insurance reimbursement (compensation), medical institutions and social contributions, the actual burden of medical expenses within the scope of the policy, in accordance with the prescribed standards to give aid.
(C) outpatient assistance. Medical aid recipients suffering from common diseases, chronic diseases, the need for long-term drug maintenance treatment and emergency, emergency, can be given a certain amount of outpatient assistance.
(D) preferential relief. Medical aid recipients in the designated medical institutions, the designated medical institutions should be in accordance with the relevant provisions of the outpatient registration fees, treatment fees, medical equipment inspection fees, hospital bed fees and other preferential reductions and exemptions.
Each region should actively innovate the medical assistance model to improve accessibility of medical assistance.
Article 8 The relief object due to special difficulties inability to hospitalization or hospitalization during the medical expenses are difficult to afford, localities can explore the development of pre-medical assistance or medical assistance.
Article IX by urban workers, residents of basic medical insurance and the new rural cooperative medical reimbursement (compensation), the policy provisions of the scope of out-of-pocket hospitalization costs, within the prescribed maximum limit, in accordance with the proportion of not less than 50% to give medical assistance. Specific standards of assistance by the municipalities and counties (cities and districts) according to the local level of economic and social development, medical assistance funds, per capita expenditure on medical costs and other circumstances.
Article 10 of the relevant basic medical insurance reimbursement (compensation) and medical assistance, the burden of medical expenses is still too heavy, individuals and families can hardly afford, depending on the medical assistance fund annual savings to give aid again, the specific procedures and standards set by the local community.
Article 11 of the medical aid object to implement the classification of aid, to scientifically formulate the subsidy program, a reasonable set of starting line and ceiling line, and constantly improve the level of medical assistance. The five guarantees in rural areas to cancel the starting line of medical assistance, the urban and rural minimum subsistence guarantee recipients and other people in need of assistance to gradually reduce or cancel the starting line.
Article 12 adhere to the urban and rural areas, urban and rural residents in need of medical assistance, should be gradually unified relief conditions, policy standards, relief procedures and management services.
Chapter III Medical Assistance Procedures
Article 13 Each region should establish a medical assistance and basic medical insurance for urban workers and residents and the new rural cooperative medical care, the fixed-point medical institutions to connect with each other's information **** enjoyment platform, and to strengthen in the management, hospitalization information, the cost of billing and other aspects of the convergence of the simplification of the rescue procedures, improve the efficiency of the rescue.
Article 14 meets the conditions for medical assistance for the needy to apply for hospitalization medical assistance for major illnesses, medical assistance management agencies at all levels should promptly handle the relevant procedures to improve work efficiency.
(a) for the rural five guaranteed dependent objects and the urban and rural minimum subsistence guarantee objects, the implementation of medical assistance costs instant settlement. With ID cards, rural five guaranteed support card, urban and rural minimum subsistence guarantee card and other valid documents, to the designated medical institutions, in the basic medical insurance reimbursement (compensation), for the policy within the scope of the medical assistance costs, by the designated medical institutions instant settlement, the aid recipients only need to pay personal out-of-pocket expenses. Due to special circumstances did not participate in the urban workers, residents of basic medical insurance and new rural cooperative medical care or not to the designated medical treatment, in accordance with the provisions of the second paragraph of this article to apply for medical assistance.
Where conditions exist, the scope of immediate settlement of medical assistance can be gradually expanded.
(2) other residents in difficulty to apply for medical assistance, in accordance with the following procedures:
1. By the applicant through the domicile of the village (neighborhood) People's Committee (enterprise trade unions) to the township government (street office) or industry authorities to submit a written application, and provide ID cards, household registers, family income status, illness and other documents and supporting materials. Village (neighborhood) Committee (enterprise trade unions) should be completed within three days of the material authenticity of the investigation and report to the township government (street office) or industry competent authorities for review.
If the village (neighborhood) committee (enterprise labor union) fails to report beyond the specified time limit without justifiable reasons, the applicant can apply directly to the township government (street office) or the competent department of the industry.
2. Audit. Township government (street office) and industry authorities should be completed within 7 days of the applicant's household verification, accurate understanding of the family's economic situation, medical expenses, etc., and put forward audit opinions. Meet the conditions for relief, reported to the county-level civil affairs departments for approval; does not meet the conditions for relief, to the applicant to explain the reasons.
3. Approval. County-level civil affairs departments should be completed within 10 days of the review and verification of relevant materials, if necessary, can carry out household surveys. Meet the conditions of the rescue, sign the approval of the approval; does not meet the conditions of the rescue, sign the approval of the disapproval, entrusted to the township government (street office) or the competent authorities of the industry to inform the applicant in writing and explain the reasons.
For urgent relief of sudden illness, should be special, timely relief. In order to ensure that the object is true, the material is accurate, the relevant procedures can be appropriately simplified.
Each region in the simplification of medical assistance operating procedures at the same time, to standardize the workflow, improve the management of services, and establish and improve the democratic supervision mechanism of medical assistance, timely medical assistance to the name of the object, the standard of assistance, the amount of assistance, etc. to the community to accept the masses and the community to supervise the public to achieve the policy is open, the funds are open, and the object of the public.
Article 15 to encourage the conditions of outpatient assistance, specific conditions and procedures for assistance by the municipal and county departments of civil affairs, in conjunction with the financial, health, human resources and social security departments according to local practice.
Article 16 When reviewing the applicant's medical expenses, the local authorities should exclude the unit subsidies, social contributions to the medical expenses and participation in various medical insurance reimbursement (compensation), payment of medical insurance premiums.
The settlement of medical aid expenses should be linked with the basic medical insurance for urban residents and the new rural cooperative medical care provisions of the reimbursement (compensation) range, beyond the local provisions of the catalog of medication, diagnosis and treatment, as well as the provision of medical services incurred. Medical expenses, medical aid fund will not be settled.
Chapter IV medical assistance funds raised, allocated and management and use
Article 17 of the medical assistance funds to the government budget arrangements. Each year, a certain percentage of the welfare lottery public welfare funds at all levels shall be used for medical assistance.
Article 18 The provincial financial arrangements for special funds to carry out medical assistance around the subsidies. City, county (city, district) government in accordance with the number of local medical aid recipients, financial needs and other arrangements for medical assistance funds, included in the financial budget.
Article 19 in the county to establish a medical assistance fund-raising and disbursement platform, in which all levels of financial budgetary arrangements for medical assistance funds are pooled into the county social security fund financial account, the implementation of special account management, earmarked for special purposes, any unit or individual shall not be withdrawn from the funds of the management fee or other costs; other channels to raise medical assistance funds to be used in conjunction with the financial budget funds.
Article 20 of the medical assistance funds should be in line with the principle of safe and efficient, convenient for the masses to allocate and distribute.
(a) subsidized participation in the funds, by the county-level financial departments in accordance with the civil affairs departments at the same level of the number of subsidies recognized by the subsidies to participate in the insurance (co-operation) and the standard of subsidies, directly allocated to the urban residents of the basic medical insurance or the new rural cooperative medical fund in the financial account of the accounting.
(b) the fixed-point medical institutions instant settlement of the aid funds, in urban workers, residents of basic medical insurance and new rural cooperative medical reimbursement (compensation), should be paid by the medical assistance, the local financial departments to allocate. The fixed-point medical institutions regularly to the civil affairs departments at the same level to report the details of the expenditure of medical assistance funds, the civil affairs departments to review the summary reported to the financial sector at the same level, the financial sector audit, timely and full subsidies will be directly allocated to the medical assistance agencies or fixed-point medical institutions.
(C) other medical assistance funds, by the county-level civil affairs departments regularly to the same level of the financial sector to report the list of medical assistance, approval information, the amount of assistance and the use of funds, the county-level financial sector after review and payment to the county-level civil affairs departments, the civil affairs departments issued to the person. The county-level finance department may preallocate part of the funds to ensure that the medical assistance funds are distributed on time. Other medical aid funds to gradually implement the socialization of the distribution, to ensure that the distribution to the medical aid objects themselves.
Article 21 The financial, civil affairs, health, human resources and social security departments at all levels shall work closely together to improve financial management and accounting system, and strengthen the use of medical funds management. Medical aid funds shall not be used for medical aid management departments and organizations work expenses.
All localities should pay attention to the effectiveness of the use of medical aid funds, the cumulative balance of medical aid funds shall not exceed 15% of the total amount of funds raised in the year, and in accordance with the provisions of the timely carry-over to the next year. For the excessive balance of funds, the higher financial and civil affairs departments to reduce or stop allocating subsidies, as appropriate.
Article 22 The financial, civil affairs, audit and other departments at all levels to strengthen the use of medical assistance funds management checks and audits.
Chapter V Departmental Responsibilities
Article 23 The departments of civil affairs, finance, health, human resources and social security at all levels shall strengthen communication and coordination, and strengthen the articulation of medical assistance with the basic medical insurance for urban workers and residents and the new rural cooperative medical care, and gradually realize the information on personnel, medical information and medical expenses between different medical security systems **** enjoy, and give full play to the overall effectiveness of the various systems. The overall efficacy of each system is being brought into full play, and work efficiency is being improved.
Article 24 The civil affairs departments at all levels are responsible for the formulation of urban and rural medical assistance policies, organization and implementation, the issuance of funds, and timely disclosure of medical assistance policies, assistance standards, procedures, the establishment of a public announcement system, set up and disclose the consulting and supervision telephone.
Article 25 The financial sector at all levels is responsible for medical assistance funds, the establishment of standardized procedures for the use of funds, timely disbursement of funds, strengthen the management of medical assistance funds and the use of supervision and inspection, and according to the needs of urban and rural medical assistance, to arrange for a certain amount of funds.
Article 26 The health sector at all levels is responsible for the people in need to participate in the new rural cooperative medical management services, with the new rural cooperative medical information management system and medical assistance instant settlement system data convergence, to strengthen the supervision and management of medical insurance institutions, supervise the implementation of preferential exemptions and exemptions.
Article 27 The human resources and social security departments at all levels are responsible for doing a good job of the people in need to participate in the management of urban residents' basic medical insurance, with the urban workers and residents of the basic medical insurance information management system and medical assistance instant settlement system data convergence, and to strengthen the supervision and management of medical insurance designated medical institutions.
Article 28 The medical aid designated medical institutions with reference to the urban residents of basic medical insurance and the new rural cooperative medical care to determine the scope of designated medical institutions, by the municipal or county (cities, districts) government civil affairs, health, human resources and social security departments *** with the negotiation of the determination, and publicized to the community.
Article 29 The civil affairs department shall strengthen the supervision and management of medical aid designated medical institutions, in conjunction with the health, human resources and social security departments to establish the access and exit mechanism of medical aid designated medical institutions.
Chapter VI Legal Liability
Article 30 The staff of urban and rural medical assistance management institutions shall be criticized or punished in accordance with the relevant provisions of one of the following acts; constitutes a crime, shall be investigated for criminal responsibility:
(a) perfunctory, not to meet the conditions of the medical assistance assistance or delayed the time limit for assistance for no reason;
( (B) self-serving, do not meet the conditions of medical assistance to give aid or unauthorized increase in the standard of medical assistance;
(C) to help or work with others to fraudulently obtain medical assistance funds;
(D) embezzlement, misappropriation, misappropriation, retention, fraudulent collection of medical assistance funds.
Article 31 The civil affairs department shall sign an agreement with the designated medical institutions, clear responsibilities, rights and obligations of both parties, and strictly fulfill.
The implementation of medical aid instant settlement of the fixed-point medical institutions, should carefully check the identity of the aid recipients and the relevant documents, the impostor generated by the diagnosis and treatment costs, medical aid funds will not be settled.
The fixed-point medical institutions and medical personnel in the diagnosis, treatment, prescription and other medical links of fraud, help fraudulent medical assistance funds, the unit and individual responsibility, and in the medical assistance funds to be deducted. If the situation is serious, the relevant departments to deal with the law, cancel the qualification of designated medical institutions.
Article 32 The applicant has a false behavior, once found not to help, the fraudulent medical assistance funds recovered in full. If the situation is serious, the relevant departments shall deal with it according to law.
Serious interference with the normal working order of the medical assistance management organization, violation of the legitimate rights of the staff, by the relevant departments to pursue legal responsibility.
Article 33 of the county-level civil affairs departments to make the decision not to approve the medical assistance is not satisfied, you can apply for administrative reconsideration or administrative litigation.
Chapter VII Supplementary Provisions
Article 34 Each region shall, in accordance with these Measures, formulate specific implementation measures or implementation details.
Article 35 These Measures shall come into force on April 1, 2012, valid until April 1, 2017.