The medical insurance funds mentioned in these Measures include basic medical insurance (including maternity insurance) funds and medical assistance funds. Article 3 The supervision and management of medical insurance funds shall adhere to the principles of supervision according to law, efficient coordination, openness, convenience and safety. Article 4 The people's governments at or above the county level shall strengthen their leadership over the supervision and management of medical insurance funds, and the relevant work funds shall be included in the fiscal budget at the corresponding level; Establish and improve the medical insurance fund supervision and management mechanism and law enforcement system, and strengthen the capacity building of medical insurance fund supervision and management. Article 5 The administrative department of medical security of the people's government at or above the county level shall be responsible for the supervision and management of the medical security fund within its administrative area, and other relevant departments shall do relevant work according to their duties. Article 6 Any organization or individual has the right to report and complain about the illegal acts of the medical insurance fund, and the relevant departments and units shall promptly handle them according to law. Chapter II Raising and using Article 7 The basic medical insurance fund shall be co-ordinated at the municipal level and gradually at the provincial level; The medical assistance fund is arranged by the government budget as a whole, and the overall level is coordinated with the basic medical insurance fund.
The medical insurance fund shall be included in the financial special account management, earmarked for special purposes, and budget performance management shall be implemented. Eighth workers, urban and rural residents to participate in the basic medical insurance according to law, pay the basic medical insurance premium, not to participate in insurance.
Medical assistance objects to participate in the basic medical insurance for residents of individual contributions, can be subsidized by the medical assistance fund. Article 9 The tax department shall collect the basic medical insurance premium in full and on time according to law, and timely and accurately feed back the information such as collection to the medical insurance agency through the information sharing platform. Article 10 The medical security administrative department of the people's government at or above the county level shall implement the list system of medical security benefits, and implement catalogue management of medical security drugs, diagnosis and treatment items and medical service facilities.
Insured persons shall enjoy medical security benefits according to regulations and shall not enjoy them repeatedly. Eleventh medical institutions and pharmaceutical business units that have signed a service agreement (hereinafter referred to as designated medical institutions) shall fulfill the service agreement and use the medical security fund according to law. Twelfth to establish a multi-channel long-term care financing mechanism. Long-term care funds can be raised from the basic medical insurance fund according to a certain proportion or amount.
For the insured who applies for long-term care needs, if they meet the requirements after assessment, the nursing institution that signed the service agreement can provide nursing services according to the service agreement. Thirteenth designated medical institutions should implement the main responsibility for the use of medical insurance funds, improve the internal management system, strengthen the information construction of medical insurance, promote the application of electronic medical records and medical insurance electronic certificate, and provide quality and convenient services. Fourteenth designated medical institutions should improve the evaluation system of the use of medical insurance funds, regularly check the use of medical insurance funds in their own units, and promptly correct the use of medical insurance funds in violation of regulations. Fifteenth designated medical institutions shall, in accordance with the provisions of the state and province on centralized procurement of drugs and medical consumables, standardize the procurement behavior of drugs and medical consumables, settle the payment in time, and complete the agreed purchase quantity of the selected products in centralized procurement with quantity. Article 16 Individual accounts of basic medical insurance for employees can be used to pay the medical expenses incurred by the insured and their spouses, parents and children in designated medical institutions, as well as the expenses incurred by individuals in purchasing medicines, medical devices and medical consumables.
Personal accounts of employees' basic medical insurance shall not be used for public health expenses, physical fitness and health care consumption that are not paid by the medical security fund. Chapter III Handling and Service Article 17 The administrative department of medical security of the people's government at or above the county level shall strengthen the leadership over its medical security handling institutions and fund auditing institutions, and guide and supervise them to perform their duties according to law. Article 18 Medical insurance agencies shall establish and improve business, finance, information, safety and risk management systems, perform duties such as agreement management, fund allocation, treatment review and payment, improve the workflow of designated application, professional evaluation, agreement signing, agreement performance, agreement modification and agreement handling of medical insurance services, and implement online processing. Nineteenth medical insurance agencies should standardize the handling process, improve the direct settlement mechanism for medical treatment in different places, promote the online settlement of basic medical insurance, serious illness insurance, medical assistance and other expenses, and provide standardized and standardized medical insurance handling services. Twentieth medical insurance agencies should use data comparison, screening and other means to timely and accurately verify the insured payment, medical insurance benefits and other information. Twenty-first medical insurance agencies should sign a service agreement with designated medical institutions through consultation and negotiation, and stipulate the service content, payment methods, payment standards, total annual expenses and incentive and restraint measures.