Shandong Jining new rural cooperative medical reimbursement?

On the unification of 2010 the city's new rural cooperative medical reimbursement compensation program notice Jining City Health Bureau Jining City Civil Affairs Bureau Jining City Bureau of Finance Jining City Bureau of Agriculture Jining City, Jining Wei Ji Women's hair [2009] No. 35 on the unification of 2010 the city's new rural cooperative medical reimbursement compensation program notice of the health bureau of the urban areas of the counties, civil affairs bureaus, financial bureaus, agricultural bureaus, the Jining Hi-Tech Zone Management Committee of the Bureau of Social Development, Finance Bureau, Jining North Lake Resort Management Committee Office, Finance Bureau: In order to fully implement the municipal government "on further deepening the implementation of the reform of the medical and health system" (Jifa [2009] No. 17), the municipal government "on the issuance of medical and health system reform in the near future focus on the implementation of the program (2009-2011) of the notice" (Jijinzhifa [2009] No. 30) the spirit. According to the Provincial Health Department, the Provincial Civil Affairs Department, the Provincial Department of Finance, the Provincial Department of Agriculture, "on the consolidation and development of the new rural cooperative medical system views" (Lu Wei Nongwei Fa [2009] No. 5) requirements, combined with the city's actuality, is now unified in 2010 the city's New Rural Cooperative reimbursement and compensation programs and other related matters are notified as follows. First, the financing standards in 2010, the new rural cooperative financing level increased to no less than 120 yuan per person per year, of which, the financial subsidies at all levels increased to no less than 100 yuan per person per year, the individual farmers contribute 20 yuan per person per year. In the provincial financial (including central subsidies) to the city of participating farmers per person per year subsidy of 45 yuan on the basis of municipal finance to Yanzhou City, Zoucheng City, Jining High-tech Zone participating farmers per person per year subsidy of 6 yuan, on the city of Central District, Rencheng District, Qufu City, Weishan County, Beihu Resort farmers per person per year subsidy of 10 yuan, on the Sishui County, Yutai County, Jinxiang County, Jiaxiang County, Wenshang County, Liangshan County, farmers per year subsidy of 24 yuan. Subsidies of 24 yuan per person per year, the balance of the county (city, district) level of finance to make up for the 2011, the new rural cooperative financing level increased to no less than 150 yuan per person per year, of which the subsidies at all levels of government of no less than 120 yuan per person per year, the individual farmer contributions of no less than 30 yuan per person per year. Encourage places in a position to do so to appropriately increase local financial subsidies and farmers' contribution standards in accordance with the financial situation and farmers' affordability. Second, the compensation model in 2010 the city continued to implement a unified hospitalization co-ordination plus outpatient co-ordination model. Outpatient co-ordination fund (including health check-up costs, etc.) accounted for the year the proportion of the total amount of fund-raising is generally not more than 35%, hospitalization co-ordination fund and the year the withdrawal of risk funds accounted for the year the proportion of the total amount of fund-raising is generally not less than 65%, of which the withdrawal of risk funds in accordance with the Provincial Department of Finance, the Provincial Department of Health, Lu CaiShe 〔2008〕 No. 18 document implementation. Third, hospitalization compensation 1, hospitalization starting line The establishment of four levels of starting line, first-class designated medical institutions for 100 yuan, second and third-class designated medical institutions for 500 yuan, designated medical institutions outside the city for 600 yuan. The starting line for hospitalization compensation is deducted from the expenses within the scope of compensation and is not compensated. Participating farmers who are hospitalized in the same hospital will only have the starting line deducted once in a year.2. Hospitalization Compensation RatioThe reimbursement and compensation ratio of the first-level designated medical institutions is 65%, the reimbursement and compensation ratio of the second-level designated medical institutions is 55%, the reimbursement and compensation ratio of the tertiary-level designated medical institutions is 45%, and the reimbursement and compensation ratio of the provincial-level designated medical institutions is 35%. Counties (cities and districts) may fluctuate on this basis, but not more than 5%. When calculating the actual amount of compensation for participating farmers, the reimbursable expenses minus the amount of the starting line should be applied and then compensated according to the prescribed compensation ratio. Guaranteed compensation is implemented, and the actual compensation ratio for hospitalization at county-level and above medical institutions is no less than 25%. For the non-referral record, in the province outside the city of new rural cooperative designated medical institutions hospitalization can be compensated according to the stipulated compensation ratio of 60%; without the referral record of out-of-province medical treatment and non-designated medical institutions in the province (except for the participating migrant workers in the workplace medical treatment and emergency) will not be compensated. 3, the participating pregnant women hospitalized in the delivery of a fixed amount of compensation for delivery of 200 yuan. Cesarean section deliveries are still subject to the requirements of the "Four Unified and Four Defined" management methods. For medical expenses incurred by newborns born between the previous and the next payment period of the New Rural Co-operation, their mothers can enjoy the New Rural Co-operation reimbursement policy if they are enrolled in the program. 4. The hospitalization reimbursement ceiling is 50,000 yuan, and the hospitalization reimbursement ceiling is calculated cumulatively with the actual amount of reimbursement received in the current year. 5. Participating migrant workers on the construction sites and participating migrant farmers out of the hospital with sudden illnesses can seek medical treatment first, and then be notified by telephone within a week or before discharge. 6. The New Rural Cooperative Medical Institutions in the coordinated areas will be informed by phone before discharge, and the medical expenses incurred in hospitalization will be compensated with relevant certificates in accordance with the reimbursement ratio of the local designated medical institutions of the same level.6 The reimbursement ratio of the national basic medicines will be increased significantly, and the reimbursement ratio of the medicines in the list of basic medicines will be increased by 10%. Appropriately increase the proportion of compensation for traditional Chinese medicine services, the proportion of compensation for traditional Chinese medicine costs (excluding proprietary Chinese medicines) increased by 10%, and the proportion of compensation for hospitalized patients' acupuncture and other Chinese medicine appropriate technology treatment costs is 90%.7 Strengthening departmental cooperation, and doing a good job of effectively linking up the New Farmers' Cooperative Scheme with the Rural Medical Aid System in the areas of policy, technology, service management and cost settlement. At the county level, a unified service platform for the NIC and rural medical assistance was established, realizing the information***sharing of the two systems, and implementing a "one-stop" service for poor farmers to settle the NIC compensation and medical assistance subsidies on the spot at the medical institution after seeking medical treatment for the convenience of the poor farmers. Fourth, non-hospitalization compensation 1, outpatient compensation outpatient outpatient co-ordination generally in the new rural cooperative level and village-level designated medical institutions compensation (not included in the integration of rural health services management of village-level medical institutions shall not be designated as the new rural cooperative medical institutions), there is no starting line, outpatient costs are compensated at a rate of 20% of the outpatient expenses, per person per year outpatient reimbursement of compensation for the cost of the ceiling line of 50 yuan to the amount of the year to the actual amount of compensation cumulative calculation. Chronic disease compensation shall include the following diseases: hypertension (stage II), heart disease with cardiac insufficiency, cerebral hemorrhage and cerebral infarction recovery, rheumatoid arthritis, chronic active hepatitis, chronic obstructive pulmonary emphysema and pulmonary heart disease, epilepsy, hepatomegaly, uncompensated cirrhosis, diabetes mellitus with ineffective dietary control, chronic nephritis, Parkinson's disease, systemic lupus erythematosus and herniated intervertebral disc, Chronic pelvic inflammatory disease and adnexitis, tuberculosis, schizophrenia. Chronic diseases shall be identified by experts or prior medical record verification organized by the county-level new rural cooperative agencies. Patients with chronic diseases voluntarily choose a county-level designated medical institution to treat their chronic diseases and receive compensation at the county-level designated medical institution of their choice or at the county-level New Farmers' Cooperative Cooperative Organization, with a starting point of RMB 200 yuan, expenses below the starting point being compensated in accordance with outpatient compensation ratios, and compensation ratios above the starting point of 40% (nominal compensation ratios), with a cumulative annual cap of RMB 1,000 yuan (the amount of compensation received). Funds are paid out of the Outpatient Coordination Fund. The large outpatient treatment costs for special diseases such as malignant tumor radiotherapy, aplastic anemia, hemophilia, and organ transplantation anti-discharge treatment are implemented in accordance with the inpatient compensation of the same level of hospital. Patients with special diseases voluntarily choose a county-level designated medical institution for treatment and are compensated at the county-level designated medical institution of their choice or at the county-level New Farmers' Cooperative Organization, with a starting line of RMB 400 yuan; expenses below the starting line are compensated in accordance with the proportion of outpatient compensation, and expenses above the starting line are compensated in accordance with the compensation for inpatient treatment at the same level of hospitals. The annual cumulative cap line (compensation income) is 5,000 yuan. Dialysis treatment for chronic renal insufficiency and large outpatient treatment costs for leukemia are compensated in accordance with the inpatient compensation of the same level of hospitals, with a starting line of RMB 400 yuan, and an annual cumulative ceiling (compensation gain) of RMB 50,000 yuan. The above funds are expended from the Hospitalization Coordination Fund.3. Secondary CompensationSecondary compensation is not a regular compensation method and is not advocated; however, where the fund balance for the year or the cumulative fund balance for the past years is high, farmers who have received compensation for major illnesses in that year can generally receive secondary compensation, not only for a few farmers, and at the same time, the organization of publicity and publicity for secondary compensation should be done well, so as to avoid unnecessary comparison of treatment among participating farmers.4. At the same time, the organization, publicity and announcement of the secondary compensation should be done well to avoid unnecessary treatment of the participating farmers. 4. For the participating farmers who also participate in the commercial medical insurance or meet the cost concessions stipulated in other policies, the commercial insurance payout or concessions should be carried out first, and then the total medical costs of the participating farmers should be compensated in accordance with the provisions of the New Rural Cooperative Compensation Scheme. Fifth, continue to implement the "city a pass" system in order to further facilitate the participating farmers to the city at all levels of the new rural cooperative medical institutions to reimbursement, continue to implement the "city a pass" system, the City Health Bureau announced the city, county (city, district) and township-level new rural medical institutions in the city, county (city, district) and township-level new rural medical institutions. The city, county (city), district and township level new rural medical institutions are recognized by the municipal health bureau, and all participating farmers are no longer required to go through the referral procedures when they go to Jining City's new rural medical institutions at all levels for medical treatment. If a participating farmer is hospitalized in a mutually recognized New Rural Cooperative Medical Institution, he will be entitled to the same reimbursement rate of the New Rural Cooperative Medical Institution at the same level as that of the participating farmer's location. Sixth, clear scope of participation in accordance with the General Office of the Provincial Government "on the comprehensive promotion of new rural cooperative medical care pilot notice" (Lu Zhengban Fa [2007] No. 1), clearly define the scope of coverage of the New Rural Cooperative Medical Insurance and urban residents, to avoid duplication of participation (insurance). The principle of participation in the New Rural Cooperative Health Insurance on a household basis is strictly enforced, and participants should be registered as residents with agricultural household registration; where reform of the household registration system has been implemented, they can be defined as rural residents on the basis of the family planning policies, veterans' resettlement policies and urban low income insurance policies enjoyed by their families. Primary and secondary school students and preschool children with rural household registration should participate in the New Rural Cooperative Program with their parents. Strengthening supervision and management to ensure standardized operation Strictly implement the basic drug list, diagnostic and treatment items list and antibiotic use guidelines and other relevant provisions of the New Rural Cooperative Medical Care, reasonable examination, reasonable treatment, gradient medication, reasonable dispensing, no abuse of medication, prescribing large quantities of prescriptions. Discharged patients should be discharged from hospitals with medicines in accordance with the prescription regulations, and the amount of medicines discharged from hospitals for general acute diseases should not exceed 7 days' dosage, and that for chronic diseases should not exceed 15 days' dosage. The implementation of a system of mutual recognition of examination results by medical institutions; if a higher-level hospital has already conducted an examination and issued a report on the results, the lower-level hospital should recognize it, and the reports on the results issued by hospitals at the same level should be mutually recognized to avoid duplication of examinations. An out-of-catalog medication and diagnosis and treatment notification system has been implemented, and the proportion of out-of-catalog medication costs to total medication costs in villages and first-, second- and third-level designated medical institutions is no higher than 5%, 10%, 15% and 20%, respectively. Supervisory departments of the New Rural Cooperative at all levels shall implement a system of notification of average hospitalized medical costs and warning and admonition, and regularly publicize the medical costs of New Rural Cooperative designated medical institutions in an appropriate manner. County (city, district) new rural cooperative management department, the new rural cooperative designated medical institutions at all levels to develop specific measures to strengthen the audit management of the cost of consultation, to put an end to the new rural cooperative fund irregularities in expenditure, violation of the management of the new rural cooperative provisions, the cancellation of the qualification of the new rural cooperative designated medical institutions and in accordance with the relevant provisions of the relevant responsible person seriously dealt with. Eight, the instructions 1, the city's unified reimbursement compensation program since January 1, 2010 onwards. 2, in the city continue to implement the new rural cooperative medical care "four unity, four fixed" and "four one" management approach. 3, the counties and municipalities every six months to organize at least a New rural cooperative supervision committee member units to participate in the supervision and inspection, in order to ensure the safety of funds. 4, this notice is not exhaustive, should be in accordance with the Provincial Department of Health, Provincial Department of Civil Affairs, Provincial Department of Finance, Provincial Department of Agriculture, "on the consolidation and development of the new rural cooperative medical care system of views" (Lu Wei Agricultural and Health Development 〔2009〕 No. 5) regulations. December 3, 2009