Purpose
Through the implementation of the new rural cooperative medical system, to further enhance the awareness of rural residents of mutual ****ji, improve the health of the majority of rural residents, to promote rural economic development, regulate the contradiction between the supply and demand of medical services, standardize the behavior of medical units, to curb unreasonable growth in the cost of health care services, to improve the utilization rate of health resources, and to maximize the participation of the rural residents. Benefit.
Second, the implementation of time
New rural cooperative medical care according to the implementation of the annual operation, rural residents in the prescribed time limit for payment of individual participation in the new rural cooperative medical care.
Implementation year refers to the operation of the new rural cooperative medical system cycle, each year for a cycle of operation, that is, from January 1 to December 31 each year for an implementation year.
Payment time limit refers to the government organization, guide the county rural residents to participate in the new rural cooperative medical care to raise individual contributions, also refers to the rural residents to pay the new rural cooperative medical care individual contributions, the county new rural cooperative medical care system provides for the time limit for the payment of individual contributions for the first month of this year, the county's rural residents must be within this time limit in accordance with the implementation of the program provides the standard of payment of individual contributions in full. Part of the funds, the implementation of the start of the year, is not allowed to return the paid funds or make up individual funds to participate in the new rural cooperative medical care.
Three, the object of participation and its rights and obligations
(a) the object of participation:
Anyone who does not enjoy the basic medical insurance for urban workers, urban residents of the basic medical insurance of the county's residents in rural areas, can be voluntary participation in the family as a unit. The county uniformly issued documents, a household a card, with a card, the participation cycle is calculated on a yearly basis.
(2) Rights:
Participating rural residents have the right to compensation for medical expenses in accordance with the provisions of the right to supervise the use and management of the cooperative medical fund; the right to the cooperative medical management institutions, agencies and their staff to put forward comments and suggestions; the right to the medical services provided by the designated medical institutions to put forward criticisms and complaints.
(3) Obligations:
Participating rural residents consciously abide by and maintain the rules and regulations of cooperative medicine and the relevant provisions; pay the participation fees in full and on time; actively cooperate with the designated medical institutions to carry out health care services; and supervise the work of the cooperative medicine management institutions, the operating institutions and the designated medical institutions and their staff.
Fourth, the new rural cooperative medical compensation mode
Inpatient co-ordination "outpatient co-ordination
Fifth, hospitalization co-ordination compensation program
1, the starting line, the compensation ratio:
Name of the institution hospitalization compensation ratio of the hospitalization starting line inpatient capping line
Township 85% 100 yuan cumulative 100,000 yuan
County level 75%-78% 300 RMB 100000 RMB cumulative
Municipal level 65% 1800 RMB cumulative 100000 RMB
Provincial level 55% 2500 RMB cumulative 100000 RMB
Out-of-province tertiary level 40% 4000 RMB cumulative 100000 RMB
Explanation: 1. The same enrolled rural residents shall be deducted again for hospitalization due to a different disease in the same year. hospitalized again for treatment, the starting line should be deducted again; for the same disease, such as malignant tumors, hospitalized several times for continuous treatment, from the second hospitalization in the same year, the starting line is no longer deducted;
2. On the basis of compensation for normal births within the plan in the national hospital delivery subsidy program, the New Rural Cooperative will again subsidize the standard of 300 yuan per case, and selective cesarean sections will be subsidized according to normal births, and pathological cesarean sections will be subsidized according to normal births. The subsidy for elective caesarean section is given on the basis of normal delivery, and the fixed compensation for pathologic caesarean section is 700 yuan.
3. Medical treatment for major diseases
The medical treatment for children with congenital heart disease, leukemia, women with cervical cancer, breast cancer, severe mental illness, end-stage renal disease, kidney dialysis, multidrug-resistant tuberculosis, opportunistic infections of AIDS, lung cancer, esophageal cancer, gastric cancer, intestinal cancer, rectal cancer, chronic granulocytic leukemia, acute myocardial infarction, cerebral infarction, hemophilia, type I diabetes, hyperthyroidism, cleft lip and palate, etc. will be provided according to the standard of 300 yuan per case, and selective cesarean section will be subsidized according to normal delivery, and pathological cesarean section will be compensated at a fixed amount of 700 yuan. Cleft lip and palate and other medical treatment in accordance with the implementation of the program issued by the Health and Family Planning Commission.
4, in accordance with the Hebei Provincial Department of Health "on the full play of traditional Chinese medicine in the new rural cooperative medical care in the notice" Article 3 "reasonably reduce the county-level designated traditional Chinese medicine (traditional Chinese and Western medicine) hospitals to compensate for the starting line of the New Rural Cooperative Medical Care. In principle, the starting line between the county-level designated medical institutions and township health centers", Li County Hospital of Traditional Chinese Medicine reimbursement starting line set at 200 yuan.
5, in accordance with the relevant provisions of Baoding City: the implementation of provincial fees and charges of municipal hospitals can be treated as provincial fixed-point.
(I) Scope of Compensation
(1) The diagnostic and treatment expenses incurred by participating rural residents who are hospitalized in designated medical institutions and referral medical institutions due to natural diseases or accidental injuries without a responsible person shall be reimbursed in accordance with the "Hebei New Rural Cooperative Medical Care Diagnostic and Treatment Items Compensation Provisions", except for the non-compensable and price-limited compensation items, according to the "Hebei New Rural Cooperative Medical Care Reimbursement Medicines Dictionary (2014 Edition)". Catalog Dictionary (2014 Edition)" and "Hebei Province Medical Service Diagnostic and Treatment Program Specifications and Service Prices" shall be compensated.
All the medicines in the National Essential Drug List (2012 Edition) are included in the reimbursement catalog of the New Rural Cooperative Medical Care, and 95% of the reimbursement ratio for essential medicines is carried out by the designated medical institutions at the township level, while the reimbursement ratio for hospitalization at the county level and above is increased by 10 percentage points. In order to support the national Chinese medicine cause, the reimbursement ratio for Chinese medicine (including: proprietary Chinese medicines, Chinese medicine tablets, Chinese medicine diagnostic and therapeutic items, and Chinese medicine preparations included in the reimbursement catalog of the New Rural Cooperative Medical Care) has been increased by 5 percentage points. The reimbursement percentage will not be increased repeatedly for basic medicines and Chinese medicines.
2. If a newborn child born under a planned delivery is not within the time limit for payment of fees, and enjoys the New Rural Health Cooperative treatment with his/her participating parents, the reimbursement costs incurred by one of his/her parents will be calculated together, and the maximum reimbursement can be made up to the one-person ceiling line. Newborns are exempted from the payment of the year's participation fees, not counted as the number of participants in the year, the financial subsidies at all levels of finance will not be additional funds;
3. Compensation for accidental injuries, in accordance with the "Hebei Province, the new rural cooperative medical care program compensation provisions" regulations are carried out.
4. For medical institutions outside the province, by inquiring whether they are non-profit medical institutions, for-profit medical institutions will not be exempted, and non-profit institutions will be exempted according to the standard of the third level outside the province; the third level outside the province refers to the third level outside the province and the third level above medical institutions.
5. Rural residents hospitalized in designated medical institutions in neighboring counties will be exempted from reimbursement according to the compensation standards of designated medical institutions of the same level within the county, and the terms of the agreement will be strictly enforced.
6. If a participant resides in a foreign country, after registering for foreign medical treatment at the New Rural Cooperative Medical Institution in the participating county, the medical expenses incurred in the New Rural Cooperative Medical Institutions in the foreign country will be compensated in accordance with the provisions of the New Rural Cooperative Medical Institutions in the participating county.
7, one of the following cases, the new rural cooperative to participate in the actual payment of rural residents as the basis for compensation program to give compensation: ① receive medical services have special funds to subsidize; ② receive medical services have medical institutions to reduce or waive the cost of medical services;
(b) the scope of the non-compensable:
Province is not in the list of designated medical institutions in Hebei province Medical institutions are not included in the scope of exemption; medical expenses incurred by participating farmers in outpatient and inpatient care at designated medical institutions and referral medical institutions are subject to the non-compensable and price-limiting compensation items stipulated in the Provisions on Compensation for Diagnostic and Treatment Items of the New Rural Cooperative Medical Care in Hebei Province.
VII. Procedures for compensation of hospitalized medical expenses
(1) Hospitalization compensation: When a participating rural resident is discharged from a designated hospital at county and township levels in the county, he/she shall hold his/her Cooperative Medical Care Certificate, ID card or household registration book, diagnostic certificate, certificate of discharge, list of hospitalized medical expenses (printed on a microfabricated machine), and fee receipt (printed on a microfabricated machine) to the hospital's Cooperative Medical Care Reporting Office to receive the compensation. A certificate of referral from the county cooperative medical center is also required for discharge from designated hospitals above the municipal level.
(2) participating rural residents in the reported fixed-point medical institutions to report the cost of exemption by the medical institutions of temporary advances: reported exemptions by the township new rural cooperative offices (village-level fixed-point medical institutions), the county joint management center audit, the county financial sector review, the bank verified that should be reported exempted from the cost of direct payment to the account of fixed-point medical institutions. The relevant personnel of the designated medical institutions shall fill in the "cooperative medical certificate" carefully according to the regulations, and the expenses for irregularities caused by laxity in the examination and checking of the designated medical institutions shall be borne by the designated medical institutions.
Eight, to participate in the new rural cooperative medical care and referral regulations
(a) fixed-point medical care, medical care with a card: participating rural residents must hold a cooperative medical card at all levels of fixed-point medical institutions, so that the cost of the computer management system, the implementation of the hospital that report, due to the person does not provide the required documents in accordance with the provisions of the resulting compensation is not timely by my responsibility.
(2) referral provisions: participating rural residents can independently choose the integrated area of the New Rural Cooperative designated medical institutions for medical treatment. Because of the condition of the need for referral, by the county designated medical institutions (the county specified hospitals) for timely referral procedures, and by the patient or his family members to the county-level agencies for the record. If the referral and filing procedures cannot be handled in a timely manner due to special reasons such as emergency, critical or serious conditions, the participating New Rural Cooperative Medical Institutions shall be notified in a timely manner and the relevant procedures shall be completed within 5 days. Participating rural residents who are hospitalized for normal referral procedures shall be compensated in accordance with the 2014 New Rural Cooperative Medical Care Hospitalization Coordination Compensation Program. For those who are directly hospitalized in a medical institution outside the county without being referred by a county-level medical institution, the compensation will be reduced by 20% on top of the compensation ratio of that medical institution.
If you fall ill while you are away from home on business, you can be admitted to the nearest public, non-profit, microcomputerized medical institution for treatment, and within five days, you can call the cooperative management center to inquire about the regulations on medical treatment outside the county, and then register with the cooperative management center to go through the referral procedures.
Nine, supervision and management
(A) management and supervision of the fund:
The rural cooperative medical fund is managed in accordance with the principles of determining expenditures on the basis of revenues, balancing revenues and expenditures, and openness, fairness, and impartiality, and is managed in accordance with the principles of keeping a separate account, storing in a special account, and using the money for specific purposes, and is not to be squandered or misappropriated.
The cooperative medical supervision committee examines and audits the financial accounts of the cooperative medical care once every six months, and the county cooperative medical care management center carries out sample audits of medical units from time to time and comprehensively examines prescriptions, medical records and reimbursement procedures, and analyzes and evaluates the cooperative medical care fund of the whole county. The county cooperative medical care management center and township cooperative medical care offices regularly report to the cooperative medical care management committee on the income, expenditure and use of the cooperative medical care fund, and take the initiative to accept the supervision of the audit, finance, discipline inspection and supervision departments, and make the income and expenditure and use of the situation in the government affairs open board open to the public every month to accept the supervision of the masses.
(2) Management and supervision of medical service organizations:
County, township and village cooperative medical institutions, accepting the management of the county cooperative medical management committee, and accepting the cooperative medical supervision committee and public supervision.
1, the designated medical institutions should provide timely and effective diagnostic and treatment services for the participating rural residents, comply with the rules and regulations of cooperative medicine, strictly grasp the principles of treatment, adhere to the rational use of medication, reasonable treatment, designated medical institutions at all levels should strictly implement the "Hebei Province, the new rural cooperative medicine reimbursement drug directory dictionary (2014 version)", "Hebei Province, the new rural cooperative medicine diagnostic and treatment program compensation regulations", all charges are strictly implemented the national regulations. ", the charges are strictly implemented in accordance with national regulations, the use of uniform prescriptions, bills and related forms, strict control of prescribing generous, indiscriminate inspection, irrational use of drugs, indiscriminate charges and other unreasonable phenomena, consciously accept public supervision. Strict implementation of the "designated medical institutions service agreement", do a good job of the new rural cooperative medical "hospital discharge report" work, monthly publicity, and accept social supervision.
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