(a) the financial sector in accordance with the region to carry out urban medical assistance needs and financial ability to pay, in the annual budget arrangements for urban medical assistance funds. Specifically, including: the central financial aid funds, the provincial level according to the central financial aid amount by 1:1 ratio of funds, the city (prefecture), county (city, district) financial not less than the provincial subsidy funds 1:1 ratio of urban medical aid funds. City (prefecture) and the jurisdiction of the specific proportion of commitment by the city (prefecture) government to determine.
(b) the province, city (prefecture), county (city, district) from the welfare lottery public welfare funds retained for local use in accordance with a certain proportion or a certain amount of funds for urban medical assistance;
(c) the community donated for urban medical assistance in the endowment funds;
(d) the formation of the urban medical assistance fund interest receipts;
(e) According to the regulations can be used for urban medical assistance other funds.
Provincial subsidies are allocated by the Department of Finance, Civil Affairs Department in accordance with the number of urban medical assistance, financial situation and the effectiveness of the work and other factors to determine.
Second, the scientific and reasonable development of aid standards
The counties (cities, districts) civil affairs departments should be in accordance with the ability to do their best to do their best to live within their means, the principle of keeping expenditure within the limits of revenues and balancing revenues and expenditures, in conjunction with the health, labor security, finance and other departments of the region of the aid object of the previous year or the previous three years of the actual expenditure of medical expenses for serious analysis and calculation, scientific and reasonable determination of urban medical aid standards, and can be According to the actual income and expenditure of the city medical aid fund to adjust the standard of aid in due course.
After deducting the part of medical insurance that can be paid for by the aid recipients, the part that should be reimbursed by the unit and the part that should be reimbursed by the social mutual help, etc., the individual burden of medical expenses exceeding a certain amount or the medical expenses of special kinds of diseases will be given a certain proportion or a certain amount of subsidies. Specific subsidy standards are formulated by the civil affairs departments at the county (city and district) level in conjunction with the health, labor security and finance departments at the same level. In principle, the same city district, the same administrative area subsidy standards should be relatively consistent, for special difficulties of the personnel, may be appropriate to raise the standard of subsidies.
Local governments at or above the county level, civil affairs departments, health departments **** with the consultation, to determine the local relief object to provide medical assistance services to medical and health institutions, in principle, with reference to the local urban workers' basic medical insurance Class A medication directory, diagnostic and therapeutic items directory and medical service facilities directory to develop medical assistance object service standards.
The cumulative annual amount of medical aid subsidies for individual recipients should not exceed the local standard for medical aid, and should generally not exceed 4,000 yuan for the entire year.
Third, standardize the definition of the object of assistance
(a) the scope of the object of assistance:
The urban medical assistance object for urban residents of the minimum subsistence guarantee object, the specific conditions by the county (city, district) civil affairs departments, in conjunction with the health, labor security, finance and other departments and reported to the people's government at the same level for approval. Suffering from the state's special infectious diseases of special difficulties, according to the relevant provisions of the state to provide assistance.
1. Major disease relief. For those who suffer from serious illnesses and have difficulty in bearing the medical expenses, affecting the basic life of the family, assistance is provided within the stipulated amount of assistance. Localities according to the local actual situation, to determine the types of major diseases and aid standards, to determine the starting line of aid, the ceiling line and the payment ratio. Each place to determine the major illnesses generally should not be less than five.
2. Basic medical assistance. For suffering from major illnesses other than diseases or common diseases, medical expenses, affecting the basic life of the family, during the period of illness, the sick person himself to implement the classification of the limit subsidized assistance or protection of additional care, the amount of assistance is generally not more than 10% of the local urban minimum wage standard throughout the year.
3. Conditional localities can explore the way to solve the medical difficulties by subsidizing the aid recipients to participate in the urban workers' basic medical insurance and commercial insurance.
4. Special infectious diseases treatment. State regulations of special infectious diseases treatment costs, in accordance with the relevant provisions of the appropriate subsidies.
(B) the following cases are not entitled to medical assistance:
1. Fighting, traffic accidents, alcohol abuse, drug abuse, suicide, self-inflicted injuries, etc.;
2. Organ transplantation, dentistry, cosmetic surgery, orthopedics, prescription lenses, etc.;
3. Pre-marital checkups, health care, rehabilitation, etc.;
4. Unauthorized in non-designated medical institutions, Purchase of medicines or non-designated retail pharmacies;
5. People's governments at or above the county (city, district) level stipulate that other medical assistance should not be enjoyed.
Fourth, strict application, approval and issuance of urban medical assistance funds
Urban medical assistance funds should be strictly in accordance with the following procedures, the implementation of standardized reporting, approval and issuance:
(a) the person or the head of the household with the urban residents of the minimum subsistence guarantee vouchers, proof of domicile to the community committee of residents to submit a written application to fill out the "urban medical assistance application approval form", and provide truthful and accurate information. Approval Form", and truthfully provide proof of medical diagnosis, receipts for medical expenses, necessary medical history materials, participation in the basic medical insurance for urban workers or various commercial insurance subsidy vouchers, proof of social solidarity to help the poor, etc., by the Community Residents Committee to be publicized after deliberation, the public period of 7 days, no objections, by the Community Residents Committee reported to the street office (township people's government) for review.
(b) Street offices (township people's government) to take household surveys, neighborhood visits and letters for evidence, etc., on the applicant's medical expenses and family economic situation and other relevant information to investigate and verify the conditions of medical assistance within 15 days of the county (city, district) civil affairs department for approval.
(C) county (city, district) civil affairs departments of the street office (township people's government) reported the relevant materials for review and verification, and within 10 days to sign the approval opinion. After reviewing the conditions of medical assistance, approved its enjoyment of medical assistance amount, and entrusted the street office (township people's government), the community residents committee on the amount of assistance to be publicized, the publicity period of 7 days, the publicity of no objection, approved its enjoyment of medical assistance, and the issuance of the relevant vouchers; does not meet the conditions, the applicant shall be notified in writing, and explain the reasons.
(D) county (city, district) civil affairs departments to record the approved enjoyment of medical assistance personnel account, and reported to the same level of the financial sector review. After the county (city, district) civil affairs, financial sector review and determination, the city medical aid funds from the county (city, district) financial sector from the city medical aid financial account into the designated bank to pay directly to the aid recipients. Medical institutions may directly reduce or waive the medical expenses of the recipients of the assistance by the financial department or the civil affairs department to the medical and health institutions. When reviewing the amount of medical aid, the following expenses shall be deducted: the fees waived by medical institutions in accordance with the regulations; the fees subsidized by the unit or relevant department of the aid recipient suffering from a serious illness, the reimbursement of medical fees by the unit of the family member, and the funds given to the aid by mutual assistance from all sectors of the community; and the medical insurance premiums paid out by participating in the basic medical insurance, the major medical insurance, the supplemental medical insurance, and the various types of medical insurance, such as commercial insurance; Other expenses that should be deducted according to the regulations.
V. Strengthening the management of the urban medical aid fund
The urban medical aid fund should be used to subsidize the medical expenses of the aid recipients in accordance with the provisions of the fund shall not be withdrawn from the fund management fees or any other costs.
The city medical aid fund should be included in the financial account of the social security fund, the implementation of special accounting, special management, earmarked. County (city, district) financial departments in the social security fund financial account to establish a "special account of the city medical aid fund", for the collection of funds, accounting, payment and other business. The funds arranged by the county (city, district) financial budget are transferred to the "urban medical aid fund special account" of the financial department at this level on a quarterly or monthly basis; the lottery public welfare funds approved to be used for urban medical aid shall be transferred to the "urban medical aid fund special account" from the financial special account in a timely manner; the county (city, district) financial department shall establish a "urban medical aid fund special account" in the financial special account of the social security fund to handle the fund collection, allocation, payment and other operations. After receiving the subsidy funds from the higher level, the county (city or district) financial department shall promptly allocate the full amount to the "special account of the urban medical aid fund"; donations from all walks of life and other funds shall be deposited in a timely manner into the "special account of the urban medical aid fund" of the county (city or district) financial department in accordance with the principle of territorialized management. "
City medical aid fund special account.
The annual income and expenditure plan of the city medical aid fund is formulated by the civil affairs department of each place, and is reported to the people's government of the same level for approval and implementation after the audit by the financial department of the same level. Civil affairs departments regularly to the same level of financial departments and higher civil affairs departments to report the implementation of income and expenditure plan.
Six, increase supervision to ensure the safety of the fund
The city medical aid fund must be used entirely for urban medical aid object of medical expenses subsidies, any unit or individual shall not be retained, squeezed, misappropriation. Discovered false claims, misappropriation, embezzlement, corruption and waste of illegal and disciplinary behavior, in accordance with the relevant laws and regulations to deal with seriously. On the false declaration of the situation to fraudulently obtain subsidies from higher levels, the higher financial and civil affairs departments should reduce or stop allocating subsidies according to the situation.
The urban medical aid fund raising, management and use of the situation, as well as the aid object, the amount of aid and other information should be announced regularly to the community through the list of ways to accept the social supervision. County (city, district) civil affairs, finance, audit and other departments to monitor and inspect the use of urban medical aid fund, found that the problem should be corrected in a timely manner, and promptly report to the local people's government. Provincial Civil Affairs Department, the provincial Department of Finance will regularly or irregularly on the urban medical assistance work carried out in various places and the management and use of the fund to carry out random checks.
Municipalities (local) financial and civil affairs departments should start from the local actual situation, strengthen the guidance of the pilot areas of urban medical assistance fund financial management work, timely arrangement of subsidies, summarize and promote the pilot experience, to ensure that the pilot work is carried out smoothly.