(2) Comply with the laws, regulations, rules and regulations of the country, Guangdong Province and this city regarding the management of pharmaceutical services;
(3) Strictly implement the drug pricing policies stipulated by the country, Guangdong Province, and this city;
(4) Ability to supply medical insurance medications in a timely manner;
(5) During the business hours of retail pharmacies, the pharmaceutical technicians serving on duty comply with the requirements and regulations of the drug regulatory department;
(6) Commit to strictly implement the relevant policies and regulations of this city’s social medical insurance system, have a standardized internal management system, and be equipped with software and hardware equipment that meets the needs of social medical insurance.
Article 74 The municipal social insurance institution shall formulate and publish plans when selecting designated medical institutions and designated retail pharmacies. Medical institutions and retail pharmacies that apply for designated qualifications should submit applications to the municipal social insurance agency within the time specified in the municipal social insurance agency's announcement of the plan; the municipal social insurance agency should conduct a comprehensive assessment within 60 days and publish the assessment results. The top-ranked medical institutions and retail pharmacies are selected as designated medical institutions and designated retail pharmacies. Under the same conditions, medical institutions with larger scales, stronger technical capabilities, higher grades, and better integrity may be given priority to be designated as designated medical institutions.
Under the same conditions, pharmacies directly operated by drug retail chain enterprises, pharmacies that can provide services 24 hours a day, and retail pharmacies with good integrity that do not sell goods other than drugs and medical devices can be given priority to be designated as designated retail pharmacies.
Article 75 The municipal social insurance institution signs agreements with designated medical institutions and designated retail pharmacies, and manages them in accordance with the agreements.
The municipal social insurance agency shall conduct a credit rating assessment and publish the assessment results every two years based on the performance of the agreement by designated medical institutions and designated retail pharmacies.
The municipal social insurance agency will reward designated medical institutions, designated retail pharmacies and related staff based on the evaluation results, and the reward funds will be included in the departmental budget of the municipal social insurance agency.
Article 76 Designated medical institutions and designated retail pharmacies shall adhere to the principle of “treatment according to disease, reasonable examination, rational use of drugs, reasonable treatment, and charging according to regulations” and provide services to insured persons in accordance with the provisions of these Measures and the agreement. .
Article 77 Designated medical institutions should establish a system for separate accounting and separate management of medicines, standardize medical practices, strictly prohibit all kinds of billing and commission behaviors for profit purposes, and reduce the proportion of out-of-pocket expenses of insured persons in total medical expenses. , reducing the financial burden on insured persons.
Article 78 Designated medical institutions and designated retail pharmacies shall establish internal management systems and medical insurance working institutions that are compatible with the medical insurance system, and implement self-management and self-restraint.
Article 79 Designated medical institutions and designated retail pharmacies shall strictly implement government regulations on medical charging standards and drug prices and publish them.
Designated medical institutions should provide insured persons with documents such as a detailed list of outpatient charges or a detailed list of daily hospitalization charges.
Article 80 Designated medical institutions shall separately retain the insured’s prescriptions, large medical equipment inspection and treatment approval forms and reports, inspection and treatment orders, medical expense lists and other documents, and the retention period shall not be less than two years.
Designated retail pharmacies should keep separate prescriptions and detailed lists of drugs purchased by insured persons, and the retention period should not be less than two years.
Article 81 When providing medical services, designated medical institutions shall implement the relevant management regulations on the drug catalogue, diagnosis and treatment items, and medical service facility standards of basic medical insurance and local supplementary medical insurance.
When designated medical institutions use drugs, diagnosis and treatment items, and medical service facilities other than those specified in the preceding paragraph for insured persons, they shall inform the insured persons in advance and obtain their consent.
Diagnosis and treatment projects that designated medical institutions cooperate or contract with other units and individuals shall not be included in the scope of medical insurance accounting.
Article 82 Qualified physicians in designated medical institutions may provide medical insurance services to insured persons in accordance with the provisions of the agreement.
If a doctor violates the relevant provisions of medical insurance and causes losses to the medical insurance fund, the municipal social insurance agency may refuse to provide medical insurance services, announce the results to the public, notify the designated medical institution where he is located, and submit a request to the municipal health administrative department for handling according to law. suggestion.
Article 83 If an insured party uses a medical insurance personal account to purchase medicines from a designated retail pharmacy, the designated retail pharmacy shall conduct verification in accordance with the following provisions:
(1) When purchasing prescription drugs, check the valid prescription issued by a designated medical institution in this city, and the name of the patient recorded on the prescription is consistent with the social security card;
(2) Those who purchase over-the-counter drugs must hold their social security card and verify the valid prescription issued by a designated medical institution in this city, or their personal account accumulation must reach 5% of the average salary of employees in this city in the previous year.
Article 84 The actual medical expenses incurred by designated medical institutions and designated retail pharmacies in providing medical services to insured persons shall be settled with the municipal social insurance agency in accordance with the provisions of these Measures and the agreement.
The agreement signed between the municipal social insurance institution and designated medical institutions and designated retail pharmacies should stipulate settlement methods and reimbursement standards.
The settlement of medical insurance expenses adopts a compound payment system under total control.
Article 85 If the insured person transfers to a medical institution outside the city for medical treatment in accordance with the provisions of these Measures, and falls under the circumstances of Item (2) and (3) of Article 35 of these Measures, the hospitalization medical expenses incurred shall be borne by the municipal society. After the insurance institution reimburses the patient at a rate not higher than the city's medical charging standards, it will then settle the bill with the hospital transferring out of the city according to the method agreed upon in the agreement.
Article 86 The municipal social insurance institution shall agree on the reimbursement standard with the designated medical institution, and reward the portion of the actual medical expenses of the designated medical institution that is lower than the agreed reimbursement standard according to the agreement, and the expenses shall be disbursed from the medical insurance serious illness overall fund.
If there is a balance in the community outpatient overall fund, the balance will be awarded to the settlement hospital in proportion, and the rest will be carried forward for use in the next year.
Chapter 7 Supervision and Inspection
Article 87 The municipal social insurance institution shall establish and improve the financial system of medical insurance funds and announce the income and expenditure of medical insurance funds to the public.
Article 88 The income, expenditure, management and use of social medical insurance funds shall be included in the scope of supervision of the Municipal Social Insurance Fund Supervision Committee. The municipal finance and audit departments shall conduct regular audits on the income, expenditure, carryover and management of medical insurance funds in accordance with the law, and report the audit results to the Municipal Social Insurance Fund Supervision Committee.
Article 89 Health administrative departments and public hospital management agencies at all levels shall supervise and manage designated medical institutions, and include the implementation of medical insurance regulations by designated medical institutions into the assessment content of the comprehensive target management of medical institutions and into the term of office of their responsible persons Target accountability.
Article 90 The municipal price management department shall determine
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