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The qualification audit process of urban basic medical insurance designated medical institutions
According to the Interim Measures for Basic Medical Insurance for Urban Employees in Xi'an (Municipal Development [1999] No. 138), Interim Measures for Basic Medical Insurance for Urban Residents in Xi'an (Municipal Development [2007] No. 141) and the Interim Measures for Management of Designated Medical Institutions of Urban Employees in Xi'an and other relevant documents, we hereby introduce the qualification audit process of designated medical institutions as follows:
I. Interim Measures for the Management of Designated Medical Institutions" and other relevant documents, the qualification process of designated medical institutions is introduced as follows:
I. Conditions to be possessed by designated medical institutions
1. In conformity with the overall planning of designated medical institutions for basic medical insurance;
2. Abiding by the national laws, regulations and standards on the management of healthcare services, and having a sound and complete medical service management system;
3. Strictly implement the pricing policies of medical services and medicines stipulated by the national, provincial and municipal price management departments, and pass the supervision and inspection by the price management departments;
4. Strictly implement the Interim Measures for Xi'an City Urban Workers' and Residents' Basic Medical Insurance, the Interim Measures for Xi'an City Residents' Basic Medical Insurance and the relevant policies and regulations, and establish a system of cooperation with the urban workers and residents medical insurance management, and established an internal management system compatible with the management of urban workers and residents medical insurance.
5. Specialized institutions have been set up to provide basic medical insurance services and are equipped with the necessary management personnel, as well as computer networking capabilities and conditions.
Two, reporting information
1, willing to assume the basic medical insurance designated services for medical institutions, the city of human resources and social security administration to submit a written application and fill out the "Xi'an City, urban workers (residents) basic medical insurance designated medical institution application form";
2, provide the medical institution license to practice (copy), the organization code certificate, Fee license and the original certificate of legal personality and its copy;
3, a list of large-scale medical instruments and equipment;
4, the number of employees, the number of various types of professional and technical personnel and the structure of the title;
5, the previous three years of business income and expenditure and outpatient, inpatient consultation and treatment services (including the number of outpatient visits, the average cost of medical care for each visit, the number of hospitalizations, the average number of hospital days, the average number of hospitalization, the average number of hospitalization days, the average number of hospitalization days, the average medical care services per person). Inpatient days, average per person inpatient medical fees, average daily inpatient medical fees, etc.);
6. Proof of compliance with the standards for accreditation of medical institutions (level);
7. Proof of compliance with the supervisory inspections by the drug supervision and management and pricing departments;
8. The following statements for the year of application: Table 1 of the Comprehensive Statistical Table for Primary Health Care Units;
9, Proof of payment of health insurance premiums for the most recent period (a copy of the invoice or a copy of the participation certificate).
Three, the review process
1, data review: meet the reporting conditions of the medical institutions required to submit the relevant reporting information, Xi'an City, human resources and social security administrative department of the declaration of information for initial review, in line with the conditions of the fixed, complete reporting information, acceptance of the application for fixed.
2, field examination: the preliminary examination of qualified, by the Xi'an City, human resources and social security administrative departments to arrange time for a unified field examination, the inspection team by the municipal human resources and social security administrative departments, health insurance agencies and information centers **** with the composition.
3, preliminary evaluation: after the field examination, the Xi'an human resources and social security administrative departments in accordance with the provisions of the information review and field examination on the basis of the preliminary opinion of the list of medical institutions with the qualification of designated services, reported to the Xi'an Municipal Bureau of Human Resources and Social Security Bureau of the Board of Directors to study and finalize.
4. Confirmation and announcement: After being considered and approved by the Bureau Council of Human Resources and Social Security Bureau of Xi'an, the Bureau of Human Resources and Social Security Bureau of Xi'an will issue a document to determine the designated medical institutions, issue the certificate of qualification of designated medical institutions and announce it to the society.
Attachment 1, Xi'an municipal workers' basic medical insurance designated medical institution application form
2, Xi'an municipal residents' basic medical insurance designated medical institution application form
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