Chapter I General Provisions
Article 1
In order to further improve and perfect the county urban and rural medical assistance system, to solve the problem of the difficult masses of people to seek medical treatment, and to ensure the healthy development of medical assistance work in the county, according to the Xiangminban Fa [2008] No. 60, "on the adjustment of the urban and rural medical assistance policy to improve the urban and rural medical assistance system of the notice" spirit, combined with the actual situation of the county, hereby formulates The implementation of the rules.
Second
The scientific concept of development as a guide to the spirit of the 17th National Congress of the CPC as a guide, in accordance with the "emergency relief, simple and easy to implement, highlight the key points of the classification of relief, government-led, social participation, integration and coordination, *** with the promotion of the principle of", and do a good job of connecting with the various medical insurance based on the comprehensive innovation of the county's On the basis of the good connection with various medical insurance, comprehensive innovation of our county's medical aid mechanism, the establishment of "subsidized enrollment, outpatient medical aid, hospitalization medical aid, temporary medical aid, charitable medical assistance," a five-in-one medical aid system, to ensure that urban and rural people in difficulty in the county, "everyone has access to basic medical and health services. "
Secondly, the second is to ensure that all people in urban and rural areas have access to basic health care.
Chapter II work organization
Article
County Social Aid Administration for the county urban and rural medical aid approval management; township civil affairs office is responsible for the local medical aid and part of the work of the aid; villages (neighborhood) commissioned by the medical aid management authority is responsible for assisting to do a good job of medical aid work in the area.
Article 4
The county health bureau and the county labor and social security bureau are the administrative organs of the rural medical aid recipients' enrollment and their medical compensation, and the urban medical aid recipients' enrollment and their medical compensation, and they shall, within their respective scope of duties, actively cooperate in the medical aid work of the urban and rural residents in difficulty.
The third chapter of the medical assistance service institutions
Article 5 of the designated medical assistance service institutions shall hold a legal medical license and medical institutions to apply, by the county civil affairs bureau, the county health bureau review and qualified and awarded by the county civil affairs bureau as a designated medical assistance service institutions.
Article 6
Designated medical aid service institutions shall be standardized in accordance with the basic standards of medical aid service institutions in the county and the unified standards stipulated by the administrative department of health, and shall carry out medical aid work in accordance with the rules and regulations and work duties formulated by the county medical aid management department. In accordance with the policy of the development of relief-oriented preferential standards, preferential measures and to be publicized, and accept social supervision.
Article 7
The basic treatment and medication used by the medical aid service organizations for the needy shall be in accordance with the drug catalog of the medical insurance and the relevant regulations of the medical aid management organizations. The county civil affairs department, together with the county health bureau and the labor and social security bureau, shall regularly and irregularly inspect and supervise the designated medical institutions.
The fourth chapter of medical assistance objects
Article 8 of the county urban and rural medical assistance objects for all urban and rural residents of the county household registration, residing in the territory of the county of the following people:
(a) urban residents of the minimum subsistence guarantee objects.
(2) Rural residents of the minimum subsistence guarantee recipients.
(3) Rural five guaranteed objects.
(4) Centenarians and other people with special difficulties.
Article IX such as major epidemic diseases and other public **** medical emergencies, the need for civil affairs departments to give medical assistance, according to the relevant policies of the higher levels to give emergency medical assistance.
Chapter V medical assistance content, standards and procedures
Article 10 according to the medical needs of the various types of assistance, the establishment of subsidies for enrollment, hospitalization medical assistance, outpatient medical assistance, temporary medical assistance, charitable assistance in five kinds of assistance.
Article 11 subsidized participation in the insurance
I. Subsidized participation in the new rural cooperative medical care.
(A) subsidized objects: rural five guarantees and special hardship rural low-income objects.
(2)
Subsidy standard: rural five-guarantee households by the county civil affairs department unified full funding to participate in; rural low-income households in the loss of working capacity of the seriously ill, seriously disabled households individual contributions by the Rural Medical Aid Fund in accordance with the standards set out in the year classified subsidies and personal **** with the same commitment.
(3)
Procedure: during the annual participation time, the township civil affairs office according to the county social assistance management agency approval approved objects, and the township co-management office, unified for the township subsidized participation in the enrollment of the object of the enrollment formalities, the funds required through the county financial unified allocation to the new rural co-operation fund on the special account of the treasury, and by the township co-management office to issue the "Anxiang County, a new type of rural cooperative medical certificate". The new rural medical card is issued by the township cooperative management office.
(4)
Assisted recipients enjoy the same medical compensation treatment for the New Rural Cooperative Medical Care as other rural participants in accordance with the relevant provisions of the New Rural Cooperative Medical Care. Rural five-guaranteed households who are hospitalized in designated medical institutions within the county are not subject to a starting line, and the reimbursement ratio is increased, i.e., 90% reimbursement for first-class hospitals and 80% reimbursement for second-class hospitals within the county, and accidental injuries to non-responsible parties are reimbursed in accordance with the ratio of reimbursement for hospitalization. For rural five-guarantee recipients who seek medical treatment outside the county, the reimbursement rate will not be increased.
Two, subsidized participation in the basic medical insurance for urban residents
(a) Subsidized objects: urban "three no" households and urban low-income households with serious illnesses and disabilities.
(2) Subsidy standard: the individual contribution of the objects belonging to the scope of subsidy will be subsidized by the medical aid fund in accordance with the standards stipulated in the current year, and the subsidies will be categorized for their participation in the insurance.
(3) Procedures: After the civil affairs department validates the object and the subsidy standard, the urban low-income objects in accordance with the provisions of the county medical insurance office, in the processing time, to the corresponding institutions in the location of their household accounts (township government or community), to present a valid "urban low-income certificate". The payment of fees will be reduced according to the standard approved by the civil affairs department, and the relevant registration will be made. After the completion of the annual enrollment work to the township (community) statistics will be funded to participate in the list of objects and enrollment vouchers sent to the county civil assistance management agencies, after review, all the funding of the object of funding through the financial allocation of urban residents medical co-ordination fund financial account, the funding in the medical assistance fund.
(5) the subsidized objects according to Anxiang County urban residents basic medical insurance relevant provisions and other urban residents basic medical insurance enrolled in the same object, enjoy the urban residents medical insurance medical compensation treatment.
Thirdly, the standard of subsidized enrollment can be adjusted on an annual basis according to the relevant national policies and the actual operation of medical assistance.
Article 13 outpatient medical assistance
I. Daily outpatient assistance
(1) Objects of assistance: rural five-guaranteed households, the urban three have-nots, urban and rural low-income recipients of incapacity to work for the severely disabled and need to be maintained for a long period of time for the treatment of the seriously ill out-of-hospital, and the elderly over 100 years of age.
(2)
Relief standard: The relief objects are issued with a Daily Outpatient Relief Card of not less than 50 yuan per year by the county medical assistance management authority for outpatient treatment and purchase of medicines. Expenses incurred within the limit will be advanced by the designated medical institutions or designated pharmacies, and the urban and rural medical aid fund will settle the bill with them on a regular basis.
Special Chronic Disease Outpatient Relief
(1) Objects of Relief: Rural five-guaranteed households and urban and rural low-income households.
(2) relief diseases: advanced cirrhosis, cerebrovascular accident (hemiplegia), mental illness, lupus erythematosus, Parkinson's disease, epilepsy, chronic renal insufficiency, advanced schistosomiasis, tuberculosis, type 1 diabetes mellitus and so on
(3)
Relief standard: the relief object each year by the county medical aid management organs issued 200 yuan of "special chronic disease outpatient medical card", for outpatient treatment and purchase of medicines. It is used for outpatient treatment and purchase of medicines. Expenses incurred within the limit will be advanced by the designated medical institutions or designated pharmacies, and the urban and rural medical aid fund will settle the bill with them on a regular basis.
Third, the fixed outpatient assistance for special diseases.
(A) the object of assistance and types of disease: rural households with five guarantees and urban and rural low-income households are not hospitalized due to economic difficulties and treatment effects and other factors.
(ii) the rescue disease and rescue standard: suffering from malignant tumors, uremia, organ transplantation, leukemia, aplastic anemia
, severe pancreatitis, severe and extensive burns and other mega-diseases, the rescue object each year by the county social assistance management bureau according to the main disease of different nuclear aid, in principle, not more than 1000 yuan.
Four,
Outpatient medical assistance procedures: In addition to the daily outpatient assistance, you need to apply, verified by the village (neighborhood) Committee, to the township civil affairs office declaration, township civil affairs office review (collated materials), to the county social assistance management bureau to declare, approval.
Fifth, the applicant should provide the following materials: I apply for the report; fill out the "outpatient assistance application form"; hospital diagnosis and treatment of the original information; my ID card or household registration; rural five guarantees of support certificate or a copy of the guaranteed low.
Sixth, the aid recipients can only enjoy one kind of outpatient aid each year, and shall not be repeated. Seven, "outpatient medical assistance card" by the county medical assistance management organs audit issued.
Article 14 Hospitalization Medical Aid
I. Objects of Aid: Rural five-guaranteed households, urban and rural low-income households and centenarians who are diagnosed with illnesses that require hospitalization.
Second, the standard of assistance: hospitalization assistance in accordance with the following standards for assistance.
(1)
The rural five-guaranteed households and rural low-income households participating in the new rural cooperative medical care are hospitalized, and the remaining out-of-pocket hospitalization expenses after obtaining the new rural cooperative medical care subsidies, fee waivers from designated medical institutions and other policy-based subsidies. If a rural five-guaranteed household or a rural low-income household is hospitalized in a designated medical institution at the township level, no less than 50% and 20% of the medical aid will be provided by the rural medical aid fund, respectively; if they are hospitalized in a designated medical institution at the county level, no less than 20% and 15% of the medical aid will be provided by the rural medical aid fund.
(2)
Those who have participated in the basic medical insurance for urban residents are hospitalized, and after receiving reimbursement from the basic medical insurance for urban residents, fee waivers from designated medical institutions, and other policy subsidies, the remaining out-of-pocket hospitalization costs will be given assistance at a rate of 15 percent. For the severely ill and disabled persons who are incapable of working, such as the three have-nots and the urban low-income households, assistance is provided at a rate of 20% of the out-of-pocket expenses. Medical aid recipients who do not participate in the basic medical insurance for residents are hospitalized at a rate of 10%, with a maximum of 1,500 yuan.
(3) Medical expenses incurred outside the basic medical insurance and the New Rural Cooperative basic medical catalog and diagnostic and treatment items are not included in the calculation of hospitalization assistance.
In principle, the maximum amount of hospitalization assistance shall not exceed 2,000 yuan.
Three, the procedure: I apply, the village (neighborhood) Committee verification, to the township civil affairs office declaration, township civil affairs office review (collate materials), to the county social assistance management bureau declaration, approval.
Four, the applicant should provide the following materials: my application report; fill out the "urban and rural medical assistance application form"; diagnosis of disease; hospital diagnosis and treatment of the original data; hospitalization cost list, hospitalization bill, medical insurance or new rural cooperative hospitalization cost subsidies detailed list; my ID card or household registration; rural five guarantees of support or a copy of the guarantee and so on.
V. Medical aid recipients who have received inpatient medical aid will, in principle, no longer be eligible for outpatient aid for special chronic diseases and fixed outpatient aid for major diseases.
Article 15 temporary medical assistance
I. Objects of assistance: rural households with five guarantees, urban and rural low-income households other than low-income families suffering from a serious illness, resulting in high medical costs, causing special difficulties in family life.
Second, temporary medical assistance by the township and county medical assistance management organs, township civil affairs office is responsible for the initial examination, the county medical management organs are responsible for the approval of the issuance of a certain amount of temporary medical assistance in accordance with the family's difficulties and illnesses categorized, in principle, the maximum amount of assistance does not exceed 1,000 yuan.
Three, temporary medical aid funds in the annual medical aid fund within 10% of the total proportion of the expenditure.
Four, the conditions for applying for temporary medical assistance:
(a) hospitalized due to a serious illness caused by family difficulties in the poverty of marginalized persons.
(2) must be hospitalized within the current year, and apply for temporary medical assistance within three months after discharge from the hospital;
(3) other poor people by the county people's government agreed to solve the problem.
Fifth, the procedure: apply for temporary medical assistance shall be issued by the patient application report, signed by the village (neighborhood) Committee with the views of the township Civil Affairs Office to fill out the "Temporary Medical Assistance Application Form", the township Civil Affairs Office of the patient provided by the diagnosis of the disease, the invoices for medicines, health insurance (New Farmers' Cooperative) subsidy vouchers and other relevant medical information in the original, the household registration book or a copy of identity card for the preliminary examination, the preliminary examination of the qualified stamped Official seal, by the patient with copies of the above information to the county medical aid management organs for temporary medical assistance.
Article 16: Charitable Medical Aid
Families suffering from major illnesses with medical expenses of 50,000 yuan or more, which cannot be met through medical aid or temporary medical aid, may apply to charitable organizations, which will give them one-time charitable medical aid in accordance with relevant regulations.
Chapter VI Funding, Disbursement and Supervision
Article 17 of the urban and rural medical assistance sources of funding, including higher-level grants, budgetary funds at the local level, welfare lottery, social donations, charitable funds and other funds.
Article 18
The urban and rural medical aid funds are stored in special accounts, managed in special accounts, and earmarked for special purposes. The county finance bureau in the financial social insurance special account to establish urban and rural medical aid fund account, for the collection of funds, the appropriation, payment and other operations; county social aid administration bureau to set up rural and urban medical aid fund aid funds issued account, for the medical aid fund appropriation, payment and issuance of funds, and the establishment of the urban and rural medical aid fund detailed account.
Article 19 of the rational planning, scientific use of medical assistance funds, with reference to the total amount of medical assistance funds in the previous year, a reasonable division of the proportion of each special medical assistance funds.
Article 20 of the county medical aid management organs in conjunction with the county financial bureau in accordance with the actual needs of the medical aid work and financial resources, the preparation of annual income and expenditure plan for medical aid funds, reported to the government for approval and implementation.
Article 21
Medical assistance funds must be strictly in accordance with the procedures for sunshine operation, the county civil affairs, finance, health, labor and social security, auditing and supervision departments should be in accordance with the relevant provisions of the funds management, and effectively strengthen the management of medical assistance funds. Finance, audit, supervision departments should be urban and rural medical assistance funds to implement financial supervision and audit, found that the problem is corrected in a timely manner, to ensure the rational use of funds.
Article 22
The mobilization, management and use of urban and rural medical aid funds shall be regularly announced to the public, and the parties concerned and those responsible shall be seriously held accountable for disciplinary, illegal and illicit acts. Constitutes a crime, shall be investigated for criminal responsibility.
Chapter VII Supplementary Provisions
Article 23 of the Implementing Rules by the Anxiang County Social Assistance Administration is responsible for the interpretation.
Article 24 of these rules shall come into force on the date of issuance. The original "Anxiang County rural population in special need of medical assistance for major diseases implementation rules" is repealed at the same time.
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