Article 1: In order to do a good job of the new rural cooperative medical care (hereinafter referred to as the new rural cooperative medical care) municipal designated medical institutions through the reimbursement management, simplify the reimbursement process, convenient to the participating farmers, and guide the participating farmers to reasonable medical care, in accordance with the "on the further enhancement of the city's construction of the new rural cooperative medical system of the implementation of the views" (salty government office hair [2008] No. 64) and the Notice on the adjustment of the city's new rural cooperative medical care operation program related issues" (salty cooperative medical care group office [2008] No. 5) and provincial and municipal documents related to the new rural cooperative medical care, specially formulated this approach. Article 2: The establishment of the management system and operation mechanism of through-train reimbursement for the municipal fixed-point medical institutions of the New Farmers' Cooperative. New rural cooperative municipal fixed-point medical institutions through reimbursement system in the city under the leadership of the Office of Cooperative Therapy, by the municipal fixed-point medical institutions and counties (cities, districts) Cooperative Therapy Management Agency **** with the organization and implementation. Article 3: the new rural cooperative municipal fixed-point medical institutions in accordance with the third-level medical institutions, second-level medical institutions for classification and management.
Chapter II reimbursement methods and standards
Article 4: municipal hospitalization reimbursement of fixed-point medical institutions are divided into single-disease flat-rate subsidies and non-single-disease proportional subsidies for two types of reimbursement. Article 5: Single disease fixed subsidy. Implement the "Xianyang City New Rural Cooperative Hospitalization Single Disease Fixed Payment Management Standards" (2008 version) (issued in a separate document). At the same time, the following provisions shall be implemented: 1. All participating hospitalized patients diagnosed with single disease types shall only pay the full amount of out-of-pocket expenses upon admission to the hospital, and the rest of the expenses shall be temporarily advanced by the designated medical institutions. 2. In accordance with the "Outline of Management Services of Xianyang City New Rural Cooperative Hospitalization Single-Disease Fixed-Payment" (issued in a separate document). (3) If the patient is diagnosed with a single disease but combined with other serious diseases, the subsidy standard for non-single disease shall be implemented. 4. For illnesses that belong to a single disease type, the cost of consecutive outpatient examinations prior to admission to the same designated hospital shall be subsidized at 35% of the total amount of the bills. Article 6: Non-mono-disease types are subsidized proportionally. 1. Setting the starting point of subsidy. Tertiary medical institutions (including secondary hospitals agreed by the provincial health and price administration departments to implement the tertiary fee standards), secondary medical institutions subsidy starting point of 3500 yuan (2100 yuan for children aged 14 years and under), 2500 yuan (1500 yuan for children aged 14 years and under), respectively, included in the scope of reimbursement of the costs do not reach the starting point (except for single diseases), the cooperative medical care will not be reimbursed, and the participants will not be reimbursed. If the reimbursable expenses do not reach the starting point (except for single diseases), the cooperative medical care will not reimburse them, and the enrolled patients will pay for all of them. (2) Non-single disease patients will be reimbursed at a rate of 50% of the hospitalization expenses (Xingping and Wugong will be reimbursed at a rate of 45%; Qindu and Weicheng will implement the starting point of 800 yuan for tertiary hospitals, and the reimbursable expenses above the starting point will be reimbursed at a rate of 45%; the starting point of 400 yuan for secondary hospitals, and the reimbursable expenses above the starting point will be reimbursed at a rate of 50%). (3) Continuous outpatient examination costs incurred by the participating farmers at the hospital before admission are included in the scope of reimbursement for hospitalization. (4) During the hospitalization period, because the hospital does not have the conditions, the large-scale instrument and equipment examination costs incurred in other hospitals are included in the hospitalization reimbursement scope after the hospital's Cooperative Therapy Section has reported to the business dean for examination and approval. 5. For large-scale medical instrument and equipment inspection costs (large-scale medical instrument and equipment inspection refers to the inspection in which the cost of a single single inspection in a tertiary hospital is more than RMB 150 yuan, and the cost of a single single inspection in a secondary hospital is more than RMB 100 yuan), and disposable medical material costs (refers to the 26 types of domestic and popularized disposable medical materials as specified in the Management Measures for the Use of Disposable Medical Materials by the provincial fixed-point medical institutions of the New Rural Cooperative in Shaanxi province (for trial implementation)), the hospital shall reimburse the expenses incurred in the hospitalization. Universal disposable medical materials), the first 30% of the costs paid by the patient, the balance of the reimbursement of the scope of accounting for the joint therapy. 6, for trauma, respectively, according to two cases of differentiated treatment, one is no clear third party responsibility (or unknown cause of trauma) of trauma patients hospitalization costs, in the exclusion of other non-reimbursable range of costs, and then by the patient to pay 30% of the cost of the balance of the reimbursement of the scope of the accounting for the joint therapy; two is the third party responsible for trauma in accordance with the provisions of Article X of these measures will not be reimbursed. Article 7: Setting the subsidy ceiling line. The city has determined that the cumulative new rural cooperative subsidy per household per year shall not exceed 15,000 yuan. When reimbursing participating farmers for hospitalization, each municipal designated medical institution must carefully and in detail check the reimbursement records on the cooperative medical certificate. The cooperative medical care will no longer reimburse those who have already received the maximum reimbursement limit of 15,000 yuan per household/year.
Chapter 3: Hospitalization Management and Cost Control
Article 8: Strengthening the identification of participating patients and management of hospitalization. 1, the participating patients with a certificate of health care, valid identification (household registration or identity card) and hospitalization certificate for hospitalization procedures, the designated medical institutions are responsible for reviewing the patient's identity, and urge the patient to the county (urban) health care agencies in their timely filing. 2, participating patients to the municipal designated medical institutions hospitalization should be in advance (non-emergency) or within three days of hospitalization (emergency, serious illnesses) telephone report to the county (city, district) the co-operation center for the record. Each county (city, district) joint medical treatment agency should do a good job of consulting services, in full respect for the patient's right to free choice based on guiding patients to reasonable medical treatment, shall not be forced to retain patients or artificial barriers. After receiving the patient's report, the county (city or district) operator center must communicate with the receiving medical institution's co-therapy department within three days to confirm and inform the patient's basic information and the reimbursement situation that has been obtained. 3. The receiving department shall determine the type of disease according to the condition of the hospitalized patient, and the treating physician shall issue a hospitalization certificate, and at the same time inform the patient to go to the medical institution's cooperative therapy office for the relevant formalities; after confirming and registering the enrolled patient, the medical institution's cooperative therapy office shall add the notation of "Agricultural Cooperative Patient ()" (with the words in brackets) on the medical record or other information, and shall notify the patient to the medical institution's cooperative therapy office. ()" (with the words "single" and "non-single" in parentheses) on the medical record or other information, and notify the hospitalization department and the billing office. Article 9: The municipal designated medical institutions of the New Farmers' Cooperative shall improve the quality control and cost control measures, so as to achieve reasonable inspection, reasonable medication, reasonable treatment, reasonable charges, and strictly control the unreasonable increase of medical expenses. The following control indexes shall be achieved: 1. The average hospitalization cost of all participating patients shall not be higher than the average cost of all hospitalized patients; 2. The cost of medicines in municipal designated medical institutions shall not be more than 38% of the total hospitalization cost in the tertiary hospitals, and the cost of medicines in the secondary hospitals shall not be more than 45% of the total hospitalization cost; and the cost of out-of-pocket expenses for medicines shall not be more than 5% of the total hospitalization medicines cost; and